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Home My WebLink About20220032.tiffFOIN �o. PUMP INSTALLATION AND TEST REPORT Fr Ofeo. U.. only ws •32 11190 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER RECEIVED t, WELL PERMIT NUMBER OCJ 1144 2 OWNER NAME(S) Mailing Add ressa4r.' City, St. Zip 3o Phone ( G3) '7 3. W9LLLOLOCATIpi+i_AS DRILLED; ) 1/4 5t- 114. Sec. (e , Twp. I . /V , Flange 6 b tom? DISTANCES FROM SEC. ONES: ft. from 5 Sec. line, and _.*SO It. from Sec. line. SUBDIVISION: F T BLOCK FIUNG(UNIT) STREET ADDRESS AT WELL LOCATION: ? V 4. PUMP DATA: Type L Installation Completed •1-•- 13 - Pump Manufacturer Pump Model No. n S S L -f t 031-5. . Design GPM = IQ at APM HP Volts o Full Load Amps 1 Pump Intake Depth _ -I( Feet, DroplColumn Pipe Size Inches, I{lnd c. ti ADDIPONAL INEP1MAT1ON F A PUMPS GR AT 50 PM: TUR9INE DRIVER TYPE: ❑ Electric O Engine ❑ Other Design Head feet, Number of Stages_. Shaft sLze Inches. 5. OTHER EQUiPMENTi Aldine Installed QYes [!i Nc Orifice Depth ft- Monitor Tube Inslalled ❑ Yes ® No. Depth ft. Flow Meter Mfg. _ _ Mater Serial No, Meter Readout ❑ Gallons, 'Thousand Gallons, ❑ Acre feet, ❑ Beginning Reading 5. TEST AT : ❑ Check box tf Test data 1s submitted On Supplemental Form. Data -.f Total Well Depth _f ' Time Sr , Static Level jfH Rate (GPM)_, _ Data Measured Pumping L'1. 7. DISINFECTION: Type 14T y _ Amt. Used I '/ . )p5 di lueJ4 tata 8, Water Quality analysis available. ❑ Yes No 9. Remarks 0. I have read the statements made herein and know the contents thereof, and that they are true to my knowladg jPursuant to Section 24-4-104 (13)(e) CMS., the making of false statements herein constitutes perjury In the seCOr degree and Is punishable as a class I mi,demeanor,j - I CONTRACTOR 5pai. Senvcce. Inc. Phone (303__65-/584 Lie. No.71S Mailing Address 2{ 2 E. Lujton,Jo. 062{ Name/Title '(+Pleasse type or print) CrSignature _ y� r A. Oatyy })��. To W. J�3aLrl ne iL ETtt /)+ N r �`�V r4 J — F ri+ MO- w WELL CONSTRUCTION AND TEST REPORT G''i5-31 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER t 1,`40 For ceo. U.a only RECFIt/ED H.2 94 f�Ctti�� S141>I� 1i 1. WELL PERMIT NUMBER _ 1. a ti s 2. OWNER NAMES) Kent Dreher Mailing Address 16321 WEst 93rd. Avenue City, St. Zip Westminster, Co. 80030 Qhas►a ( 303 ) 429-1979 3. WELL LOCATION AS ORiLLE4: SW 114 5E 114, Sec.• 12 Twp. 1 N-, Range 6 66 W DISTANCES FROM SEC. LINES: 250 ft. from S Sec. line, and 2480 IL from E Sec. line_ OR SUBDNISION: Martin Bro . P11O Amended P1 LOT w..0 BLOCK FILING(UNIT)_, STREET ADDRESS AT WELL LOCATION: 4. GROUND SURFACE ELEVATION ft. DRILLING METHOD Rntary , DATE COMPLETED . TOTAL QEPTH ioo fLDEPTH COMPLETED tt. S. GEOLOGIC LOG: DUO Dawe oftn d MU ffipa. . Cow Wmw Lon) IL HOLE DLAWI"' in.) Fran (R} Tc jft) 8 1 1 l -- fY - _ f, 111 ? - 100 7. PL4JN CASING 00 (in) Kind Wall Size From(ft) To(11) 6 5 8 Steel .188 �+1 72 l` ++iARIL_ ____ ________ ________ ____ PRF. CASING: Screen Slot Sze:3/ / 1 s " torch o1 4 /2 5tee1 ,-1$B --2Q_ 101° _ _ F9flRLt �1iip shalaisand tnnP 1PrlgS 81 f1-9 90 Pc x hi l 1 RAndc _ 9Qn-1Q0Q RT.1]P Shel R - _— 8. FILTER PACK: Material N/A Size - Interval 9. PACKER PLACEMENT: Type Haliburton Basket placed at Depth _ 10. GROUTING RECORD: Material Amount Density Interval Placement >mant 1 flRna i :1 i 1! 0-72 ❑i y— REMARKS:5, 1 DISiNFECTtON: TypeGraflUlar Chlorine Amt, Used 3 cups dissolved in 5 gallons wa er, poured rough drT1T pipe & agitatedrough zone Wg" TEST DATA: ❑ Check box if Ter Data is submitted an Supplemental Form. with air. TESTING METHOD Air Static Level 560 ft. DatG(rime measured 6-17-94 4: 00pm Production Rate 12 gpm. Pumping .level Jet L i ng ft. DetelTlme measured... , Test length-(hrs.),,.2(hr s Remarks at 100 3, 1 hay* raid e. arWrrnd mad. hw.in and Iagw tlr aanwnw iha W. and thM w MX 10 rw. WKW* A" tPWWAWd 1b 9.edon 24+101 1131101 C.R9.. 4w m.* n d hiaa i .r ra r h.Mn oon p•rlurn in ft - - d 4pni and i Our Wsr6ia = a oias• , rnfadamaandr.l CONTRACTOR John's Drillin Inc. Phone ( 303) 423-5246 Lic. No, 827 MaifingAddress Rt. I Box 640 Golden Co. 80403 NamelTtle (Please type or pilot) Lloyd John Owner/President Signature Date I 7-15-94 7f INSTRUCTIONS FOR WELL CONSTRUCTION AND TEST REPORT The report must be typed or printed In BLACK INK All 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 well owner's name, the perm.number, form name(rlumber 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. The original and one copy of this roan must be subrnlllad to the State Engineer's Office within 60 days after completing the well or 7 days attar the perms expiration data, whichever Is eerier. Another copy of the form must be provided to the well owner, 1. Complete the Well Pam tR Number In full 2 Fill In Name and Mailing Address of Wed Owner where correspondence should be sent 3. Complete the blocks for the actual location of the welt where drilled. It the owner has more than one well servingtllls property, provide the identiflcWon (Owner's Despoil) for this well. DO NOT USE THE OWNER SUPP1J D LOCATION unless a survey has been provided. For wells located in subdivisions the lot, block and subdiv ion lnfgrnatlon must also be provided. 4. Report the ground surface elevation In feat above sea level N 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 depot drilled and the actual completed depth of the well, 5. Fully describe the materials encountered in drilling. Do not use formation names unless they are in conjunction with a description of materials. Examples of descriptive terms Include: Grain me —Boulders, gravel, sand, sift, clay. Hartz reea.-Loose, soft, tight, hard, very hard Color —All materials. Most critical In Sedimentary rock. Depth when water Is encountered (If ft can be determined). 6. Provide the diameters of the drilled bore hole. 7. The outside diameter, kind, wall thickness and Interval of casing lengths must be Indicated. 