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Home My WebLink About20220035.tiff1/Lf Cck i Ley-- - • 1 COLORADO WELL PERMIT NUMBER 185249- 1 Division of Water Resources RECEIPT NUMBER 0381113 ORIGINAL PERMIT APPLICANT(S) APPROVED WELL LOCATION ROSE MURRAY Water Division: 1 Water District: 2 Designated Basin: NIA Management District NIA County: WELD Parcel Name. MARTIN BRCS PUD Lot: 19 Block; Filing: Physicai Address: NIA SE 1I4 SE 114 Section 12 Township 1.0 N Range 66.0W Sixth P.M. UTM COORDINATES (Meters. Zone: 13. NAD83) Fasting: 523917-4 Northing: 4434632.6 ,ee the original well permit file for permit conditions of approval and additional details The original permit file can be viewer ising the Well Permit Search Tool at www.water.state.co.us Date Issued: 3/f011995 Issued By Expiration Date: 3/10/1997 ≥ERMIT HISTQRY 10-04-2018 CHANGE IN OWNER NAME/MAILING ADDRESS Printed 12-13-2018 For questions about this permit cL1 303.866.3581 or go to www.weter.state.co-us Page 1 01 1 Scanning Cover Sheet for Septic Permits Permit # G199 0111 S Permit Type: Health 1 EHS History! ITHS Conversion History Situs Street Address 4146 MARTIN ST Situs City, State, Zip Sec/Town/Range Parcel # (12 digits) Owner Full Name: Owner Address: Contact Name: Contact Address: 12-01 N -66W 147112403019-R0225794 MURRAY STEVE 7005 W 42ND AVE WHEAT RIDGE,GD 80033 Application Status: Finaled Application Date: 03111/1996 Owner Phone #: 303 4224422 Contact Phone# Information above has been Verified in Accela by employee noted below x August 12, 2008 Proc by: Date Report ID: EHS00024v003 Print Date -Time: 811212008 8:32:31AM Page 1 of 1 ,•l,-�i-- I�t;F'1?r,�l=• `IFIJIilUi�l_ 13f=tzJralE i7:I il'I .L yiFI'�i !'EkI1EI IIL;, l�J1;.LIS EC1l..II' I Y HrL TFI FIE Pi-+RTI"lFHT NER RE1-%,II E'Jlf ClfIME.:I1f1,1.. !EL IF'i F'.F'{,f F'3 3t:rl:i iF,TF! o- V1...1E CJL.IF, I {;=.1 Li ', € I.' c1+h=?J. iW1\1l-F NLJIU'Rti'Y. '.:3JI=r.'E iiF.[JFEUU ;'.rr_hr li 4$ \i.J ( )E { II t lI-1ir f FliGF-= a_F �I IC'• 1)I;F�l;R CiI= F I,LII' 1.-Jt3E' 1) cF`..i-i FF..I I 41.ci.^• 1' 11 I4 S I I-1 I._L}PF 11PJ L U EE -s21 LEG,'1!- L5f_'I;i-'I':I1=' f 100 LIF- `3I r!: ; _1= 1 rf..1 `:,:E. '.I? TWI=' I R1 G Ei Il-1 , ' ;. I[?J'•1: !''Ir�iFti,T'TLI Ff L " F 111) L_L E $9 RLE!Lk ': F1_I-Ai-; LJUF TYPE::- RES:fDEI'1-FIRL_ I-1C31J'RE U FTiFJ(,JiE 1.r L l T :iI G ieC_I.s}tr'`s C-lEF)R,CJiIIIIE U F'i EJ`IEral Pl-IJI°iI_cTF•FR i V. WLII-I E -I faI_JF'EL_`{ F kJE:I_I_ ii PI_I;rH LJI'l F EE, F:EC T) .FY (;fr1II fl' 1ILE C? R'-TII-F 1IF7'�^L PE' F:CL:1 F IC'N I-TE L'.Ci I'1III F`EI_FF IFU Ll-I L II -11', I JE' 1't.Ml'1F. 113 RUE I' ` LiIl_ 1 YUlE LJNs(III.�ILE...I- I-ERfa l'dT LaHl,INri L IIF'f 1;{ LIRLIvTFIlM I_- REL}LJI'R1'LF; FI'JL�IWF—FR 0E` 1519 ILU IN 1r ,s YEAh I-Lf_Cir'r PL.ri{N ,,3N'E: I'•Jf:: FFI:JN THE. 1'+I'f L_l....AT:fl.ihl :LFJ1-1-1hhir'1'1 Ii!'J 1.3F'F•'f„IJi::.E' illHD TIT,` I;MhI f FL `=('II-- PE? -:UL I r, 1-,I ]IV IiR r ; TI-IE. OIL I- 12IqING M.INIMIII`F IAST-iL..i_raT1FlN SPECIFIC_r-1TIGCJ' r F hEL1LJIRED: Ll='fFC' fi:; I- .lCh-) GALI-f]#d[ . F1r,SLI['F 1:r_I!Fi1 iF:IHLND-I ryit::i_7F'F'Tll k\I BED 14 ' Ii F- C_ TRl AIII:I ITLIi'.I.. ki,r FF:1=ATI 13 !=;IIUf-1:'.T TM T1 -IF 1-CiLI,FJL31I -i ALQ I.FL)Ni4I, T1i[< E: i1Nini MILl PERMIT LU 1I'J f6:P, CEMF'OI11,ARII_Y TCI r_ !.._.OW { h sR1:= TRi.1[ I"ICJI`] IL] C U 1l I I'd€'t F-[[tH F'T__f- F] Rlr1Y 1tk_ f: f.:Jill '.E I) I;.iFr 'i,1.J=fiF L_!'l?Sf-1s F+'f LHI :: IAJk-1 U ;;:;C:'FJH-F HI . [H I.;E '+11 IMC;f•1T' ICFR RF - :€}I„iti f I-C,:1FII'r'I1 1'14 TI•IE'= NEIL.[} C;IILJI`-IT;` 1hJDf r';ilLJi"iL f;I,I'7C #" f f ,1 (]'cI(4I_ S'r'RTFII RI LILJI_MI[❑IRR i1\IE:LC!I]T,E`JI_' FAILURE TI? I EEL: F iO'sNY TERN FIFE CCIN!I)TTIiJII IF!F'CrREIJ I HEFEE❑J\E ill_IRIFJtr- TEI'MF-'LlFM-F'1 LiFI 1-I'IAL.. r1F-'F R'OVA!_.. 11-11 i J'- EJAI,ILiF- i IF 1--I1 'L; G'C_G:h'IT'I" t. ]F -.!'s J-11 f; {711 ] TIT ....rE s`3L1! 11'' LIilhl F `i' 1I IE f}E:F'ittfR;'T'ME:R•!T [FR IS E:NRE._L',7`tEELI OF L..IAPTL.,IIT1 FLIP THE F,111_..1IRE OR 'Ih]i"sl?Ei=1L!t1C1 CJF THE SE=WAGE DISF'FILU ._ UY::i 1 L -Ill. EFH'$IF:(:11'JT°IEN TAI_ :}-'I f"IF1l__IU1UP FE [HIT PERMIT :f 11131 FI=;AIVtiF=[=.#: llal._Fr f-11`dM 53F-Ir,E I_ L -S€;+ IIIYf[ 'JCl:L1] IF I:i''c`a'i'E',i`1 r:=t)6'Jz'T'1 1..1t I fGI`1 Hill, Mill C( I"IME INK-E.FI WJTFITM COVE '1`ERR CJF I LU. J 'SliAhN:'E. FrEFI1RE lUl.Jll41_i FIrIFL_ F`Fh F.f_7','r1L, [IF •EI h1 F'EFF l"Ir"F THE !ieF.l__%i O1)U•.11Y lA"tiL_TI I IIE_FI-lr'lf=1l11 F.1=R,ERVEL; THE. R',(.;1111 "1 U II1 {I' E iwf)V,.l-- TIOINF11_ l Ek•:hM ARIi:J C'Cfl\1f:1T 1-1(IME -REF iIJ1! [:I.]` FM MEET EII.IR RF.iliUF A I -t U!ME LIFJ U [1111311 NL![NE 1113— EIFs.. FINAL_ I'F_RI'Ifr (wF'PI-I'l7Nr;I- ER f 0JNlllAR-111.NI IIF'ilM TI-IE 111FJi'rL._ J J1:7iI::EC:T{1:11'! {]]-.- 'flit' (:E1 'I_E'k-Tf E—5tFI_,RI Er' THE WEI_I_r C'r7I.JNTi' M.-OLTE1 riE=F';F-;1i411.:!LIC., U-iYC} FUN FNCCFMEER 1l_ '/fi _, _.,, ril -F-U'! F -+I.. , Y C=1"I FF T'r�l I I I' ��' I— tNFlr.. II r- L i1L-T TES C ' __ I II L h:1' r ^I 1FI' I A{__L_.ED _•7 EIdJ1.IzC11•,!I`1F:!dTr+ -1f=';=Lrli, ftI.. THE 1wLlIIFIFJLFr f: F" E F1:EFT I'f f `I'1'I:T Ill1F='EI NI -IF Fill i I: IFLFIF'L_ 1r21'JCE WI -1 -Ii IF F-IR -IT RTI$., [I:FJLJh!'1'1` JI; L.+ZI-i-ll i;E=FF-JL- t! 1' l,:F fIJIIDI1.9(,, f f'r_IIIR.F.!'Il-r,l"F .. MIFF: :=HULL 1,'I r1[ } I "El=i'f'I'F—i' TI ll-Fr ILl 11_f:1 F cLFcFfI WTI._J L1F'El,o-5'FE :II- L [IFI [v''il'•11''1 UJET}I h -;'FI UhCF;F' I JriIF. c.i1NV riFlll RI I iIIIF: h ECFI'.I{,lti,F' J I} F'FI -,II,'.H I i H r'+1 I II ;!_I }r'r„ 11 Ii F- i I:':; ' 7? ;. (lc - lF fill U E: 7.C:E1'T 1 -HR FIG f-{_lk F C!k', OF 1113 f F+E.1.:; !]CJi_ EmIt_ ( fF •L1;r l 1F NM IRl`.;1+1E. t_E-:la ;'i i fir! F:-11 1' SIJAPNC E= EIF i-1 E_C1R:r'FL. °ri'�I--IJI:,-II'-ll; r I l :1;'PIIT h>LJl ,:;1..]iil'!`I 'f f:i f r?. [U -t+1 IF III 1 I'•Ih''iL--h=1'1=Lal:r'.f�J 11:11-I--i.lC'FIF: A L PHA ENGINEERING CO. LAND DEVELOPMENT PROPERTY SURVEYS 517 5TH STREET ---- P.D. BOX 392, FORT LUPTON, COLORADO 80621 FAX & VENVER 573---5186 OR 1-800-767-5186 ----- FT. LUPTON 857-2308 July 6, 1995 Weld County Health Department 1517 16th Avenue Court Greeley, CO 80631 RE: Inspection of Septic System for Lot 19, Martin Brothers PtJD- Amended Plat„ Weld County, Colorado. (Steve Murray, Permit No. G-9501 18) Dear Sir, I inspected the above Septic System and found it to be substantially constructed in accordance with the approved plans for this site. (Alpha Engineering plans file No. 12-1N6-11) Sincerely, '11826 Bill J. ❑elap, PE 11826 , File # 12-1N6-11 ��''fas� #Ati,.�"'` WELD COUNTY BOAR➢ OF HEALTH ENGINEER DESIGNED SYSTEM REVIEW APPLICANT: Steve Murray PERMIT NO.: G-950118 (New) LEGAL DESCRIPTION: PT: SE4 SE4 SECTION: 12 TOWNSHIP: 1 RANGE; 66 SUBDIVISION: Martin Brothers LOT: 19 BLOCK: 00 FILING: 00 SITE ADDRESS: Pending Martin Street, Ft. Lupton FACILITY: Residential 3 bedroom home PERC RATE: <5.0 SOIL; Unsuitable WATER SUPPLY; Well LIMITING ZONE: At grade -sand ACRES: 5.0 Yes ENGINEER DESIGN (3.5) N❑ EXPERIMENTAL DESIGN (3.14) ENGINEER: Cecil Crowe, Alpha Engineering ADDRESS: P.O. Box 392, Ft. Lupton, CO 60621 ESTIMATED FLOW: 675 G.P.D. PRIMARY TREATMENT: Standard tank CAPACITY: 1000 gallons DISPOSAL METHOD: Absorption bed SIZE: 645 Square feet REQUEST FOR VARIANCE: n!a STAFF CO'Q NTS; The unsuitable soil four feet on each side and under the bed must be removed and replaced with soil having a percolation rate o€ 10 mpi. The system is adequately sized for the proposed load. STAFF RECOMMENDATION: Approval ENVIRONMENTAL PROTECTION SPECIALIST: Pam Smith REVIEWED BY BOARD: April 25, 1995 R.O.H. DECISION: APPROVED: DENIED: TABLED: !C Norma Taylor, Chairwoman Weld County Board of Heal HE:P1.tioF' INDI'JI':?LI; L EF II'JL:L.E 1:}I SF.'OSA.V_ `WSTE'l,. K'ERFA I F:JFt L) LGLJN1 / iEF1_ H Le'#':F'i)F..' FMEilT F1RLiIv{ IFr•i TFi._ HEAFL F -H SEJLF.S 1717 I TH 'ENUE fC'OO!UR:T. (7F:EEL_EY. LL3 O0 LE1 E;.T.2,_2.. OWNER MURRAY, SIEVE ;Dflr':E:E S 7i)u5 L -J 41N1L V FL -L'.T co ADDRESS OF FR!LJF'UEED 5 STE_N Ff NDINC E Er.1DN-.L- `i t :It) LER .L DF_SCRIP7[DO 1R SITE: SE4 5lrSEC .[:: FWP t ROG b i,II':'DI'UI5llc : Ml T. r.Fo E;r.,['i FLT _.f:+'F15' I-sLLJE-F' f sl_rl'JL': '-ISE T'"I-'E- FEFIIOF,NTIA!__ IiCiI.117 FER')i[1 Ic` : F'E RRUN`_ __ ,r_ IF-F.'OERS 2.�7v L L 1 SIZE 5APA ii:,kl 1I F'EGF:DON ' BASEMENT PL.LJF1I IF'+{G YES WATER. LJPP'I...Y F•:f}JE:I_.[_ Eli. L1 _Ft '1 iE' I1EF- FEF J'. F'H w:'0 1 422 --44111? -1011_IC:LI.-ION FEE $2T 5_DO lIE L 1) HE DATE 4/)7/1F1 Ii= N4 i [:— MARTIN HAS,—,- I,'A T{•F 4/177717 F'FRE:::OL_r T1OO F:t4TE MIN PEP INCH LIIPIITIRS ZONE 4. FEET &d) :Lll 1.,,i. F•E CF: I' ,L1 1t..;;,. i- - - L, .R':I .. � � •� ��s�. .�r� , �1-.1_. [IT �F:- L - �l ir-'� 1 �: �.II-: t. I]r•J £ F EQUI .: S F- r1Ef_{;: F F Ii :F=1 s _ IN iYEAR F ' 01111 F L0.T:-I LCIrIF: F'F'f'JE'I IF -IL F 1'E'L'i Pi 'I i:[='ir! ],iF oR!1rJUN SUPPLIES 1ur 4_ilL F -IN— SITE._ :'-: Fi1L I'E R1:u l__ . 11;]I`E LJr, ! t'•i - _._ i liF._ FLILL_C14JIiJt; 1�111'•.I]i-1LIi~1 INS Ti:aL_C.4,T 1Ci?J �?F'E[_it liar-, I-I1-iFJ> riR:E. PEG?l,llr'i_R7� Li I I 1 Jcjtc GAI,„I_i ic,. POSOF;I' T:I.e]I I "I-i- [",riL.',I I ... :1D C'F:FTIi]Fi PEE ti+T,_ ED. FT_ IiJ iif1l=i`-FI?fJe-t+117 F f-i7,[T IS..,'_L:L,rEi 1 iL -NIL• F=01 I_ DOll /•il]D F't]fJr-i iF r Ft' --s =i J i..!P+.1[.}1 ii?rd VC+I....k_( Q_[AfL/ _I.-i'le. r�� —- I HIS F'ERM!] F IE URANTEO "TEMPORARILY' TO OF-F-F_1W FC'NET'F;IJLITION Ti=! L_IIIIMEr.II::F. THIS FEF;1`lk-I NRY EE REVOKED 117 -t_!STLFN15E-U U ! H1IF LJJ CL?FJPJ'1Y 1EAL-I-ii I;FF'X--! PiIEIT I- iF 1=.k:tkf;UfJ; FE' FORTH IN THE DELI ) C,L:IUFI-I'r` [I'IEil'Jli,?4IF'EI_ SELJFAIEFI DISPOSAL BYSTEl'i FIEF,I-fLATIDNE II`1El_ULi:;I'-[ FAILURE Ill IIRE T ONE TERM OR CONiDII [F -IN IF IF'i'15C.i:! THEREON DUFNN[ F E-,IiF DRAR 7 UR ! .INOE. APF'RL.iLO _ THE U EUANL:F' LIP 11.117 1 F'.F:NiT DOES NOT I. N DTI IL fF -,;FFINiMP f 101.1 IRE THE ill 1=OF.T11�_11 F L!1-: ITS 1F"l--L F:F=`. OF I. Ifyl I[....F I FF-FIR THE F [I_LI C7 .IriUU;F (}I 10 02 OF SE''ASF DI:-POSA1 SY Eit7�1 f F1I=r-IT;yI_ FEE 17+. LEFT liA F7 THIS FERMI F IS NOT TF•.a,r FEF.OLiLE AND SHALL RELUME VOFIL IE SYSTEM TEEIS'1 RIJII T TIDE IPo 3 NUT LI[F-IM€INLE D LJI-I HIN UNE` YEAR OF I F`S ISFI.i/ NLG:. OL_FL'F=;E IFEIJINE, F INL,I- 0PPF-[.YO_ F- F- 1 H I-'r-7,FF 1 THE WELD C,CE.JNTY HEALTH I1[=PAR] ME I I r FE R'rES THE RIGH-I -F0 I': -iF-'UF_ ALrFiI- TIO1NLi'._. TEEMS AND C{.700ITIUNS REQUIRED 71:1 MEET OLJR RELRLJ[.OTIONS ON A EDN INl..J.INS 00- 515. FINf4L PL--RM[F AF -PE C•JO!.. IS CDNTINFEI'1'F .IF'ON 1I -PR ItNlOE ,LN:7F'E:C TION UP THE CLJi`i' EL 'PYl-1PM 1+ FHE WELD LULIIIT '! H&.OL.-1'H 1.1FF'i--HR TMF'NT.. t-IFT!:;ICJLF_ -OF FI._ICON I L;! '.-'Y-L1C1-IN WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL PROTECTION SERVICES SITE EVALUATION OWNER; 1/Il t lrP6 4, ' APPLICATION NO.:q, f/4 SITE: /' PT SS' S /A T / R DATE: 41'f SUBDIVISION 1Tt4, , Ilft LT /? BLK C] ' FLG PERCOLATION TEST DATA: Start Time: Hole Hole H2O icfD /O miry. No. Depth Remain min. min. min. Min. min. min. min. min. min. incTT 1 1f f r 3 __ ,X ______ ________ ___ so" c - ] ` ________ ________ ________ ________ ________ ________ ________ ________ \' 6 All measurements in .mm unless otherwise indicated. * - Add H2O Total Average Rate Environmental Specialist PLOT PLAN SOIL PROFILE rr med . I + I. Crap e�►tea. -t r S .s( • WESTERN SOILSL_INC. Geotechnical Engineering • Project #: 95103 Date: June 23, 1995 Weld County Health Department 1517 16th Avenue Court Greeley, CO 80631 • AY N: lam Smith • On -March 31, 1995, Gary Rosson-of Western Soils, Inc. accomplished a test boring in the -area. proposed for the new septic field. at 15508 Weld County, Road • 35 in Weld. County, Colo€ado. We have not been provided with a site plan for this property in order to show the location of the boring. The boring was drilled slightly dowrthill.trom the new building site on a gentle west facing slope. Six percolation holes were also. drilled in this area. The test boring revealed a- surficial' laver of topsoil underlain by a deposit of brown to tan, silty to very silty sand, which continued to the maximum dept:h.'of 10 feet beneath the existing ground surface.. No groundwater or signs of. - • - seasonal groundwater were noted throughout the depth of the boring. • If we can be of.further assistance; please call. Sincerely, _ S_5 1 RN SOU, ING � ��$ • qtr, G_ ocs n; ?.E. cJ.. c.4 . ' •. . ,, • cb ��rr's�1Nx�:` irrrF411�ttl1l11i11111 . cc: Roy & Jody Murry' 7431-N. 73rd Street Longmont, CO 80503 .. , 6595 Ode{I PI., Suite G. BPUIdea, CO 80301 - Tel: (303) 581-7711 Fax: (303) 530-2808 APR 14 '95 07 59 GREtN CON$7 INC PAG€ 2 DESIGN DATA; PURPOSE OF THIS DESIGN IS TO PROVIDE A SEPTIC SYSTEM FOR A THREE r'BEOROOM�SIWGLE FAMILY HOME. AVERAGE PERCOLATION RATE FOR THE SM SOILS IS LES6-- THAN .5 MINUTES PER INCH (PERCOLATION RATE TESTING BY WELD COUNTY). THE SOIL 4ON EACH-SIDE'AND UNDER THE BED -MUST BE REMOVED AND THIS AREA REFILLED WITH 5 TO 10 MINUTE PER INCH PERCOLATION -RATE SAND: SEPTIC TANK SPECIFICATIONS: MINIMUM 1000 GAL, CAPACITY, WITH TWO (2) COMPARTMENTS OR UNITS IN A SERIES. ABSORPTION AREA (A). IMPORTED SOIL PERCOLATION RATE 5 TO 10 MINUTES PER INCH. 21.5 SQUARE. FEET PER BEDROOM X 3 BEDROOM S 645 SQUARE FEET. USE A 18 FEET X 36 FEET ABSORPTION BED. NOTES: 1. PROVIDE A MINIMUM OF FIVE (5) FEET BETWEEN THE DISTRIBUTION BOX AND SEPTIC TANK. 2. PROVIDE A MINIMUM OF FIVE (5) FEET OF SOLID PIPE BETWEEN THE DISTRIBUTION BOX AND THE LATERALS AND PROVIDE A MINIMUM OF FIVE I5) FEET BETWEEN THE SEPTIC TANK AND ANY BUILDINGS. 3. ALL CONSTRUCTION IS TO BE IN ACCORDANCE WITH WELD COUNTY. COLORADO HEALTH DEPARTMENT'S INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS, CERTIFICATION: I HEREBY CERTIFY THAT THE SEPTIC SYSTEM SHOWN ON THIS PLAN WAS MADE BY ME OR UNDER MY DIRECT SUPERVISION AND IS ACCURATE TO THE BEST OF MY KNOWLEDGE OR BELIEF. BILi. J. 6ELAP, P.E. 11826 an REr ~ 11826 AF'FF'I_IC +1 CJN! 1OF. I ll_l_):!'lliE3UAl_k;F1'JfaliJi Z)I:iF°CJL z;�'„11-ELM HO, 0-5 1i'IE:; WF_C_F) EII1JLH T'; FILIaLTFI L)EFFR'TINJEl I CIE1J i F'F'L 11L.='sl IC:r ENVIFUhaMLNT{1_ 1-JEF I._-TH 5EFViOF." 11t7 1'i H ( EN UE .L'!+117' T. OFEI_E.Y. C: F'! E: — I S5 F_=:T.._,_ i'CIdF,F•: MUPE:rw'. bIE.lE AL F:E.E it -i4` W 'ND FBI?r. f -H 110 1 WF11=_i%'Fh;fI-1r;E v`I:J ,c -1,,;; F )I}F;F3;7 (IF F'r:'1 'iJUEl) ` '1":; FEiM F'EML:1[NC LERM_ i_1E=3; I- IF=' E IODFl OF „':fTE_: i E4 - F,4 5E(_. 1a:', TLJF I. F:IJr SLJ60{YIc37:(:§E`J: h1FiPl11'•1 1!FF1;S F1.J1) !_i_1'Ti; i F_r1F;ir: :-_r F=1I_IFlL- IJ`T>I_ T`r'PE l E=5IiJE',_:flTIFI_ HiJl,.l51 , 5F-I''�?I' -F _ F'CF'CCSrJS l NF;Dr111S 2iO I_C+l SIZE= 5.'_40 A11=ET;E S F:•A':iEI E-.'I`Il' l'!..LJf•1El1l'.(G Y`EE.( WI 1 EN EI,JFi !_-;' F-W!::II,i.. 4LIC:F;CJ f'=::P•IC!1,+L NET -EEC fr'•FC TF•lf- CT'_!MF ±__E FF=r1E :_:c IF 1F•0T-�.i'F'-IC.r'r I'I'C!I`i .o r rifi-!-C!'fL{fp:iL_ J!T'1:11'J f E! Iflk=1( rNU_i,.s' iri.I rryl' 'I•E:: 1I iilN1:i F r_1 ?f, i _. ,i:J i`I-'r BE r:F.l_3LlLF:f=L1 i'--i-1-IL l::;LIL.hIF'r HE.,;l_l_H DUFFElME::1iT TL1 EU 1^1�;FIE. 11.11) F I..€F h,::i_tiHE1) Pti TF-1l_ C;F'F'!,1-CALJ-F LIE E:'T tHF L'Jiir'.'T'Y" iiF il_ll,' EJE:.1'Fi['Fr'IEIJ? 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Scanning Cover Sheet for Septic Permits Permit # G19940436 Permit Type: iieaiiih i Eiia i-iistury i EHS Conversion History Situs Street Address 17894 CLARA LEE ST Situs City, Stale, Zip Sr-cfrownil3.aiige: 1 —v filM 1I IjV_U i�r 1i�Il.tnua.auvii VUMMUS. rit aftr Application Date. 03111/1996 Parcel # t12 dI Ittl 147112403020-80225894 Owner Full Name: PETTIJOHN DARRELL Owner Address: 7535 SOUTH EVERETTE LITTLET0N,C0 80123 Owner Phone #: 303 9799252 Contact Name: Contact Address: Contact Phone# Information above has been Verified in Accela b employee noted below x August 14, 2008 Processed by: Date Report FD : EHS00024v003 Print Date -Time: 8114/2008 12: 09:19 PM Page 1 of 1 FOP 066 TND:[VID4.JAt SEWAGE I)ISrOAL. i.Y,3TEM PERMIT hlo, C']-•rnoam WIELD COUNTY HE:AI, r1 :Di::fi'ORTNE:NT NEW F'E IR(rII i EhlV:[RONI'li]:N'l'A1.. F'IC:AL_T!-H SEF�'VT[:1:= .1. .L / .Lfa 1114 11V1 -.M1.11:: l,.1i131': w , lah!^.1 .I_,!:_ r • I..l.d 3 t.:J 063`5 L:XT.?"225 C]WNEF2 F'1=:TT E301 -IN •, DAFZIyL:i._I._ J F1I)I)ILSS'r 7 SOU'T'H EEVEIl=::T'rE PH ( ;i0;:i } CXVtl- 7L. LITTL..E.TI.)N TO 80I2. ADDf 1E 3H O1I Fti0I- ED SYstEll .. FT l..I.J I"' i S.11 `1 1. 0 O 3OC I LECyr-4L DF._SCR:[Fri014 OF S:I:TF : SE4 .SEC .1.TWI1 pt'10 fife 43LUB+DIVISIC]N: MARTIN £tk[]7HEF'. f'u1 LOT [?o ILOCI{ 0 T":[1...:#:I'u 0 U3E TYPE: itil:::w`s:[I)[ hl I'l:fal._ lj{r 4 BATHROOMS 3.00 LOT SIZE . ;'.1} s`iL:J:{E.Si EfE:DROOt'IH Firs{ E::I :: L°1) :1111 Y3 -;s WA'rFR CsuF'L..Y CWCWD Al- F'L.IC ATION FEE i i 0.00 I) Iiy t ;[NDY SALAZAR SI(3NET) UY DARRELI... l'1= TT :t:r{:)hlN OF1E. 07/07/94 t DATE 09/07/94 r-f•;C:CII._ATION [-ATE: .3I.Q III PER :iiti1(:I1 I_.IMIT i1')G ZONE':: ��-_.. f•'E:;E-T- I -r'+rl=�f_ .i is� o .._.._.... .....F'Ic:1-'CENT r i:KWD • rr]w•1::: �, ! Tr'r-C.ra:r_lfy ]A! f:E:fl[.)'[RI=f:'s E I*Ifx:[i'li=:E Fti DL::S I ('N f T Ihl 100 Y[ A1. FLOOD FL IN LONI,. FROM fHf Ar:'l::'I...ICAr:FON :LI•II�OkNA'T'ION E:3iJi='t-'t.I#i;[) AN!) THE ( N 7:C'1'[: SOTL F'ERCOl...A'r:1:ON DATA .[.:1TAI-_.LAT EI: N E C [' I FICAT I N ARE :E • : RE::. IITF hC)L..L..QWJ:N[3 W[.l'h�11,1TALl .iIGAL[.-(JN:. A .)lid IJ:4)II IRE::N(;I'-I UI:i AEPSORE'l T01 ICEI') ``L SIT. - T N r1DDIT3:ON f: r' 1-'f:::';I'1':T I4 i k:1,Il: ;T VO T'I L. I�•(:11_I :lrNis I)I �Iyy'T,��" DIAL_ 'rL +'��7 N Na O NS .: 4L......,,,..... _ .........._...._..,_.... lFiTs PERMIT 1C3 GRAI-ITE'I) TE:I*li'f7F , ':rI_Y T€? ALLOW CONS'TRUC'T:ION TO COMMENCE.. li-I:I:`,') F'ERiI3A MAY DL: RI:'JOI<L:0 OR HLJ:jI'E::ND) D BY TH! trI]:I1) COON IY FIC_AL._TH DI- I'Al. Jill _:NT #-(1R T:1-:ASOIIE:3 :l:_r FORTH IN THE: WELD COUNTY i:NDIVII)UAL. SEWA[3EI: I)Isi-0RCaL-- t;YTJ1"l:lri RECAJI...G`,TTowI Ihl('L,L-IDlN6 A:t:l._UF.IE. 10 MEET ANY -T"I:::hi I OR CONI)1 T:[A:IN .1 I'1(JHE::D THEREON DUL:I:i•03 -FI:_Ill-ORARY OR I I HAT_. OVAL.., THE: :I:`$' ,RJ NCE OF THIS PERI'l:I:T DOES NOT CONST:TTLifE-:: AEEGk,WIPT'J:ON BY 11 -IF Dl-pil1rl: T,lll:::l*I•r (:k174 :I:T S Fill -I OF L:iADIL_ITY FOR TI -1E FAILURE OR :F.[MIADECIUACY OF THE: SEWAGE I)1SPOSAL. EiY`.:iTF:IrJ, c..,_ i4' n U1. Irll � ] . !-----._..._�. _..._..... i..ilV Ilti(:iNt'II-1�IT At... I'IE;C;IAL..:[ ST DAf 'ri•dT> 13Ri•1:IT is NOT rRr-ERAELEAND SIAAl_I-- ESLI:OME VI):1:O IF HYSTI-lI t;(:INv'3Ti<H{ ri:Ohl I-IA;,S 101 ( C)lrll'IL.lICF::I) wJ- ti -Fl "hl ONE: YR OV ITS _ISSUANIC;[_'.. DER:}RE." Tf=3E;U3'hI[.= I lIIA].. AF'r:'FROVAL_ C3!'= TIITE3 I RI -0 l:: Iill:::I._D C:0(.JWTY I-IE::Al 114 Dl'4='AFti'rIII NT RESERVES TI FE NIIH'r TO IMPOSE AI)D:C I.ITJNe )E. II Ftil`l;i AI'u) [;1 i'wiI.LUN'4uJ.Fo.iJ IU MLi 1 UUR khlaLILPIl.lN'v ON A LUN111,10,NL, LS {-.... C:3 i:s l :II•CAi_ 1='L RIlII: r RF'I 'it[:3 JA1... is C`,[:11 #1 :€I+Ior_ii UPON ml:: 1;: 1NAl._ 1:1-ISF'4:_C IICJN OF:. T'HI'=: Loll- PL_E'TED SYSTEM lY THE WEL_I) C f7l,JLiTY HE:At..TF'I I)L:':F'FJr4TN£:NT IF;TOI'-IrI...---nr'PL_:1CAI-f C[:]Ir'-Wc:I•ID W(:F'ILJ F:tl VI Y ,arL! COUNTY REAL Th DEPARTMENT ENVIRONMENTAL PROTECTION CERVICES Sim EVALUATION OWNERS_________________________________ APPLICATION NO. : "1___ SITE: ,rte. IC3cPTL S2. T� R_ DATE___________________ SUBDIVISION: i' 1 i,' LT^ 2c RLK FLG _ ax`1=a=CS'ixtt.�=s= CL:��CCs�ssss�-7�CxksaazmiccfresssxaaEaxssss�sssxssssrxxxssxssxT',p=n PERCOLATION TEST DATA: Start Time: Hole No. Hole De th H Remain (d mina min. min, min. min. min. min. min. min. min. 1E i ,gt r I. [fi r r to 2 6lo0 520 ^. uC 3 Q ;{ZS X2O Ft 7Y : 4 4 4 rrt a All measurements in .mrr unless otherwise indicated. * - Add H2O Euvirorimentai Specialist .[', d L Total !�a*� Average Rate '3 PLOT PLAN 4.JS4.dx� C.r�_'� pl• 1 SOIL PROFILE a . p IIiF'I.U6F^ AFF'L.:I:C;ATIOH FOR 114D.MIDUAL ",1;'MAt;3E DISPOSAL.. SYSII I') NU. (;•;•••9'J043 WT:_L_I) DOI.JI'ITY HEALTH DEF'AF:TMFF'F'T' NEW A1::'FIw.E T1:OH F::.MVIRC)NME_INIEAL HEAT...111 SEr5/:TLF:;•r 1517 :116TH AVEl'UJF COLJRTx (3;RE;EL.F-Y. CO 30631 'i-0635 EXT..:?1'.25 f:1WNEJ F•'Je.Ti:I3UHN. OARRL::I_.r... ADDRESS %'35 OCILJTII EVER1=TTF 1='1•i ( 3Oj 979--9A`5 1,_ITTL..E TOI14 To 80L2.J ADDRESS 111 r.'RC)ROSs.-) SY.S-I'EI'I WC:K- 37 , 1.0 Fl - L.-L!F' T ON CO 0806:1 L f:iill_ CJ;3t,ISIF''T I'f:)I I UI P31T E4 81:::(:`, 12 T{+JF` HI.1DI:viSICWI,: MARTIN DROTF-IL:T< POD LOT r::(7 USE 'T' YP13DFJA 1- 3. Al... cE_RV:CC;i'Gi9 f=`L.Ff':31WI i 4 BA 1R(:)OMC ::3..'J0 LU SiZF I)1.=iiFtiC)t:ltTl 4 IDASE::I'lf_: N T pit IIiI: 1FIG YCS F�I4G 66 si.., C}f:'. K 0 F 11.. :i: N4:3 0 A1'F'L]'CAN1 ACKNOWI.,.E::DCIE:S THAT TI1E: CI..JI'11'1,E'TEh1i:: 3fS OF TH:C s AF PI._:CCA'I'i:ON :1:5 CONDI'11()I,4F-oI.. L1C1N I::-CsR'TI-I1::l IMAI-�1DA'TORY AND Aon:I:TTf71-4A1._ Tl:_ST S AND REPORTS AS MAY IE 1;I::GILl:f.1='i3:D BY THE WC::1_.D tT l.IhITY HEAL T I -I 1}£::#:'AR-T PIIEI�I T TI) DO I,'1ADE AND 1= LSTif (T.,ahrF::IJ i;Y THE AFT'L_:I:f.:AL-IT OR Si 1110 WC::I-D COUNTY HEALTH 0F.f-'ARTMEItl'T FOR F'fIF1!'t],:il:"S OF THE I::=VAI_UAT:CON OF THE AI=II_3:C'A'i'IC)I'I: AND THE ISs:-s1.YAHCE: 0{i' 'T'HE F'E:RrFIT' :I:;:i :32.J5;Jl; C -1 (C) SUCH TERMS ANT) T;;CIhIT)ITIl:l-1 A' DEEMED NECESSARY IL) ii lc:ilJRI: CCIIIE:'l_TAI1IGI::: WI [U RIJF..I :S AND RI IJI_.A'T'If1Il#S ADUF'TE;D (.i$'lDl k A:l'CI,-I. 1U:L9/:t., AS AMENDED 1 I1: Al'PL..:LcflhI 1 U_Fi iii 1E 5 1 LoA l nu. F-TMI'USEI) ISY,S I'I- I'f W:I:I...I Ni 1'X' DI. I..OLA'T'C::0 W:I:'T 1-1:T.Ia 40C) I' r :T CJI:- A CC31*IMiiNI T"Y SEWAGE 4xY{3 ii TI 1,J1 iDE:FCt3-l:fahlF!) IIG.FI :I:<Y FERTIFIES THAT AIJ.. STATEMENTS MADE. II'IF J1':IT# ,'T'T(JI I AND REF -OPTS S3l.Jlctrl:l'TTIi::U hJI-1RI:::W:L'T'H AND i:•I::CII.J,171-1) TO Li1::: 5t.JD1'II:'T.TkD BY TI-H€U APOL:1CANT ARE., OR WILL.. BE,- RF-I-'REOE:1•,ITED TO BE: TRUE F1h11) CC)F:- l'.T 'T'i:x THE BEST 13F MY KNOWI..ED(:31::: AFNID DEL. 11: -IF AND ARE DES I(GIgk...I) To EE FL(:::E..:C#::I) 0444 ft TL-IE WELL) COUNTY HEALTH OE F'AR'TI'11�:NT :(:ICI EVAL.IIATI1�t:3 OF ., ti ,.. FERN 1111_. _ ._ O.., , .. ,_..:. , ... .... .. .. ... . t 1-1Y:- iHA.K::. F O F-UF•,F (:a �F::�:'r 3:,.s':rJ .E• G THE F:`k.i l ix. [ f-li'-F L.