8. Indicate the type and size of filter (graven pack and the interval where placed. g. Indicate the type and setting depth for any packers Irtstailed 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 pips or positive displacement The percentage of additives mixed with the grout should be reported under remarks. 11. Record the type and the amount of disinfection used, how placed and the length of time left in the hole. 12. Report well test data as required by Rule 10.7. Spaces ate provided to report all measurements made during the test The report should show that the test compiled with the provisions of the rules. if a test was nor performed explain when it will be done. If available, report clock time when measurements were taften. 13. Fill in CCoinpany Name and Address of Contractor who constructed the wall. The report must be signed by the licensed contractor responsible for the construction of the well .-Form No. OFFICE OF THE STATE ENGINEER GWS-20 COLORADO DMSION OF WATER RESOURCES ale contomw Bldg. 1313 9hsrm.n at. O.nvrr, cotorwdo 503 qm0 ee&3491 APPUCANT KENT DREHER 6321 W 93RD AVE WESTMINSTER CO 8003O (303) 429-1979 PLAIT TO COTRUCT A WELL WELL PST NU11tl D1V. t CNTY. 82 WD 2 DES, BASIN MD 827 Lot 1 8loo1- Ffrrq: ffiebdi, : MAP11N 8ROTHEflS PUD AMENDED PL APPROV,j. WELD COUNTY SW 114 SE 114 Section 12 Twp i N RANGE 66 W 6th P.M. DISTANCES FFtQM SI=CTION LIMES 250 Ft. from South Section Une 2480 Ft. from East Section Une ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDfl1ONS OF APP13O9►AI 1) T Is well shall be used In such a way as to cause no material Injury to existing water rights. The iSsudnCs of Itle 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 shalt be in compliance with the Water Well Construction arid Pump Installation Rules 2 CCR 402-2, unless approval of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installs Ion Contractors In accordance with Rule 17. 3) Approved pursuant to CRS 37-92-802(3)(b)(I) and policy of the State Engineer under the following conditions. 4) The use of ground water from this well Is limited to ordinary household purposes inside one single iamity dwelling, watering at domestic animals and the irrigation d not more than 12.000 square feet of horde gardens arW lawns, as recommended by the Oivislan of Water Resources to the county commissioners. 5) Production from this wait is restricted to the t arartale-Fox Hills aquifer which corresponds to the interval between 810 feet and 1095 feet below ground surface. Plain casing shalt be Installed and sealed to prevent production from other zones. B) The maximum pumping rate shall not exceed 16 (3PM. 7) The annual amount of ground water to be withdrawn shall not exceed I. I acre-feet, 6) This well shall be constructed not more than 200 feet trom the location specified on this permit s q Node.- To insure a maximum productive life of this well, perforated casing should be sett rough the entire producing interval of the approved zone or aquifer Indicated above. APPROVED DWR sm. [moM No. 0366388 z >e DATE ISSUED M'1AY 3 1 1994 9TION DATE MAY 1996 rs�:s.rK<. 76 COLORADO DIVISION OF WATER RESOURCES II StR Centennial Bldg.. 1313Sherhten St_, Denver, Colorado 00203 eIV� RPERMIT APPLICATION FORM VE1E Applkatlon must W 014194 be complete where {)'C1 A PERMIT TO USE GROUND WATER r9l applicabie. Type or print fn BLACK ()1 A PERMIT TO CONSTRUCT A WELLmm1 It FOR O1 A PERMIT TO INSTALL A PUMP 9k � INK. No overstrikes 04LQ. or erasures unless ( ) REPLACEMENT FOR NQ . initialed. 1 } 0TH ER /735 WATER COURT CASE NO. (f APPLICANT - mailing address NAME _-lP 1]FFfiPt- /�— STREET[ r_�Lv CITY (JLrP r15fP�Q. L]�o b (State) 1210) TELEN40IYE NO. (2) LOCATION Q]]F PRO SED WELL County of the I/, Section /2 f1 i�Y Twp. IL , Rig.___ 1142 P. M IK,SI IE M (3? WATER USE AND WELL DATA Proposed maximum pumping rate (gprnl Average annual amount of ground water to he auorvprtated (acre-feet}r_ Number of acres to be irrigated: a •`- C. V. Proposed total depth (feel) Aquifer ground water is to be oblained from: d Owner's well designation GP t, Nyi WATER TO BE USED FOR I I HOUSEHOLD USE ONLY . no irrigation 10) ( DOMESTIC (1) { I INDUSTRIAL (5) LIVESTOCK (2) ( l IRRIGATION 161 } COMMERCIAL (4) { I MUNICIPAL (B) I OTHER 191 DETAIL THE USE ON BACK IN l} 1 ) (4) DRILLER Name _ _ , Cho 5- /Cc// F Street U 1AQbtfa 4 City Ca. tali ,�7 q Telephone No. — Z L "2 Lc. No. �J - FOR OFFICE USE ONLY. DO NOT WRITE IN THIS COLUMN Receipt Basin Gist. -- 1Zk 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 riot assure the applicanl 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. iL-t4-T4 I Aw 5 rJ 1J Y ,yhnJ; F f1 Et f ti L- 3est C()PY Available APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION DATE BY 1.0. (STATE ENGFNEER) COUNTY (5) THE LOCATION OF THE PROPOSED WELL and the area on which the water will he used must be indicated on the dielgram below. I Use the CENTER SECTION II section, 640 acres) for the we location. — -j- ± - I �i ----- 1 Mtl.e, e280 FEET { + - + + + + -f- + - I � I + — _ NORTH SECTION LINE NOa1'rf r 20____ __ U lfJ j h l N ( l � I 4 +_ t 11 rn I 1 i N I rn #I 1 1 SOUTH SECTI j + + + - f - f I I ! I The scale of the diagram is 7 inches = 1 mile Each small square represents 40 acres. WATER EQUIVALENTS TABLE (Rounded Figures) An eGre•foal cnvars 1 arre of land 1 foot dean 1 cubic foot per second Ictal .. 449eailons par minute igpml A I1mifV of 5 will require epprovenalely 1 acre -loot of warer per year. 1 acre-foot ... 