�.A ED I- lJ��: rvi,-.r�t,.:s. i''s i. r OR i r i[:.TZ i.ii�ii5i::.rc S TRF4T7 TI . T ANY F-(31_SiI :CL A II II t i-I€; Ill 31J _#'fEt::fiF::I I'T'A'T':CtJN MA-( F..C;'SIJI. I IN 1 111E:: I?I:::lal( I_ c:)f:' '1111::: Al:l'f'L..:It Al TON Elk kE:VC)lAl [UN (II ANY F'F_1 1x11 1 URAN I L::I) BAD UI DII SA :I: T7 Al I::'1.. 1'C All ON AlIT) :1111 L.E:::cAI,.. ACT .IC)114 I'(:1R 1�'E::I'4�TURY AS F'R1.JIJ:I:IJI_D DY I,..AD. AFF'L_TCAT :I:ITM EEL $3 50_00 t3E(::.I) DY t::,I:NDY SA1._AZAIE DATE: 0'9/07/94 `iCj)NAL--13:1='1-Tt:;ANT; CC1F'V---WCI••ID DAFREL_l_ I -'F I I IJUI-ihl OWNEI:i'/F3fal :h1 T 5.' wATL1RE: DAT'E':: .!1 p' .�a ?,� a5/p,riq 1` Wf:l-11)•-C-I.1€:i MAY, 1954 Kim Ogle From: Williams - DNR, Joanna <jcanna.williams@state.co.us> Sent: Monday, July 26, 2021 8:25 AM To: Kim Ogle Subject: Re: well permit Attachments: 180758.pdf i iri'_iun- This emaiI originated from outside of Weld County Covermment. Do nut click links or open attathmenty unless you recognize the sender and know the contemn is.sa€e. Good Morning Kim Attached is permit no. 180758 which was issued for Lot 20 of Martin Brothers P00. We did not receive any information that a well was constructed under this well permit and I found no other well permits issued for the property. If a well was constructed under this well permit then evidence of welt construction during the period when the permit was valid needs to be submitted to our office. Regards, Joanna Williams, P.E. Water Resource Engineer P 303.866.3581 x 8265 1313 Sherman Street, Room 821, Denver, CO 80203 Joanna.Williarns state.cy.us I www.colorado_gov/water On Mon, Jul 26, 2021 at 6:49 AM Kim Ogle <kogle(weldgov.com> wrote: Thank you Joanna I have another one, Lot 20 Martin Bros PhD PIN 1471-12-4-03-020 Kim Ogle WeId County Planning ≥ertricss 97C 4Q0 6100 off ice 910.1003549 Oirert kagle!,)wgldguv,corn Confideetialiry Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, Confidential or otherwise protected from disclosure If you have received this Communieatiorl in error, please immediately notify sender by return e-mail and destroy the communica'_ on. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any ittitchmerts by anyone other than the named recipient is strictly prohibited, From: Williams - DNR, Joanna <j.williams@state.co.us> Sent: Thursday, July 22, 2021 12:07 PM To: Km Ogle <koRIe@weldgov.com> Subject: well permit C,:'itsn:T This email originated from outside of Weld County Government. ❑O not click links or upon attachments unless you recognize the sender and know the content is safe. Good Afternoon Kim, Attached is the well permit for Lot 8 of Martin Brothers PUD. Regards, Joanna Williams, P.E. Water Resource Engineer P 3a3.s6M.3581 x 8265 1313 Sherman Street, Room 821, Denver, CO 80203 Joanna.WiI1iams@state.cc.us i www.co{orado. ovlwater Fj i No WS -25 APPLICANT OFFICE OF THE STATE ENGINEER COLORADO DIVISION OF WATER RESOURCES 910 O9rderniai Bldg., 1313 Shaman Si, Drnvrr, Colorado 8020$ ( 3) 58-355 WELL PEI tMfT NtJMBER 1 8 - DIV. 1 CNTY. 62 WD 2 DES. BASIN MC 1 -IC Lot 20 81ock- Filing: Subdty: W.RTIh( eROTHERS Pun APPROVED WELL LOCATION WELD COUNTY DARRELL PETTIJOHN NE 114 SE 114 Section 112 7535 S EVERETT Twp 1 N RANGE 66 W 6th PM. LITTLETON CO 80123 DISTANCES FROM SEQT1ON LINES (303)979-9252 1500 Ft. from South Section Una PERMIT TO CONSTRUCT A WELL Ft. from East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDIT!OHS OF APPW VAL 1) This well shall be used in such a way as to cause no material in)ury to existing water rights. The Issuance of the permit does not assure the applicant that no Injury will occur to another vested water right or preclude another owner of a vested water right from seeking relief in a civil court action. 2) The construction of this well shall be in compliance with the Water Well Construction and Pump Installation Rules 2 OCR 402-2, unless approval of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in accordance with Rule 17. 3) Approved pursuant to CRS 37-92-602(3)(b)(I) and policy of the State Engineer Linder the following conditions. 4) The use of ground water from this well is limited to ordinary household purposes inside one single family dwelling, watering of user's own domestic animals and the irrigation of not more than 12,000 square feet of home gardens and lawns, as recommended by the Division 01 Water Resources to the county commissioners, 5) Production from this well is restrrctad to tha Latamis-Fox Hills aquhfer which corresponds to the interval between 775 feet and 1060 feet below ground surface. Plain casing shell be installed and sealed to prevent production from other zones_ 6) The maximum pumping rate shall not exceed 15 GPM, 7) The annual amount of ground water to be withdrawn shall not exceed 1,1 acre-feet. 6) This well shall be constructed not more than 200 feet from the location specified on this permit. Note: To insure a maximum productive Iffe of this well, perforated casing should be set through the entire producing interval of the approved zone or aquifer indicated above. " 9/+ ',J � � APPROVED DWR +t,C 9t EWI ., Receipt No O372154 DATE ISSUED AEG 1 7 1994 EXPIRATION DATE AUG f 7 �gf wRJ.5=Rs Y. T6 Appl'cat�on must be complete where applicab)e. Type or print in BLACK tNKNo ov@r5tri t!5 or erasures unless initialed, COLORADO DIVIS10N OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Derretr, Colorado 80203 PERMIT APPLICATION FORM A PERMIT TO USE GROUND WATER fi A PERMIT TO CONSTRUCT A WELL FOR A PERMIT TO INSTALL A PUMP ' (1) APPLICANT - mailing address { I REPLACEMENT FOR ND, ( }OTHER WATER COURT CASE NO NAME _ 1.0 `r REVFIJ JLL 12'94 CaA FOR OFFICE USE ONLY- 00 NOT WRITE IN THIS COLUMN Receipt NC I STREET 17..L__E E VE.'Q Basin Ost �T� CITY! { d%1i [ a Ica tstanl rtla7 G INDITt4N4S OF APPROVAL TELEPHONE. NO, This well shall be used in such a way as to cause no material injury to existing water rights. The (2) LOCATION OF PROPOSED WELL issuanceot the permit does not assure the applicant that no injury will occur to another vested water // right or preclude another owner of a vested water � County 141 right from seeking relief in a civil court action _ Y. of the _ %. Section / Twp_ I AZ, Rng, Lo ah. Cd P.M. I N St ( [WI ,,,/ (3) WATER USE AND WEL4�DATA 3046 1.i FiI'r,,� Proposed maximum pumping rate Igpm) .5 r c cc Average annual amount of ground water If /J ns to be appropriated )acre -lest): _ p Number of acres to be irrigated: r? CL __ Proposed total depth Ifeet]: r tr Aquifer ground water is to be obtained from 14'G�s Owner's well designation GROUND WAT R TO SE USED FOR: l 1 HOU5fHOt_I7 USE ONLY . no irrigation ICI 5.>(1 DOMESTIC (11 [ } INDUSTRIAL [5I { I LIVESTOCK {2) { ) IRRIGATION 1S) { l COMMERCIAL 141 { k MUNICIPAL 18) I 1 OTHER 09 DETAIL THE USE ON BACK IN {111 )4) DRILLER Namc Street City (Steel {Zip) Telephone No tic No. 2-: = BY_ r hh COUNTY +' V� H2O, l2LDO6 F (3Y Ict 7?5 .loa -1 A e ry APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION D&YE .�_�c o u a {STATE ENGINEER) (5) THE LOCATION OF THE PROPOSED WELL and the eras on which the water will be used must be indicated on the d'segran below. L$e the CENTER rSECTION f1 sect+on, 640 ecresl for the well location. 4- t Tartu._+ - --I +— ->} ;�----SMlL6-S2t;9PET -�I + rt ± + fi f + -� NORTH SECTION LINE Of> Tll A p i J I l + Y i I � I I I — 7 •S0UTH SECTION LINE She scale of the diagram Is 2 rncltes = i mile Each small square represents 40 acres. WATER EOUIVALENTS TATE hounded Frpurerl Ar acre -fool cnvors 1 acre of I and I loot deep 1 cubic fop' per second Irfsf 449 gallons Der minute Igpml A Family pt 5 wilt v're apprOKimafely 1 acre -}oar of water per year 1 acre -fool .. 43.56O cubic Farr 325.900 gallant 1,600 Opm pmmpIC r:ont,npoUtly Far One day eroauCet 4.42 acre -leer (5) THE WELL MUST BE LOCATED BELOW by distances from section lines, D3 ft. from sec- lino {nor'h or ( %out 1 '— ft. from !eC- lint Curt or weeq LOT O BLOCK FILING SLJdOIVI5ION d €- (71 TRACT ON WHICH WELL WILL SE 1 LOCATED Owner D'i/1 � No. of acres - ✓ Wi11 this be the Orly Well on this treCt7t (8) PROFS SED CASING PROGR M Plain Casing f 1 8 + in. from f ft to it %in. } 4 m from ft, to h. PPeerff0rated casing G— in. front d A ft to_____1 d tt in from ft, to ft. (9) FOR REPLACEMENT WELLSgivedistance and direction from old well and purls for ptugginq At A. \(lO) LANQ QN WHICH QRQtJN_Q INATI<I WILL BE SEQ; Owner4sl f,4M L 1 5 I f! r� p N PG �i o r, _ No, qr acres: .S, S Legal description (111 DETAILED DESCRIPTION of the use of ground water, h$ousahofd use and domestic wells must indicate type of disposal r etettt to be u sad. 0 O J..7 ' i- i C (12) OTHER WATER RIGHTS used on rhis lard, 'ndudinq wefts. Give Registration and Water Court Case Numbers. �ff Type or right Used for {purpose) Descripiion of land on which used _. A' 47• (13) THE APPLICANT (S} STATE(S) THAT THE INFORMATION SET FORTH HEi1EON IS TRUE TO THE BEST OF HIS KNOWLEDGE. SJGNA r1i OF APPLICANT SI Use additional sheets of popes if more space is required. 1199PT WILL DITA SHIT - II➢TIO 81511, C06OIADO IPILIC11T; Dit116L PITTI1011 11CI1PT ID. 311154 LOCITIOI: 11114 or S1111 Of SIC. 12, r ii, B IIW. 11504 554, 526 151) P➢0POSOD 1QIIFI1; 6121111-10I FILLS SDfCl I611ITIOP: 5000 1#1111 of 1C➢IS II T41CT: 5.5 IS P14PCITT 11111 SIt!ICI 0001111I11 02 1611CIP141t4 S.B.$ 001111? 11PS? PO_ T➢S_ 10 SDID111S101 IS DIDI➢ 11CINTATI01 P1,1I, CISI 10. IS , D1T. — 10 10121015101 1&5 20001111010 TOR 1PP➢0T84 ➢T T@I Willi 111110E11' B1[000, 0110 0? LITT10 IS 11T0111T101 01 SDBDI11SI01 011 TRACT Of Lb161SPICi16 115711CT1OIS: evalsated bt Ll oo 106151 10, 1991 141117101 DIPTI TO 111311, --------------- 1IT ------------ AP1?MD? S71IDS IQOlI➢I SOT. TOP SAID BOt, TOP 1- 00112 11➢S0il 60191110101w --- ---- ---- ---- --- ➢011' 12 - #FFI➢ 1IiPI10I --- 4O11i11➢IP1I01 4672 1904 07 368 136 0.907 III 7'1311 11711}I all 113 141 llU TT -T 1,119 acte: I iodicatec locatloo is at aquifer 6otadart tied values gat le more approiiaate, a tsdicetes the proposed aquifer. III values are iaterpola1e1 from the 5.1.5 data but aeseabled In ➢Oveaber et 1986. Lot 20 Martin Bros PUD Potable Water Well not Permitted From: Williams - DNR, Joanna <joanna.williams@state.co.us> Sent: Monday, July 26, 2021 8:45 AM To: Kim Ogle <kogle@weldgov.com> Subject: Re: well permit Caution: This email originated from outside of Weld County Government. Do not click links or open attachments unless you recognize the sender and know the content is safe. Hi Kim If they have the well construction report that report should be submitted to our office as evidence of well construction. If the well owner is unable to locate the well construction report (form GWS-31) they can provide a GWS-68 form. Please note that the GWS-68 form must be signed by a Licensed Well Construction Contractor or Authorized Individual (per Rule 17.1.7 of the Water Well Construction Rules and Regulations, 2 CCR 402-2). Regards, Joanna Williams, P.E. Water Resource Engineer COLORADO Division of Water Resources 1]epartmenr )F hlan,rel 1 w4 iT c.5 P 303.866.3581 x 8265 1313 Sherman Street, Room 821, Denver, CO 80203 Joanna.Williamsastate.co.us I www.colorado.gov/water M C 44.3 11� V PUMP INSTAU.A110N AND TEST REPORT STATE OF COLORADO. OFFICE OF THE STATE ENGINEER - por Gci un { _ Y. WELL PERM NUMBER - Z OWNER NAMES) - - Mailing Address .. _Jr C+ky. StZip f T +i� U1,52 t- - -- Fhone ( 5 -1 3 WELL LocATION AS DR1iL€D:.. cx 114 SF— .114. Sec...i2 T'"'p. i__- �1• Ra,� �r. �Eit . DISTANCES FROM SEC. LINES: eon _ ft born ecu Ph SeC. Vne. ami sa It. from See, One. , _ -- 3uBDMSloN:iat1n Brothers PI_YIl -.- . - LOT . BLOC! _. . - F1UNG(UNIT) .LOT STREET ADDRESS AT WELL LO AT 14: 4147 SutheLan ihto. 060 4. .MDATALTypO�suj raible --.,_. Ins 11e onCompleted, L 1_7195- Pump Manufacturer Go Pump Model No. 1 DS1O412 Design GPM_, t n _ at RPM 14rfl , HP_ . Volts 2311 . Full Load Amps. fl ..0 .-- Pump Intake Depth „7 24' _,. Fact, broplColumn Pipe Size A,- _ _ Inches, Itlrtd _ q .1 van is d�_ ITuaNAL INFORMATION FOR PLM'$.tREATER THAT 50 t PM - TURBINE DRIVER TYPE: Electric 0 Engine Q Other - Design Head teet. Number of Stages_ Shaft size rnt. 5. OTHER EOUIPMENTE. . Airline Installed Yes ❑ No, O Mae Depth IL _720'. Monitor Tube Installed Q Yes [D No, Depth f Flow Meter Mfg.. Meter Serial No. Deter Reado u Gellor+s; Thousand Gallons,, 0 Acre teat, 13 Beginning Reading d. T ST DATA; O Cheer box If Test data Is submitted on Supplemental Form. Date -114,71951- 1-147495 Total Well Depth + Time 7.OOP t 8 DOPH . _ - PM Static Level Rate (GPM) _I4.1_ U7 - 1 Date Measured iijq Pumping i_vl. 400' 485'_ 519' 518' 7. DISINFECTION: Type HTH uranular Amt. Used 25 oz . __ B Water QuWlty art*sIs avallattle. 0 Yes G No 9. Remarks 0.1 have read the stateniants made herein and know the contents thereof, and that they are true to my knowledge [Pursuant to Sect%n 24.4-104 (13)(a) C.R.S.. the making of false statements herein constitutes perjury in the secon degree and Is punishable as a dais I misdemeanor. j CONTRACTOR „tr jr-gu= gUat- a- - Phone (3Q3)431-!7 54 Lic. No.1 194 _ _ _ Mailing Address o . 80OQ Name itla (Please typi or print) Si Date .xirKirbyner 1 11/1495 rw n AND TEST HEPOFfE STATE OF CC RADO. OFFICE CAF THE STATE ENGINE StELL For Orlics Usa only 01 FEMW NJA8 106182 2. DWNER NAM90) MaAki�Addiusa 'i 024 Perk � CIS►, SL 2 _ti ni- 8021 -- Phone(303)654.1239 a WEL L1.QC.411QN Ad d�LLEa: SE 1/4 SE 114, Sam 12 T uD 1 N Range66 W DISTANOES FROM SEG. LINES: 860 R. from S Sec. lIns. and 620 IL fmm E Sac. lire. OR SUBDIVISION: tits lhro ru PUD LOT 2 _BLOCK ! FILING(UNIT) ___ STET ADDRESS AT WELL LOCATION: 4< GROUND SURFACE ELEVATION tt. MILLING M -ICO R DATE COMPLETED _8-17-95 .TOTAL TOTAL DEPTH 1060 R DEPTH COMPLETED 1060 IL &OLOGiCLOG Depth n ig- 1pem+ d Irypa" color, Wa$ur L ocr10i1 0-12 IL HO .E DIAM. (1n.) Frnm (It) To 8 314 0- 2 _ 6r 1_' 60 7. PLAIN CASING OD (in) Kind Wadi Site From(f) TO) 65L6 Steel +1 22 4 _ Steel .188 22 830 . CASING: Screen Ski3116" torch cots 41/2 Steel.188 830 1060 - Slue shale ve a Ie eared ue sha a - ue sha 1 of coal um e 8. FILTER PACK 1Aaliarlai N/A Siena lntolv8l a PACKER PLACEMENT: Type t placed 'at Depth 830' 10. GROUTING RECORD: Marl llrrraunt Densly Interval Placement t,ement 54I 7 81/beg0-830 Pte -..' en C� tCr 1 DI$INFE0flON:TypeGranularQIorineAnn. Used 3 cups dissolved in 5 gallons of wa 2 6 wn Form No. G3Ssplemer* Well Teat. LL T QAT a TESTING MErTHOD Air Static Leval 470_ -It Datefflme messtx Prior Jiilon R20_ jpm. Pumping leach a ft. DWgfllme meawu'ad _ ,+. Teal length Rxs.) 3 t I1arrmrks $ l hura road th. ilramuras ROHM harufn and know tlro oo+�lana ti..or, Ind rinat er an iron M mviQwrrl*dlJI. IPuraum! 10 X4104 (1 C.R.&.11 nA*klaa d idtru andemsrls hs,sln.oi .lw prrnlury In IM saomrd dpru_ and r punk mbln r ■ Diann 1 mkdnraanor,] CONTRACTOR to hn v al na l l i gg _ ._. Phone L 3oi 423-245 _ Lic. No. 827 �� type or l ms's Daft Lloyd ,john 8-29-93 _ —a-fL---_..,•- - - ... - - — ._.n_ - - _.. INSTRUCTIONS FOR WELL CONSTRUCTION AND TEST REPORT Rev. Oct. 94 The report must be typed or prU ited in BLACK INK Ail changes on the form must be Initialed and dated. Attach additional sheets if more space is required. Each additional) sheet must be identified at the top by the weD owner's name, the permit number, form name/number and a sequential page number. Report depths in feet J 1_� below grvu'unu surieoe. This t rm may be reproduced by photocopy methods, or by computer generation with prior approval by the State Engineer. Photocopy reproductions must retain margins and; print quality of the original form, The original Corm must be stetted to the State Engineer's Of . within 60 days altar comple1ng° the well or 7 days air the. peirni't expatiodata, whoever is er. r. A copy of the Win must be provided tea the we'll, owner. 1, Complete the Wall Permit. Number in, full'. 2. - Fill-in Name -acrd -Mailing Address -at Well Owner where correspondenceshoi,ld 1s eeM. � __ 3. Complete the blocks for the areal, location of the well where drilled!. Illthe owner hays more than one well serving this property, provide the id!enti ation (Owner's Designaben) for this well, Imo] NOT USE fl OIN ER SUPPLIED LO M LMM unless a survey has been provided'. For wails located in subdivisions the lot, block and subdivision information must also be providled. 4. Report the ground. surface elevation in feet above sea level, if available. This value may be obtained from a topographic map. Describe the drilling method! used to construct the well and the date completed. Indicate the total; depth drilled and' the actual completed depth of the well. 5. Fully describe the, materials. enoou:ntered in drilling- Do• not use formation names unless they are in conjunction with a description of materials. Examples of descriptive terms inciUd'e., Grain saza--Boulders, gravel, sand, sift, clay. Hardness --Loose, soft, tight, hard,, very hard.. Color -All materials. Most critical in sedimentary rocK. Depth when water is encountered. Qif it can bee delerrmiried). 6. Provide the diameters of the drilled bore hole. 7. The outside diameter, kind, wall thickness and interval of casing lengths must be indicated, 6. Indicate the type and size of fitter (gravel) pack and the interval where placed. 9. Indicate the type and settling depth for any packers installed. 10. The density of the grout sllurry must be reported and may be indicated as pounds per gallon,, gallons of water per sack., total gallons of water and number of sacks used, etc. Specify the grout placement method, i.e. trernia pipe or positive displacement. The percentage of additives mixed with the grout should be reported under remarks. 11. Record the type and the amount of diisintection used, how placed and the length of time felt in the hole. 12. Report well test data as required! by Rule 10.7. Spaces are provided to report all measurements made duiring the test. The report should show that the test complied with the provisions of the rules. If a test was not performed explain when, it will be done. if available, re -port wick time when measurements were taken. 13. Fill in Company Name and Address. of Contrador who constructed i the well. The report must be signed by the licensed contractor responsible for the construction of the well. COLSDIViSION OF WATER RESOURCES All eid E. 1313 Shermm O!, Owlwt, 0ol ads 3 00401 KIRK & TEARY LOVELL 1020 PARK AVE FC WPTON co 801 PERMIT Tip' A WiL WELL PEFMT NlJMBER �.. � — . ON. 1 CNTY. 62 WD 2 DES. WIN Mt] i. t 21 f : F111ne: subdiv: MARTIN BROThERS PUP w r• SE 114 SE 114 Seltlon 12 Tw i IN RANGE 66W 0 P.M. DISTANCES FROM SEGTIQN L& 860 FL from South Section Line to Ft. from East Sermon Line iSSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT +CIPIiO'�11�1. 1) ale wellshall be used In such a way as tocalisonometedal injury to a dsting water rights. The ice of the permit doee not ar aiie the applicant that no injury wig occur to another veld weer dgtt or predlitde another owner of a vested water rift tram aseldng relief in a civu and fir. 2j The construction of this wall 5h be In compliance with the Water Well Construction and Pump lnataMation Rules 2 OCR , unless appmvai of a variance has been granted by the Sumo Board of Examiners at Water Wei Construction and Pump tnelaflelionC+c awom in CoI with Rule 17. 3) Approved pursuant to CRS 37 (3)(b)(q and policy of the State Engineer under the following condltl 4) The ure of ground water from this well Is limited to ordinary household purpraoea inside one single family dwelling, watering of domestic animate end the irrigation ct not mote then 12,OO0 equate feet of home rdo and tannins, as recommended by the Division of Water Resources to the county Comm-isic nsm 5) Production from thia welt Is restricted to the Lararaie Fort Hits aquitar which corresponds to the interval between 775 feet and 1060 meat below ground outlaw. Plain casing shd to Installed and sealed to pre vertt production farm eRfrer Zones. 6) The matrimum pumping rate shall not exceed 15 GPM. 7) The annual amount at ground water to be withdrawn shall not aiued 1.1 acre4ee1. 8) This well stall be constructed not more than 200 fast born the location spacified on this permit Nate: To insure a maximum productive No of this we@, perforated casilt shcrrid be set through the entire producing Interval of the approved zone or aquifer Ind icalad above. 4117/9 ≤ .i. 4L .r. CKZLW—Z r i APPROVEDt I Receipt 7 No. 0382847 — DAT1E ISSI.IED APR 18 RATIO ANE R f 8 i997 rl_ WRJ•5-Rev. 76 COLORADO DIVISION OF WATER RESOURCES S118 Can�tennuai Bldg., 1313sherrnan St., Denver, Colorado 80203 PERMIT APPLICATION FORM RECEIVED Aptyli atioo must be complete° where I 1 A. PERMIT TO USE GROUND WATER 2 applicable. Type or (X) A. PERMIT TO CONSTRUCT A WELL (print in BLACK FOR- (?�) A PERMIT TO INSTALL A PUMP WATERRl tAt''" Ih1K. I�o ¢rv'erstrikes. STATE Qr erasures unless ( } REPLACEMENT FOR NO. irtktcalecf_ { OTHE:IR WATER COURT CASE NO. (1) APPLICANT - maiiing address FOR OFFICE USE ONLY. DO NOT WRITE NN THIS COLUMN NAME. Receipt NotYI. 0 f STREET1t' 9 Park ve. Basin — — Dist. ________r CITY_Ft.LZapton,Colorado.8O621 - Iststal (ZIP) ' 0NDITIV_NS APPROVAL -This 'well• shall be used i n such a way -as -to cause lb rnaterial in -jury to existing water rights. The (2 LOCATION OF PROPOSED WELL issuance of the permit does not: assure the applicant. that no injury will occur to another vested water riglrt or preclude another owner of a vested.. water County Weld) right from seeking relief in a civil court acti:on.. . E 'G of the S.E. %, Section 12._-_- E1oc k1f1 �,s � E, r -- - „� S Two. —I N , Rng. 66 _ _ I!` — u- P.tsA a L z fwlo.tart , fQ.D. (�.5f ce.wwz S IIiif9. (34 WATER USE AND WELL. DATA c L.- fY1q I S b 70 7 G I7 + x e70u QI' ; rr Proposed maximum pumping rate 4gpm) � � l f4 r K14'. Auerage annual amount of ground atr r..q to be appropriated lacre-feet}: Acre foot Best Copy Available Number of acres to be irrigated: 1 Ac re Proposed total depth (feet): 1 000 1 Aquife► ground water is to be obtained. from.: L. ' II Laramie Fox Ffi11 Wt} ► O�r�r+vl �Dwner's well designefion F1f A .