43.550 cubic 154r - 325,900 pill❑rra 1.000 pn Pumped cpnrinreu,It for one day Produces 4.42 acre -feel (6} THE WELL MUST SE LOCATED LOW by distances from section lines.y ft. from ' r secline (noetrr or touch) 1 bL ft. from + sec. line (ease or wellI LOT___'_BLOCK _BLOCK Ff ING SUBDIVfSIOIV_ - (7)TRAT 9NWH1CftVyELL LOCATED {7wner: ay4 fwekpr Of acres 5P 63 Will this be the only wall on this tract? (8) PROPOSED CASING PROGRAM Rain Casino in. from __ ft, 10 4 ft. I [r in. faom J -t. tr}20 ft. Perforated casing ;;,, _in iroln 5o t, to_______Q � ft. in. from ft. (9) FOR REPLACEMENT WELLS givedistance and direction from old well and plans for plugging - 10} LAND ON WHICH GROUNJiAIER WILL Owner{sl: P N . of acres: . t Legal description. v ■ (1 1( QETAI El O QESC.RLPT(4f L of the use of ground water. Household rite 4szd domestic wells must indicate type of dispossI system to be used. . _ - L , _ I L_ - - - - -I . L_ r _ - 1 . - (12 OTHER jA1IR RIGHTS used qn this land, including wells. Give Registration and Water Court Case Numb(:rS Type or right Used for (purpose) Description of land on which used (13) THE APPLICANT (S) STATE(SM THAT THE INFORMATION SET FORTH HEREON IS TRUE -TO THE BEST KNOWLEDGE. SlGNArt/FE OF APPLJC.ANT($1 Lite additional sheets of paper if more space is required. HIM WILL DU 5111! - D11T[1 11SI1, COMM RPPLICRIT. HIT DIRIIR RRCIIPT R4- 318113 L1lCATIOR- SI111 OR 81111 41 5tC 17. T 11.. I.811. Il50 SSI,, 2411 111.) PRDPOSID 1g1T11a, ,1! 141U IiiLS 51111('1 1f,U 11011 5955 111111 OP 1CIKS I1 T11CT: S-03 1t 1181 I?P WITITI t1141rY #f1RINIRt Or IIIIrIPlt1r1 s B s fnIS1RRT NIP St 10 TIS 1P 4115IYItiAR fUnit 1RGMrlT11IAR PLII MR In IC Dl!. TI 4fRMAIit1lll I1c IYr11Mlt1iIPA MI 1PPIll11l. PT TI1 Will' 11AItCt111T RP11(R, DITR DY I,RTTII IS 1ommyA1 AI Sll16111S11FI AI TIICY At I,I101CPtrl11, Ir9TIlrYMES- erlllltei by 41 oI IP116 29, 1194 ►1,1!1!1(01 AIPTI 10 RINIAL --------------- II, .__._ .__._... RPPIOP 8fl IS >'DnIr1R R1l7 TAP sun POT TOP 1-r nPPrl DREDI ___- --.- ---- - -- Irw tI Ai1SA1 ---- --- Ar11rr rl"ll RIIPII0t UYVII 111fJAt 191.1 461)1 Ion .119 I.1fI 0 Rai 111 IL&H11I-P0111Li.A a91 4741 UI Isis 111 1 112 IT Mot a- R 1�Airatop 1firRt;ar is rt 4aniP.r h4arr1ar1 1++! TIIL+e Vol 1rAre htt giJ ld ta, • +•AI_^`-- nrnnnrr,I analrr All ■r. Pp rl,# { I R Aafa hAea a.t+a bini4 ill leRraher nt late. Scanning Cover Sheet for Septic Permits Permit # HE94:0:135 Permit Type: F ieaith a Gi is i iia tur y i 0 13 conver sicn i"iisbr Situs Street Address 17601 CR 10 Situs City, State, Zip Sec!lowniRanae• Parcel # (12 digits( Owner Full Name: Owner Address: Contact Name: Contact Address: 17 -fl 1 N_JAW 147112403001-RO223994 GREIN CONSTRUCTION P 0 BOX 381 BRIGHTON.CO 80601 Apn1ition Stattfa- Finalerl Application Date: 03/11/19913 Owner Phone #: :3U;3 65938#9 Contact Phone# Information above has been Verified in Accela by emolovee noted below X_ August 26, 2008 Processed by Date Report ID • EHS00024v003 Print Date -Twme: 8132612008 10:39:11AM1 Page 1 of 1 • r ' HSP1O6P INDIVIDLAL SEWAGE ➢IEPO8AL SYSTEM PERM;T NO. G-940135 MELD COUNTY HEALTH DEPARTMENT NEW PERMIT ENVIRONMENTAL HEALTH SERVICES 1517 16TH AVENUE COURT; GREELEY, CO R061 353-OG35 EXT.2225 OWNER GREIN CONSTRUCTION ADDRESS P D BOX .381 PH (303? 659-3969 BRIGHTON CO 80601 ADDRESS OF PROPOSED SYSTEM WEED WOO i-6 r car FORT LUPTON CC 80621 LEGAL DESCRIPTION OF SITE: 5W4 SEC 12 TWP 1 RNG 66 SUBDIVISION: MARTIN BROS LOT 0 BLOCK 0 FILING 0 USE TYPE: RESIOENTIAL WOOD fRA1E SERVICES: PERSONS 2 BATHROOMS 2.00 LOT SIZE 5.00 ACRES BEDROOMS .' BASEMENT PLUMBING YES WATER SUPPLY PWELL APPLICATION FEE $150,00 RECD BY DATE 03/31/94 SIGNED BY KENNETH GRIEN EN DATE 03/31/94 PERCOLATION RATE 10.0 MIN PER INCH LIMITING ZONE 8 FEET SOIL TYPE SUITABLE PERCENT GROUND SLOPE 1i'. DIRECTION N REQUIRES ENGINEER DESIGN NO IN 100 YEAR FLOOD PLAIN ZONE NO FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON -SITE SOIL PERCOLATION DATA THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED: SEPTIC TANK 1OGQ GALLONS, ABSORPTION TRENCH 549 SO- FT. OR ABSORPTION BED 780 SO. FT. IN ADDITI❑N, THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND CONDITIONS: THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT MAY BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SET FORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE D I SPOSAL SYSTEM REGULATIONS INCLUDING FAILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPORARY DR FINAL APPROVAL.. THE ISSUANCE OF THIS PERMIT DUES NOT CONSTITUTE ASSUMPTION BY THE DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR INADEDUACY OF THE SEWAGE DISPOSAL SYSTEM. p PAM SMITH 04/C)4/94 L ENVIRONMENTAL SPECIALIST DATE C. THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI- TIONAL TERMS AND CONDITIONS REQUIRED TQ MEET OUR REGULATIONS ON A CONTINUING BA- SIS. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE COM- PLETED SYSTEM BY THE WELD COUNTY HEALTH EJLF RR UNLIV SYSTEM INSTALLER FINAL INSPECT " ATE __ SYSTEM ENGINEER APPROVAL TYPE OF SYSTEM INSTALLED x � ENVIRONMENTAL SPECIALIST THE 1 SSUANCE OF THIS PERMIT DOES Nil IMPLY LUMPL I ANLE W I I H U i HE=hi S i A! t, LUUN I OR LOCAL REGULATORY OR BUILDING REQUIREMENTS, NOR SHALL IT ACT TO CERTIFY THAT THE SUBJECT SYSTEM WILL OPERATE IN COMPLIANCE WITH APPLICABLE STATE, COUNTY AND LOCAL REGULATIONS ADOPTED PERSUANT TO ARTICLE 10, TITLE 25, CRS 1973, AS AMENDED, EXCEPT FOR THE PURPOSE OF ESTABLISHING FINAI. APPROVAL OF AN INSTALLED SYSTEM FOR ISSUANCE OF A LOCAL OCCUPANCY PERMIT PURSUANT TO CRS 1973 25-ld-Lll (2). ORIGINAL --APPLICANT; COPY-WCHD WCHD-EHS MAY, 1D84 .,y !ta`':Ehlr:F' IfIlPI-'llU1.Jr'IV :i1.:.6lll f: [sF'(i,ril, :31'!ii'1-:..f;l'f1'E I{Ca.. I I•r',L., II.iC:a.,.X) ( CilJl•1 I" I El:: i"i! - C1 I Y}f # "111:I I°II..I'I�' Id1::-(rJ ••i• F;YI-( 1 i.il. I IF i^,I d i f !;1::I=;:Lf:! (',;1r; ; :. 1,! T' I-. ,1 -. U 7 I I I ... ,. ..--'.1 ti.. . C)1.{::[:• {;l:i 1'a T 1=(JC; i L t:ih! r i17t•l:: `,r:, ! . ( ii.].: S E i:II (.1a:Ifit•IIFlll {::(j i`i:i. t:li- !'ii1ll L-iisl:::l1 3 7 :i i l -!'I (+JC;I ' _`i-.'' rry.}!_i I:JL:IC 1..i i•YI'•; 1' I_ III•r C'I! C'd j i3rt;,F':I F ir d._ 1i1::' i(.F, 11I' f ( iiJI! 4:11 `:r',I: T F :: :UJ 1 ;il I ] .' C'Ir:'' I, r:I I(:: ,5dir llII LI'# C;I (:)::i L(:1I i? Iil Cil;#:I !} [IL I:l•II:; r} 411::. I TII:: !':I::.,:Y.#.J..'I:.1--E1 1 r11 WOOD IIii1# J--F2V i,f:l i:: Ef,,[.4{IIE:'i 1silII(1{'jl'I:'s <_ till l III f; I /!:: i:I ri- }•!_r„II'll• 111(: y;1 d.LTIh; ;:1;fII..' !&JI.:.1..1.. r[-•I:'I_1i' I-.l.fil�I i I F: 1:1!"0,.t}r} I:(: I•II:I? 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COLORADO DIVISION OF WATER RESOURCES 838 Centannlal Bldg,, 1313 Sherman St. Derrver, Colorado 80243 (303) 866-3581 827 APPUCANT WELL PERMIT NUMBER _,.