— _! — GF OUNO I[ATER TO BEUSED FOR: k l - ( } HOUSE FI0LD USE ONLY • no irrigation (Ok I ,� Ix1 DOMESTIC (1f ( I INDUSTRIAL (5} I J LIVESTOCK (2) ( ) IRR(CAPON (6) I I COMMERCIAL (4} I I MUNICIPAL (8l I I OTHER l94 APPLICATION APPROVED DETAIL THE USE ON BACK IN (11) PERMIT NUMBER (4), f RILLER License #827 John's Drilling Inc. Name Street City Golden Colorado 80403 i Ilse lisp) TelephoneNo. 303-423-5241..No._ 827 DATE ISSUED EXPIRATION DATE LIt" Lr LITER ;E5[i-. I (STAT E AI f fa! R I I.D. COUNTY Z - s#GNA 5) THE LOCATION OFE PROSE© WELL and the isrers on Whiccht re Grater will be used must be Indicates tiro titre diagram below. Us the CENTER SECTION EI section, 640 etiral for the well location. } — + —± — -(--4-----+--- -4-- + — + P. '# fNILE.allMIT--Irl I + + + + + + . + ± — 4 — M0RThBErTIO4LINe I MONTH T , 3 I I —+-- I I —+— I I I I I +_ T I I I I + + + + 4 4- 4 + ± I I I I I 4- --t--f -+--j---4--+ --i- - -�- The scale of the diagram is 2 inches = 1 mile Each smal I square represents 40 acres_ WATER EQUIVALENTS TABLE (Rounded Fivurn} An ecr -fact carters I bcrs 01 lend I foot deep t cubic foot per moortd Icfsl .. • 449 Gallons per miners tWrnl A family o4 5 will reiluirs approxirmtely I rfoot of wee* per Vast. 1 ane-foot . , . 43,560 cubic feat .. 33S.9oo gallons. 1 ppm Pumped continuously for one der produaea 4.42 acre-feet. (61 Th V EU.MUST B LOCATEDBELPW. by distaneen from section bet. 860 ft. from South sec. Tine (mmiii ar eaapi 0 _set. hats.. East; eue.lirre settle ar tilt) Ll]T 21 BLOCK --__ F I LING a __ SURD I VISION S PtiJt (7) ThACTON_WHJCILWELLW.ILL.E LOCATED Qwnar:_1(irk & Terry Lovell Na of acre . Will this be the only well an this tlract?_Yes (8) PROPOSED. GAS1NG PRC1. O RAM Plain Caging 6 5 6 k'. from 0 tt tie 20 ft. $ In. tram fE. tfx ___ 6 Irt. Flerfafsted coring 441/2/2 in. tram 7_ 80 ft. to 1000fit. frofn_ ft. to. (9) FOR REPLACEMENT WF LS glvedistanear and direction from old well and plans for pluggirsy K/A (10) D- ON C R D W T D: ownerfd: „kirk W. Love l 1. & Terry L . Love11 Pia of fsEreF- _5 Legal description: Same as #6 (111 DEFILED OE.SCRIPTIOIll of the use of ground water: Household use and damastk wells moat indhiate type of diepasd gynain"6a� st:ic — (1) ONE Household _ -- Septic ftstext (12) used on this land. including wails. Give Registration and Water tout Case Numbers. Type or right Used for Ipurposel Description of lard on which used N/A N 'A r (13) THE APPLICANT(S) STATE(S) TI4AT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE. Use additional sheets of paper if more space it required. 4 - 1IU1 IV MTh 5STi1T - Dh:16'CM DI�SI1, COLDRI{DOI APPLICHT ° TIM. h TMIIMF LOp16b 91C1PT O. i241' LGChTIQ F S1I14 1P S11 OP SEC. i2,. T.I1 , k 6€.MSN, 18SG S$L, SI4 PMQ?QSIID WIF'M11: LA9'1!11-at $1US 51DP' I IIL1 h1"IQM. 5012 1111 B dB hCMM I9 T 1 T: S 15 P PKITT' 9`I.T'M[I4 SMIPICM ED91DRIES Of MOMICi I ! S.I. 5 C4 SMST — YI..S...... it 549DIII•SI*Q. 1.$ —. IF SMMDITISIDN' MhS MICC0MMMI.1111 16M SP1'1C 5I, It T1.1 HTER M:Ir*tGIIMIIMT Fula, DMTl Of LITTMM I5 IM M 14YM DI HMt IPISION: OR 1&t M6LM* S� I*L R 5.?RMIC 4S: eralaated° hF LM aa. $PM'I.I. 14, US5 MIS virrQ'M iirfl To HFOAL --------------- 917 --------------- OIP1≤ee T.1Ts. b FIFM6 MDT. Tif? SLINK EDT. 1" DP 1'-M IkUh`1l tf�11a1�M ---- ---- ---- ---- - --- ---- --- D1M-BMTL ---- ---- ---- ---- ---- ---- --- LOW.H. AM PMIGI 4665 49t1O 99 361 132 O.M41 Jr tLd,9`d111401 HIUS d9I4 4256 UT 16'54 TT 6 1.95 67 aote:. M indi atee- Incati.oa is at aqulter boa dart aad ►aluea uap bd mare apprati.ate. t indaeatea the proposed aquifer. III ealaes are ieterpoI&t•ed troo the S3.5 data base asaeANI.ed Ixbar of 16. Scanning Cover Sheet for Septic Permits Permit # G19950229 Permit Type: Health ! EHS History I EHS Conversion History Situs Street Address 4147 SUNRISE LN Situs City, State, Zip Sec/TownlRange: 12-01 N -66W Application Status: Finaled Application Date: 03/1111996 Parcel # (12 digits) Owner Full Name: Owner Address: Contact Name: Contact Address: 1 471 1 2403021-R 02259 94 LOVELL KIRK AND TERRY 1029 PARK AVE FORT LUPTON,CO 80621 Owner Phone #: 303 2897042 Contact Phone# Information above has been Verified in Accela by employee noted below August 05, 2008 ❑ate Report ID: EHS00024v003 Page 1 of 1 Print Date -Tirane_ 81512008 11:18;19AM EIf;`sE"'1€seSl"' :1:1;1I):I:�.�:L I)t.JA1... SEWAGE I):I:c){:li I,.. 1hlfl.. Cs•••9,`,r 3;�;', ,!`• WI::I...I) UC:itj rT'Y HEALTH i)E:F'I"IR T l"J:INI•T I I:W I'r21rI:!' T i:'.I'!{J. I. I-:(:fHMi: NTciI... I' I1: AL.. III ':YI::.f�V1.(..E:S 1.;'.1.'7 16 H AVE:I'l.JE: (:(jLJf4'T faFtiF::I:::l.�:"Y,� f: ( :1, '035 .V1_ 2225 i2f'1f_' t:JWhlI:IR L..i::rt11:1...I..,F{IRK Il'II) 'T'I:1.()2< PARK Avi::: I::I•'I (103) i:'.::3tx'-.. 0iF F F I...i.JFT(]hl t:ll::• FI i.i i T I.i.7 ;:il.lFdl"::l:;:'i1:: I._rli`II::: IDF: T. 6HT (]1•I (:ro P- 06o 1 I,.,i:::(;iAI... [)i :.:i(::F1.11 ' T`:Ili (71 '3I'T'Ll:::(' :Lk ' 'I•WF:' :1. I'-:I'IU 6 7 f:JI.JFtl):I:',l:l:'::I' (:)ii''F 'rl•' i i!•'I :(:<I I:1 I I II:::I?{3 I:'I.la) I...f:0 T :':k [ I. OC K 0 FILING C) 1.JS:)I::: 'TYF:'f: ,, r:I:::;:r:I: DI;::I-•rr:r At... I••Fot. FI: RVII 1:: ,:; w F I:':F4SONS ' 1ifl T f'iROOM . „ 00 L..O'T' ?:[ /E:: :,T.� 00 (ll:'I I:;.{: I:r1:•::L)F' OOMS 3 l:[!:tY ENT I"'l...Uf'1T:I:I:J�I(a YES W 1 T1:::Jt '-:;1.JPPI...Y` F::w1:1_..1... :l:l::•f'1!':[I.N Ii:l::: {Itr,.{;1{} I) IT I••FO1...1...Y Dl:t1114:E:5 s:1:(:31::I) BY •TE_R!'4Y L_.- DATE ()x�/2 1/9 Ur1E 06/2:1. /95 c:N I A 11,.: { .. h 1w I l f''1:: R :I F�Ic F•I 1...:1:441:[ r :I: hE(::+ r:C)I•^iF, {;(:)'IE... T•YT'I::: !'3F.I:E: T ABL. E. F'I::F (:l;: N T' (:71J1'II.t:1FrlDIRECTION 14 (IJt-iLRE S E:1'l1I:i:Id1 F::1 ii:.:€:liI i(:1 :[I�1 :1.()x} i I..t:)GI) F'L..r1:TIF (1IiI: it1 i..I�:t,llxl Ti••ir:: fyF='1'•'I._:1�(::AT T:L:ih1 II s1 -1F t:3RMAT-:i.c11••i I1.il''F'I..IF::I) AI'II) 1I'IE: t'lhl•—{3:lIT ..l l••fl: F•(]I...l..OW:F:l,N:I MINIMUM ;I:hI i (I...I..AT•I()I'1SPECIFICATIONSI:1:: REQUIRED, ii:F''•T•IC T AI�II< I.{)00 (:•�AE.._I...(:II+lS r� .::''(]Ftil ' 1 1(]hl T1• LI1�I(::I.1 I •'•-, {" -- . .4A..., .�I.I,� i 1, BED 7 J. '1. IN AD[).C T I.(:)IT I•I.I.;3 PE::,I•�EYI.I. i .i.SUBJECT T C) T I•'II" #` �1i. L..(.iixl.Li�1(.7 ADDITIONAL T I::.l,lYl.:> AND t. CND 1. IF. UF�1S ;r T'1.1i:€:iP'#:::I FrN.I. T - ..E. 3 (:xl'':AL'1T_.....) •T'E:::3'IF''!':lRA S:I:I...Y TO AL..I...(]W CONSTRUCTION T -O COMMENCE.TF--I:i:x PERMIT MAY I'll::. RI ::: )UI<I.:.D I:1#i ISI E I`IDF::D I:BY T! -II::: WELD t::UU1••I TY HI g[ TN T)I:::F'AR THE 'I'T F' Uk RI �( I.•:•T FORT 1 I I: hl i I -di::: WE::I...Ii:I�II):I: v:i: D1.Jf11___ '..: I;';.tdA GE DISPOSAL BYSTEM I I:•.:i�I.JL,r•'5 i-T:Ci:IN•�I{� :I:E•Ii:;F...I.JI}.f:hll:J ]"AIL..F..IR1::: 'T'U 1711 I ANY •1 Ii OR f:(:]N) I •I Ii Ii :I:MT C]'.: L T1•'FF::FiI UN 01 ii FNG'I TEMPORARY (.1k F Ni APPRO i AL . T'I•ll::: :I: h}#:31. Ahl(:rF::: t: OF T!•'I:I S7 PERMIT Dl 1If:7'T Ii i'If `s"T :I: Tl.f Ti::: r1S:i#:1111'11 1 P (]II BY 1 i . 1; I':::I•: AR TF*Il:::t+F'T OR :1:'TS E::::YIF'L..OYEE :S h F L..:[ AI'{:I_L..:I' c F •I.JI': '[HE I:: :I:1..l.JItiE:: OR :]:I1ADENUrAt:: Y 0I . 'I'F•IE:: :�I:: WA(:1E I):E: f:3POSAL �:1YS TIF'1., AI..,F. 1.I•I 5:3 TUF;-i.F;.: ' s r r I:'.a'F''.' .I.I .(,i1411LH N T r iL SPECIALIST I'EF:l1:l:"T :I: i:i hl(:T'T T1Y:�-1h1'.: FE:::C�:Ak)I...L : (III) S 1AL,1... I:{t:::(_.c 11i:: 4'i:I:I:I) i:F= S.?Y S T i:: M ( (:)141;:?Tf;1.1(:."T:E: (:III F••II�#:a NBC (:1I3I''IIYIE::hl(:::1.:i) W:I. TF-{:I:1�I C3hIl: YI fl CJfF ITS:? ISSUANCE. I:til:::l D {I:::: :F:r:a;34.J !:t•Fl:a 1 :1.I4 I... fi1F:'l::I I:IUrd.. (]f:' T'i••I I. I#:F4E1:[-T THE WF:I,,.I7 C C)1_JI;I•T' ' I•HI:AE_.•TI•I I)F:::P(TR;TI•'11: F::I:t:']I••ITT' ..i•(7 'I:IYFL•f]`.-'3k:. AT)I):r---- •T'9:C)hFAL,. :rf:)hNI :i.1J!•,Is: FI:.:CTU.l:I:I :I) TO Ixsl._•E'!' €:14.JI: F:l::(:71.JL..F "T I:(:1I4' €_II,I A i:(.Jh1 r IL'!1-JJ:hll:-4 L s1.... :[; « i •:i:i tAll... :f:. :r cx CONTINGENT I•,iPON 1 I.•IIE F' :I: hlAL :ti h' SPE-:C: T 7: F] I t:OF. THE:: f::(:JI`I • k..I,.i.ir.li) r• i:`� ' ~ i.... -: ", .� r T'IyI1:::hi�T - .. ..a ..} :< p.,p:: ::....1. t..:(:I-l�T Y 31:;:�a1... T't l T)I:;:E��'F1F4 c:... -. .... • ., . •_� ,. ..� aYSTI:Ii .[3I,aTAI 1 I E :. x.............._...................._........I�I{'IAL J:i'•I,sf'E(_J.1.DF, 1 L ... -......a.. .ti x {1}YI'}1 E, I. i.)t::.1...kli:`.LI IE::I:::F: :... •...., 111'1 f:{::tvrrL .................. ....� 7.,r.. ,,...,.,__. S:�Y�:1 T I::.IYI .1.1I:.a 1 I•YI...L..I�• 1 • � I..I I , .f.l•tiCT3`IIYII1 d .'' T 1•11:. If:JSU 141(::1:: OF TI"FI S F'I:_IY.I'i:l:T IC::y I•II'1•i• :l:IyMJ1..,Y (::(:)Iwlf'1..:rAI IC:1: W1:•1Ii l:r!"IHII":I: STA E, ((:IIJ1!I'i (.)L: 1...(:iE Al.. II:::iaUf...ATt:1!".Y III ": NI.J.l:I..,[);I.h1T:] RI::.OUIR:::III :::NI ,, h!Uh f:Il"15L-t__ .1..T• A " III (::ir TF1"'Y THAT• T'b•tI : ,:;Ur• ,T1:(: T SYSTEM WILL :i: hl Cl')1*IPl..:l: 5h1(:::1::: W:i: -T F•I r1F"'1''!-. 7:E'riIT:'L..E:: SPATE ., i:;(:)ul` T I.. i:II A1_- I I;::(:tI.JL._r1TIUh!S:3 AI)UF' II;'D I1l.JAi'F.l.. .F'(:l At T:1:(:,J...I::: :i l;), 1 :F:TL.-I 'IL',, (:;Jti;:i I. 97AS Al*ilIhII)f:::D I:.':) (::l::.F'7 I:: FOR ` Till: F'URF'(:1E:: Of I:::;:+'TAO1,..;Il••I:I:III :I r •:I:1IA - Al•'F'J UVAL.. OF AN :I NTl AL..L ED '.: YS IL II I" DI ISSUANCE UI A I..UI .11 OCCUPANCY 1"'E:f=;lYl:f'r' 11'I)fUA1'IT NI I:S=; 'I.9"7 T 1.0....:1:11. (:t:'.l .. )b. (:lI :E:U:ENIAL..•- AF'•'Pl :l:(:r51' VI 1 (::oI::'Y- w(:i I1> 1a,It::i--1I)...-I :F1:'. 1x AY. :1 {•':341 AJ 40' q1 HSP1O6P INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WELL) COUNTY HEALTH DEPAFTMENr ENVIRONMENTAL HEALTH SERVICES 1517 16 T F-1 AVENUE COURT. GREELEY. CO 8o :i 353^ 0 `1 64 3EXT.2225 OWNER LOVELL. KIRK= AND TERRY ADDRESS 1029 PARK AVE FT LUPTON CO e0621 .ADDRESS OF F'ROPOJED 5YB 1E≤M 4147 SUNRISE LANE SRIGHTON CD 80601 LEGAL DE�CF;IF'TIONI OF SITE^ SUE+DIVISIC'!N: MARTIN SPOTHER'S F'UU USE TYPE: RESIDENTIAL HOUSE SEF VTCE5: PI RR[JNS 4 T F-IF:UUMS SEDROCJNS 3 SASEiFEN..C APPLICATION FEE $Z'X RECD BY I-flLLY OE_NNIS DATE 0.?,/21/9h NO. G-950228 NEW PEFMIT F'H (3,0::,ti'k 2e9--7042 SEC 12 TWP I RNG b6 LOT 21 RL.CC I.`. 0 FIL IiiNCS 0 2.00 LOT SIZE +.00 ACRES F'LUMElING YES WATER SUPPLY FWELL 16NED ERY TERRY L. LOVELL DATE 06/F1/95 PERCOLATION RATE _o MIN PER INCH LIMITING ZONE ? FEET SOIL TYPE / #=FRCEN1 E RD JND SLOPE "Z DIRECTION REDUIRES ENSINEEF' DESIGN AC IN 100 YEAR FLOOD PLAIN ZONE /[ 'O FROM THE APPLICATION INFORMATION SUPPLIED AND THE UN ---SITE SOIL PERCOLATION DATA THE FOLLOWING I'.TNI..Mk.ih'I INSTAL.LAJION SF'E _'.IFICATIIUNS AIL RCiEJIRE 3� SEPTIC TANK /cc LUALLONS. AOSORF'TIDN TRENCH j1�7 SO. FT. OF ARSORPTiON RED OO. FT. IN ADDITION. ITHIS PERMIT IT THE E F-OL_LOW�INO ADD:, T ION1— 0TER''�"tS AND CONDITIONS: THIS PERMIT IS GRANTED TENF'URARILY TLl ALLOW LONSTRUCTICiN TO COMMENCE. THIS PERMIT MAY LSE REVOKED OR SUSPENDED IJY THE WELD CC]L]NTY HEALTH DEPARTMENT FOR RESBNS SET FORTH IN THE WELD COUNTY INDIVIDUAL DIaPOEAL SYSTEM REGULATIONS INCLUDING F AII_URE TO MEET ANY TERM OR CONDITION IMPOSED THEREON I)t1RING TEMPORARY OR FINAL. APPROVAL. THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE DEPARTMEN`1 OR ITS €ECiF'L DYES =: OF LIADILITY FOR THE FAIL_ .IRE_ OR x' FADEDUAEY :=- TrHE E'JEWACGE DISPOSAL SYSTEM. l.Ju ` 0' -b 3 EP lVIEC'NMENTAL. THIS PERMIT IS NOT TI:ANSFERABLE ANL SHALL. BECOME VOID IF SYSTEM CONSTRUCTION HAS NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL AF'F'ROVAL OF THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDi-- T'IONAL 1'E:RMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS O1'4 A CONTINUING &A-- 518. FINAL PERMI.T APPROVAL IS CONTINGENT UPON THE FINAL TNOFLC'TION OF THE COM— PLETED SYSTEM hY THE WELD COUNTY HEALTH DEPORTMENT. C]F:IL3.T_hIA! HPF'I.ICAI'c'i ; COPY—WDH WCi_ D—TH8 MAY.. 15"G# ..f WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL PROTECTION SERVICES Y , %TE EVALUATI' ONN OWNER: L s ello- Ark 4Wf r, rz APPLICATION NO. q SITE/'y'4r=►( ?Lr PT_ S/. T. /__ R DATE: '". ' q4� SUBDIVISION:_ „ LTBLK FLC PERCOLATION TEST DATA., Start. Time: Haile: Hole H2O Min. No. Depth Remain mire min.. min.. mini min. min, chin. mire. minim nc 1 2 . __ tM' 0 .lie qv H9C. . ___ ___ ___ .5 o .t 0 '" ___ ..-------- a+aC S` 'CY 6. L) -r Jc • --.-.-- ____ _____ ____ ____ All measurements in ,rrrm. unless. otherwise indicated. * �. - Add H2a Total E.nvironm ntal Specialist Average Rate PLOT PLAN . SOIL. PROFILE l7 :> ' // f Lzal_r r J i�l+A'ti, S / Va on f� Q mL�i!Irl� " ''eta /J /r ` 'L HBRjO6P APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM NO. G-950229 WELD COUNTY HEALTH DEPARTMENT NEW APPLICATION ENVIRONMENTAL HEALTH SERVICES 1517 16TH AVENUE COURT, }/G]REELCEY. CO 806:71 .y ti 5..-C 35 EXT..� 225 OWNER LOVELL. KIRK AND TERRY ADDRESS 1+04 PARK AVE PH (703) 2RS'-7042 FT LUPTON CO B0Ei21 ADDRESS OF FR:❑FUSED SYSTEM 4147 SUNRISE LANE FRICHTDN CO 80601 LEGAL DESCRIPTION OF SITE:: SEC 12 TWE I RNG 66 SUE+DIVI.SION: MARTIN BROTHERS POD LOT 21 BLOCK 0 FI ThB 0 USE TYPE: RESIDENTIAL HOUSE SER(V≥CE S. F'ERNONS 4 BATHROOMS 2.00 LOT SIZE 5.00 ACRES BEDROOMS BAGrM N'r PLUMPING W -e3 €'DATER SLJF'PLY F'WELL APPLICANT ACKNOWLEDGES THAT THE COMPLETENESS OF THIS APPLICATION IS CONDITIONAL UPON FURTHER MANDATORY AND ADDITIONAL TESTS AND REPORTS AS MAY BE REDUIREE) BY THE WELD COUNTY HEALTH DEF'ART MENT TO I+F MADE AND FURNISHED BY THE_ APPLICANT OR BY THE WELD COUNTY HEALTH DEPARTMENT FOR FeJRPOOES Or THE EVALUATION OF THE APPL.ICATI❑N: AND THE ISSUANCE OF THE PERMIT IC SUBJECT TO SUCH TERMS AND CONEUTIONS AS DEEMED NECESSARY TO INSURE COMPLIANCE WITH RULES AMP REGULATIONS (fUFTED UNDER ARTICLE 10. TITLE 25. CRS' 1973. AS AMENDED. THE AP'PLICAN-r CERTIFIES THAT THE PROPOSED SYSTEM WILL NOT DE LOCATED LiJIfHIN 400 FEET OF A COMMUNITY SE>tJAGE: SYSTEM. THE L€NI)ERSIONEI) HEREBY CI RT;IFIES THAT ALL STATEMENTS MADE;. INFORMATION AND REPORTS SUBMITTED HEREWITH AND REQUIRED TO E+E SUBMITTED BY THE APPLICANT ARE, UP WILL SE. REPRESENTED TO BE TRUE: AND CORRECT TO THE BEST OF MY KNOWLEDEE AND BELIEF. AND AIDE DE:SIL71NED TO HE RELIED ON BY THE WELD COUNTY HEALTH DEF'AF:TMENT TN EVALUATING THE SAME FGP PURPOSES OF ISSUING THE PERMIT APPLIED FOR HEREIN. I FURTHER UNDER- STAND THAT ANDY FALSIFICATION OR MISREPRESENTATION MAY RESULT IN THE DENIAL OF THE APPLICATION OR REVOCATION OF ANY PERMIT ORANTED BASED UPON SAID APPLICATION AND IN LEGAL ACTION FOR PERJURY AS F POVIRFL) BY LAW.. AF'F'LICATION FEE 1150.0() REL;'D £-;Y HOLLY DENNIS DATE 06/21/95 TERRY L. LOVELL e.ir e•,.y1 1C'yLI CJw€4FR Aa EN I 1 CFiTarF DATE. UJR1SIt+4A;._.--APPLICANT° CJPY--WCHP, WE HD —EFTS MAY. l9Fa4 FORA cvs3t WEU C.44STRUC11ON AND TEST REPORT STATE OF COLORADOI, OFFICE OF THE STATE: ENGINEER rte. r�rnm* was omV r , 9 {$ I STS: kr� 1 WELL ` NUMBER 15°13 a OWNER NA fE(Sr QLIW1 Marling Address — City, St, ZP Phone ) I - 3. WELL LOCATION AS DRILLED: ?E 114 _1/4 Ssc. Twp. , Range. DISTANCES FROM $C. LINES: -. It from ji jL Sec. Ie4 and l h. from `T sec. I;no. OR of ar wr4q SUBDIVISION~ 111L LOT_ BLOCK,_, f FJUNG(UNIT)____ _ STREET ADDRESS AT WELL LOCATION: 4. GROUND SURFACE ELEVATION IL DI LL.ING METHOD DATE COMPLETED RUCc, [GI TOTAL DEPTH D It DEPTH COMPLETED 1�_. 5. GEOLOGIC LONG- D.pd aI. YYd & I OLE jD AM. (in.) From Q1 ) Ta I 7. PLAIN CASING O (its)' i nd Wall a From(ft) To hl Iris PEAF. CASING. Screen Slat- Sae:II .lS? -qi- f-1 Itl-tF1L di _ 86 FIL_TE.R PACK, 9. P K!R PLACEMEN!T: Materiad Type Slze Interval Depth C lit, GPOUflNG R E.C R : aerial Amount Density Interval Eicarnent _ - ►D RN grILL- _._..S EMAAxs: f DISIf ECTION: T Amt. Used CELL TEST aA4TA Check bc. if Test Data Is sutam ed cn Suppiernental Form. TESTING METHOD IJR Static. Level fl. DateITme measured Production Rate gpm. Purnping MeveR fL DatetT me rmeasuiedjtrQTest length (hrs. Remarks 3. t ha++. r..d 4 wmw+r«+Y ,, rrrq and #vow a.. aatY.o ti . - w.r w Nu. To-" +. iPl.iruu Yt $s on 244104 {11}(a] t RS.. aM d Ealta If aa�q,Iw puwrY in the drgrr acrd Y purYrrli ra a dwr I iriudui�r.l CONTRACTO 1 I. Phone () fl-LV53 I Lic. No._ .--- Ma�Wng Address JNa�ie tease typ �prir4tj SIB D INSTRUCTIONS FOR WELL CONSTRUCTION AND TEST REPORT The report must be typed or printed in SLACK INK All changes on the form must be initialed and dated. Attach additional sheets if more space is required. Each additional sheet muss be identified at the top by the well owner's name, the permit number, form name/number and a sequential page number. Report depths in feet below ground surface. This form may be reproduced by photocopy methods, of by computer gerteratlort with prior approval by the State Engineer. The origInal and or copy of d form rrhnaa be s timited to the _ Engin�sars OfI ce within eQ days alter complathwg the well or 7+dhtys after the peril ampkafion data wtidwrar Is canter. Another py of the form must be provided 'a the wall owner. ' 1. Cocnpte1e the Well Fermi Number in full. Fill in Narita and Mar'firhp Addrem of Well Owner where correspondence should be sari. 3, Complete the blocks for the arltrei lo�catlon of the well wherdrifted. 1f the owner has more than one well serv€ng this propary. provide the tdardl icatbn (Ohhvr,'s Dhhaigntlor) for this wee DO NOLQUOWN SUPPLIED LOCA7IQM unless a sunray has been provided. For weirs boated In subdivisions the fat, block and subdivision information must also be provided. 4. Report the ground surface etenation In feet above sea Ie~+at r available. This value may be obtained from a topographic map, Des$ribe the drldln method used to car front the well and the date completed Indicate the total depth BrHled and the i1uaJ completed depth of the weL 5. fully describe the materials encorRar+ed ki drin$. Do not we formation rhamee uniesa they are in conjunction with a description of matat1ors. Examples of descriptive terms k'hciude: Grain slzw Boulders, pry el, sand. trill, clay. Hate —Loose, soli, tight. her very hard Cobr-pf nrtttwtela. Most critical in aedirr*ntary rociL Depth when water is encountered (If it can be dstermirrod). 6. Provide the diameters d the drilled bore lids. The outside dnarneter, kind, wall thickness and Interval of casing lengths must be indicated. Indicate the type and size d filter (grevel) pack end the Interval where placed 9. Indicate the type and setting depth for any packers installed. The density d the grout slurry Wo.0 be reported apq may be indi.eted as pcxinds per 0slion, galions of water per sack total gallons of water and number cif sates used etc. Specify the grout placement method, i.e. tremie pipe or positive displacement. The percentage of addRhves mixed with the grout should be reported under remarks. 1. Record the type and the arrnourl of disinfection used, how pieced and the length of time left in the hole. 12. Report well lest data as required by Rule 14.7. Spaces are provided to report an measurements made during the test. The report should show that ttd 'test complied with the provisions of the mules. If a test was not performed exptaln when It will be done. If evalable, report cbck time when measurements were taken. 3. Fill in Company Name arhd Addraas of Cof9me or who construed the well. The report must be. signed by the licensed contractor resporhsible for the construction of the well. O° *o.I PUMP INSTALLA11QN AND TEST REPORT For Ceo. Lie. rinIy WS -3: i 41910 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 1. WELL, PER T NUMBER i C. a,. OWNER NAME(S) G Mailing Address kxfl&67, Rf% Y Chy. SL Zip = Phone ( 3. W O S Rt . Wt. 114 X114. Sem -.. TWR LV . Range thL DISTANCES FROM gC. UNES: 1 U1 t' R From. Line. and 1.C) R from SST Sec. line ,Sec. SUSDMSION: 1 F TRIES OT BLOCK FiL.ING(UNIT) STREET ADDRESS AT WELL LOCATION: 4. PUMP DMA: Type _•..lnstakflon Completed 4 S 1C PumpMWiutacturer Pump Model No. Design GPM at RPM , HP 3 VoRsc Full Load Amps Pump Intake depth Feet, DropfColurnn Pipe Size Inches, IQnd ACIDMOYAL F tF` RMATION E . F�C1MPS dR TER THAT 50 GPM-, TUASIP E DRIVER TYPE, 0 Eiec O Enke 13 Cam'. Design Head feat. Number d Stages Shaft size inches. 5. OTHER l=AUIPMENT: Afrllne Installed O Yes ❑ No, Orifice Depth ft. . MOnitor Tube installed] O Yes O No. Depth It______ Flaw Meter lung. Met r Side No. Meter Readout O Gallons O Thousand Gallon, tJ Acre fe t, O BegInt* g Reading 6 DATA 0 Check boxif Test data It eubmeed on Supplemental Form. Dam llceal Well Depth: Time Static Lewd' Rate (GPM) Date MeasuceG Pumping Lvt. 7. Dl$INFEGT1 N: Type _ _ T { AmL Used & Water Quality aralysls avalfabie. O Yes Jo 8. FRen arks Q I have read the statements made herein and know the contents thereot. and that they are true to my knowledge tPursuerlt to Seer 24.4-04 (133(a) C.R.S., the mekln� cti tam state s hereLn constiKr::9s penury inthe degree and is puflsfiaNe as a: claei 1: misdemean tr.) CONTRACT -OR 1 Phone C3Crl(.A- L453 1 _ uc. No.c1 Mailing Address 1 - NamfTttlra (PIease typ. or prints 5 pate ��'� lN31RUCf CNS FOR, PUMP 94STMJ.ATtQN' REPORT ` The report must be typed or printed In BLACKB1ACKJK All changec on the form must IrriUai:ed and dated Attach additional. shits if more Space ° is required. Each addh-ional sheet must be identified at the lop by the well owner's ,acne, the pert d number, fount narnei'nutrtber and a sequential page nun b r. Report depths in, feet below c, ,round surfaces This form may be' reproduced by photocopy methods, or by computer generation withprior approval by the State. Engineer. The original and copy at' this flaunt mt be mAxrwftad'to the S'fa .e Engirsew a O witfrin 60 days amen completing the we or 7 days Mar the petal a pir�ion daM w1,b. : is a drat: Another copy of the form, must be provided to the well owner. If this farm is submitted iin i4cfkwi wi' the WToo Repc . L krm number GtirVS . i,. ONLY THE PERWT NUMBER AND III N TO BE CMS irr Item 11 and' 1. Complete' the PmTA N�,rwwber. in fuJL a Fill In M rrwe' s d Mg A: d Wag' O'vrwewr where esponclence shooed he sent. 3. Complete the blocks for the a*rai locetlon of the well. For weVs locat : in subdtw Woes the lot, block and $ubdisiorr lnforrnatFon must aiso be provided 4. lndcats the type of pump tafied and o mpleC: the. requested lrfon tion. When instafliig pumps greater than SO gpni complete the' additional lnformatiion in this area.. 5. Provide the i forestation on other equiprrmr which may to UIst.aAleC. in, the well. 6. Report teat date as reqiirgd by pu4 13.9' Spam are provded 10 report all measurrermmerts miracle during the test, The report should show that the teat compiled with the provissfons of the rules_ II' a test was not performed ew%plain when It wain be ms. d avarl8 report dbck taint , when measurermerrts were taken. 