`�:} ' DIV. 1 CNTY. 62 WD 2 DES. BASIN MID Lot: 2 Block: Filing: Subdfv. MARTIN BriOS PUD APPROVED WELL LOCATION WELD COUNTY MARK & MONIQUE I-1IMMELREIGH SW 114 SE 114 Section 12 P O BOX 281 Twp I N RANGE 66 W 6th P_M, FT LUPTON CO 8(1621 (303) 857-9318 PERMIT TO CONSTRUCT A WELL DISTANCES FROM SECTION LINES 1000 Ft. from South Section Line 1825 Ft. from East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONE) TONS OF APPROVAL 1) This wall 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 14 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 wall shall be in compliance with the Water Well Construction and Pump Installation Rules 2 CCR 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 CR5 37-92-602(3)(h)(I) and policy of the State Engineer under the following conditions. 4) The use of ground water from this well is limited to ordinary household purposes inside one single family dwelling the watering of the 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 of Water Resources to the county commissioners. 5) Production from this well Is restricted to the Laramie Fox -Hills aquifer which corresponds to the interva) between 755 feet and 1040 feet below ground surface. Plain casing shall be installed and sealed to prevent production from other zones. 6) The maximum pumping rate shall not exceed 15 (3PM. 7) The annual amount of ground water to be withdrawn Shall not exceed 1.1 acte-feet. B) This well shall be constructed not more than 204 feet from the location specified on this permit,41A t� Note; To insure a maximum productive life of this well, perforated casing should be set through the entire producing interval of the approved zone or aquifer indicated above, APPROVED , 1e? 9W6v EiQlh By Fleceipt No. 0377240 DATE ISSUED DEC 12 194 EXPIRATION DATE DEC 12X996 Z =n. •I ✓ WELL CONSTRUCTION AND TEST REPORT For Otfic u only 10"» STATE OF COLORADO, OFFICE OF THE STATE ENGINEER Rf C # 1. WELL PERMIT NUMBER 1 3 `95 2 OWNER NAME(S) Mark & Monique Hirwielreich Mailing Address P.C. Box 281 City, St. Zip Ft. Lupton Co. 80621 _f"r`t' Phone( 303) 857-9318`' * WELL LOCATION AS DRILLED: 114 _rF114, Sec. 12 Twp. 1 N . Range ,6 _- ,yam• DISTANCES FROM SEC. LINES: 1 nnn ft. from c Sec. line, and 1R25 ft. from E Sec. IinB. OR SUBDIVISION: Martin Rrns- POD LOT__ BLOCK FILING(UNID STREET ADDRESS AT WELL LOCATION: 4. .GROUND SURFACE ELEVATION 11, DRILLING METHOD Rotary DATE COMPLETED 2-18-95 . TOTAL DEPTH 1040 ft_ DEPTH COMPLETED 1040 ft 5. GEOLOGIC LOG; B, HOLE DIAM. (in.) From (ft) To (ft) r IrR�•sR... fb COLORADO DIVISION OF WATER RESOURCESJ ECEW Big Centermirll BIB., 1313 SMrmeh St, DaMr, Cgforado 611 APpllcation must be complete wfierf epplicettde, Type or print in OLACK INK Noaverstrikes or erasures unless initialed. PERMIT APPLICATION FORM IA PERMIT TO USE GROUND WATER I A PERMIT TO CONSTRUCT A WELL FOR: XAPERMITTO INSTALL A PUMP (11 APPLICANT - mailing address I REPLACEMENT FOR NO. I OTHER WATER COURT CASE NO. NAME 4 f Imo'k `� I r!one r "he- 1'C 4 STREET�} di /� _ CITY I `' L C�3 �] b e ) Isuu) 1 is+or TELEPHONE NO. &)3 i .q3/ (Z) LOCATION OF PROPOSED WELL County �-/ CI tt4 /of the________ 14. Section % Twp. f /= Ftrrog. rcc . t P.M 1 k.5r (E.01 (3) WATER USE AND WELL DATA Proposed ma,rimum pumping rate (ml .. L Average ennual amount of ground wale to be appropriated (ape -feet ): Number of acres to be irrigated: C] CJ .T. d � Proposed total depth lfertl- 7 Aquifer ground water is to be obtained fm to: FOX 1 // Owner's well designation USEDF R: ( 1 HOUSEHOLD USE ONLY - no irrigation (0l I DOMESTIC Ill ( I INDUSTRIAL (5] ( 1 LIVESTOCK I2} I I IRRIGATION (61 1 I COMMERCIAL 141 I I MUNICIPAL (8l I I DTHER (s) DETAIL THE USE ON BACK IN l i 1) (4) PBI.LL.ER Sueei kJ Uf i, f bx rd y o Telephone No W3_5 Y Lit. No. 2 Z- 0 014:94 TEM FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN Receipt No�. I Basin O1st. 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 vested grater right or preclude another owner of a vested water right from seeking relief in a civil court action. L3 -rte M4itTi<N ftrrNtw- Py0 oso S L kif gib_£ P+1 .kghts 12� &IN r. I Ar PL Kr �Al✓ APPLICATION APPROVED PERMIT HUMBER DATE ISSUED EXPIRATION DATE T`, "'_ l5Gili 6U,R, C{;cCh� r . � - F; } fF LATEfl tiE9L'tES MATE ENGINEER) BY I.D. -- , Z COUNTY_L-_5 a (5) THE LOCATION OF THE PROPOSED WELL ard the area on which the water will the used mint hs indicted on the diagrarn below. Use the CENTER SECTION f1 section. 640 acres) for the well Location, 4 1 MIt.E.5ZSO FEET }I + -- + + 1+ + --- ± f I I + C — NORTH S€CTION {INE t+____ NOATH � � m FA m ! 1 f } ( T + . i1FUrnaLLrl4N Lent + 4 - --l-- The scale of the diagram is 2 inches - 1 mile Each small square represents 40 acres. WATER EGUrVALENT5 TABLE lrloundiG F.guresl An sertf041 coin 1 acre of land 1 IClot dtkp 1 cubic tool per second di). .449 eiIIQn$ per minute lgpml A family of g will '!quire aPProeuroltlly I acts -fool Of wit! per veer. 1 icrp.1 or .. - 43,560 cubic feet . . 325900 gallons. 1.000 gum Ou roped continuously for one day produces 442 acre-fr rt. (6) THE WELL MUST BE LOCATED BELOW by distances from section lines- ) O ftfrom d`� set:line (nort'h OF moth) ft. from�1 �5 f set . line lain or wlitl LOT BLOCK FIL(NG ■ SUBDIVISION ►1 fir] Pic (7) TRACT ON WHICH WELL WILL BE LOCATED Owner?*JZiryr /2hii,et l rmm JV- C No. of acres .� . Will this be li V the only well on this tract? 1 rt s -I-- to) rmuru Ed CASING, PROGRAM Plain Casing 6 in. from O ft. to—� ft. t u 2` in. from h. to b J ft PerfnF led casing f _ in. from __ ftto1_ `� ft — in. from ft. 10 ft. (9) FOR REPLACEMENT WELLS givedistence and direction from old well and plans forplugging it: � EE3 USED= (101 LANG ON WH1CH GRbE1Np.._WATERWI �,• _/-kije1reiaLNo. of acres: Legal description: jjL j1tp.+j✓d am (1 1) T_ E TI .fzf_the -use-oLground_water—.Houteholduie-and-domestic welt-ntust indicate -type of disposaF - syifiRn #re used. }} .