7. Record the typo and to amount of disinfection, used, how placed and the length of time left in the hole. 8. Indicate it a water quality enasls was performed and submit a copy of the report If avaaailable. 9. Use the rernatts. area to note any add ltl nal imllbrmadion Including additional equipment installed, water supply COn5t:flAction probeff. 10. Flit in c : : 1 Camend Addrees. of Cca• or who weed the., well. The report must be signed by the licensed factor responsible for the It t.allath n of pumping equipment. Form Na. OFFICE OF THE STATE ENGINEER S - COLORADO DIVISION OF WATER RESOURCES sis ce owrm tip.. 13r1• ervarr�.r+ 9r.. Dwow. Cow"m dU241 War. AP'PLOANT' JOSE WIS EARRUTIh. 12672 WCR 6 #315 BRIGHTON', CO 80601 PERMIT TO CONSTRUCT A WELL. WELL PFJHiilT1 NUMBER oN 1 CMTf. 62 WO 2 DIES.. BASIN —_ MD 489 APPROVED WELL LOCATION COUN y G LD NE 1/4 SE 1/4 Section 1 2 Twp 1 N -, Range 66 W S P.M. DIST!.fS ROM SEGTI I _UNIE: 14 4 0 Ft.. from South Sections Line 150 Ft, from East Sion Lire ISSUANCE OF T IS PERMIT DOES NOT CONFER A WATER RIGHT fl'*S OF APPROVAL This well shall be ueJ in such a way: as to cause no material knlury to misting water sights. The issuance of the permit does riot pure the ap�cant that no injury will occur toanother vested water right, or preclude another owner of a vested water ° right. from seeking relief In a cis art action. Approved pursuant to CRS 37 -lam' -802 3 (I).(r) and polle-y of the State Engineer under the totlowing condditions. Punductlonfrom tftls weft is restricted to the Laramie -Fox Hills elder which corresponds to the interval between 780 fee and 1,,060 feet below ground surface. Plain offing shall be idled and seared to prevent production fror from other aor. The use of ground water from. this well' Is limited to ordin household, purposes: insidle one &ngie family dwelliing, the watering of donumic ariknais, and the itr etion. of not more than, 12 •� square feet of horn gard ns and. lawns. The maximum pumping rate shalt not exceed 15 GPM. The annual: amount of ground water to be withdrawn she$ not exceed 1.1 acre-feet, as, recommended by the OMs ion of Water Resources to the county com- missloners. ThL% well shall be constructed not more, than 200 feet from the location specified on this permit, tang on lot 22, Martin' Estates Subdivision, Weld County. Nate: To insure a rna irnu�m produ the lisle of tlils wwall,, perforated csicg should be set through the entire producing irttev'al of the approved zone or aquifer indicated aloe, APPROVED, j,,r,.,, LkLdi4' Receipt No. 032'114 DATE. ISSUED FE 0 4 er PI. TION DATE FEB i'1zIJ it�r3.Y..ts COLORADO DIVISION OF WATER RERCE.S RECEIVED L .—_. H8 CanEanniat B1dq_. 1313 5her-man 9t., Danrar, Colorado. &2G3 7, O991 1 PERMIT APPLICATION FORRMI , Applies Iipm mast 3 Irl W E CITM RESES be carnplate where • . fi A PERMIT TO USE GROUND WATER 5TA1[EENGINEER !� app k_-aWe. Type or (ji() A PERMIT TO CONSTRUCT A WE:Lr_ OI.0. point in BLACK - R: (> A PERMIT TO INSTALL A PUMP . f_ Naaverstri as ,.,j . r or erasures ur�iess { I REPLACEMENT FOR NO. initiai•ed alt':..• r , { } OTHER 8TA U.C4F-EFt WATER COURT CASE NO. (1) APFLICArd•T . mailing address NAME i [ITh2h 'I # •�# # #i u a (2•) LQ ATIQ.N!QF PROPOSED WELL County — �1 I -ado cif — Twp. _ - f. r Rng. -. L LN•.Sl- (3) WATER USE AND WELL DATA Proposed maximum pumping rat# (9pm] — Average arwpjai amount of ground water to be appropriated (acre-feet)_ 11r)el Number of acres lobe irrigated_ LS _ U] _ 111)e, _- Proposed total depth (feet) : _ 1 OIQ, • ..._�_� Aquiferground water i.s to be obtained from: Owner's well designation tF a +1 e 4 ( I HOUSEHOLD USE ONLY - no 4rrwgation (Ul (XI DOMESTIC (-1 l I ) !!NOUS1 RIAL {5) 1. M LIVESTOCK (2I { I I R_RlGA.TIOAl ¢6I i I COMMERCIAL (4J I 1 MUNICIPAL (8'I I OTHER 19) DETAIL THE USE ON BACK t'1 Ill) (4) DRILLER, Name l.iiu1Oad ril ❑- —, Street. utsi p Telephone No. ¶ 53 Lic, No. FOR OFFICE USE ONLY, OO NOT WRITE IN TH fS- COLUMN t•� Receipt Flo. ' Basin fist. r CONDITIONS. QfAPPF.YAL This weal shall be used in such a way as to. cause nia material injury to existing water rights. The ,1 issuance of the permit does not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested • water right from: seeking relief in a citril court action. APPLICATION' APPLOVED PERMIT NUMBER DATE ISSUED EXPIRATION DATE {STATE N I SRI BY________ I.D. " f ____.._ __ COUNTY______________ (Sj THE LOCATION OF THE PROPOSED WELL anthe&eaam which the water wit l be uiedi rnu.ttt be indi.c test cart, the diagram I'3eio*. Use tte CENTER SECTGON (I section, 64O: acrvml for the well location- + !i- -1MILE,52130F&ET-- p -I 1- + + + + + -- + f w I4VH h$ECTI0NLINE NORTI4� � I i + — —F + fi � I � r 5QUTt4 SECTION LITN Z I I -I- + -F + -- + + 4 - The scabs of tlwe dYagiram, is 2 lydies 1 mile Each. 5rttaJf squ re tepre ect 40 ac=res. YwATEfi. EOUrVALENTS TABLE IRuundrd' Figures) An •cre.roct coµ■.rx I acre of ljnd I. rail deep 1 cubic foal per second fcfsl .. 449 garltris per minute rnJ ,A family of 5 vole rep,urre apprt tini4taly 1 acre -lour or wirer per yiamr. 1 ecre•fRr i , . 43,5 cubic last ... 325.` gmilons 1.000 gprn crump+C' Conrinwouaii v for one d'aEv- produces 4.42 scrw-teat. (1 D} (6i) THE WELL MUST BE LOCATEDI E. W� __.ft �FE1Vir ftVe5di ft. from sac, line 1.;,3.90(northar ouFhi ft. from ._ sec. line tams! a, writ) LOT PLOCK1_FILING e Q.__- a: $US01VISrcNMa are. & () TRACT C)NQ WHI H WELL WILL BE LDCATEF71 f ,riner: No. of sues .S . Will this be the only wall on this tr8ctx-- (a PR.OPOSED CASING PROGRAM D CASING PROGRAM Pain Casa _rre fromn .. _. ft. try L t. iri. from J5L_ft. to J ! Q_.... tl, Perforated! casing, _ in, from _.« tt. w d Q It, in frGrry , ft. to . ft. t9 FOR REPL.ACE'MENT WELLS givadast'annce and direction from aid welif and plaels for piugg.irxgi it: OwnierCs : C lf' T Flo. of anres: ..5_ — — Legal da:coripsior-; 0 (t1) DETAIL,ED I)ESCRIlr5Tl©. of the use of ground water: Hou.whold use and domestic weris must indicate type of disposal ey l-frern to beused), a . X12) OTHERWATER RIGHTS used an this land, including wells. Give Registration and Water Court Case Nurr.bers. Type or right Used for (purpose X Description of land on which used (13) THE APPLICANT(SI STATE(S1 THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE_ S1GNATURF OF Use additional sheets of paper if more space is required. EXEMPT WELL DATA SHEET - OENVER BASIN, COLORADO APPLICANT: 11ARRUTIA RECEIPT NO. 321149 LOCATION: NE1/4 OF 5E1/4 OF SEC. L2, T.1N., R.61W. (1440 511. 150 ESL) PROP03EO AQUIFER: SURFACE ELEVATION: 5040 OMEN OF ACRES IN TRACT. 5 15 PROPERTT WITHIN SERVICE DOUNDAAIES OF NNICIPALITY 8.0-5 0048FIT APST 40 YES_ IF SUBDIVISION IS UNDER AU EITA1'ION PLAN, CASE N0. IS . DIV. - tf SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY THE WATER MANAGEMENT BRANCH, DATE Of LETTER IS INFORMATION ON SURO1VISION OR TRACT OF LAND/SPECIAL RESTRICTIONS: rt1, �4,as...RJ.� Y 1aEr�f .valuated by JWB on IEBRURRY 1, 1991 €LEYATION DEPTA TO ANNUAL -•-..------•--- MET -•---------••-- APPROP STATUS AQUIFER 907. TOP SAND DOT. TOP A -F UPPER DAWSOM LOWER DAWSON DENVER - - - UPPER ARAPAHOE .. -- .... ---- LOWER ARAPA�IOE. 4669 4891 96 314 143 0.116 NJ! LARANI�E-FOIL NIL`!" 3910 4252 1411 ]O6O 111 1-314 NT onto: E Indicates location Is of aquifer Iruuoder1 and vvIugs awl be aura approsl+eete. ' Ii4Iclius Ilia ProPosld sgUiisr. All V.I., a are Intorpaleted from Ike 5.0.5 o4le best aaiu.blid In Nornnbor of 1986. ROY RO:MER: JERIS A. DANIELSON G�wemor State Engineer OFFICE OF TH!E STATE ENGINEER DIv6SION OF WATER RESOURCES 1313 Sherman Street -Roam 818 J ,: ..t Denver., Colorado 80203 (303) 996-35@I TO: Jose Luis Ba.rrutia FROM°: John W. Bilisoly► .__J33. RECEIPT NO.: 32'1149' DATE: January 11, 1991 Your epplica ion for a permit to construct. a well is. being returned for the reason(s) Fisted Wow. The amendments and/or additional information or documentation! requested is required before we can proceed with theevaluation of your application.. All amendments, made to the application must lie typed ur printed in iACKWK. Please Mail and dam, altl . . made then return, the and au atta rlrrleri to this effice.. If you have any questions, feel free to contact this office. Item (2) must be completed. According to your proposed distances from section Tines as given in item (6) on the back,. the t/'4, 1/4 sexton designation in item (2) would, be the NE 114 of the SE 1!4. In Item (6.} on the back. the name.- of the subdivision is. stated as, being "Mlartiin Brothers Planned: Unit". According to informabon In this office, your proposed. well would plot inside of t ..e "Mlartln Estates" subdivision. Please explain. Also, according to the U.S.G.S. topographical map, your proposed well site plots the well inside the boundaries of the Dougan Reservoir. Please see the enclosed; map, recheck your proposed well location,, and correct. Items (2), (5) and (6) as necessary. ('ALA1IAl f —' Car.r:�� a ''. �Ja ■��rrr. � p � v ��.. � �' .,,�a �r' rn{�. i � f/ - ,' - �. r r"••yam_ - �- -s k y "�t �"I Ir dry -_ � � f� _ ;} rJrF'� 4.�h ,� � C� ° � - �'r. "mot Y �� -�f- w•, kS�lt�� Ff Ith 1<,'n+ ( •- 1 ••:- - • - . . I ci:i: • ._a 4yr d- • ! .C1 • • Gk: f� .+ yam{ y � s6f�`,�"'� .-'�'_-- (�. ,s y'Y F r L-lA T 1 �!'jb/1• { "rev �ti �/ 1 [� tr-T sosa• I� 9 _� ITT* � -� !` * r • I _______ -I I .. - y J!� ,titiiJq ' 1Ti i a Scanning Cover- Sheet; for Septic Permits Perrrit# 619990259 Permit Type: Health I EHS History I EHS Conversion History Si:tuis Street Address 17952 CLARA LEE ST Situs City, State, Zip Sec►rTowniRangs: 12-01 N -66W Application Staitus:, Finaled Application Date: 00.11111996 Parcel. # (12 d:igiItsk 147112403022-RO073891 Owner Full Name: BARRUTIA JOSE & TERESA Owner Address: 12672 WGR 6 BRIGHTON,.C.Q 80601 Owner ° Phone #: 303 6592.233 Contact Name: Contact Address: Contact: Phone# Information above has been Verified in Acce/a by employee noted below � I October 28., 2008 Prot sed by: C�at.e I. Report ID: EHSC0024u iO3 Page 1 at 1 Print Date -Time: 1012:81200& 8:44:54AM I••ISF'i{•I6F' INDIVIDUAL SEWAGE DISPOSAL_ SYSTEM PERM:I:T NO. G-900259 WELD COUNTY HEALTH DEPARTMENT NEW PE=RMIT ENVIRONMENTAL. HEAL 'H SERVICES 1 517 4 6TH AVENUE COURT, GREEL.FE.Y, CO 8()631 353--063Lx EXr..222 5 3WNE.R 1 ARRUTIA, ..JOSE & T1-'RESA ADDRESS OF PROPOSED SYSTEM 17952 FORT LEGAL. 1)E.XCRIF"TT.ON OF SITE: 5E4 ;VUPDIVISXi#N: MARTIN BROTHERS USE TYPE: RESIDENTIAL HOUSE SERVICES: PERSONS 6 BATHROOMS HEDRQOMS 3 BASEMENT APPLICATION FEE 5000 RFC ' I) BY JUDY SCHMIDT DATE 12/07/90 ADDRESS 12672 WCR 6 PH (303) 659--2233 BRIGHTON CO B0601 CLARA LEE STREET LUPTON CO 00621 SEC 12 TUF i RNG 66 LOT 22 BLOCK 0 FILING 0 2.00 LOT SIZE 5.00 A.CRES F'LUMBINF, YES WATER SUPPLY PWE:LL SIGNED BY JOSE LUIS BARRUTIA DATE 12/07/90 PERCOLATION RATE 6.3 MIN PER INCH LIMITING ZONE S. FEET SOIL TYPE: SUITABLE PERCENT GROIN SLOPE 2% DIRECTION NW REQUIRES ENGINEER DESIGN NO FROM THE APF'LICAT:[ON INFORMATION SUPPLIED AND THE ON -SITE SOIL PERCOLATION DATA THE FOLLOWING M.TNIMIJK INSTALLATION SPECIFICATIONS ARE REQUIRED: SEF'TI.C TANK 1000 GALLONS, AFtS'ORPTII N TRFNFCI-I 495 SQ. FL OR AB90RPTION BED 645 4Q_ FT, IN ADDITION, THIS PERMIT I9 SULJECT TO THE 1=OL..1_0WING ADDITIONAL TERMS AND I::ONDXTXONS: THIS PERMI`l IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT MAY F.tC RI VLJI(LD FIR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SET 'FORTH IN THE: WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM FR'E"i:;LILATIONV INCLUDING FALURI TO MEET ANY TERM OR COND'J: NON IMOE1) THEREON DURING TEMPO ARY IJI' i- :I.NAL_ APPROVAL.. 1'HE. ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION E{Y TIME DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE. OR INADEQUACY OF THE SEWAGE DISPOSAL SYSTEM. 4tr/U0 WES POTTER 02/21/91 ENVIRONMENTAL SPECIALIST 1)ATE THIS PERMIT IS NOT TRANSFERABLE ANI) SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF THIS PERMIT 1'HI:= WI:=L_D COUNTY HEAL.Tti DEF'ARTM:ENT RESERVES THE RIGHT TO IMPOSE: ADDI- TIONAL TERMS ANTI CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING PA-- NIS. FINAL PERMIT AF'F'F;CIVAL IS CONTINGENT UPON THE FINAL. INSF'E:CT:F.(N OF THE. GUM-, 1='LETED SYSTEM BY THE WELD COUNTY HEALTH DELAI<.TMENT. SYSTEM I:NSTALLEF< FINAL INS"'E TE0 DATE ' YSTEM ENGINEER AF'Pf0VAI. id... TYPE OF SYSTEM INSTALLED _. ENVIRONTFl.. f'ECIAL:[ST THE ISSUANCE OF THIS PERMIT DOES NOT IMPI..,Y CO:IMPI_.IANCE. WITH OTH[.:k STATE, COUNTY OR LOCAL REGULATORY OR FUILDING REQUIREMENTS, NOR SHALL IT ACT TO CERTIFY THAT THF: SI.JIi,,ILCT SYSTEM WILL OPERATE: IN COMPLIANCE WITH AP'P'LICABLE STATE, COUNTY AND I...00AL. REGUL.AT:FONS ADOPTEI) PERSLIANT TO ART`:I:k:,LF: 10, TITLE 25, GRS 1973, AS AMENDED, EX(.CEF°'T FOR THE PURE"0E U1=" ESTABLISHING F:[NAL APPROVAL (:IF AN INSTALLED SYSTI:-,H FUR ISSUANCE OFF A LOCAL. OCCUPANCY PERMIT PURSUANT TO CIS 1973 1125-10-f (2>. ORIGINAL -APPLICANT ; COPY-WCHD WCHD....EHS MAY, 1904 T' o. 11 rbf I 14S1' i 06F' :i'NI):[V:[iM.JAL JG'1. D1:.5'I"'oSAL. S'Y.STEM I ERMI'T N0. G_•900.'.59 WELD COUNTY HEALTH DEPARTMENT NE 1 F'ERI1:C T' ENVJR1JNhENT t1 ]'TEAL.TI•i .SERVICES 1 51 7 i 6TH AV IENIJL C;1ILJRT, GREELE:Y, CO 00631 :3`T3•-•063 FXT ,. 2225 oI1NE:R TIARRUTIA, JOSE: & TE:,S'ADDREti.5 I '672 WCR 6 PH {3{);3) 659--2233 F RIL1-IT{1N CU 00601 ADDRESS OF 1='R{:ll0.'?f_:1') s'YETCH ci...ARA LF.E STkF:ET J-0RT LUF'TUN CU 806'21 L_Cf AL_ F)r.SIrF,IF'ITtJN 01" SF [F EE4 L 12 TWF:' I RNG 66 \UDL TVI.5'TON: MART :I:N I F;IJ i HLk [..0T1:I._UC;K 0 [Ii [N 0 USE TYPE : RF::.1'IDI:NTIAL 1-1C)LF�'[:: SERVICES: F''I.kS'0NS 6 OfIHkUUlS 2.00 LOTSIZE 5.00 rlialE: Fii_DI';IJCI1s 3 r1AE1 MF..:NT PL.IJMI.f:[NF YES Ixlr1TER .S'L1F'I-'f_.Y F'WELL.. APF'LI.CAT.LON L-p.L. il150,00 I,EC'1) BY CIJI�[..EY, I)IANNF: DA'I'I::: 1 2/07/90 S1:CNIED BY JOSE L1_II ' f:rAF:RUTIr-ti D rTE 1'/07/90 F'L:FC:f3I„A L J1JN RAIL _ 'c3 MIN PER ]NCH L.CMI'r1:NG 7€:INF' FEET SC:]II_ TYF'IPERCENT GROUND SLOPE % DI. ECTI0N ijld}, RECUIRl=N ENGINEER PESTGN car" FROM THE: AI:'F'L:[CAT :[oN 1:NF'ORMATION ,SUPF:.L.IED AN.D THE ON-'Si:TE SO 1:1... F:1'..f4COL.A'r:I:C1N DATA T'F"1E F'U1--LOWrNG M:1:N .Ir1UUI INSTALLATION EI'I'LIP 'ILr TIClIVS ARE ItiE:QU:[Id :.I) .S'I::I III ; 1ANI< . OafJ... (:-AL_J..l:FN.5, AT>s.S'[JR1-''rI€:)F! TRENCH 7 ,S'Q F T} €:)R A r:r S C.) F+ I"' T T O N F:{ J-: D } .S Q . FT A IN cDDIT•ION, I:F Pf..-tMI'V 1:S S'I.BJ1:..CT' 'l'0 T1 -IF. I OLL.OWING ADDITIONAL TI_.._RI r1NI) COND:I:TI:ONS': .____..,...-..._. .......... T'H:I:S f='EIRF-i'TT' J:S GRANTED TEMI"GRAR:[LY T- 0 A[..I._f:1W [;€:IsTI'F IJf;,'I':I r:DN TO COMMENCE h TI -I11' 1='L RM IT MAY Iir. RI::VUI(I_'D OR .SusF:lE lDF'F) BY THE WELD COUNTY HEAL -"[I..1 DE PARTMEN I F'OF; h LAUN S LAT F:'ORTH IN TEAL WELD C UNTY INE) I V )'PUAl-.. S'I:::WA1.L1: I)1:S[')EA1... SYtiTE-H J Lf:1UI._AIONS :I:NC:I_.LJI):I: f€ F- AT.LURF TO MEL:F ANY IF::RM 1J1, I OND:LTION :I:MF'OS'1:::I) [HF'RI=:UN DURING' 1LIIF'ORrad;Y OR F-INAL.. AI"'F"RUVAI._x 'rl#L- I.S'SUANCE_ OF TH:I:S IERM1 1' DO[::,5 Nf:IT I;CIN,S"'I TT'UTI= A,S.SUMI`'II flu'! X T1.1F.' DL_,'PAR 'lMI::NT' CJR 1 T Er`MI"'I...CJYFF.5' Dr L:EAFrIF._TIY 1 U [III 1 FA:IL..UI.E OF; INADEQUACY DI=' I"I4F:. ,SI wr D'ISFIOSF I_. S'YST'IFi .�.. �'y.._''I'il..:j➢�_�._.._��,.,�..w. � TH'I:. PERMIT IS Nor TRAHSFERAC-rLE F NI) EVIAL_L 1 f :C [JMI:: VOID If= sYSTE:M f;{:lusTRL1C:T:f.C;l h! HAS NUT ' [;UMMLNCI':I) W:II'1HI'N ONE YF-AR ClITS I,5 ",S JANLE:. E EF 0k!: I,S'sU.I.NC F'1:NAl._ Al I'RGIVAL. 1)1". TH1:S PERMIT f:1 -IL WELD COUNTY HEALTH DEPARTMENT RESERVES' THE RIGHT' TO INIF"O.S'C: ADDI 1'1'fNAL l'ERMS AND CONDITIONS' HLQU: RED TO ME: -E!- OUR F;f €RULAT':ION c ON A CONT'INU[N€1 EA --- ST'S.. FINAL IMP :T APPROVAL.., :CS {;Cl l.I. #:NCrE:NT LI ON rHE: FINAL. :[N,S1 F:C:T:I:UN OF:' THE {}CJM-•° F'LJETED SYSTEM IIY THE WI'.I...D COUNTY HEALTH DE•_•.PAfR;TME::NT. =r„ ' 1'I I A " ! T1 A .IT r,nr.,.v__!.rr LIT' YIY'k-Jr\._r-'ti' L1nv 4 ii- - WELD COUNTY IIEAI,TIi DEPARTMENT ENVIRONMENTAL IHEALTII SLKVLCES SITE EVALUATION Ouitc.r 4 L4 c3 AppIic.at.ian' 1o. Sice - PT SJ_rjR {� , {trace Sutx Lot____ � BLuck FYL in.g •?ERCOLA7YL II. T1rST DATA: Start me a !I- • - ---I _____ 1.1 a . I r�.rl�ll�ii j��A •PL T ?LA.N yv jo SOIL FROFiLE 'l:z ,L4 AL PHA ENGINEERIN CIVIL £W /NE(RIN L 4 OFM W T PNQF(R rr S U V V RECEIVE[ vAN TAfl3N D * 1Clu� 1 DEC 27 1990 December 2 .. 1990 ;: RG {1TT. Weld County Health Department 1516 Hospital Road Greeley. CO 80631 RE: Septic System for Lot 22. Martin Brothers Planned Unit Development - Amended Plat, A Subdivision of Weld County, Colorado. ( Jose Barrutia) Dear Sir, a I drilled a soil profile hole at the above described site and found a soil profile as shown on figure 2 attached. Sincerely, }514YI11Nrlll . Cecil R. Crowe r.•°fi1Sr PE 8 LS 12330 I� e•. h r ••a L• ••a Ili;h:11S= • N, 4617 5TH Sr. - P 0. BOX 392 FORT LUPTON, COLORADO 80621 Ph. DENVER 1303)573-5156 FORT L UPTON (303) 857- 2308 �. - + _ ' -.� r 2 4 L ,yam v i - r •—M F;•�wr, �: fao.''' ka ''6 •m�1'`0it14ge - _ gga�r . j'•'r �r • ,••. •' * .r ' /� �yy HL CL1RA LE sTREET&,--t ---------f- r �• r� Y �,. r.,.,.•...r rnrrr..r. Y� �rrrrr r+•.w rr.r. Y! I1 T 7 * y _ r�"i I* �►•t "'-w'. r.:�..�,t3 .,yam.''., - T ; _ - .. • 1 j` 50 HOM j O 5.571 Acret 20 \22 IC) 5.571. Acres 11'. pKor�c..•5. crag SYSTEM €arm Ito 135+ utWty a PLOT PLAN `GALE Vwa15 k . O O 0 2 Z a 0 o ti #Ivoy Jet T •5M SOIL PROFILE I FIGURE 2 • I '. 1 ._.• L + I-Isp'10 6F' AF'F'I..-ICA'r:[(:IN FOF, INDIVIDUAL >'I .'.'J(G!.rtNU, L -`,x'00257 WIELD E:OUNi Y i-1EA1. TI-! nir ri1EN T !F.I A,F'f='E..IC T:I:C}lit L:et .L!'{r1 11''iC»i`J I j., HEAL rl I E.E: VICL. I i 7 i ?'Ii f}VF.NFi1_: €..L}I.fl i , 1 I::.I::F L , L.0 60631 353- G 635 EX ! .222'"7 O(+NE DAR'RUT'TA, 4.J1'.1 1-: T!-RL5r,, 12672 JCk 6 EN {303) 659._LSf)Fr; .i F:IGH'1'ONN co 00601 OF F. F.LIF`€:1, 1=E? 'YS rEM CL.ARA l...E:F' STF,F:ET FORT !_U1-''!'t.1N CO 00621 LEGAA'_. DE::;CRIP11-ON OF' TTE: E4 , l'::i, 12 TWF' i r+:N[:: 6.6 SIJBDIV1 ;':1:(:,N : 11(Jti'r:l'i'! - i Iil HI L-' i 0-1, ,.i2 1)1 Uf"it i) F I LING 0 !_J 1:-:' 'i' TFr FtiIDEN I I:fAL., HUJ{.ISL SEi;VILI::: i:.L;:Iti'a'(:1r! 6 JA1HFti]i3M. '?A(t(.) L.0T' 1"J'/ -.},')! CII; , ri:':.'D1 #:3i:!MIS' 3 IRAFiE:N"f' !'l:(IMP TNG YES +LJAT'I:h . 1.11'!'1 Y i 'll:::II... firF'I='L_1CANT ('t i Nti L.1::L'GE.. TH T'i' ...J..E!E CON1'I_E'TIZAES,!; (1I_. THT(S Al-PL..ICA'1ION is CONDIT':i>NaAl_. UF't.IN FURTFIEI MANDATORY AND A rD:f.-i'.I:C.-aNAL. rES'TS AND F;F::I'DJ TS' AS MAY TEL: F;E>";(I:ERF" EY THE WELD CULJNTY i II :F`iL T H 1)i::i''t=-k T HEN'T TO !-i!::: HADEW AND F'L IIt !'f' .H[:1) TJY T'ITE::: ArF°I 1CAr!']- OR 'Y 1 l -IL I...T) i:;UUNT i' !-IF- ;r`ui.TI"i n?I: ' ARr'IM!:"N'' F'OE=1 !='Uf.!'`D r'.a t]F "(III' I`V,ijLIiATL'fl OF "III::: AF1='L.:lt:,`A1': ON IIL :I S' U=;NC;F f+F I iIL F'I. kr ]''T :F.S' J �i,.ii:_C'I 'TO SUCH IIri.S AND UC1NJ7J:T'1:CJ4.5' A' Di:l-ThE::IJ F:CL-. Ai r IL' TN,5Ur.Ctlrfl=°1.,:CANCE:: 4J:IT F -I Rh! ,_I -:,S AND Fri: C LJI...r1'f :I:DM5 r1DDF''rF::D UNDC L Al T:I:I:i._F_ 10, illi L '5, L;1,s' i9 3, A' Arii:MDI:1)h "f''IL I.)PPL:I:CnN't' i.;F1R'f1'.FTCS THAT 'nil I rile'(. -J 1') SY,S'TC:i WIL_L. NOV x:1I=: I...i;t:p,,mi) W;E.'rFll:N 4o I'I' I- I (JJ::' Al [: t:ifiti{.IN I"C'i" J 1lA J SY 'TEM rF F: {.1tDLi' l NFj it1'::RI:rY CER' 'FFIES flIA`E` ALL. STATEMENTS i1i. :I:rEE'Iii'irir,r:i: EN AND FtL:F'E:lF4'T kUIMTf-JTI:::1) !-II..:.F:W:I:TFJ AND REihiIJ1RED TO BE ,'uDJai:E i_ L•::i7 F!Y T!-JE AIF'!•'1...1CAN F ARE, OR W:!:LL. BE:, w' r 1'[J riF:: 'fILli:'. hlhji.j rJ,kI r'i"'"f' r❑ '1'JTf' )'IES''7 rir riY iC 1f:J'µli...!:::F)iyl::: ii !1) 111 !'I ! f1i�l�+ ul:=,5'J:I-NE:D 10 P!-' !';I-L_:I:J:_1) CE1•! DY TIDE J,l1'rt_ ) r;t:iUr.. IV III:::r 1.,711 iE 1 hL-.rff 1r EVAI,..UA 1 ;F:i C I II Ik.F'i)"I::;. OF :I: `, sUINli:; 1 lIE I' I`-,-LkiMi.,r A! ' `I._'i:I 1) FC)R IA1:1 F;1 :1N E: F'LII ..!'.LIEF. LiN Dfw1",.... Tali}!F) ['lIf1T F1 1.Y F I._S':[I''.T.i:f lUN OR E't2; F f I ;::,' N"t'iii ':ION ilrii' LC'S"4-J!_T I:N TF-IF:' 1)1 N Ai_- fli .'Hr-. A1=".''L.1Cr I :I UN 111; i,EVf:'L AT'J:UN OF ANY I'L L€E1 {' 1 PA';7IA) UA5L.) III fl (I Ti AI'i.,.J:''A I T_C: N r=1HD I N I. CAL AL,T 1D1IN F 0F', PERJURY AS FIWV 1i)ID by LAW ICA.T.'I:ON FEE $ I ';0 00 FkIC '1) ]iY LOI"'!,'E=Y, Di ANNE 1)ATE is /(1'7!9 ) JOSE LUIS 1=:AI:tF:F.1T l:F�i in'tl1J:::i';rl:::Ji"1' si..AFLIJE )f3 Ti::: r, �i r:_-f'i,il _.AI+I::'1 rrM,MT . rnPY---i,4r'I-IT. I,II";a T;•-fFI.C` MAY . i tPI.t' L is o PUMP INSTALLATION! AND TEST REPORT For o� ico us only t "2 I STATE QF COL.ORADO„ OFFICE OF THE STATE ENGINEER. PLCEIVEL' WhUF4�S S*RtTC�nc@F 1. WELL. PERMIT NUMBER c2 o 2,. OWNER NAMIE(S) A'' u J., d(a - Mailing Address o .e City, St. ZipL--1 7 w R gri C7 a tr'y .1 I Phone 3, WELL LOCATION AS RILLED; S.t 1/4 114, Sec. / T.1 -Range r a ut DISTANCES FROM SEC. UNES: /355 ft. from a ,'7A Sec. line. and V FrFr ft. from .6a f Sec. line. SURDIVISVON: / f r g l r LOT 3! BLOCK FIU.NG(UUNIT) STREET ADDRESS AT WELL LOCATIDN: a C'l' -' ;kq 4. PIMP DAT& Type £ >�-r r..r , �" Installation Completed Pump Manufacturer " 9 kd5 Pump Model: No. r� Design GPM L _-_____-- at RPM ,. HPP _ , V'otts . . , Full. Load Amps Pump Intake Depth 2 n Feet, DropfColumn Pipe Size. Inches, Kind: L U, ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM.: TURBINE DRIVER TYPE: ❑ Electric: El Engine 11 Other Design Head feet, Number of Stages Shaft size inches. 