- f irsr L J,rJ,r,r A 4h- AA Cht- c I r .r- 11.A -CA, k 1z�T7i (12) OTHER_fATER RIGHTS used on this land, including wells Give Registration and Water Court Case Numbers. Type or right Used for Ipurposel Description of land on which used (13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE. I 1 r . WGNATURf OF Use additional sheets of paper if more space it required. EXEMPT YELL DATA SHEET - DENVER BASIN, COLORADO APPLICANT: H!MNERLEICN RECEIPT NO. 377240 LOCATION: SN1r4 OF SE114 OF SEC. 12, T.1N., R.46Y. (100* SSL, 1825 ESL) PROPOSED AQUIFER: LARAMIE-FOX HILLS SURFACE FLEVATION: 5010 NUMBER OF ACRES IN TRACT: 5 IS PROPERTY WITHIN SERVICE BOUNDARIES ❑F MUNICIPALITY S.B.5 CONSENT MAPS? MO_ Ys__ IF SUBDIVISION IS UNDER AUGMENTATION PLAN, CASE NO. IS , DIV. IF SUBDIVISION SFAS RECOMMENDED OR APPROVAL RI' INC WATER MANAGEMENT BRANCH, DATE OF LETTER IS INFORMATION CN SUBDIVISION ON TRACT OF LAND/SPECIAL RESTRICTIONS: evaluated by RAN on DECEMBER 2. 1944 ELEVATION DEPTH TO ANNUAL ------- NET -------•----•-- APPROP STATUS AQUIFER GOT. TOP SAND GOT. TOP A -F UPPER DAMSON ---- ---- ---- ---- ---- LOWER DAMSON •--- ---- ---- ---- ---- DENVER ---- .... .... ---- .... ---- UPPER ARAPAHOE --- ---- ---- .... ---- ---- LOVER ARAPAHOE 4678 4921 102 332 89 0-867 NNT *LARAMIE-FOX HILLS 3966 4257 149 1042 753 1.118 NT note: E indicates location IS at aquifer boundary and values may be more appruAimate. * indicates the proposed aquifer. ALL values are interpolated frarti the S.R-5 data base asseabled in Novenber of 1986. Scanning Cover Sheet for Septic Permits Permit # 9940559 - ___I Permit Type: Health 1 EHS History) EHS Conversion History Sites Street Address 17636 ARGIE ST Sites City, State, Zip SecfTownlRange: 12-01 N -68W Application Status: - Finale Application Date: 03/1111996 Parcel.# (12 d ►s) 147112403002-R0224094 Owner Full Name: Owner Address: Contact Name: Contact Address: HEIMMELREICH MARK PO BOX 281 FORT.UPTON.CO 60621 Owner Phone #: 303 8579318 Contact Phons# lnforrnaiion above has been Verified in Accela employee noted below x January 12, 2009 Prvoessed by: Data Report ID: EHS00024v003 Print Date -Tree: 111212009 12:11.25PM Page 1 of 1 . HSP1O6P INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT NO. C3-940559 WELD COUNTY HEALTH DEPARTMENT NEW PERMIT ENVIRONMENTAL HEALTH SERVICES 1517 16TH AVENUE COURT. GREELEY, CO 80631 353-0635 EXT.2225 OWNER HEIMMELREICH, MARK ADDRESS PO BOX 281 PH {303} 857-9318 FT LUPTON CO 80621 ADDRESS OF PROPOSED SYSTEM 1L /i' 00000 LEGAL DESCRIPTION OF SITE: 9E4 SEC 12TWP I RNG 66 SUBDIVISION: MARTIN BROS PUD LOT 0 BLOCK 0 FILING 0 USE TYPE; RESIDENTIAL HOUSE SERVICES: PERSONS 2 BATHROOMS 2.00 LOT SIZE 5.00 ACRES BEDROOMS 3 BASEMENT PLUMBING YES WATER SUPPLY PWELL APPLICATION FEE $265.00 REC'D BY CHAD YOUNG DATE 12/02/94 SIGNED BY MARTIN HASZ DATE 12/02/94 PERCOLATION RATE 5.1 MIN PER INCH LIMITING ZONE 8 FEET SOIL TYPE SUITABLE - PERCENT GROUND SLOPE 0Y. DIRECTION REDUIRES ENGINEER DESIGN NO IN 100 YEAR FLOOD PLAIN ZONE NO FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON -SITE SOIL PERCOLATION THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED: SEPTIC TANK 1000 GALLONS. ABSORPTION TRENCH 495 S. FT. OR ABSORPTION BED 645 S0. FT. IN ADDITION. THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND CONDITIONS: - -- DATA THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT MAY BE REVOKED ON SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SET FORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDING FAILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPORARY OR FINAL APPROVAL. THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR INADEQUACY OF THE SEWAGE DISP AL SYSTEM. w� PAM SMITH 12/07/94 �jjf 4� LENVIRONMENTAL SPECIALIST DATE THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI- TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING PA - SIB. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE COM- PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT. SYSTEM INSTALLER '('j FINAL INSPECT/ SYSTEM ENGINEER 44 APPROVAL TYPE OF SYSTEM INSTALLED 7t4p 4 ENVIRONMENTAL SP C LIST THE ISSUANCE OF THIS PERMIT DOES NOT IMPLY COMPLIANCE WITH OTHER STATE, COUNTY OR LOCAL REGULATORY OR BUILDING REQUIREMENTS. NOR SHALL IT ACT TO CERTIFY THAT THE SUBJECT SYSTEM WILL OPERATE IN COMPLIANCE WITH APPLICABLE STATE. COUNTY AND LOCAL REGULATIONS ADOPTED PERSUANT TO ARTICLE 10, TITLE 25. CRS 1973. AS AMENDED. EXCEPT FOR THE PURPOSE OF ESTABLISHING FINAL APPROVAL OF AN INSTALLED SYSTEM FOR ISSUANCE OF A LOCAL OCCUPANCY PERMIT PURSUANT TO CRS 1973 25-10-111 (2). ORIGINAL -APPLICANT, COPY-WCWD WCHD-EHS MAY, 1984 • Y _ • J HSf 1061 INDIVIDUAL. SEWAGE DISPOSAL. SYSTEM PERMIT NO. C-940559 WELD COUNTY HEALTH DEPARTMENT NEW PERMIT ENVIRONMENTAL HEALTH SERVICES 1517 ].6TH AVENUE COURT,GREELEY, CO 80-631 353-0635 EXT.2225 OWNER HEII1MErLREICH MARK ADDRESS PD BOX 281 PH 0303) 857-9318 FT LUPTON CO 80621 ADDRESS OF PROPOSED SYSTEM ethAA I 1 .�. 00000 LEGAL DESCRIPTION OF SITE: SE4 SEC 12 TWP I RHO 66 SUBDIVISION: MARTIN BROS F'UD LOT 0 BLOCK 0 FIL.ING 0 USE TYPE: RESIDENTIAL HOUSE SERVTCES: PERSONS 2 BATHROOMS 2..00 LOT SIZE 5.40 ACRES BEDROOMS 3 BASEMENT PLUMPING YES WATER SUPPLY F'WELL APPLICATION FEE $265.00 REC'D BY CHAD YOUNG SI3NED BY MARTIN HASZ. DATE 12/02/94 DATE 12/02/94 PERCOLATION 1ATE .±.._ MIN PER INCH LIMITING ZONE _ FEET SOIL TYPE PERCENT GROUND SLOPE _ DIRECTION I REQUIRES ENGIN ER DESGN IN 100 YEAR FLOOD PLAIN ZONE FROM THE APPLICATION INFORMATION SUPPLIED ANb THE ON -SITE SOIL PERCOLATION DATA THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE RE J D: SEPTIC TANK GALLONS, ABSORPTION TRENCH • so. 1='T. OR ABSORPTION BED SQ. FT. IN ADDITION, THIS PERMIT IS SUBJECT TO THE FOL_L,.RWIHG ADDITIONAL TERMS AND CONDITIONS------.__�___---,_ THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT MAY DE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SET FORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDING FAILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPORARY OR FINAL !