5. OTHER EQUIPM1-- rr�E��NIIT: II� Airline Installed LJ Yes u No, Orifice Depth ft. . Monitor Tube Installed 11 Yes L.7 No, Depth ft. Flow Meter MIg. Meter Serial No. Meter Readout [I Gallons, El Thousand Galions, ❑ Acre feet,© Beginning Reading S. TEST DATA.. © Check box if Test data is submitted on Suppiemer*al Form. Date �� Q _99 Total Well Depth Time °{ ,�* ! _________ Static Level _, Rate (GPM) Date Measured ! a -y ' Pumping Lxl. 5 -s DIS1.NFE:CTION: Type I dA Arm. Used . J l-5 7. e.. Water Quality analysis available. ]: Yes [3 Na 9 . Remarks —_ GL I have read the statements made herein and know the contents thereof, and that they are true to my knowledge [Pursuant to Section 24-4-104 (13)(a) C_R.S., the making of• false statements herein constitutes perjury in the .secon degree and is punishable as. a class 1 misdemeanor.) CONTRACTOR. S IN Phone .a u r Lic. No./9. Mailing Address 71 ` I -t U y r 41� I NameiTitle (Please type or print) Signature Date INSTR TONS F PUMP NSTALJ_ATII N REPORT The report must betyped or printed in BLACK INK. All -changes on the form must be inttialod and dated. Attach, additional' sheets if more space is required. Each additional sheet must be identified at the top by the well owner's name, the permit number, form name/number and a sequential page number. Report depths in feet below ground surface. This form may be reproduced; by photocopy methods, or by computer generation with prior approval by the State Engineer. Photocopy reproductions must retainmargins and print quality of the original form. The original f'orrm must be submitted) to the She Engineers OHS within 60 drays after completing the welt o 7 days after the permit expiration dam, whichever is earlier. A. copy of the form must. be provided, to the well oWnn:er. If this form is submitted in conjuriebon withthe Welt Completion and. Teat Report, form number GrMS 31, TIE PERMIT NUMBER. AND OWNER NAME NEED TO BE COMPLETED! in items: 1 and 2. Complete the Permit Number Ln full. 2. Fill in Name and Mailing Addhess of WOU Owner where correspondences should be sent,. 3. Complete! the blocks for the actual location of the well_ For wells located in subdivisions the lot, block and subdivision information must also be provided. 4. Indicate the type of pump installed and complete the requested, information.. When instaallin€g pumps greater than, 50 gpm, complete the additional information in this area. 5. Provide the information on other equipment which may be installed in the well. 6. Report test data as required by Rule 1i3.9. Spaces are providedi to: report all measurements made during the test. The report should show that the test complied with the provisions of the rules. If a test was not performed explain when it will be done. If available, report clock time when measurements were taken. 7. Record the type and. the amount of disinfection used,, how placed and the length of time left in the hole. 8. indicate if a water quality analysis was performed andd submit a copy of the report if available. 9. Use the remarks areato note any additional information including additional equipment installed, water supply construction problems. 10. Fill. in Company Name and Address. of Contractor who installed pumping equipment. The report must be signed by the licensed contractor responsible for the installation of pumping equipment, - 6R'�i71 r VVtLl WNb I t1UI4 I IUN I NU I Lb I I11l 1JI1 I mm STATE OF COLORADO, OFFICE OF THE STATE ENGiNEER For 0llle. Lira only EI'/Err Il a a lo nN sri 1. WELL PERMIT ME(S) . Aj0 Sri h. s%/ .4 g o . _ City, 8t. Ilp 1�. .T h n c �, �'gis�. ! PIS( ) S. IWU. LOCATJON AS tlRi_t. . 114 _1114. Sect Twp. . RangpfdMli sal. DISTANCES FROM SEC, iD1E.S. ft. from lire!. m IL rnom Sec. Imo, OR _ SUSDMSlON: it' LOT BLOCK - - IUNC(UNM STREET ADDRESS AT WELL LOCATIOFt GROUND SURFACE ELEVATION I DRLWN© METHOD �17 y�- DATE COMPLETED •. TOTAL DEPTH ft DEPTH COMPLETED Ik & 5. GEOLOGIC LOG: 0.0 Oaearlprion ar MfiMriel (rypsCaler. w too4ionF e •L 6. HOLE DIAM. (ft) From ( To (It) _ Jo �.... __ / i . LAIN CASING 00 (in) Kind Wall Size Fmm (It) To" _ ,rr ____ _ PERF. CASING: Sceri Sint Siza:o+�c Cf 4 ._ ______ __._r..,r� y 1 w 4e o so54q he B. FILTER PACK I PACKKER PLACEMENT: IYlet■riel Type hrdrvel f]eplh 1a. GROUrTING RECORD. Amau7t Density Interval Placement / rtM DISWFECTlOlrl: Amt Used b$ I WELLfi TDATA: IJ Chodr laorc4 tse9t Data is subrnlfled on Form No. GWS 39 Supplemental Wel Test TESTING METHOD ► f Stmic Level x1. Daa t11itns nrlreaur - 9 • Production Ra> Pumping level y So ft. E7oe�TErtie mt wed � , +y_ - . Tale length (# 1 A �. Rerr S. i hire aid 1hs msra+ m*d. rnr in and tmow ih. wwerf.nl. and srwt th y► aa su. is ny lowwled. [Pueusne b Ser.71e. a-704 (19I CAL to nald ig of fue a1Jhenle amwYMMs prepay in 1hs ssBead dsWss WA1 •s praniali6ls *s a .lift 1 nirdemeanor j CONTRACTOR ('2OL4 1 M JkJII Phone J Ur. N0.A_ I Nsinigntlu (Please We or pdrr) Lovc + !it fi.e} > Date e- S - ? u - -I INSTRUCTIONS FOR WELL CONSTALUC'f1ON AND TEST REPORT Rev. Oct 94 The report must be typed or printed in BLACK WK All changes on the form must be initialed and dated. Attach additional sheets it more space is required. Each additional sheet must be identified at the top by the well owner's name, the permit number, form name/number and a sequential page number. Report depths in feet below ground surface. This form may be reproduced by .photocopy methods, or by computer generation. with .prior approval. by. the State Engineer - Photocopy reproductions must retain "marrgins'and print quality of the original form .- The origstal Ivan must be ceded to the Stabs Engrneees Office Within 60 days aver compiedng the well or 7 days atl9er the permit expiation date. wiichever is earlier. A copy of the for+ must be provided to the well ner- Complete the Well Permit Number in full. 2. Fill in Name and Meting Address of Well Owner where correspondence should be sent. 3. Complete the blacks Tor the actual location Qr the well where drilled. cif the owner has more than one well serving this property, provide the identification (Owner's igna'ban) for this well. DO NOT L! Ti OWNER SUPPJED LOTlOIlunless a survey has been provided. For wells located in subdivisions the lot, block and subdivision information must also be provided. 4. Report the ground surface elevation in feet above sea level if available. This value may be -obtained from a topographic map. Describe the drilling method used to construct the well and -the date completed. Indicate ,the total depth drilled and the actual completed depth of'thewell, S. Fully descn'be the materials encountered in drilling. Do not use formation nerimes-unless- they, and -in conjunction with a description of materials. ` E amples bf'descriptive terms include: [a�ui sue —Boulders, gravel, sand, silt, day. _ Haress—Loose, soft, tight, hard, very hard. Color —?1l materials.- Most critical in sedimerrtary rock. Depth when water is encountered (if it can be determined). - . Provide the diameters of the drilled bore hole. 7. The outside diameter, kind, well thickness and interval of casing lengths must be indicated. B. Indicate the type and size of filter (gravel) pack and the irrterval where placed. 9. Indicate the type and setting depth for any..packers installed. 10. The density of the grout slurry must be reported and may be indicated as pounds per gallon, gallons of water per sack, total gallons of water and number of sacks used, etc. Specify the grout placement method, i.e. tremie pipe or positive displacement. The percentage of additives mixed with the grout should be reported under remarks. 11. Record the type and the amount of dssinfec on used, how placed and the length of time Iefi in the hole. 12. Report well test data as'regi lred. by Rule 10.7. Spaces are provided'to report all` ripe sure rents made during the test. The report should shdw that•the-test compiled with the provisions of the rules. If a test ` was not performed explain when it Will be done. If available,' report clock time when measurements were. taken. 13. Fill in Company Name and Address of Contractor who constructed the well. The .report must be signed by the licensed contractor responsible for the construction of the wall. , ' IN 0. I STATE OF COLORADO F oR u• onrp HECEN1311 E a7 OFFICE OP THE STATE ENGINEER ., rf15 Curi WnW Rd .,13i, > &, I] NW, skxr aarxct e 3-351 � 2 4 1999 C30 ) w►,T�N a[sauaCFs YT TE ENG�MESQ COLD PRIOR TO COMPLE.14G FOI I,. SEE MA4 IHIJCTIONS ON FEVERSE SKYE CHANGE IN OWNERSHIP/ADDRESS / LOCATION WEUL. PERW, LrIESTOC1(TANK OR ICON CONTWIL DAM NEW OWNER s .. ........... ..l....... :.... ,. ..... MaIIing AddreM... 3 P......1 G . Y�'.J..S ..... - - City, St. Zip ..,t.U/ 7 I'1/ . Phone (3 $ ..." ..... 2. THIS CHANCE IS FOR ONE OF THE FOLLOWING: WELL PERMIT NUMEER r C� ! T5.2............ ............................. ❑i LIVESTOCK WATER TANK NUMBER ............... .. _ .._....,_-..-..-...., O EROSIONCONTROL DAM NUMBER ........................... 3. WELL. LOCATION: COUNTY........t c-.. ........... .. ........ OWNEFrS WELL. DESIGNATION .......................................... .........................................................._.............,........._..........,...,..........................,........ .-..........,..,..,,...,........................................,.... .. -114 on n 5.,E -.,114, Sec,.. ,.-. Twp..,f .... Ic'�I III. or ❑ S., Range t 1 E, a W. .-. _.,.. P.M. Distances fkom Section Unes . ..., Ft. from 11 tN, a [1 S. tine, . . ..... .... .... Ft. from ® E. a OW. Line. Sutaditrision. 1' ... '. .-....... _ Lit . ... Eilack Filing (UNt)......- ------------- 4. UVF TOCK.TANK OR EROSION CONTROL DAM LOCATION.: COUNTY...._............_._... ....... ..._... _. ......... 1:14,Sec. ............... Twp:.......,...... ❑ hill. cr ❑ 5., Range............. G: E. o ❑: W. P.M. 5. The above listed owner(s) sey(s) that lie (they) own the etructUre described tsereirl: The existing; record Is being amended for the following reason(s): EChange in name of owner. El Change in marling address, LJ Correctrorn of location. S. , I (we) have read the si.atement:s. rrtade herein, know the contents: thereof, and state that they are true to my (cUr) knowiedge. (Puisuarit: to Section 24-4-104 (13)(a) C.R.S.,, the making d falseamemanta herein constitutes perjury in the second d;agrea. and is punishable as. a class I misde:meamor.I Namef rit a (New Owner) Please type or prtrtt Signature (New Omer) Gate FOR OFFICE USE ONLY ACCEPD AS A CHANGE IN OWNSRJP AND/OR MAILING ADDRESS. Y281999 Sx e. E:n ir* . I7�b Court Case No. Div. Co. WD MD use - August 10, 199-8 INSTRUCTIONS CHANGE OWNERSHIP -ADDRESS ILOcATION CORRECTION FORM NO FEE IS REQUIRED The form must be tyrpiewritter. or printed in BLACK INK. Initiak and date any changes you make on the form. THIS FORM MAY BE REPRODUCED BY PHIOTOCO PING. OR. WORD PROCESSING MiEANS. INCOMPLETE FORMS WILL BE RETURNED. ATTACH ADDITIONAL SHEETS IF MORE SPACE IS NEEDED, The form is to be. completed by the new owner. Print the new owners name and include the mailing address. and phone number. 2. Indicate if the change in ownership /address is for a well permit, livestock water tank or erosion control damn,. Be sure t¢a include theproper r rmit tank or dam number. 3. Complete the well location inforrmatior,. If the address of the well location is different than the mailing address of the owner, include the address where: the well is located.. If the owner has more than one well, provide well name or number as designated by the owner-, i.e. North, Well. The actualwell location must include %, %, Section, Township and Range. Check the appropriate boxes for North. or South and East or West directions. Complete the Subdivision, Lot, Block and Filing information, if applicable. 4. Complete the location information for the livestock water tank or erosion. control dam_ The actal location must include /t, Section, Township, Range and P.M. Check the appropriate boxes for North or South and East or West directions., 5. Check the. reason(s) for submitting the form, whether it is a change in o:wnershipfaddress and/or location correction. 6. The owner of the structure must sign. Print or type your name in the first block if it is different from ftem No. 1. If signing as a reprOntiv°e of a company who owns the structure, then your title must also be included: in the first block. Sign the send blck. and date the last block_ USE THIS:. FORMA TO CORRECT THE LOCATION OF YOUR. WELL IF: A. Your well was penniitted. registered, or first used prior to. May S, 1972 for ordinary household purposes in up to three single4arnily d Ilings, fire protection, the watering of poultry, domestic animals, and livestock on farms and ranches and the irr-iigation of not over one acre of home gairdlens and lawns. S. Your well is not of the type described in. A above, but was permitted or registered. prior to May 17, 1965. Inside the Designated Ground Water Basins, other procedures and publication, may be required. C. Your well was decreed Ly the Water Court for the correct location. IN ALL OTHER. CA.S:ES USE FORM GW$�-42 If you have questions, contact the Denver or the Division Office where your well is located DIVISION 1 'SION 2 Box 5728 DIVISION 3 Box 269 DIVISION 4 Box 456 soc.. am Ave Rrn 321 310 E. Abriendo Ave. Ste 8. 422 4th St 1540 E Niagara Grey CO 80631 Pueblo CO 81004 Alamosa CO 81101 Montrose CO 81402 (303) 352-6112 (719) 542-3368 (719) 589-6683 (303) 249.6822 DIMSION 5 Box 396, DIVISION 6 Box 773450 DIVISION 7 Box 1880 X33 U'S Hwy 6 &2.4 . 1120 So.. Lincoln Ave Ste 101 1474 Main St Glnwd Spgs. CO 8:1:801! Stmbt Ss CO. 80477 Durango CO 81302 (303.) 945-5085 (3(3) 679.0272 (303) 247.1845 DENVER OFFICE Rrn 821 1313: Stierrnan St Denver CO 60203 (303) 866-3581. Form No. OFFICE OF THE STATE ENGINEER OWS125 . COLORADO DMSfON OF WATER RESOURCES 81e Certennlal. Bldg., 1313 Shem isi St,. Donvear. C:ola,rade 8003 LIC APPLICANT MITCHELL L MARTIN 1214 5TH. ST FT LUPTON CO 8O521 (303)857-61931 PERlifiR` TO COI1TR(JT A WELL WELL. PEFtMFr N!U)!IiBER 04458 - DIV. 1 CNTY. 62 WD 2 OES_ BASIN MD Lot. 21 Block.: FN'ing Sub ! taAARTI:N ESTAi ES APPROVED WELL LOCATION WELD COUNTY SE 114 SE 114 Section 12 Twp 1 N RANGE 86 W 6th P.M_ DISTANCES FROM SECTiON LINES 1255 Ft. from South Section Line 498 Ft. tram East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CO DMONS CW AP"PI {QVAL. 1) This well shall be used in such a way as to cause no material injury to existing water rights, The issuance of the permit does not assure the applicant that no injury will occur to another rested water right or preclude another owner of a vested water right from seeking ratio( In a civil court action. 2) The construction of this well shall be. in compliance with the Water Well Can9truetlon Rules 2 CCR 402-2, unless epprcnwai of a, variance has been granted by the Slate Board of Examiners of Water Well Construction and Purim installation Contractors in accordance with Rule. 18, 3) Approved pursuant to CRS 37,92 02(3)(b)(f) arid policy of the State Engineer under the toll wiring conditions 4) The use of groundwater from this well is Amlted to ordinary household purposes Inside one single (amity dwelling, the watering of the user's own, noncommercial, domestic animals, and the Ini:gation of not more than 12,000. Square feet of home gardens arid lawns,. as recommended by the Division of Water Resources to. the county commissioners.. 5) Production from this well Is restdcted to! the Laramie -Fox Hulls aquifer which corresponds to the it lervaal between 780 teat and 1,065. feet below ground surface. Plain casing sha .l! be installed and grouted' to prevent production from other zones. 6) The maximum pumping rate shalt not exceed 15 GPM. 7) The annual amount of ground water to be withdrawn shall riot exceed 1.1 acre -fiat. 8) This well shall be constructed not more than 200 feel from the location Specified on this permit. Note; To Insure a maximum productive life of this well, performed easing should be set through the entire producing interval of the approved zone or aquifer indicated above. Note. The ability of this well to withdraw its authorized amount ci water from this non-renewable aquifer may be lOss. Than the 100 years upon which the amount of water in the aqurTer is allocated, due t:o anticipated water level declines. Note- Expired. permit 156297, was proviou y issued for this lot, Notate: This permit hays been approved for the irrigation of not over 12.000 square feet of home lawn, and garden' modifying item: 5 on the well permit: application team. Ycau are hereby natrfl d:that you have the right to appeal the issuance of this permit, by filing a written request with this office within sixty ) days of the data of fesuance, pursuaarr to the State A.drnlnisirarive Procedures Act. . Section 24-4--l04i through 106. C.R.S ), £7i'A7 LEi T EXPWTNIA.iE EtNDEDij APPROVED JvS'i6a as Z t 61,111 Receipt No, 041764 DATE ISSUED. AUG 0 8 1997 EXPIRATION DATE AUG a 8 19 COLORlt DO.DLVISION OF WATER RESOURCES DEPAR7�IwtENT:OF r' AT"URAL RESOURCES � � ≥ . 1313 SN.ER...i N ST.,, RM_ 8.1.8, DENVER CO 80203 phoi e - info, (30371 866-35.87 main: (3031. 866-3581 whsk �wfop RESIDENTIAL f lriDta: You may also re (laic lbm+ m apply iar tlwrriook watarinal Water WWPermit Application Review instructionsprior to comoleting form Must be completed in black ink or typed 1. APPLICANT INFORMATION 6. USE OF WELL (chediapprop.iate rrtry or entries) w�n..r.aa+k.m 8.e Mt#lntctki to ds .nn i. u.o(afor which you may guavy • - ❑ A. Ordinary household use in onesingle-family dwelllnp f LL�rIN l oars'ial4'r us�el n 1A B. Ordinary househiold use in I to 3 single-family 1 L[ - `~ dwellings: Number of dwellings: I r;kv ZIP°°d' , Home gardenhlawn irrigation. not to exceed 1 acre:: rte area irrigated 1 _❑ sq. ft.. acre rdanxwNunb.rrndPJd.wm�d.r Domestic animal watering --(non-commercial) 2. TYPE OF APPLICATION (check applicable boxes)) (3 C. Livestock watering ion farmlranchhar�Qe/parture) D Construt.-t lie* 06. 0 Use existing nei 7. WELL DATA ❑ Apace existing well 0 Change / Increase Use Mrrim{.rr • hI N.d .norht Jo b. nnbdnwn ❑ Change (source) aquifer RL Reappiicationt• rsiriitI 5 cum , cr-feet O Other; io•+awm +4+�r 3. REFER TO (if a icable): 16 feet1 1IJh' water rout cm r Pamrlt r 8. TYPE OF RESIDENTIAL SEWAGE SYSTEM Septic tank I absorption leach field veresi a« h"-knrirq #rd6 a okaovriadgmaru f 0 Central systern! -VE- MH- District nome- War ,vma or ©. Vault Location eawege to be hauled to: 4. LOCATION OF WELL 13 Other (attach copy of enieeiing design) County Quarterlsuardr oMnrt+f 9. PROPOSED WELL DRILLER (optional) .5 E To+wrahip N S Rang. E or W P+ierciA.i W++w s.ction or 2 E3 p C 1D, SIGNATURE of applicantlsl or authorized agent Di:trnm of well from eacticn lints The making of false statements herein constitutes ptsrjury //,, )2.5.c ft. rrum D M Y 0 s ft. from E D w in the seconai degree, which is punishable as a mass t mis- Well I.wrf.n ��r, if di fk d in n, apalwmt.adr... pf IN"' I*& derrrewor pursuant to C.R.S.. 24-4-104(13)(a). I have read the statements herein, know the conterrts thereof and state IKK row6mvMnt w ',riv - di.tir.rs d dir.rar.n hnn .ri...0 m ner..rl t they eme TMue to my knowa. feet direction "``""'"�"' 5. TRACT ON WHICH WELL VALL BE LOCATED A. You roust check erw of the fclnwina . S.. I p.0 I2 Subdivision(; Name ` iS+nry OPTIONAL INFORMATION Lot no. I Block rro, FfinglUnit '°t+= nww DWR n' no.�Surf&nMar. County exemption (attach copy of county apProrr® Cc aurti' } Namelno. Tru t no. . ` �l`ficUte Only � DIV I]e AAiitirsg claim C.MackY copy of Barad ar sur+a�i Nemelno. le, i , - _ ❑ Other (*techkpal deaeription to applcataoal P 1- r-'? 114Yis F .nrn ` I i ,� Q 44T E.R r L..5 JUR J ... B. STATE PARCEL'' WD Milk (ine"•e. 1# t Z' -I f1 cep,. I M 3 C_ a ■er.a in tr.ea 9. Are you the owner of thin property? SS YES C) NO Of no - see detaLad inns(.' I BA E. Wig this be the only well an this tract? �IYES ❑ NO l f other wells art on this trial - sac detailed instj of J !r -f L. .J54 USE MD Form GWS-A4 (11195) CQLoRADo• DIVISION OF WATER RESO:IJROES GWS-44 Fh lNST (12!951 DEPARTMENT OF NATURAL RESOURCES RESIDENTIAL..APPLICA.TIiONS - GENERA.L INSTRUCTIONS There Eire a variety of uses for ground water in Colorado. This form IGWS )! can be used when applying for a, permit for a new well' or replhcement of an existing well for the following types of uses: ORDINARY HOUSEI O'LO USE inSide one single family residence (No outside water use allowed OTPIER RESIDENTIAL: USE (sometimes referred, to as *domestic" use) which may include use in up to three single- family residences. watt'+ri.g of up to one acre of borne gardens and lawns, and watering, of domestic animal'. LIVESTOCK WATERING on a farm, ranch'., range, or pasture If you are. applying far a NEW household use only well, or for a NEW 35 � acre residential well outside the Denver Basin or Designated Basins of eastern Coloradoplease use simplified fames GW549 or GWS-50. DO NOT use this formfor registration of an existing unperrri tied well (Use Form, GWS-12), montt:aringlobservetion wwe% (Use. Form GINS -4661, grawFel pit wells (Use Form GWS-27}, or for other uses not listed', above, including - conhn erciall. industrial, crop irrigation, municipal, etcetera (Use GENERAL PURPOSE Form GWS-45•x. FEES Applications must be submitted with the appropriate required non-refundable filing fees. The required filing fee for most well permit applications is $1541.. The filing fees. for replacement or deepening well permit applications for most previously permitted rcidentiat and livestock water wells is $20. Checks should. be payable to the COLORADO! DIVISION OF WATER' RESOURCES. Applications are evaluated in chronological order. Please allow approecirrately+ six weeks for processing. APfLlCA.Tit)N:S must be completed clearly, and 11in BLACK INK or typed_ ALL tlTIMS' in the application must be colleted. Incomplete app[ioaltions may be returned to the applicant for more iforrratiori. 