•yf;'�"fr'OValn- _ ri-EE ISSSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE T'PA4 TMENT. OR !'EIS'tMPLOYEEE-O'F' L IAEIIL_IT..Y- FOR HE FAILURE OR INADEQUACY OF THE SlNAGEDISPOSAi SYSTEM. . ENVIRONMENTAL SPECIALIST DATE THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS NOT COMMENCED WITHIN ONE YEAR OF I:TS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI- TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA- SIS. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE CLJM- F•LETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT.. ORIGINAL -APPLICANT: COPY-WCHD WCI-IB-EHS MAY.. 1924 NEIL CONY HEALTH DEPAIIIlIE�IVT ENVIRONMENTAL PROTECTION SERVICES SI' t EVIILUATION ER: L 1LQ,� s I AAd(_{.iCw ._��.. APPLICATION *O.: w+ SITE: 4 L�.. C�•V 4 PT S( S, j�. T�� R DATE:_____________________ SUBDIVISION: !ls LT ? BLK €I.G �mima�aimaa:lm+ai'+a-- == PERCOLATION TEST DATA; S to r t Time._______________ Bola No. Sole Depth H20 Rain I- min. « min. iun. min. miri. min. min. miti. miri. min. Tn1 I zq Zt's S'b 9J 2 ZI0 ? 2c S' 3 Aso 4 yl+,� (`o 2#0 S . 31 6 rip c-- , All measurements in .ii unless otherwise indicated. +► - Add Ho :.• - } L(1 YU.A ' t5f' Environmeetal Specialist a Total 1)0,11 11 Average Rate 's PLOT PLAN /J.. SOIL PROFILE /lam q frr 1 ' •1 HE FSL06P APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM NO. 6-•4�1O555 WELD COUNTY HEALTH DEPARTMENT NEW APPLICATION ENVIRONMENTAL HEALTH SERVICES 1 517 16TH AVENUE COURT. GREEL_EY, CO 80631 353--0635 EXT.2225 OWNER HEINI1ELREICH, MARK ADDRESS PO BOX 281 F'H (303) 857-9318 FT LUPTON Co 80621 ADDRESS OF PROPOSED SYSTEM 00000 LEGAL DESCRIPTION OF SITE: 5E4 SEC 12 TWP 1 RNG 66 SUBDIVISION: MARTIN BROS PUD LOT 0 BLOCK 0 FILING 0 USE TYPE: RESIDENTIAL HOUSE SERVICES: PERSONS 2 BATHROOMS 2.00 LOT SIZE 5.00 ACRES BEDROOMS 3 BASEMENT PLUMBING YES WATER SUPPLY PWELL APPLICANT ACKNOWLEDGES THAT THE COMPLETENESS OF THIS APPLICATION IS CONDITIONAL UPON FURTHER MANDATORY AND ADDITIONAL TESTS AND REPORTS AS MAY BE REQUIRED BY THE WELD COUNTY HEALTH DEPARTMENT TO BE MADE AND FURNISHED BY THE APPLICANT OR BY THE WELD couN'rY HEALTH DEPARTMENT FOR PURPOSES OF THE EVALUATION OF THE APPLICATION, AND THE ISSUANCE OF THE PERMIT IS SUBJECT TO SUCH TERMS AND CONDITIONS AS DEEMED NECESSARY TD INSURE COMPLIANCE WITH RULES AND REGULATIONS ADOPTED UNDER ARTICLE 10, TITLE 25, CR5 1973, AS AMENDED. THE APPLICANT CERTIFIES THAT THE PROPOSED SYSTEM WILL NOT BE LOCATED WITHIN 400 FEET OF A COMMUNITY SEWAGE SYSTEM. THE UNDERSIGNED HEREBY CERTIFIES THAT ALL 15TATEME:NTS MADE, INFORMATION AND REPORTS SUBMITTED HEREWITH AND REQUIRED TO BE SUBMITTED EtY THE APPLICANT ARE, OR WIl.._L BE, REPRESENTED TO BE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND RELIEF, AND ARE DESIGNED TO BE RELIED ON BY THE WELD COUNTY HEALTH DEPARTMENT IN EVALUATING THE SAME FOR PURPOSES OF ISSUING THE PERMIT APPLIED FOR HEREIN. I FURTHER UNDER- STAND THAT ANY FALSIFICATION OR MISREPRESENTATION MAY RESULT IN THE DENIAL OF THE APPLICATION OR REVOCATION OF ANY PERMIT GRANTED BASED UPON SAID APPLICATION AND 114 LEGAL ACTION FOR PERJURY AS PROVIDED BY LAW. APPLICATION FEE $265.00 MA • IN 1-1A52 RECD Eli CHAD YOUNG ---__-•-- 12/02/94 DATE 12/02/94 OWNER/AOF.NT SIGNAT E DATE: ORIGINAL -APPLICANT; COPY-WCHD WCHD-EHS MAY. 1784 ;MR rev. PUMP INSTAL LAT1ON AND TEST REPORT Fw Oise. u.. err to STATE OF COLORADO. OFFICE OF THE STATE ENGINEER RWW J` �1�1CCUU {f 1, WELL PERMIT NUMBER /X05`? x 2 OWNER NAME(S) MaiUng Addrs#s wh'^ City, SL Zip Photo ) 3. WEU.LQ,C4_T1ONAS Dpi M, mod) 114 51„114. Sc, J2_T 'p. /_- !✓ . fian a jK — DISTANCES FROI1 SE. LINES: 593Ta h. from See. Arta. and �_ & From Sac « SUBDMSION: /,- LOT .� SLACK FTUN4(UNrI) STREET ADDRESS AT WELL 4- LOCATION: ' / PUMP DATA; T,I ] Installation Comp#ed }/itl/t c2 >��+_ Pump Marv.* tursr Pump *ot7M No. Deslg t O'ML et PPtrt NP1_Vori2F44o.d nn 1. - Pump Intake Depth Feet DrnpICoiurnn Pips Size Incites, Kind ADDITIONA INF Rlut MPS GR THAT PM TUPBtN€ DRIVER rcVE: Eleatic O Engtro OOther Qe, gn H"d feel. Number d Sieges Shaft; On kx:h a. OTHE'i ECUIPMENNT: S Ai:gr►s In I fled ❑ YssD No, Oditce Dept" tL, _ Mor*w Tub. Irataltsd O Yet}[] No. D. t TI_______ asa+. heater Softy N0. Mater Rsedout _altars. O Thatsartd GalIon here feet. O Qesnirq Resdry t! AT : O Cheat bait ! Test des Is subm*ted on &WOW I M fame. Dare Total wei! Depth - There___1.111.11111 Static Lsyst Rats (OPY) _______ Oats Measured Pumping IM. DISINFECTION Type j/T1 - Mt Used ___t 1�� 7, sl W aver Ouetily *nelysts wealia lAa O Yes No 0. I hem read the staternentsx rrssds hersln and knave the catterns fTretsal. and U they are true to my Irnowtsd (Pumkdrl to Section 24-4-t04 (13!(2) C.Ft.9., the malatrt¢ of fares stetsm.r hwem canetltut.s psrlexy in the sevor degrl.r end is puntsteblo as s cfsM I mtsdsmeertor-J CONTRACTOR £L 1* NO. Marerq AAddtess Nam (Please type arr prinq j SPgnalpDaw rx P�j FORWELL CONSTRUCTION AND TEST REPORT Far diw. ta. a* I-$ 3t STATE OF COLORADO, OFFICE OF THE STATE ENGINEER RECE I� ir�oa I` i. WEU. PERMrT NUMBER / OD 2. OWNER NAME(S) ► M 12'94 MattIng Addres9 IV j irrr.iflrgrNC�� City, St_ Zip ST' Phone ( t 1 /A -s -) —Ills 3. WE=LL LOCATION AS GRILLED: , r4 pus, sec. Twp/_, RangeCi? 0ISTANCES FROM SEC. Lulls: 6_ nL from Sec. tine. and 3� It. from ________Ssc- lire OR or .K or SUBDMSION: LOT_K BLOCK FIUNG(UNET) STREET ADDRESS AT WELL LOCATION: 4. GROUND SURFACE ELEVATION ft, DRILLING METHOD _ C� ___ R, LATE COMPU=TED 54 GEOLOGIC LOG: REMARKS: TOTAL DEPTH I ft. DEPTH COMI 7. PLAIN CASING OD (In) Kind Wall SLze - From(ft) ta(tt # • Y/? -, PE~RF. CASING: Screen Slot Size: & FILTER PACK: 9 PACKEffi PLACEMENT: Material Type Size Interval Death 10, GROUTING RECORD: aria- Amount Density Interval PI emer-t T, 1� 1 DISINFECTION: Type Amt, Used ` WELL TEST DATA: E Check tpx if Test Data is submitted on Supplemental Form. TESTING METHOD Static Level ft. DataJlma measured ?g f . Production Rate gprn. Pumping level ¶ R Dateliima measured jiMTW 9f....0, Teat length (hrs.) 3 i fi.r. nerd d,. rr.w.M. mad. hwrn rd ' ,au, Nr. ova.