0o not change or alter the application in any way. THE LOCATION of the well in item, 4 must be correctly and accurately ddeacribed. The county, quarterlrluarter, section, township, range, principal meridian,, and thence from section litres must be provided. NOTES Distances are: not necessarily the same: distances as the dlis#anc5S from Iyour) property Ones, For additional assistance in describing the location of your well, review the publication entitled 'How to Determine Well Loc t.ion" which was provided with your packet, or can be requested from any Colorado Division of Water Resource: office. A. LEGAL DESCRIPTiON• of your lot or parcel of land is required in item 5. For tracts of less than 35 acres approval may depend uponwhether the tract was created by a division of land: after June 1, 1972.. It your lot Is lei than 35 acres in size, it would be prudent to haves deed or legal description that shows your tract was divided from a larger tract prier to ,came 1, 1972. This may be eccomplrshed by obtaining a copy of a deed for the tract issued prior to. June 1, 1972, An ORIGINAL signaturernt be on each application. The applicant's authorised aqanill may sign the applications, ifs letter s0nxa!di by th-e a.choii or is submitted with the application authorizing them. to act: as agent for the purpose of obtaining: a well permit. - IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call' the. Division of Water Resources Ground Water Iflformation Desk (303.-866-3597)., or the nearest Division at Water Resources' Field Office (located in, Greeley (970-352 712), Pueblo 4719-542-3388), Alarnow! (719-589-66831, Montrose (97O-249-66221, Glenwood Springs (970- 945-5665), Steamboat Springs (970'-879-O772.), or Durango (970-247-1845)_ DETAILEfI INSTRUCTIONS ARE AVAiL-ABLE UPON REQUEST COLORADO DIVISION OF WATER RESOURCES, 1313 SHERMAN STREET, FRO:OM 82.1, DENVER, CO 80203 PHONE- 3oa-She-25e7 ilhNTM%atkdnr. ao 84fi4-3156 8 [Mein. 3 03 -WS -3447 M' S Weyer ffightt corda), 30.3-960-3589P CFa4. r EXEMPT WELL DATA SHEET - DENVER BASIN, COLORAD APPLICANT: MARTIN MITCHELL L RECEIPT NO. 417641 LOCATION: SE1/4 OF SE1/4 OF SEC. 12, T.1N., R.66W. (1255 SSL, 498 ESL) PROPOSED AQUIFER: SURFACE ELEVATION: 5040 NUMBER OF ACRES IN TRACT: 5.571 IS PROPERTY WITHIN SERVICE BOUNDARIES OF MUNICIPALITY S.B.5 CONSENT MAPS? N IF SUBDIVISION IS UNDER AUGMENTATION PLAN, CASE NO. IS IF SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY THE WATER MANAGEMENT BRANCH, INFORMATION ON SUBDIVISION OR TRACT OF LAND/ SPECIAL RESTRICTIONS: ELEVATION DEPTH TO ANNUAL --------------- NET --------------- APPROP STAT AQUIFER BOT. TOP SAND BOT. TOP A -F UPPER DAWSON ---- ---- ---- ---- LOWER DAWSON ---- DENVER ,.«.__ ---- ---- UPPER _-- ARAPAHOE ---- ---- ---- ---- ---- -___ _-- LOWER ARAPAHOS 4669 4901 98 371 139 0.919 NNT IE-FOX HILLS 3977 4260 148 C 1063'i <780' 1.237 NT note: E indicates location is at aquifer boundary and values may be m * indicates the proposed aquifer. All values are interpolated from the S.B.5 data base assembled in Nove I., To b mud whta iawM well pemriss wed lIMahan other than at ciwed. Please file with ft, Receipt No._'I 1-7 (P' i Name of Apocart Summary of change(s): + ■ la D/? fc Signed- - Print Nam h- C,."'--_ J y vi%%,abVO JUL 1 2 T999 rtcot-a 783+979+5185 FR0`'I • CHILrkr•• . ';Ci. Pt-}tI1rIt 7i 3+g79+5165 Pug. i`4 09` 12:29P11 p] •k H 1►� �< ! i i, Form Nc. Oi FICC OF I HE STATE E CHNEEH CU' QiA.GO DrvISON OF WATER RESOURCES ale �•ntfI alaq. t13 p kernx•n 9t. t]•nL+r. CpiertIda i$Q.3 **346I -- DIV.. I CNTY, 2• WD 2 DES. SA fN FAD ata: 2.1 O1Qo k' Pifrr. TiP I gTArR% (IC 1W'COUNTY Std 1/4 Se 1)4 �lootlon, 1-$ MrrcHgLL k, MARTINI I2 t4. 5TH S1' +► 11J 6th P.M. FT LVPTON CO 4 53[h��C1.�7,61 y3 1'25Et• Ft �I'tt1L South atafk LI!* 496 Ft. from Et Sectiok Ulm f!'f1 C): CON:ainUCT A WEu. t p€RMt DOES NOT CtiHFER A'AAT1:P1 FCIC31IT 1} 7h 5 win t Bna. rte ucea in 1Jt'a a way lis to c4ial fret rRitetlal rnury to erl ing watt*' di* me eianCO Qf Vie pwrM does mcp assure the nprrcanl ;r�Mt nj•u"jugr MN ote'Ir to eTamr mad liteler i4ti cr p.ckgs rsr Dale' tiWM (ii vs&Wd 14V1Pr i l I ko:n s eklny rolls! n ■ cIII ocW10n 2) .. j(j CM rtructicm tales 2 OCR 4O2-2, u:n l*3a awravir at a v� ff r w: C9rrat*4+c�ttGo And Pump ador Cxrntrecterii Err 3) A t_ f ti 7' Entptnaer undue It NY4fe OM 4) r. RECEIVED I purpoMl1(rte we >f e'stmt ciwracNn;�, tfw n rtr>� a wT of riot mars than T9'.61C lgWet.re fe9t. of I>itxrne gtl,rdan+l kk Q he county co•mmI4�tiQnrrm_ 4) P �-1 L r vaniom oorraspx,ndis tm melntenraM mean • lo. us ed l Cpit' ` gr uied Ic prevent prod tictIcnt'or'n other aortae-. ••�` WRTEHftESOu1 C.ES g.tR 7) TI j ! 1.1 r rwter. 1 Ti /r f[p r1 rm aryeaftd on thin pr9!'rlrlk. n C ' E mekV ehothd be eat IJV U trim inure prc .iut k1g ni.r of /54O ( I 4AO IE atluCa'Ced, dkia to eltlt ipaled welted: l 14 i2.Ood. sgdjare t v1 hams wn andl garden; ruerxlf - n ' fW yor he Pw rt k u. e th ofte withkL satyr' d& of the. dlsi. cf APP GVL lia r-0 Iaec I Idpi. d 4 ti 7t 1 OM.re I9$UE I AUG 0 8 1997 EXPIFtkrt4+ ' DATE AU& a 8' i DEPARTMENT OF PUBLIC HEALTH AND ENIVIRONfVIENT I,I 15.55 N. 17th Avenue Greeley, CO 80631 www walrihPalth nra if3— t L _ 1I Hegi Adminlltration Public Health b CIi111oa1 En"renmsntal Huaeh Cammunicatlen, Education i Plsnnirt Enirryoncy Pr4pa*+dn4as l RespO IfRil Records S/+*I{R3 T,e a o 3l s410 Teie 9 TO aO4 9d2u Ssnlcsi rse v, 6J, s Tsle 970 30i 5a*a o 1V031Iwii,' 'k Teie 970 aaa sago 0a= 77o31J A53 Fa•. 90 F412 Fat 90 X4 Fa+ 9'0304641• Fgx Our HSwn ragerw wieh the eannwtlns M 34". wr an +4fNeq m m1AI Wek1 Cau t' NN iil44 u,J piRC1 ICNrr4t1U� W rn, wah 6W ARY crim+i('_ Dar it — PinIr.+0i W%RJJ16l 1 l %-1 M wRrds.a Application Number,SP-1600250 Owner Narrre;SCHRADER RAIY Site Address: 4211 CR 37 WELD, CO 80603 Type. l+ t :.i:.-- i !%Ncvj OWTS Sept -n App Type; tilc. N%ani i I�ti�.�Ivv� s.1 ..T..l�. STEVE DICKINSON 2D ENTERPRISES PO BOX 504 FT LUPTON. CO 80621 Parcel #: 147112403023-80226094 nl 11-'1 n 6A C7 h1 r1C 11 PLAT Lt9gidi ur:3 L. 1v,�-2J LLJ I $Ar\ 1119 Ll, \LJW I UD - t I9 _IVI/ D Work Description: HOUSE EHS SEPTIC GENERAL. Associated Disaster Permit No Number of Bedrooms 5 Number of Persons 2 Parcel Acres b`b Private Water Supply Permit Reference 204458 Public Water Supply No Repair Reason Type Repair for Failure Waive Fees No EHS SEPTIC ACTUAL (FINAL): Septir Tortk Size nallnnc 1500 Absorption Bed sglt 4263 Design Type Rock and Pipe -Bed Dosing Yes Pump Size Yes Dosing Pump C(�amber Size 400 Pump Specified 29.5 Finaled Application Status; r-inalea Applied Date_ 08/2&12016 Issued Date: 08/31/2016 Finaled gate: no!2nr2n1g NOTICE The issuance of Ihls permil does not imply compliance with other ;We. county. Or local €egulatory or buirding repuirenie.nts, nor shall it act to certify that the sutlject system will operate in cornp1,eoce with applicable state courlyt and local regula1ivns adoplect persuant to Aiti.cie 0. Title 25, CRS as amended, except for the purpose of estei41isfhing final approval of installed system torissuance �,f a local ocr:upancy remit per&uanl to 25-10-t12(ti}{t- G R S This pefmit is non -transferable and non-refundable The We'd County Department of Public Health arrd Environment reserves the right to impose adrlili0Ral terms and conditieris required to rneet our regulations on a coniirlunri oasis Final pairliit approval was coi 11111yet p upoli he final ii pectioil of the completed system by the. Weld Codify Departmenl of Public Health and Environment Katie Sall September 20, 2015 Environmental 4- ea.ilth Specialist Oats YI.,`_• n�.� T..=«, fl `>n.'lfl lI��kil I -:a __I �'l l{+n'1"5 Po 'i of 'i f Ill It L/PIC I ilild. UJc U CJ EU �J,Jrt.LJFI IYI Septa, I' G111{IL 1 IIIGi LI lci.JLJ.dJn" -'�- -% K DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17th Avenue G 1 wavy, CO ^00631 ' www.weldhealth org Public Health N..sn siarwi$len wire MM A nled SftWF .rft1 n.lm Cs. Iwnier�.., snrrNrrq PNPWNW u NO r,cop4 s.Me.. s.rrle.. Fd.F.son r waminr pnpeno* T• eN 3,e 6419 TO CT ao+ sTile 970X.45415 rwa e U X)4 6dn Tel, r7a 761 am FLr irOXM04TZ Fv 6D Qiii7E Fe. 4709 44*f Fpi- 90314hi5i Fm 479XK415Q Oiw i T4weerrrath is u.....r+r% wpm.-s-mq a .M.woC=*m.+T.l�.r�seft+w+w.r rsn mil' Septic Permit New Application Number: Owner Name: Site Address: SP -1600250 SCHRADER RAY 4211 CA 37 WELD, CO 80603 App Type: Health\ResidentialWew OWTSISeptic Application Status: SIEVE DICKINSON Final Pending 2D ENTERPRISES Applied Date: PO BOX 504 08128/2013 FT LUPTON, CO 80621 Intake Person: Parcel Number: 147112403023-R0226094 MSWAIN Permit Expiration Date: Legal Deec: MB -23 123 MARTIN BROS PUD - AMENDED PLAT Work Description: HOUSE EH8 SEPTIC GENERAL: Associated Disaster Permit No Number of Bedrooms S Number of Persons 2 Parcel Acies 5.57 Private Water Supply Permit Reference Number 204458 Public Water Supply Na Repair Reason Type Repair for Failure Waive Fees No Sepi c Permit With Eng Design EH: Print Date -Time: 9.201 fi 8 08 13AM Page 1 of 3 EHS PERC TEST (SITE) : Engineer Design Required Yes Engineer Evaluation Received Yes Engineer Job Number B1218 Ground Slope 1 Limiting Zone Feet 4 Limiting Zone Inches 4 Limiting Zone Qualifier Equal To Long Term Acceptance Rate 0.15 Profile Pits 2 Slope Direction Southwest Soil Description Clay loam Soil Type 4A Treatment Level Level 1 SEPTIC SIZING INFORMATION: From the application information supplied and the on -site soil percolation data the following minimum installation specifications are required according to the Engineer's evaluation: EngineerSpecified Installation Recommendations: Dosing Pump Chamber Size 400 Dosing Specified! Yes Engineer Design Absorption Area Specified 4200 Engineer Septic System Design Type Specified Rock and Pipe -Bed Pump Size 29-5 Pump Specified Yes Septic Tank Size 15x0 CONDITION S: Description: Permit Conditions Comment: Approved based on Engineer evaluation Construct onsite. wastewater treatment system according to Engineer design Need an engineer approval letter approving system as knstalled per engineer design. Engineer designed OWTS must be inspected by the design Eilyi iae ):.limit u:+ IJd C.ktiII1f1L . OrsOrst ii cotriiWilt ayah iii Iifust Lu i�Ci Irulft property line Install th:e soil treatment area within 50 feet of the sods test location. Septic tank must be at least 50 feet from any well. Soil treatment area must be at least 100 feet from any well. Place bottom of soil treatment area no deeper than 15 inches below original grade due to groundwater at 51 inches Alf easements shall be verified prior to installation of septic system. All Weld County reg iIations are applicable INSPECTION RESULT: Description Site Comment: Status: Approved to issue Septic Permit With Eng Design EH: Print Date - Time: 9/112016 8:08 13AM Page 2 of 3 NOTICE This permit is granted temporarily to allow construction to commence nce This pennrl may be revoked or suspended by the Weld County Department of PubMC Health and Enwivinmenl tot reasons set 104Th in the W CII County Un5ne vvaaleweterl i rearmernt ay .iem Ragwiaiiitl iS ii iui iuie ig faiuie to , i+crt any term or condition mlposed Iheeeorl during Temporary or fir cal approval The issuance of this permit does not corialilute assun i1ion by the deparxnent or its employees of liabibty for the failure of Inadequacy of the sewage disposal eystem hs n n d nnnrrefundable. Betiore issuing final approval of lhi s permit the Weld County Departmental Pubhe Health and Eriliir`oranerd reeertres the right to impose addilrgnal terms and conditions required to meal our gulalions on a continuing basis Final pemiil approval is Cllrrtingesd upon the final inspection of the corrtpleled system by the Weld County Depanrrient of Public Health and Environmerrl Katie Saf August 34.2018 Environmental Health Specialist Date c,Ar tjr Pprrnit',A th Fns f7-cinn FH` Print Date _Tithe 91112016 8'08 13AM Pape 3 of 3 DEPARTMENT OF PUBLIC HEALTH AND- ENVIR0NMEN.-T .'ti xr r # 555 N. 17th Avenue OFee!sy CO 3131 - - www-weldhealth org Ii U Piu-MicHralttr rreami wdrttintatration Public Hairh A Cirnrcal EnrirlhnnUrtt41 H4a1I1 Ca+rimunicaned, Enrryanty Pr i paradnaaa V aI !arnrda IUr,tca4 94Mani Eoucatwn a Prann1np i RaapolIIc Tt' 9'C 33454+n Tere97C3C4r14a' F'aa. 9103046411 Fax 370 XM 6.tlb Tried'^'^454+5 T'r,!a?'f?301M FAT 9O4.4l1 e.4l1 Far g7q pa 545? Te:e B.'C'04S4_' FaLi 870 3645455 veer rimer' 7r441 erur i4 cL,rrir.,vrwt,da — Its w.. ,e w0tMr.; Ii) mNI5b Ywr o Ladle) uw nbw1r.ep plu re irw la aril Worry aan Pay Septic Permft Application Application Number SP -1600250 App Type-. Health\ResidentialtNew OWTS\Septic STEVE t1l(`K!N'SCN, 2D ENTERPRISES PO BOX 504 FT LUPTON, CO 80621 Owner Name: SCHRADER RAY Parcel' f:- 147112403023-R0226094 Lebai uin%:i, rv0U-23 LLJ Ivus-sr. 1 tN URkJJ rUD - AIVIE UCU PLAT Work Description: I -LOUSE Site Address 4211 CR 37 App Specific Info: WELD, CO 80603 Nunibef of Bedrooms 5 hb,rmer• riF Pron 2 Parcel Acres 5.57 Pubs€c Water Supply No TERMS AND CONDITIONS A permit roe. as set by separate ardinarrae cf the Board of Weld County Commissioners. shall be required of appllcarxts mm cri itewaslewaler trealrserrt systems. payable at hrttc of appl;wVan. Permit feet are row -refundable; permit appficationa are uoo-L,arriferabra. iT br,tli d elrnitand an +_c'WS are isa adfor tf satire property and consYrucuon is not commenced prior to the erpiiatron date of the building permit. Ire 4V4TS permit shall expire at the same lime as the building permit If an DNlTS vermeil is issued for a orooerty tttat dges nm retfiirte a tttlildinri riernxl the (WT R neural strati erriire one veer after lIe i4Srlan.ry If' rnnatnrclinn in - tie septic system lies not r,.ommenced Airy change iri plans Cr speClficertiorts alter the permit etas been issued invafivatat the permit unless approval a feoured from the Health Officer or tesrher desgrlated agent Expired permits can be renewed by payment of the permit fee onlr d There has been r1a Change in 111e plans and speC41JUatons of the propnsed system as act. out in the vnginal application or such changes rawewed sod approved by a Division Representative S The surrounding land is use ar ccntng has not ^_hanged sa•asio cause the original appIicai on net in be acceptable Linder these regulations NOTICE The corTlpletprIess of this appfiraton is conditional upon kurther mandatory and additional tests and reports as may be required by the Weld Crtunty Denartmenf of Public i-lcalth arid 6nveunmentl,WCDPI Eti. The issuance of the pe«nit is suhjec.rto such terms and conditions as learned necessary to insure compliance with rules and rogutnhons adn�ed under Artide 10 title ?.5. CRS as amended The applicant rerfries that the prapirsed sysfsm will riot be located within CUu Feet of a community :ruy';, r}u z-. rho u �iyri ti u. urd.i iii aid ii,P'Y4 • U IC?L1Ica uIII'LIFV irriewiiii 4ee, 0 rinv It. i 1ic ciIEc r Li LJ Lf1G dlii dote Lc the ❑egt of hislher 4.nowiedge and are designed to Ire Yelled on by the WC0PIfE for evarcatlanfor purpose S,of issulrg the perRllt applied for herein ApplicantlurtlteF urrdersiands Ihal.FalSrricatiCn Or mitrepra_5Br11a1'fir, reef result rr! the denial vtthe application n' revocatior of any perrrlrtgranted, and in Mai action or pequry as provided ty aw i f f� r .i f'7 f rr X rf Own e tie Print Date Time. 826/2016 11 33 20AM Septic Permit Application EHS00056 Page 1 of 1 } RI' .lD1 N`I I.A.L.ON-SI'T'E WASTEWATER I'HEATMI NT SYSTEM (OWTS k INSTALLA`T'ION PEt(i'i.l I. Uw or Melsair) NEW OR REPAIR RESIDENTIAL. OWTS PFRMI"I ELI:: $95-0, IE) r All payments are due al the time of application submittal; bti cash, check or credit card t ! not he acs 't J ('i'..;rd sail I. ''.H:9or. -1t.- ^lap and des gn tjocaurnert must he irclruded; �� ili�iCtr snizlscu �sJria :wi i �j •+ i`--' �..".._` r• r�, PARCEL NO.: 971 (l DIGIT NUMBER) LEGAL DESCRIPTION: SECTION TOWNSHIP --- RANGE — AC'RES'. �f SUBDIVISION I [71- BLOCK. FILING INFORMATION CAN HE; OBTAINED FROM THE .ASSESSOR'S OFFICE AT (9701 353-3845 EXT 3650, OR ON THE COUNT WEFISITE UNDER. PROPERTY INFORMATION, Link to property information: tLL!2— ti3t4u�43.titi�lrl.�-itti tea rt}mtthrm tRm SITE ADDP.ESS r I)FTAIL.L D I)IRFCTIONS TO SITE (Al EACH MAP) PROPERTY OWNER: 4 MAILING ADDRFSS:��.-- C'IT}' ]t ST [ LIT' Hc)IdE PHONE: �) C 4 WORK PHONE 31;y� `) D it 1 F \X I E'MAIl. AI)1)RESS:Q lh(3 O1IT1 ti APPLICANT NAME 2 MAILING ADDRESS: lo.. --- CITYaL q±L ST_CU ZIP OZ� HOME PHONE: L _J T WORK PHONE L 1 _38 1 72 _, FA?C ( j gS7 .Si EMAIL ADDRESS:___ 22 de {U.e . Gown ..-- PROPOSED LISE: V'RESIDENTIAL NUMBER OF PERSONS; NUMBER OF FIEDR(X)MS: _ (1rpf OF STRLC.'TI iR•; (E%. houtir, ttrubde hnin ) C':)4_ 0 AUXILIARY BUILDING (Residential t�se only) TYPE AND NUMBER OF FIXTURES (shower, sinks, toilet):��, NUMBER OF PERSONS: TYPE OF STRUCTURE (Ex- personal shop, pool house)_ -_ WATER SOURCE: O PUBLIC W \JEER SUPPLY (NAM I C)F SUPPLY).. — ( INDIVIDUAL WELL (PERMIT " O CISTERN (PERMIT t!) - — — -_-- *W'AKN1Nf - Hither Weld County nor any olds afiiliatts shalI be resptmsihle Iw the mee of am inlormatrue submitted m re4e1iue rU this OWTS tnslallelam perms It is the rey iiiei ,iIr of na crTu d k,-rnIrr Wider tahal cmum[anees'the information 15 be:ngapplt.ed, and ensure that the Cn-Cum%AmLLi s arc suitahk lu theapplteatlon ufth c irilumrauun Neither Weld {'ounry nur it% emplov=%,tee liable for the Failure oT uwdct uacy of the unsite caste tinter I.realment system 5 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 171h Avenue Greeley, CO 80631 Public Healtth Web: www-weldheaSth.org Heatlh Adminlelaallan PWIlc HeartI+ a Cllnleal cnveroru U&I Hadtlr Co m unlcatlon, Erner�rrtf P17pandotaa Yllil Rrcada Sarvfcaa 9Rrlces Edytaelan a Pliilrrlp i RaaporMe 7ele B7d 3(I4 MID ¶afe 974 304 642G Tele 9₹0 391 6415 Tdc 470 304 19170 THe 970 3O4 6420 Far 0 74 304 9417 Fax 9'0 3CN 6916 Fax 470 304 S411 Far 070 ,104 445.7 Far 970 304 &5 Our ri sion TcQ,lt E!f wfA me m"melnws t4 e wm-a K4 are iM� to r'. Yb !3 COurifV the 71skb11Ad51 to em $am, w0" aMAHY AUTHORIZATION FORM RE: Q PERMIT APPL€CATION Q OWT'S EVALUATION UATION SALE OF PROPERTY Q WATER SAMPLE - _IN I - I Th gives permission t❑ lS e for the property (properly Owner) (A&enI Applicant) located at_ I l t,t } -. to apply I`or requested services checked ahoae_ LI (1AL DESCRIP`IION: SEC_ TWN _-_RING SULil)IVISION NAME: LOT BLK Agent/Applicant can be contacted at the hollowing phone #'s: Home Work 303 Fax tt 2o3 9S- f5 I -5- E -mail: o e~7eF]f (SE. ( kC o . w The. property owner can be contacted at the following phone #'s Home .3 3 i 7 acr f Work :3O31'>I 1'> I Fax # E-mail: SLi Ar v f► V � &�I .' ET Correspondence mailed to (only one): f'1gcntJApplicant Property () ncr DATE u •l4 OWNER'S SIGNATURE ON-S-ITE WASTEWATER TREATMENT SYSTEM (OWTS) REPAIR DESIGN. REPORT AUGUST 22, 2016 Prepared By: Prepared for CHURCH Onsite Wastewater Consultants, LLC Mr Ray Schrader P.O. box 18796; Golden CO &4U 4211 County Road 31 Phnr'a. 7?n-f14A_34a4 Rrinhlnn CC PPFh n`3 Fax: 720-898-3455 Phone: 303-5904171 E -Mail: kcarney a7cowc.info Email: schrader rtebb net Subject Site 4211 County Road 37, Brighton CO Job No- 81218 Weld County, Colorado BASIS OF DESIGN The following OWTS report provides design information for a 5 -bedroom residence located at d'711 County Road !rr Wald County r'r+inrarin The ri r,7 terra rn rt is rurrent!y de ein f with a 5 -bedroom residence, and two additional outbuildings onsite. The existing on. -site wastewater treatment system soil treatment area has failed and must be replaced. The property is bordered on the north, west, and south by private developed parcels and on the east by Weld County Rd 37. The 12W . a t : ate characters c for th! d -es-- 7 2..10 expected to be c!mtbr to the, rnr qc residential raw wastewater properties as indicated in the table below. Table 8_Typical Composit#on of Untreated Domestic Wastewater _T Composition Inits T- - `-_Concentratien i + Weak AverI 1tStrong Tral grmm.nrdrl i-+ nli-I hArsfl Inn -- 7)n "krf} SODe of 20'C I Mgit_ t 10 22(} 400 Nitrogen �tatal as hid__. _ ._ _ — M //L 20- Phan horns #o#al as P 4 8 15 Fats Oils & Grease(FOG) i Mg/L 50 100 150 i- 9 jota1_Coliforxrr -- -- �. _ .1&1L _ i010? 0iasa! and Ruse. Mercall a Eddy 1931 The wastewater flows are anticipated to be in the normal range for the residential application indicated The estimated wastewater flows from the structure are provided in the calculations of the components in this report. These OVkTS design documents are based on the requirements of sound ()WTS PnoineP.r'ing design nnnr.inips anri the. Wwlrl I'.nitnty nF-nartmPnf of Puihhr Health and Environment (WCDPHE) Onsite Wastewater Treatment System regulations. effective July 1, 2014. '+ern cu + +C. V U a1 `_F` -J 1' B1218 — 421 1 County Road 37 owns Design Report August 22, 2016 - Page 2 IYVLC -L.. I ILL Lii iG Ue Igi k VI V s VI ISi1C kfiasteVV3LCI syJI U I ]I I�I Ii �%iUJU 1L&JIJ i 41 sc rvI U. 1 L VY U QI IU the design figures. The OWTS design incorporates the County OWTS regulations, as currently amended, by this reference. COWC recommends that when soliciting for costs of equipment, the complete design package be submitted to suppliers to allow them to understand the design and provide the correct components/equipment- It is the responsibility of the installer to have sufficient knowledge and experience installing systems of this type to be able to review the entire set of design documents and understand the system concept and the intent of the design. If the installer does not understand the design intent and the system concept, the system installation should not be bid. If there are items in the design that are not clear, or if errors are noted during the installer's review of the design package, the installer should call COWC, before bidding, to clarify and correct. The county permit issued for this site is specific to the engineered design documents as submitted. No changes to the system design are ailuwed without written permission From the design engineer. If at arty time, the instalipr rhang c any nnrtinn of t hF dpcinn withal it writrpn p rmiccinn from the design engineer, there is the risk that the engineer may reject the changes and that the changed items) will have to be removed and/or reworked to conform to the permitted design documents at the installer's own expense. SITE CONC1DITtOt S Date Site Investigation Conducted, 81512016 Water Well Location/Water Supply The subject property is served by an on -site well located west of the house. in ap•proximat:ely the location indicated on Figures 1 and 2. The proposed STA is located greater than 100 FT from: the existing well location and any neighboring wells. Topor ra_phy- The site is relatively flat. with slopes averaging about 1% to the southwest. The slope in the area of the proposed STA is approximately 1% to the southwest and in a depression. Soil Data A Web Soil Survey has been obtained from the USDA. Natural Resources Conservation Servsce (MRCS), and is attached to this report_ Subsurface tnvesti, ate. Subsurface conditions were investigated by excavating two test pits with a John Deere Model 310-E backhoe at approximately the locations indicated on Figure 1. 3 - Subsurface conditions at Test Pit 1 consisted of 30 -inches of loamy sand, underlain by loam with redoximorphic features. Clay loam to 67 -inches, underlain by clay to a depth of 96 -inches, the maximeim rippth explored. Siihcsrrfa- conditions at Test Pit 7 consist of 30 -inches of sandy loam, underlain by clay to 58 -inches, underlain by clay to a depth of 100 -inches, the maximum depth explored, A Graphic Soil Log has been created and can be found in Appendix A attached with this report Based on all available soils information the soil is classified as Soil Type 4A, USDA Soil Texture of Clay Loam, with a long term acceptance rate (LIAR) of 0.15. B1218 —4211 County Road 37 OI T1S Design Report August 22, 2016 - Page 3 r'..:,..;..... rm ITS' r7C......i..- ;A$ 1.-t r"`..,...+,. +i nrn�rlr ;n.1'�.. f.. ii.n r- k (Th A11Q „rub k��alt I vvr I .d I+c+..�uI%A vvc+u vuuirry O JLIC icweu.3 iriuiti.i3I�. 'Ins ti.riyiiis�r ..r+• .. .sW.� ++� 1999 for a 5 -bedroom home and consisted of a 1,500- gallon septic tank and 1,350 square feet of absorption area composed of three 55 -foot laterals, The average percolation rate was calculated at 9,1 minutes -per -inch (MPI) for the subject property, and the soil was classified as sandy silt. Landscape Position: Landscape position was determined by observation of the site in comparison to the Slope Shape and Hillslope descriptions as defined by the NRCS. Landscape position for the site is described as LC (linear, concave), having a slope to the southwest at the proposed STA location of approximately 1 % Vegetation: The site is covered in grass, with a few ornamental and shade trees surrounding the hue and near the- proposed Oki rr. location Natural and Cultural Features: There are no known ratutai or cultural features on or near th.e subject property_ Current and Historic Land Use: The current use of the parcel is as a developed residential property. Historical use ds unknown Additional information: A. Survey Site survey information was not available as part of this design. Property boundaries, building locations, and existing OVVTS locations were obtained from information collected while on site county records. and/or aerial imagery. B. Easements: There is a 50 -foot gas easement running east/west through the central portion of the property and there is a 5 -foot utility and drainage easement along the north, east and south property boundaries C. Floodplain: The subject parcel is not in the 100 -year flood plain. D. Aerial: An aerial image has been included with this report. Please see attached NRCS soiis report for aeriai imagee. E. Climate information From Natural Resources Conservation Services, indicates that the site is located near the 13 to 15 in/year Free Water Surface Evaporation. line. Please see attached NRCS soils report for additional climate information. F. Delineated VVetlands: There are no delrnneated wetlands on or near the subject property. QWTS- DESIGN The existing structure is a five (5) bedroom residence, see Figures 1 and 2. There are no future plans for additional development of the lot at this time. There are no known or anticipated changes in land use that would impact the proposed system. Desig:n flow values_ 600 gallons (3 Bedrooms X 2 Persons X 75 GPO) + (2 Bedrooms X I Persons X 75 GPD)= 600 GPO Qh ,irIinm (yn+rr' The existi— K..4rl'rnre ¢ .,I r nininn c-h'll be'ifi#i-rtr� *r)r th'o elcaairrn .Y .. .y .y r..p. iy i..ri v .n •..4 tires ., .,1 fl.. vu.y. �. 81 218 — 4211 County Road 37 OWTS Design Report August 22, 2016 - Page 4 Tank: The existing septic tank shall be utilized for the design if it is determined to be watertight and structurally sound. If it is determined to be inadequate, the septic tank shall be abandoned in place and replaced with a suitable tank decided upon by the design engineer. The tank shall be sealed around the inlet and outlet pipes and watertight risers and aids shall be fitted to both riser openings. A Front Range Precast Concrete 400 -gallon concrete dosing tank containing the effluent pump shall be installed following the existing septic tank The installer shall provide a handle extension if necessary, to bung any filter handle- within 6 to 12 -inches of the bottom of the nutlet comp,artr ent racer id. There shall be an Orenco FTS3628MAV Effluent Filter with 118" openings at the outlet of the second compartment of the septic tank with a high water alarm float wired to a dedicated circuit in the control panel; see below and Figure 3 for details There shall be a Flow Inducer Tower installed in the 400 -gallon dosing tank_ Pumping System: The pump shall be an Orenco PF3005, 112 HP, 115 Volt, Single Phase pump. capable of pumping 29.5 GPM a₹ 29.5 FT Total Dynamic Head, with an Orenco FTS3628MAV effluent filter having 118 -Inch screen openings in the second tank chamber of the primary tank, preceding the pump. The control system shall have 4 floats: 1) High water Alarm in the first tank, 2) Alarm in dosing tank, 3) Pump -On and 4) Pump -Off as indicated on Figure 3. Tank Discharge Piping: The discharge piping from the effluent pump to the STA shall be 1.25 - inch diameter Schedule 40 PVC pipe with solvent welded joints. The pipe shall be installed with an air vacuum relief valve at the high point of the discharge piping to facilitate drainage in both directions between pump cycles. A minimum pipe slope of 1% is required from: the high point to both directions, The pipe shall be properly bedded per the typical trench detail presented on the design drawings. I he dose volume Should be set tar approximately (A_1 gairons (reference pump ftoat activation elevations provided on Figure 3). To ensure that the pipe is protected from frost penetration, a minimum of 2 -inch thick, high - density, closed -cell, extruded, insulboard (not white. bead -board) shall be installed at the crown of the pine to a minimum distance of 1? -inches eanh side of the pine crown in any olace where less than 36 -inches of cover exists. The soil below the pipe insulation on each side shall be placed in lifts not to exceed 6 -inches and compacted to a minimum of 95% maximum dry density. Control Panel: The control panel for this system shall be an Orenco Systems, Inc. Si ETMCT. The panel shall be wired by an electrician licensed in the State of Colorado. All installation and wiring blldii U iii dLL;LIddil' ' With iJ irlbtluq_fiu,lb Of tiiv- IrrdlrufaLtuil7r wid the N tluilai EieL;uiU Cuue, the more stringent requirements shall govern the installation process. Soil Treatment Area The Soil Treatment Area (STA) shalt be a sewer gravel bed and pressure pipe system. The soil in the area of the proposed STA is classified as Type 4A Clay, with an LTAR of 0,15. The STA size is as follows: • Long Term Acceptance Rate (LTAR) = 0.15 Gallons/day/SF 01216-4211 County Road 37 OWTS Design Report August 22, 2016 - Page 5 Hydraulic loading rate = 600 gallons per day (5 bedroom structure) • STA = Design Flow (gallons/day)/LTAR (gallonsfday/SF)= 600/0.15 = 4000 SF Configuration: A 1 00 -feet by 42 -feet sewer gravel bed and pressure pipe STA, for a total of 4,200 square feet COVVC has chosen not to use chambers for this design because the first 30-36 inches of soil is very fine loamy sand to sandy loam and there is a concern that the soil would fill the chambers over time. The STA shall be built to the lines and grades indicated on the design figures. COWL F.a,-- chocon o w race bed fnr-the rrspair boc�s.of the d'ilift , ul1.0 of cros.sio then large r.`nq line running through the property_ The infiltrative surface shall be 15 -inches below the existing ground surface elevation. The STA laterals shall be 1.25 -inch Schedule 40 PVC pipe with 1/S -inch holes at 36 - inches on center, oriented as described on the design drawings. The lateral piping shall be placed in a 12 -inch layer of sewer gravel, and at a minimum of 6 -inches attove the infiltrative surface, Orifice caps shall be placed over each orifice to disperse energy and protect against scour. A 1.25 -inch manifold pipe will distribute effluent to each lateral. The STA shall be constructed with a berm on the uphill side of the field to divert runoff away from the field. The finished grade of the STA area shall be configured to drain precipitation or snow melt away from the field. area Vertical Separations Three feet of vertical separation is required between the bottom of the trench {infiltrative surface) and the restrictive layer. A seasonal water table was identified at 51 -inches Test Pit 1 while water was found: in Test Pit 1 at 68 -inches, Therefore, the infiltrative surface shall be located at a depth of 15 -inches to achieve three feet of vertical separation. 6urtace Activity' rwo surface activities that compact the soiis of the STA shdii 'tie peirniiied, ii is recommended that the STA be fenced and/or barriers be installed to protect the chambers and in�situ soils. Ground Cover The STA shall be planted with drought tolerant native grasses, water only until the native grass is established. Continually waterirg the absorption area will cause premature absorption system failure. The installer shall verify with the system owner who will have the responsibility of maintaining and watering the seed until it germinates and becomes established. 0WTS C0NSTRUCTI04 The OWTS shall be constructed to meet all Weld County OWTS requirements. Please see the attached septic system design drawings for elevations of the key components of the OWTS. There are no anticipated or expected construction issues with the installation of the OWTS. The. area selected for the septic tank, piping and STA are clear of interfering objects, set back from existing structures far enough to allow the use of standard excavation equiprnent and piling of soil 'i Tti .. rc c known subs irf c0 impcdments to the t it ti^n of the system. B1218-4211 County Road 37 OVJTS Design Report August 22. 2018 - Page 6 IN ;TALLATlON O3SEb':.',T:ONS The installation of the OWTS shall be observed by the design engineer. A minimum of one observation is required. 1) after the construction of the STA is complete and the laterals and sewer gravel are placed. dosing tank installed with risers on the tank, high-water alarm and pump -floats connected, and inlet and outlet connections properly bedded, prior to backfill A final observation ehall lie requirpr! aftwr the final plpr triral connection has been made prior to placing the OWTS into service, if power is not available at the first observation. Our office should be called at 720- 898-3434 to observe the installation of the OWTS at least 24 hours in advance. These observations, any repeat observations. OWTS design revisions, staking of STAB or additional site visit requirements are not included in the scope of work of this design and will be invoiced at an additional unit rate fee OPERATION AND PREVENTATIVE MAINTENANCE SCHEDULE The goal of an operation and maintenance schedule is to observe the system function and operation, perform minor maintenance to allow for proper, long term functioning of the system and to record performance data for future evaluation All system equipment will require some level of monitoring and maintenance to ensure it is functioning within the manufacturer's specifications and the intent of the design documents. The owner should obtain the manufacturer's Operations and Maintenance Manual for each piece of proprietary equipment in the system, and ensure that the equipment/component is properly serviced per the manufacturer's recommendations. To ensure that the equipment/component is :.nc coning properly, the system owner can periodically check the equipment, or can hire a trained and certified maintenance provider. Septic Tanks: The scum and sludge accumulation in the septic tank(s) should be monitored yearly. Once the cumulative scum or sludge thickness reaches 18 -inches, the entire tank should be pumped. A pumping frequency of 1 to 3 years at design flows is common An alternative is a regular pumping frcquoncy of every 2 years. Filter and Effluent Pumping System: The effluent filter at the septic tank discharge should be cleaned (hosed off) at the time of pumping or as needed. The effluent pump should be checked semi-annually to ensure pump is functioning properly. If the alarm sounds, the pumps and floats should be checked andlor serviced immediately. The filter should be pulled and observed every SIX months for at least the first 18 -months to establish a cleaning frequency. If the filter is observed to be relatively clean after a six-month interval, then the interval can be extended to 9-12 months between cleanings. If the filter is observed to be relatively clogged after a six-month interval, then the observation and leaning frequency should be shortened to 3-4 months Ault A 1buZing WaAc:The ADV should be thcckcd at the time the pump and float system is checked. Each discharge Diiae of the ADV has a section of clear PVC pipe, through which the flow of pumped effluent can be observed. To check that the MW Is properly alternating through the outlet pipes, the observer removes the lid of the ADV vault to see the ADV. Then activate the pump and observe which outlet pipe the effluent is discharging through Tura nff fhp viva pre eding the pump; wait for the effluent to drain from the ARV and allow the cam to drop into position. Open the valve again, and observe the ADV 8'1218 — 4211 County Road 37 OWTS Design Report August 22, 2016 - Page 7 t tf- Y. effluent rlirrl-, �t•n'nn through a diffor nF vI IFInF one• rn 'nzt these steps 7. mays tk }aL the vI �luc It is Ctls Y .argil g through a u,. ct plW l I -I��-u these each cutlet pipe. Report the results on an Observation Record Form. Soil Treatment Area: The surface area around the STA is to be observed monthly for signs of failure such as lush vegetation growth or effluent pending. Liquid levels within each field section are to be observed through the observation pipes, and levels recorded Flow to 1. [:�t,.1 ' } W� ,. I-..II.d iL..,...,.-. Ii..,-. u!d GG4I I IIG5�J i.�7 LO LP %.UI IIt+JIIC\.I U Ii URA h CC IS'. ',1 U1111✓ .11 1.4 pill Il I YIQI IYIVI .]. General: System users must realize an onsite wastewater system is different from public sewer service There are daily considerations such as not putting plastic or other nonbiodegradabie material into the system. Water use should be monitored so toilets are not allowed to leak when seals malfunction Allowing fixtures to flow continuously to t L..4- I:... 6.. lam, -.1 [..� rte„ is of .. n...-a..,i, Ir f b J t through h Fll et Ik. YYdlC7 ICf kG.? fl UI li ING'C.,f. fl Ivy I.l not Q4L.G�+LpLJI G. Laundry should be Spread out LI li VkigI the week to prevent hydraulically overloading the field. Although the proposed system can accommodate varrable flows, spreading water use over several hours and eliminating peak flows is recommended. To illustrate the point, a malfunctioning toilet can discharge in excess of 1000 GPO Excessive daily loading could flood and irreparably harm the OWTS. Discharging fats, oils and grease (FOG) from any source into the household drains can be detrimental to the OWTS. COWC strongly recommends that the owner limit the. use of any garbage disposal and dispose of FOG. uneaten food when cleaning dishes before washing, food scraps and food preparation remains into the trash and not down the household drains, tCUW c ..dutiUli, dydlllbL II idlldLIUll of d wcLcI SUILCIIei tit dlsl.l1a41,f1es to tiiC Sept* a OWTS, The chemical and hydraulic loading from the backwash of a water softener may be detrimental to the OWTS and a separate drywell should be constructed for the backwash waste, if a softener is installed. The design of the OWTS is based on the treatment of domestic sewage only. Swimming pool or spa water should not be discharged into the OWTS. The proposed OWTS design is based on the flows noted in the report. Increased flows may hydraulically or organically overload the OWTS. causing premature failure, LIMfTATION'S Our investigation, layout, design, and recommendations are based on data submitted_ If conditions different from those described in this report are encountered, COWC should be called to observe the conditions and rnoke design charges if necessary !f proposed cor.structibrn is changed, COWC should. be notified to evaluate the effect of the changes on the wastewater system. All construction is to be in accordance with the current OWTS regulations. Pipe type and size, burial requirements, septic tank construction, and other specifications, which are not depicted in our report. are to conform to the requirements of the OWTS regulations. The system installer shall be licensed by the county health department & have demonstrated knowledge of the LAW tS regulations & requirements. This onsite wastewater system design is intended to be used only for the wastewater load specified in the STA calculations and for the site indicated on the subject line. Any other application of this design is not authorized by CHURCH Onsite Wastewater Consultants. LLC Use of this design for any other area on the subject lot than designated. on any other lot or for wastewater volumes or strengths not indicated, constitutes a misapplication of the design and voids all liabilities on the part of COWC. B1218-4211 County Road 37 OWTS Design Report August 22 2016 - Page 8 E nis onsr�e wastewater system design is intended to be used only for the wastewater ivaci specified in the STA calculations and for the site indicated on the subject line. Any other application of this design is not authorized by CHURCH Onsite Wastewater Consultants, LLC. Use of this design for any other area on the subject lot than designated, on any other lot or for wastewater volumes or strengths not indicated, const;tutes a misapplication of the design and voids all iiabifities on the part of COWC COWC encourages the owners of the system to research OWTS operations and maintenance information and also visit online websites providing OWTS information htt .-ttwww co weld co vs/De rtrtietxts[HealttiEnvirann�er-itll=nuironmenialHealt_h}Se ticSystemsf �v tuux' hill, www r stc.edu or www c ;ow.1jc[ to ie rig i rvw the Ov%7S shhld uL,ha operated and maintainete--._. If there are questions, or if clarifications are desiredplease feel free to contact COWC. Sincerely, CHURCH Onsite Wastewater Consultants LLC. Kathryn E. Carney, M.S., P_E. 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AIL €GLJ& I -NT CC$5 FWICLES 5 -[ILL SL EXTENDED TO A Iry 0- 12 B SJW EI& DFI OF !}S ET? LJO. 4- 3ISCI-PRGE RIPE SA -L i1AVE AN AITE,VAGIJUM REllET vQY.. Al HIGH r'OII(T BETWEEN 1i_ ADY NYD THE PIL11r- oUri i 5. 'Ulna SFlAlu HAVE A COLD WEA1lCT I)ISL1-I 1155_µ[3[V. ,LL- Ill IN F]FSCE.AR45 ASSWB.f S-VA_L DRJN E7r.GK 14TO S F'TC TNk_ L-. ALFERI4ME TANK CL IGIP.M1O 5 AE f- POSSIBLE WIlI^ 'RION 0411it1' APFRa%AL OF DES[ENrtEJ F17 7 5LO F IRIS IED GRAt)E AWAY FR7W 1ANK 4175 AT MIN 5W FD F 5 -TLET, MIN SLOPE—I•CtLAF7FR IS 7% AWAY FROM TANK. Es. ETHL'NP ALL RIS[P ID I' ►&.7V[ 7JTFAGE AT FINISIIEC GRME 4 FtE1 SEPAIATION G11.CL'LATIONE: E1AICD ON A FRO1:1 RANGE FR£cAE CONCRETE TANK VIII 3-INCIR BOLIT&I F;IN 4 IF OTHER TANK MFG IS USF11, CONTACT [LESION ENC%ZLR FOR 5R I1rATiOI OF 005E VOLLIME NO MIO—SEAM TANKS 5 TALL EE aL1I)WEO. 10. PROOF ROLL SUE,GPADE BRIAR TD [ACING BFJ3OlNo. COMPACT SFI7CMG TO WIN 95% F1A%- 0171' OLNS'TY, !1. PROVIDE EXCAVATION FCF. IT 11 ACCDRCLWQE W/QSHA rREGI, ATIQIIS TO FURNISH A SA rE WCPKING L1N,PQN4AfN' fOF INSTALLERS. 12. FAS N FL[L T TREC FiETAINLR TO FA.L LIE TANK LIT ACCESS I -0L1_ 13. EFuTULATL TA TIC U([ AID RISERS if/.' CLCUEO CELL Fll tHIULATEIN AT SITES INHERE TRUST PENIETRATION EXULUL Sv 14. PRONUE A °-TA@LE 5UNGRAp FLIP. 'INK. CJFREJTCJ TE ALL &GET h Till HATE. TiALKFLL w/i/2' IAINIi1 $aep. ELCKFIU_ & C'0MPACT IN UFTS TO 11137 P1PES EfFORE INSTAL'LN.T, PALES. GLMPACT ALL SUDGP+LL & SIX TO MIN 95% MAX CFI" DQt51rr PER AFTI CB9s, T5. FEACKE1LL IN HAS 2' :IFT5 AROUND 'ARK IC Ua17ov OE dFILEF ANJ QVTT,I_T PIPES ULFIAlL HI7CIAO PIPES, RED PIPES FlETDPF PLAc io. I. INSTALL GROJN0 MA7£R IAONrTOF*1G APE Ill TANK €;,CAVATIQ}L LENT TO TAW WALL AT hlI,P,]IN1' t3. ET'TCNO C0N)UFT FULL LENGTH T:1 C'IYTROL PANEL FURNISH A I+ISlAL A COHOUIT TEAL PER NIOS INSTRLICTIONT. ❑OSING cALCIII ATluN$ VOL LA7E_AALS - 15 5 CLALS 3•-5 TIFAES LATERAL VOL - {£-.`: -- 77 5 DCL5 YOL 7PANs-aI:T PIP.- & WNCEOLD = '2.El tr•LS TLTAE. 0QSE 17L - 167.1 - 12-E �:AC5 - 74 GALS TANK G L5(QL0-l. 79 URAWDUll - 74.1 GAS --S,' 7.5 GALS/T+ - 9.5 IRONEE CHURCH OWCI LLCC Onsrtfl W ista Ste' CorssL1Il21 is r Er NeIVrviiUr F}r:'.-rrl i-Cr, Er-l'Iar.i'r, P!) F}.nr 16716 SlA.kr CT-' 9011' , —C i ['' I RPg Ss ; r, I:!.'. 11: Ur 111N 245[. ELLLlftIG4- a r]U,aE11Er8TS LINE 3151!. 