• twoA Ana Wr 1i. w v.r b'fM (H. rrrr r Saba 24+tN (I)ti art! I. a raw rawrrnnw tr.a.dur k tw o 4 " ww r wFs++a. ti. a asw ) mrd.+r.r4..l GO NTF;ACTOA " Phone L L: 51 LAC, No, Q Mailing Address /� , t Nam Title (Please type or print) Signadure Data -Doc) {cx�o Y Form 140. GW -25 APPLICANT OFFICE OF THE STATE ENGINEER COLORADO DMS1ON OF WATER RESOURCES $18 Cerkennl*l $Id9., 131$ Sherman SL, Dorww, Colorado 0203 (X 64-351 WELL PERMIT NUMBER _ _9RM - DIV. 1 CNTY. 62 WD 2 DES. BASIN MD 888 eve: 3 ate: Filing: Subdr,: MARTIN BROTHERS PUD AMENDED APPROVED WELL LOCATION_ WELD COUNTY WADE E FRARCK SW 114 SE 1/4 SeC'uon 12 276 N 11TH Twl3 I N RANGE 56 W 6th f .M. BRIGHTON CO 80601 DISTANCES FROM SEGTIQtj UNN $ ( 30.3)659-069 840 Ft. from South Section Line PERMIT TO CONSTRUCT A WELL 2430 Ft. from East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CQNDfTIOP OF APPROVAL 1) This well shall be used in such a way as to cause no material injury to e4stktg water rights. The issuance at the permit does not assure the applicant that no injury will occur to another vested water light or preclude another owner of a vested water right barn seeking relief In a oMI court action. 2) The construction of this well shall be in compliance with the Water Well Construction and Pump Installation Rules 2 CCR 402-2. unless approval of a variance has been granted by the State Board of Examiners of Water Well Con at . ct+on and Pump Installation Contractors In accordance with Rule 17_ 3) Approved pursuant to CRS 37.92.602(3)(b){) and policy of the State Engineer under the following conditions. 4) The use of ground water from this well is limited to ordinary household purposes Inside one single family dwelling. the watering of noncommercial domestic animals, and the irrigation of not more than 12,000 square feet of home gardens and lawns, as recommended by the Division of Water Resources to the county commissioners. 5) Production lrorn this well is restricted to the Laramie -Fox Hills aquilet which corresponds to tl a interval between 790 feet and 1,1}80 feet below ground surface. Plain casing Shall be installed and sealed to prevent production from ether zones. 6) The maximum pumping rate snail not exceed 15 GPM. 7) The annual amount of ground water to be withdrawn shall not exceed 1.1 acre-feet. 8) This well shall be constructed not more than 200 feet from the location specified on this permit. Note; To insure a maximum productive fife of this well, pertorated casing should be set through the entire producing Interval of the approved zone or aquifer indicated above. APPROVED War r« Receipt No. 03636.95 DATE ISSUED „ 2 4 1994 gT1ON DATE J '4 tg-96 WPJ y."v 7b COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, ColorL__ ado 80203 + a3 _ PERMIT APPLICATION FOFRECflVED RECEIVED Application must be complete where (ai(y A PERMIT TO USE GROUND WAA 4 +A�1 ice' 2 3+93 applicab(e, Type or ( A PERMIT TO CONSTRUCT A *7�t I�Gtr print in BLACK FOR:( ) A PERMIT TO INSTALL A PUM w#.iLRl[E9GUW0 INK. Naaverstrikes . Salim %TATE£M I� or erasures unless 1 I REPLACEMENT FOR NO. CQ. inilWed. I ) OTHER WATER COURT CASE NO. J�dr�Jr (1) APPLECANT • mas4ing address NAME -� STREETi- ≤52 ./Y f1 a o ■ thI'] 4 F i County Ad 14 at the ''A, Section _I1 Twp. Ae. Rng- 4_L._______P.M. (3f WATER USE AND WELL DATA Proposed maximum pumping rate (•gprn) .4" Average annual amount of ground water to be appropriated (acre-feet) Number of acres to be irrigated:,,f'� Proposed total depth ( feetj . Aquifer ground water is to be obtained from: F ,&mil L�, Owner's well designation GROUND WATER TO BE V F R : ( I HOUSE HOLD USE DNLY - ro irr}gation IUI { $ DOMESTIC (11 ( }INDUSTRIAL 151 ( 1 LIVESTOCK {2) 1 .1IRRIGATION (61 ( I COMMERCIAL (4) ( l MUNICIPAL (B) ( I OTHER (9) DETAIL THE USE ON BACK 1N (11) �4) DRILLER Name .t.+�a. tom' aka /1✓� Street 7�i! Ll.f i.f // City ( caul 1 P Telephone NcA2} 2WI Lic. No. A? FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN A/a 53 Scl "— Receipt ND.3 / sItSt" �1, ) 'vlsi.) Basin _ Oitt, lJ /fl'/ & CONDITIONS OF APPROVAL This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of the perihit 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. /v' jai Best Copy Available APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION DATE 13Y 1.0. (STATE ENGINEER) COUNTY 6 01 D (5) THE LOCATION OF THE PROPOSED WELL and the area on which the wager will be used must be indicated on the diagram below. Use the CENTER SI,) {l aeetion, 640 acres) for the well location. i �I 4 -- `I MILE, 5280 FEE'If �f NORTH 4- * 1 -(- — + + - I + - +II I I The scale of the diagram is 2 inches _ 1 mile Each small square represents 40 acres. WATER EQUIVALENTS TABLE (Rounded Figures] An ecet•foot covers 1 acre of lend t fool deep 1 cubic fooi per second lctsl .. 449 gallons per minute lgprr1 A family of 5 will require ■pproxi merely I acre foot of water per year 1 acre -foal . , 43,560 cubic feet . 325.900 as IIpns. 1.000 gpm nurnped continuously for One day products 4,42 eCre-f@et. (10 LsND ON WHICH GROUND WA R WILL E : Ownerisi µ•'" Legal description (6) THE WELL MUST BE LOCATED &EL r �lrom sec[Fan lines, ft. from sec- line ' q rnorth or south � f� ft. from sec- line (ea f or west) LOT__BLOCK FILING s Sus DIVISION /971 H47bA1J2QLD_ (7) TRACT ON WHICH WELL WILL BE LOCATED Owner. No- of acres..