7U-lJlF CRQU—, CDR PUMP'.d ONE 115Y. lO-AAIS C P.oUrr EAR COHTF015 EXISTING ',DOD GAL SEPTIC TANK AND 440 -GALLON DOSING TANK - - F[EL_RGLI. GAS*.TTEr UG W/ 2- FO4A IT-SIILATIr1N 21 INCI- r4C RI: -'R S/DPOAI.I[ S, — - 90NTL TO TAIL' Y:; RE�4NME-N0E17 ADHESNL TRLL Ft&TiL..E III F" VOTE 3) FT iY_TE9 VIOL c itF£ NOTE 3) WILATIT[N [-: rW'.L-:F ASSEMBL'i -FLTXSI [ PVC: — [.WN ,17Arr01 (f -,AST OR OCr4 -- > i HIGH WAILS 6+dp.1A BOAT )LICL > . PUMP ON F1 OAT �'jr R'UMP UFf Fl ilA7 u. uL1 INLET P]RT: o. PF5005 EF-LLJENT HIIIAP FLOW IIWSJEFFI T IWEIF li&gSiFICE 5" EIEEDINC 5.4110. TYP d44 -GAL F L fix TA WITH I NCH AN71:B_4�1 _LNG_ NTS M4 15 ILOAPO TITLE FLEES �'L5d�dEYL TN. R _..?' MIN INSLIL80rRO AU. SITES OF RISER --F-i. . Sol- HETWEEN RISER IN,L TLA 19N rg,,h, Ih51.l l_ICl?rr ARC f•.ISFR FLOAT E11VATICIA SEThHOS: SET THE -110H WATER Al FLOAT ACTEVATGF ELEV 1—m0rl BETOw 1I-[ TANK IN,.FT ELLVATItd SET 7%•H- I'UMP )N FLOAT AiCTIVATIOll ELEVATION 3—INc FE$ ltT0rM tHr HIGH Wr.TER FLOAT ATNAT191 LLEV SET IHT PUMP WE FLOAT ii ACTEVATC [LEY 4.S —INCHES RELW THE KFJMF ON FLOAT ALTTVATIOIV I I' . I R1>Nvr • T}€TIONI C sr 1;711 - t]E{A sE;.. L� EMFILFKIL., - N;LT [11111 d21f7.1F I5 JO13 NO. Bi218 3'inute3of7 Pump Selection for a Pressurized System - Single Family Residence Project 4211 CR 37 f JOB NO. 81216 8118/2016 Figure 4 Parameter larsmarge Aasemigy5lze 2 00 Indies Transporl Length .afore Valve B6 felt Transport Pipe Class 60 Transport Line Size 150 in�es orslrfbuting Vale Model 8658 Transport LangthAfIPrVatve 30 lee.t Tianspnrl P. CIasS 40 Transport Pipe Size 1.25 rndres Max Elewatian Lift 5 feet hlanirold Length 15 4:et Manifold Pipe GIesi 40 Manifold Pipe Size 1 25 inch Numberof Lareialc perCali :4 teterel Length 50 feet Latcwal Pion clean 4G Lateral Pipe Size 1.25 inches odnee sine 1re tndle9 Onfiee Spacing 3 laet ResduaI Head 5 laet FlowMetar Nore ind1es Add-cnFridJan Losses 0 feet Calct�l e1ionla Minimum Flow Rate per malice 0.43 gpm Number ofCnf0aSperZahn 66 Total Flcw Rate per Zone 29 5 gprn Number of Laterals perZone 4 % Flair Mfferntlai 1MLasl Orifice 1,3 9i TranseortVelocityOeforeVeIva 4,7 fps Transport Velocity After VeIve 6 4 fpn Frictional Head Losses Loss through iare 1.7 feet Loss in Transport Before Mahe 44 leek Losslhruugti VaFve 95 feet Loss in Tnsn sort after Valve 3.2 feet Lossii Manifold 05 feet Lossin Laterals 02 Feet Lassihrough Flewireter 0.0 feet Add.n' Fmmor, Loeres 0 0 feet Piae Volumes Vol all Transport Line Before Valve 9.1 gals Vol of 1Fanspprt LiheAftervalye 2.3 gals Vol of Manifold 1,4 gals Vol of L. tIreIs perZore 155 gals Total Vol Before Valle 9.1 gals TbtalVolAfierhhrl.a 193 gals Minimum Pump Requirements t]eagn Flaw Rate 29 5 gpm Totai Dynarnic Head 295 teat livauraL.�i u.,v.r.1%yW dxr�ni -' 160 140 120 0 60 H 40 24 ii uio�uuium io■UIU null I W mum in iii I II1IIHfl 1uI 4p 10 20 30 40 50 60 70 50 Net Discharge {gpm! Pompl3ata PF5005 High Head Effluent Pump 50 GPM, 112HP 1l 5J237V 10 6101-117.204'23nV 3EDA}F I PF5007 high Heed Effluent Pump 50 GPM, 314HP 230V i060Ha 200f230l460V 3P09Hz PF5010 High Head ElFcent Pump 50 GPM,1HP 230V 1$B0Hz, 2E10J4S0V 3110H PF$015 hf'ph Head Effluent Pump 50 GPM. 1-112HP 2 : t2GCt1;20 VZe",rllz System Curve — Purnp flrrve: ,-- Pump optimal Htarige.- c reralJng Paint! ; Design PolntQ EINI,I",C,i 4≤' GRAC; _-.-__,'; -.-:SACKT:L._ --;P1 �f111s Y \ '-.CIL. e' { (`` ' 6}iM1l_�SEENmri-F :y 1 aT"_R L, TYP I 1.25 SC HEG 14 PVC _ 1.25' 5C14(.3 4i Vf. .F';,.3*=' LABRiCJAHIFOLG ,` FPL, .. OH FROLf A{.T+. 1'ta gFc-TUN ::RF`.YF_L, iYF - - T9PJi,M. } Ii1E. GEdA7k: l tot-_. -25 -H ' .`-FLI ay, -----' - - - IL'„' ��' :.- NF 4,..'E P z F'IFE LARi f r: .lC rti 9r IS-i PRESSURE STA NTS 1 5" SCAf4 4U P4i !'RU PLJ►IP 1.25SCIIEC 40 PYC 1LWIFOLD — 1 3.5' BEI'A'EEt'I LTRL5 1 1 B-OL1'F�'i D2SERVA'IOY1 PORT — f AUFOMATLC TO THE 3OTTOMI OE PIS TI TING VALVE RC., Typ a t 1.25 SCFFEO 40 PRE LATERN_. i'T I I fLUSHING ASSEMBLY, TYP--•- -- r, rJ PS PRESSURE STA NTS WELD COUNTY ESAGCRITERIA 5 BEDR01Di RESI0ENCE LonpINCw 0r(75X3X2jt(75X2)- 600 ,PO CR JNF1LII AREA, -0/0.15 LTAR - 4,000 SF A1lEA USED hN D Si. 4z' w'EE X 100' LONG - 4,204 5F SE PAFI.,TIC'. FABRIC- i-ALL RE IIIRAFI l JLN CEbt411LL. _, OFSERVATtfiN FIVE, %RE RL:OUIRz1). TI- E tiAlJLTCD -JBS PIPE SH{JM1 i4 O'TIIJNa1 AT THE OISCR_i1ON DF THE 0*NER 3T.Nlxa❑ O3 PIPE I +Fl-'ukA70Ia SHALL C1lIT TF,E VAULT AN❑ LXIENII .TFPIPE MIN id' AIQ%t FINIS,ED GRADE. 3. ::. .4LA1E THE SOIL REATMEHT AREA 55TA} A 75-Ih1CHF,'S R!LBW F-X51NG C,Lkx 4 rW5T4LL. PAIN! 12 TAL EILIMA A,.C*i3 THE IJFi-VPIL LACE or THE STA 'O DIRFCT RUN-OIFF WII- F'k0J 1l -PE STA ALL PRESSURE PIPE SHALL BE SCHEDULE 4C PVC ?IFF ALL LATERALS SHALL BF ih5TALrED LFL1EL. PLACF LATERAL PIPE QN A LIIIllI I M OF b" CII GRAVEL P,A.:;EC 7N -H! OGTTL7u OF L CAjATI0l1 1'ERF'3RATED PVC IAERALS SHALL IWVF I/e'• ORIFICEv !JN 3E" CERs THAT FACE 6 LO','' PO 31Tl'H FOR D AJNA,E ALL OFIIE5 SHALL BE C4'EII4TC BY ORIFICE 5WFELD5 CLRTRACTOti SHALL IJRN�5H 1110 INSTALL M SOP 35 F -I) 0E'SER1/ATI If1 FIFE AT ThTF FOUR C'3i'N_l i OF THE 51k I.4'1OE .PRIG SHAD BE Ti: RESPoNSIBILETY ]F TrFE OWNLF :,EL RL5 sN RtFORY FOR oii i{ L- FA w WASTPWATER LIYITATII N ,- k AXIYLII FTTDRAULIC r-LCW= GXC UPC k AXIMLII WASTEWATER sIFZ.GTH. 250 mg/L BCEI L XIMLrM TOTAL SUSPENDED SOLOS. 210 mg/L 4AYINLNI FATE. AILS & GI'LAS5= 64) mci/L 1'40 CI- dc. ID --'CF LTF,LIf_'IJICY4 CHPiILICF 1.25' Fvt E - X I -PT AEJAFTL' W'/F'LLUC fit" FLHU 1.25' BALL VALVE ti 1 25" Ft SP00 _ -1.1S" PVC LCNt� rJ',ft ,. r,. SWEEf` 9C7' H£I.L .••�.c", , 11-, -Sfi'V :SOIL FLUSHING ASSEMBLY Ii. CHURCH OWC, LLC I't•r.ctSiur+FIS : IF. ,rye I,t L}E-SLuNCr3EV 41i:I -- L:HAA.N5Y ONA 1., r1 ric W'IC '.k'.Nl J).�I ('!I5IJ idH�_ —�,_. _ GHECKLII5'1 }LFC �- - liasleiwatx �L+C+ri.: �iny {.ivl _r: -a�nn: aATE W 12_JI a.a x Iy IIf.vLld r.COL4L�^,z OVER -EXCAVATED CIIAME1ERED SOIL TREATMENT AREA DETAILS ��--- 1!7$ HO- B12I9 !24:B`� „:C1.1 �,.�an3atr.3-?a. T-- — _ �_ � Figure 5 c4 7 AUTOMATIC DI5TR}BUTIh O VALVE ADVL NTS OR7NCO MOLEL FRO ELL4- ESL' I? F PIPE -� SEE NOTE I L.+ PROFI_" If+ 1BCRGLAS5 LOCJFw4 .I{I SEE NOT- -ZTPiBI T NrI PIF. ^ R,TYU U MP B r 13 x 5 6 cML' --5 -- E NOTti 5. TYP 12n' OUTLET PIPE, TYP -- =NE. RISER �ISTRIB J'RON VALVE - i-PAF.T FVC 1JNICN (TTP) 5'-12R" R PUCEJi, TYP --- EE NOTE 2 VAULT PI -E E35701NG —F:LrTLL1 PIPE TYP =ACE UNDER UNION NCRES. 1. B4 Kr`i'_.. & COk.PACT TOR, BE'w[FN RI4FR ?W INSUL431ON. J'P 2. VAULT SFJlL EE 5JZET IC ALLOW ACtM'; TO PIPE LNIONS TC FAC1LITA7E RCIAMAJ. OF 4UY. 3. SLOPE TINISHEO CRAVE AWAY J-PfU REF AT MALI 2K FOR 5-F'EE1 4 OUTLET CONFlGTJ-ATJON INOJCA1rLi 5 G£NI R,C. RE'FEAENCE REPORT FDA rr;TUA1 NUMBER OF OUTLET PIPES. 5. IN=.ALL 3' RICH PENS TI ()414 i"ES L.JI'I':N AT -UP OF A.TOY/A1IC NJSTRIE?LITINC VALVE. COVER Will- SOIL TO FIMSHEO GRADE, B FUi1N!SH AND IN .TALL WIN 2' TH:CI( Hk -I OTNSi1y 1{WI$LILATIDIJ QWR ALL PrPINC NOT HLIRPED TO MN CULl1T' UUNY D'F74- T. CENTEI M1N 24" WIDE INSJLAT:ON BOARD OVER CROWN OF PIPE. 11. 3 —PART JNIONs REQUIRED ON ^ AO' IONWECTOks TO INLET AN-: n1uT-1`r PIPES. 9. INSTALL CNU AS ENO ATFC C SUPP}R? IJN NCJQY & 4LOW REAL OF UNIDNS. 11LL EML W/5Cu'. 10 PRC'L'I0E SPACE +3ELQ1Y LP,JONF FEB I5;5FwrBlr. ANC El-- SENCid WTPIY 1?' ELF UNJG₹IS F]R PFr OEDO'Nu. DI5TRIBL!TIOP4 MINIFOLC & VALVES PITS E.5EFPLEHT PPE 1-5' DISTRIDUT1oN / FRO4 PUMP _ _ eSEZ NOTE 1) - - --, /-' 1.S" PE SD' /-O (TYP} 1.5' P40 ! 1 TEE (7YFl — T___.. _ � I.5' PYC zir FSAL_ VALVE ._OBEL ��) 1 $EC7lOk5. lYP T4 4J3 N -W CFA S FA I. DIETRIBUTOl! µANi'1;LE, 4FW1 BE INET,TLLEO LEVEL. 2. SEE FICVRE 2 FOP, LOEATIONEOF ESF_L VALVES AN❑ [ILFRIHr.I' ONJ 'NIFOLJ35. 3. E1T ¶- LL 3f INSTALLED AT THE h1EI' POINT OF T;4F 5*ST--kJ IJI, is 5LOPC E-IALL L7l PRIVIOFI 70 LAAIN EFFI.J'ENT FrOAI A[) TL N.YA ANSI SEPTIC TANI(. 4. FURNISH AN INSTALL 13A4L VALVES III A VALVE UCK, TI-),-' CIF IALYE 3CK 8 RrsER 5FML_ 6E IISTALLF' 3/2' ABOVE FINISFEI) GRA0E W,TF; SQL SLCPINO AYiAY FPCII.J IID AT Tx r1NIIJUL1 SLOP€ LAIMI EA :fL-'E F{JX LID WfCORRECT V.&J T IETT_PS IR INDELIBI;. . FALL VALVE ARE PPOVOLI) T➢ AMLOII SOIL LREATMEP' ANEA3 TC EL CLOSED FOR OIIrl JO NI[5 µAI3'JTENANCI.. FIRYN4 THE STA OPN FXTEHO THE LIFE ON THE. ELO CHURCH OWE RECI M11EROS RLSTING THE EYISi1N; 5TA FOR. ' YEMR, OLOSFII} ARIA SHO{JLD 9F P.OIATED I IPUALLX. IL E.ONTP.PCTOP 01LAL_ LABE_. EA. OLTiLCi FNPE wrtti coRT cl LLT EfF IKE' NUIlAAER. IN INDF JBLP SJARRER, INSIDE E3O)C• 6N TOP ON PIE, VISIfii.U: TO MCRFYQRIN43 .i MAW—EMKCE ENTITY. 7. CLMRACT 01iCNARRE PIPE SUUGRVWE w/SEVERAL PASSE= OF I PUSY- BEHIND 0HRA.7LIRI PL&IE CR VPING JACK COMP)CIDR TD CONSO{JDAT S: II_ B. PACICFLLL TC OF CDMFA,^TED TO &C J MAP 0R* NSIT' (ASW 0699) IN LANDSCAPE AREAS & 95x MAX PRY OCNSITT- IN VP905'ED AREAS 4. i•URNISH NV) IIJSFPLL CNFOUGHT VOLEIANT SEED] LIIX, 'F TLPE. 'PIPE' LIP LNJOTNLFE APFREVUI) EQUAL, AM) I(Ni TILJ'E IT!1 l7ME RELEASE FERTIL)7PRS 3E -P) DAYS AiTER `,rLDV-G SEG MIK -I-ML [NJ -.fF,F_j AT SPIN 3 :13/ '.030 SF OVER ALL ri:.45 LiISR)RBED -3`c' C1vITRLICTON •.t f.R3' '-l-B _EF,LlOr Il, E"A. FSICNEL13"- NEC CHURCH OWE, LLC ----- MwwNeY kwµ rorl;llt rJa lE 'JC C _ C:nsLltant.' rPECI TD :: g�G rIS 'P'fV9^ •Wr1I�+r Ln.J n(N'r.n, r AUTDMATIC DFSTRIBU"ION VALVE AND ..__ "TE' :I Ear i --r D1 -I -N flr, '�},1NHIII;I MANIFOLD DFTA3L$ —�' JOB NO. B121R ,.. .:, I.`. J1 tJi{!�-;J•':n d, -v%n, c799 'U4: = -- -__�..' -.._ ._ F1ciure 6 of l —WTCn ET AC Fier W.TCH E[d T — �RAOE ` • SW CUT ASr Iv -T ONLY. ' NA9 01Nt' TYPE CUT -C r7> L# l D 15r Le+sUNC JICL5S LL,:\!T-. ' i ti C! LI SE PACkFILL za n p •+Cl 'UAThI EYI5f SLES-&A( o o e 4 J °r .'I � `..'P a C:r T JPF P Ef+ CSHN 4FulrF7EWEN'S SEE NO7 1 ❑ 5-- a Y— W41ti--'A9-si SEI5C EPTrBLE ��. F1LL/R rF FILL ➢E PTN V4R•L$ . — `---' 9cGUINC .U.I'L TYP V ALL 7-R35 PIFE 13LRIEp F'PE- BUILDING SEWERIDFSGHARGE PIPE SECTION NTs `RENCH Lr�C:II.L-- -- 2 X 24" HIGH CLIi5{T ' ._ FOAM w5L Lkr r'- RFC -' P£ -_ _- /2- MINUS-•---_._— rRA�dHIAP VACNFILL ULA1ION 70HUI--- *07V- no# PIPE 7,"F- CH 99TTOd NOTES - CEM EF W 1H C^ JNSULR4MD (-VER CROWN CF PIPE cOMPA7 HEOOIHC TO EFOTECM LF PIPE ELEVATION BEFORE PLACNG PIPE 3. EUFNNFSAIJr IN5TIIiL SA -N 3' 01 BEUCING BELd11 t3OTTOh Of Elf L 4. iDNI= I.f PI. r€CT'4N 15 Ai-PPO51LL41E FOR AJEAAME WI+ITER wPOS-. PENETR41CH 'FLNc i NOTES: I. PLAC : V COMPACT BLBOlN[ kAT➢RJA_ 10 EICTrOFA CF PEE EL+ATIOH I3?FOE V_:TALONy PPE BL➢DING SHAL- LL IN PLFCL, AFIPFCTED h PIPr J.ESTf[LEtl Al T'UE OF CCI*C I ST4J4M1TIG+N B65FRVA11('N 3, BUJr7 C'CPTH M€AN5 C151AHCE FROM FINIS}tEt GFADC TC' THE PIPE CROWN, 4, FOR L.I.AA1011 WHERE TIE MIN PIPE eVRv CEFrrI-I PLO C'JI,NT[I RECIUIREl4C'.T5 IJwE,PT 3E MET, A MIN -1F 1 pF --5H OEh311-I :_OOE➢ CELL FW ' IHSUII,P,ON CNBE SUBSTITUTE : FnR EA I i' CF 5g[E i:OVER THAT IS L O'ING. A Ml J OF :?' OF FC1+N rFSULBIAR7 SHALL BE REOUIREC. ST'IRDr-lkw IEEAC ROARII IS IJCIT AGCFPTE4:E 5, MIHIkLM IN.SULl ICN WIDTH IS [4', CEN-INED Oei? CRl WIA OF PFFE. 6, ALL :C4PAL;TIOh SFLALL ESE IN ACGOROANOE FF1FH ASTL .]-699' COMPACT FILL ,f h1ACKFLL. OLTHDE RIGHT OF IFA'r TO F.IN. 90: .jot RR- JEHSrrr COMJ'ACi FLL f 541K11[. 7NSIUE RIGHT r7F I'jF 70 MIN 95% kAb DRY 7ENSTr. CHURCH OWC, LLC :Jn ;4E W iatewarFr ' OflOialtan•s Wrrr yan Er'nr*w rq.C. u i r rCi'•rr :rl I-' _I 6c,: rN T CFT1 PC (;U -Fl V' I r,',I) F98 3 7 E :.1i Tr 'Irk -A rCr- '[, TRENI,H, PIPE CAP AND LEF,NDUT DETAILS ZAP IIEF`H, TIP `�+, •' �— PC CAMP ��,� `v4W CUT. TYP f Fvc tLFAHaln, VENT, OR OFISERVA110IJ PONTS RISER PIE CNt Na-IES, iAW CITE TI 1E 'CP OF THE PPE Ti- OE" OF TFIE CAP ON THE GLL)RAF<TS 9F :HE PJ?E TO ALLCR EASE OF TA[ RL7lC*+AL IN 7r E FU7 ,RE. 2. CET, IL APPLIES TO ALL GESS£1 VATIOH PORTS AHD RrSF PIPE S . NLARcLEANOUT.�$P-- NTs I._ I ,r . - AGE r LAIGH.t Ht L c�rEOlt€J I z CATS di2:l.IhH, JOB NO. 81218 Fraure 7 of 7 APPENDIX A SOIL LOG, ORIFICE. CAP DETAIL, and NRC.S SOILSREPORT 3O:B NO. B121B 4211 CR 37. OWTS 2 I�4 5 6 7 8 9 In TEST PIT NOTES: 1 2. 3_ TP-1 TP-2 0" -- 36, LOAMY SAND FINE GRAINED, nYR 4/3, BLOCKY. STRONG. F1RM f 36" — 49", LOAM W/ REDOXIMORPHtC FEATURES AT 51". 1OYR 4/4, BLOCKY, STRONG, FIRM 49" — 57", CLAY LOAM, 1OYR 4/4, BLOCKY. STRONG, FRM 67 — 96", CLAY, 1 DYR 4/4, MASSIVE 0" — 30", SANDY LOAM. i OYR 4/3, BLOCKY, STRONG, EXTREMELY FIRM ... 10YR 3/3, BLOCISY, STRONG. EXTREMELY FIRM 56" — 100", CLAY, 10YR 6/4, BLOCKY, S f RUNG, r IfRM NOTE'. WATE1. WAS ENCOUNTERED AT THE EXPLORATORY PROFILE HOLES WERE DUG USING A JOHN DEERE 31 UE BACKHOE. THE PROFILE HOLES WERE EVALUATED ON B-15-2016 BY KATHRYN E. CARNEY, PE OF COWL. FREE WATER WAS ENCOUNTERED A7 A DEPTH OF 6B —ITCHES AT THE TIME OF EXCAVATRNG• CHURCH CWC, LLC Onsite Wastewater Cansuftants Onsite IN s',e.va. r Eng'neering-Civ i ngneern9 P.G. Sax Maine f7 0 699-3434 -< li : Y r;yI ,4F;" JE7E4NT © Topsoil Paverrent N Fitl material V1 Sit V1 Clay Sand k I Cabb€es 10 Ciaystono 5andsione ""^ L:Gi i mi Ficu 1rV eaV ie red (;Heir 4211 CR J7, SCHRADEA OwT6 SOIL LOG DI�TE 81 2 21 29 1 6 FFoI}r'0 Al .IIiIli. ::i. IIITiiI - -K flrifttto. hIDtfIc a IIJJIII■! Applications Orerit Orifice Shields are used in a pressurized distribution system to trrnrw'1 the rrrfiric firm harkfll rtphr,c that mir3hr rairp rrrifira hlockar P Orifice shield irrsrafied on fatera) pipe, stazrdard configuration Shield r----- JIT C, iiway view standard con�rguratinn 4nr Shki Li Cutaway view, cold weafircr ct 7irgwation General Urenco Ontire Shields snap -ht anti) laterals.They may be placed on ?nn of ni firma.Rth a liIn'al drr ndiri orr the krr tine of the nrific Orifice hieltts are covered by rnethod-oi-use patent # 5 360,556 Standard Models OS075. OS100, 0S125. 05150, 0S200 Product Cade Diagram OS 125 Lateaf pipe size• nominal- IIiJ LI !J ilk, 1e Lf IIIlIL1 1 Ot m 1 0011 125 min) 125 = t 29 in (32 rnm) 3 i)4 = 1.CC in (40 non) 2W - 2 t 1J in 150 inrnl Gr;foId Material of Construction PVC per ASTM D-1784 rIy iL Q, .a rrrrl,cltrrllrlrr� h+1r, F'l Stvield Q_i . Latsra pipe O'n. F1!, (111' . ([13m ------..---- --., {15100 3.5t l 1.315(M t?5 i 25 3.5 Xz 1.66 t42) 05150 4,5{l14 1.90 (4 OS2OO 45U4) 2.375 JW 3r iuca Syrsteras' c, , 3 f4 Arawdir A►rd.• Staihkri 4, Cif-7475'VSFi' ; t0 Ttl-,F rx3 '#d43 u . 41-4 44 5 • t4ww'd enu urr rr'G Sr -as R .t.i,904115 GaRal M1 Soil lMip—lead County. Colorado, $oudrem Part (f312B. Soil Map, 2046-8.22) MAP- LEGEND MAP INFORMATION p rea of Interact 'AOII Spoil area The sod surveys that comprise your AOl were mapped at 1 24.000. Arne of interest IAQIi stony Spot VVarnirrg; Sod Map may lot be valid at this sc�de. oil Sn very'Imy epct E,iafgerrent of maps bE yond the scale of mapping can cauSr Soif vlap unit Pafygoro wetEpot rniunde€standing of the de.tati of mapping anti accuracy of scat tine . • Sort Yap Unit LJne$ placement. The maps d.s not ;chow the small reas of contrasftrig U Soli 41ap Lind Peels Other soils that could Have heron Shown at a more d=taile3 scale Spec II Lrne Featur s sptcial point Features Please rely on the bar scale on each map sheet for map gluwoLt Witter Features measurerrlenls, Borrow Pit Straarin and Canal: Seuree of Map: Natural Resources Conservation ServitE rr#ntportation Web Solt Survey DRL, http lrwebsuilsurvey arcs usda.gov O Sp° t-�+ Rails Coordinate System Vleb Mercator (EPSG 3857) Closed Depressor y irate safe H hways ME ps horn the Web Soil Survey ate based on the Veb Mercator Gravel Pit US ulles Rra prt,fec-tiwh on ich preser res direction and sha:)e bu: dislorts distance and area. A. pijectrwn that preserver, area such as the Gra`elly Spot Major Po Alliers equal-area conic arolection should be used rl more accurate Landfill calculations of distance :r area are-equired Corm Rte$ Lava Flow Th s produd is generated from the USDA-NR[CS cerlihed data as of Baekpround the version date(s) lister! below. Marsh or swamp Aerial Photography Soil Survey Area: Wed County, Colorado, $oPart trtl'em Mine ?r puerry Survey Area Data Version 14, Sep 22, 2015 Miscellaneous Mar Soil map units are labele J (as space allowsi for map )cafes 150.1)01] Perennrak Water or larger. Rock Oulrrop Date{s) aerial images were photographed Mar 16 2012 --Apr 13, 2012 + saute Spot The odhophoto 01. other base map ❑n which t.ie gt;il Irr25 v re Sandy spot co t,pile'I and digitized probahly diflars from the background — severity Eroded Spot imagery displayed on lh•=_se maps- As a rewuit, sorre nenor sniftinq of -nap unit boundaries :nay be evident. S rnY.hde Silo or Slip % Sod -o Spot Natural Resources VVeb Soil Survey 8J2212t 16 art i:onaervation Service National Coaperafn'e Soil Survey Page 2 cf 3 Svl M *JFJ Ii Caunly Colorado SouIr Fri fan 8128. Sail Map 2016-&22 Map Unit Legend Mhld County. Colorado. Soslhrn Pore JCO6151 Yap Urn Symhal Map unN llama �� llcras M ACI .. I Pasant of AO1 72 Vona loamy send. 0 to 3 percent 0.8 13.4% elopes 73 Vona iosmy sand, 310 3 pernar1 50 $6 b r Totals for Arcs of Inisrest 6.0 100.01% llaMud lUssonces web soy Sw sy 11192=16 G1on - - - - srr Sarrlcu Ms1ei Coopereire Sol Ssrrrey Papa 3d 3 Map Unit D scriDiian: Vane loamy sand. 3 to 5 percent slopes --\Held County, Colorado. 6126 Soil Map. 2416.8-22 Southern Part Weld County, Colorado, Southern Part 73 —Vona loamy sand, 3 to 5 percent scopes. Map Unit Setting National map unit symbol. 363s Elevation: 4.600 to 5.200 feet Mean arrr7ual precipitation 13 to 15 inches Mean annual air temperatwre- 48 to 55 degrees F Frost -free period. 130 to 160 days i-armiana classimicarion. Not prime farmlana Map Unit Composition Vona and similar soils 85 percent Minor components: 15 percent Estimates are based on observations. descriptions, and transects of the mupurnit Clescrrption of Vona Setting Lendform- Terraces plains Down -slope shape: Linear PiLrVS3-5iu�rC Jlr G. Li ledr Parent n7atorial: Alluvium and/or eolian deposits Typical profile H1 - 0 to 6 inches: loamy sand H2 - 6 to 28 inches: fine sandy loam Ff3 - 28 to 60 inches- sandy loam Properties and qualities Slope 3 to 5 percent Depth to restrictive feature: More than 80 inches Natural drainage class: Well drained Runoff class, Very low Capacity of the most hmiting layer to transmit water (Ksafl.- High (1.98 to 6.00 in/hr) Depth to weter table- More than B0 inches Frequency of hooding.' None Frequency of ponding: None Calcium carbonate. maximum in profile. 15 percent Salinity, maximum in profile Nonsaline to slightly saline (0.0 to 4.0 mmhoslcn n} Available weter storage in profile Moderate {about 6.5 inches) interpretive groups Land capabilily ciassificafon (irrigated): 3e Land capabrlrly c1assficafro7 (norrrrrigatcd): 4e Hydrologic Soil Group. A Lcologrcal site: Sandy Plains (KU6/8YU24UU) Hydrrc soil rating: No tdr , Nahual Rsaources Web Soil l2212D16 Conaerratian Servtce N I nnat CaoperaI ve Soil Survey Page I of 2 Mai) Jilit Pescnp�ion: Vona loamy sand. 3 to 5 percenl slopes --Weld County, Colorado. Southern Part Minor Components Rernm it Percent of map unit: B percent Hydrrc soil rating No Valent Percent of map omit: 7 percent Hydric soil rating No Data Source Information Soil Survey Area: Weld County, Colorado, Southern Part Survey Area Data: Version 14, Sep 22, 2015 B128- Soil Map 2D16 -H-22 N#1ura1 Reawlrms Web Si Su+vey 912212016 Canservatlon 5ecWca National Cooperarnee Soil Surrey Page 2 cf 2 •C 1iRCrf C i ire W'a,tvsVf.,r of 11, 1r,E September 19, 2016 Mr. Ray Schrader 4211 County Road 37 Br€ghton, CO 80603 Subject: OWTS Installation Observations 42-11 County Roau �1 Weld County, Colorado Job No. B1218 Mr. Schrader, As requested, CHURCH Onsite Wastewater Consultants, LLC (COWC) performed a site visit to observe the installation of the onsite wastewater treatment system (OWTS) at the subject site. COWC prepared OWTS design documents under Job No. B1218 dated August 22, 2016. A site visit was performed on September 16, 2016 at the request of Steve Dickinson of 2O Enterprises, ises contractor 4 f sftc t 10 . n-icr Front Range Drnrarf L to p� lzl Jz the n�ractar of record. + l the tll I ll. L the .]ILL. visit, Si 1L 'u IL11 1 1 Ll li 11L1147t 1 1 L4ti.14 concrete dosing tank was installed following the existing 1,500 -gallon 2 -compartment septic tank. There was an Orenco Biotube effluent filter installed in the outlet of the existing tank with a high water alarm. The 4 -inch SIJR 35 PVC pipe from the septic tank was installed with greater than 2% slope to the dosing tank. The tank contained an inlet tee and an Orenco PF30011 effluent pump in a flow inducer. A watertight riser and lid was installed on the tank with a waterproof splice box and was extended to the elevation required for finished grade. A 1.5 -inch Schedule 40 PVC effluent sewer line was installed to a manifold that contained two ball valves to direct effluent to the new or old soil treatment areas (STA). There was an air vacuum relief valve installed in the piping preceding the outlet to the existing STA. The 1.5 -inch effluent pipe continued to the highpoint where a 6-uuLlei duturnakic distribul.iity vdlve was iimtalieu with alt ail vacuum relief valve in an insulated vault. The piping was installed with adequate fall back to the pump tank. The gravel and pipe soil STA was installed 87 -feet wide by 49 -feet wide with 1.25 -inch Schedule 40 PVC manifold and lateral piping. The manifolds and laterals were installed level. Orifice shields were installed covering the orifices throughout the STA. Flushing valves were installed at the end of each lateral and valve hexes were nnsite fnr installation at the time of backfill. Four observation pipes were installed in the four corners of the STA. The control panel and floats were not wired at the time of the site visit; therefore the floats could not be verified. COWC received video of the pump and alarm functioning as the floats were raised on September 17, 7016. The observed components of the OWTS appear to be installed in general conformance with the CHURCH OWTS design, plans and specifications. The system is currently operational. S'„1 r17'l•! 4!1 i i'L'fr I !LU-ii`��f--f$-'-i - s • _Ii 4' OWTS Installation Observations, Job No, b1218 So� - n -,k r 1O 7F" This letter provides information from observations made during one visit to the subject site by COWC. COWC observed installed components of the OWTS. COWC did not observe the installer's methods or the equipment selected by the installer and/or client. Neither the observations nor the contents of this letter imply a warrantee or guarantee of materials, or workmanship. Without continuous observation of the installation process, COWC is not able to assure that elements of the system comply with the intended functionality of the design documents. If there are questions, please call. Sincerely, CHURCH Onsite Wastewater Consultants, LLC r. • J Kathryn E. Carney, M.S., P.E. Onsite Wastewater System As -Built Drawing 2. 3 4 7 In ! Y 19 32' 47' ' . . -4 140 163' r H A $ $ Property Address 1 " Permit # 5P -Jla Pa2.$0 System Completion Date , Installer Name 2 D 1 �s '{ Installer License # IL 0100133 Installer Address PZxiV4-•��u�►o, Installer Phone 1 4110 r `DY 3 lI - K e z :_T Ex4ST/J * fL r _ Hello