( . Will this be the only well on this tract2_ (8) PROPOSED _CASING_ PROGRAM Plain Casing -- i in. from _ -. ft. to _ _., ft. Esc 4 in. from ", ft. to ft. Perforated casing in. from ft, to—, f- tt ,_ in. from ft. to tt. 19) FOR REPLACEMENT WELLSgivedistance and direction from old well and plans for plugging it: NA. of acres: %C M& (11) I?ET IJ.P DESCRIPTION of The use of ground water- Household use and domestic wells mutt indicate type of disposal system to be used- -.. �� (121 OTHER WATER RIGHTS used on this lava. including wells. Give Registration and Water Court Case Numbers. Type or right Used for (purpose) Description of land on which used (13) THE APPLICANTS) STATE(S) THAT TIj2INFORMATION SET FORTH HEREON IS TRUE TO THE PAST OF Hid KNOWLE E. S!GNATUAE OF APPLICAN Use additional sheets of paper if more space is required, EXEMPT I& LL DATA SHEET - DENVER BASIN, COLORADO APPLICANT:' FRARC4 RECEIPT NO. 3$3635 LOCATION: SW1/4 OF SE1f4 Of SEC, 12, T,1N-, R.66i1. (840 SSL, 2430 ESL7 PROPOSED A JlfER: SURFACE ELEVATION; 5045 NUMBER OF ACRES IN TRACT: 5.032 ------------------------------------------------••--------------------------•--------------------------------- IS PROPERTY WITHIN SERVICE RaUNbAkiFS dF MLFNICIPALITY S.B.5 CONSENT MAPS? NO ✓TES_ ;F SUBDIVISION IS UNDER AUGMENTATION PLAR, CASE NO. IS , DIV. _ IF SUBDIVISION WAS RECEIMENOEO FOR APPROVAL BY TIE WATER MANAGEMENT BRANCH, DATE OF LETTER IS INFORMATION ON SUBDIVIS[O11 OR TRACT OF LAND /SPECIAL RESTRICTIONS: evaluated by SWm an JANUAWY 21, 1994 ELEVATION DEPTH TO ANNUAL --------------- HET APPROP STATUS AQUIFER ROT. TDP SAND NOT. TOP A -F UPPER DAYSON ---- ---- --- LOWER DAMSON ---- ---- DENVER UPPER ARAPAHOS - ---- ---- --- L AHOE 4681 4930 109 h,,1i 0,390 NNT LARAMIE-FOX HILLS 3464 4255 149 1081 1.125 NT note: F indicates Location is at aquifer botrdery and values nav be more approximate. + indicates the proposed aquifer. ill values are intarpateted from the 5.8.5 data base asaemb(ed in November of 1986. je lrl Pe^-, rt.� STATE OF COLORADO OFFICE OF THE STATE ENGINEER Oivision of Warer Resources DeparEmeni Natural Resources RECEIVED of 1 )1 ] Sherman Sireel, Room 8I8 ��y r1 1, V r'F R.1j s Denver, Colorado & 2fl] �l1 Phone [3431 8b5-3581 FAX (303184t•3589 Um RRESQUIYES Roy Romer Si#TE €NQP4EFF Gmernor LO Kett Salaiar Exec, iWeDirector h ral 0. Simptnn 51a1e Engineer TO: Wade E. Frarck RECEIPT NO.: 363635 FROM: John S. Gabert DATE: December 31, 1993 Your application for a permit to construct a well is being returned for the reason(s) listed below. The amendments and/or additional information or documentation requested is required before we can proceed with the evaluation of your application. All amendments made to the application must be typed or printed in BLACK INK. Please initial and date all amendments made then return the application and all attachments to this office. if you have any questions, feel free to contact this office. According to our records, the distances from section lines that you have indicated in your application would place your proposed well outside of Lot 3, Martin Brothers P.U.D. Amended Subdivision. Our findings show that the center of your lot would be 2,430 feet from the East section line and 840 feet from the South section line. This would place you in the SW1/4 of the SE1/4 of Section 12. Please review the information you have concerning your well and amend Items 2, 5. 6 and 10 of your permit application. Scanning Corner Sheet for Septic Permits Permit # G19940162 Permit Type: Health J EHS History 1 EHS Conversion History Situs Street Address 17576 ARGIE ST Situs City, State, Zip SeclTownlRange: 12-01 N -&6W Application Status: Finaled Application Date: 03111/1996 Parcel # (12 digits) Owner Full Name Owner Address: Contact Name: Contact Address: 147112403003-R0224194 FRARCK WADE & KAREN 276 H 11TH AVENUE BRIGHTON.CO 80601 Owner Phone #: 303 6590639 Contact Phone# Information above has been Verified in Accela by employee noted below X August 27, 2008 Processed by: Date Report ID: EHS00024v003 Print Date Time: 8127/2008 8:19:33AM Page 1 of 1 HSP106P INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT NO. G-940162 WELD COUNTY HEALTH DEPARTMENT NEW PERMIT ENVIRONMENTAL HEALTH SERVICES 1517 16TH AVENUE COURT, GREELEY, CO 80631 353-0635 EXT.2225 OWNER FRANCK, WADE & KAREN. ADDRESS 276 N 11TH AVENUE PH (3O3) 659-0639 • BRIGHTON CO 80601 ADDRESS OF PROPOSED SYSTEM 17576 ARGIE STREET FORT LUPTON CO 80621 LEGAL DESCRIPTION OF SITE: S2 SEC 12 TWP 1 RNG 66 SUBDIVISION: MARTIN ESTATES LOT 3 BLOCK 0 FILING 0 USE TYPE: RESIDENTIAL WOOD FRAME SERVICES: PERSONS 4 BATHROOMS 2.25 LOT SIZE 5.03 ACRES BEDROOMS 3 BASEMENT PLUMBING YES WATER SUPPLY PWELL APPLICATION FEE $150.00 RECD BY DATE 04/20/94 SIGNED BY KAREN FRARCK DATE 04/20/94 PERCOLATION RATE 8.6 MIN PER INCH LIMITING ZONE B FEET SOIL TYPE SUITABLE PERCENT GROUND SLOPE U% DIRECTION REQUIRES ENGINEER DESIGN NO IN 100 YEAR FLOOD PLAIN ?ONE NO FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON -SITE SOIL PEiRCULATIUN DATA THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIDNS ARE REQUIRED: SEPTIC TANK 1000 GALLONS, ABSORPTION TRENCH 495 SD. FT. OR ABSORPTION BED 645 SO. FT. IN ADDITION, THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND �-ONE I T I ONS : THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT MAY BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SET FORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDING FAILURE TO MEET ANY TERM DR CONDITION IMPOSED THEREON DURING TEMPORARY OR FINAL APPROVAL. THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR INADEQUACY OF THE SEWAGE DISPOSAL SYSTEM. PAM SMITH 04/20/94 ENVIRONMENTAL SPECIALIST DATE THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADD1- TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA- 5IS. FINAL. PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE COM- PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT. SYSTEM INSTALLER 257 4 ?Je-?AFINAL INSPECT E a2� SYSTEM ENGINEER dtJ APPROVAL TYPE CF SYSTEM INSTALLED _7_:� At Sz? ENVIRONMENTAL L.ALIT THE ISSUANCE OF THIS PERMIT DOES NOT IMPLY COMPLIANCE WITH OTHER STATE, COUNTY OR LOCAL REGULATORY OR BUILDING REQUIREMENTS, NOR SHALL IT ACT TO CERTIFY THAT THE SUBJECT SYSTEM WILL OPERATE IN COMPLIANCE WITH APPLICABLE STATE, COUNTY AND LOCAL REGULATIONS ADOPTED PERSUANT TO ARTICLE 10, TITLE 25, CRS 1973, AS AMENDED, EXCEPT FOR THE PURPOSE OR ESTABLISHING FINAL APPROVAL OF AN INSTALLED SYSTEM FOR ISSUANCE OF A LOCAL OCCUPANCY PERMIT PURSUANT TO CRS 1973 25-10-111 (2). ORIGINAL -APPLICANT; COPY-WCHD WCHD-EHS MAY, 1984 II`[i' .l Fl J,I•IC) I':+:F1iFJr:iI.. S,iE UF,llii.:, IiI'!:il-='fl;.::ril_ :.-,..I1::l1 I-'I:i:l='!I3:I I'dEJ„ I,�...I•sl,.l,:,a�' IFIll.1_-I) ?::IJI!I•I'1' E•I!.:.i",I...III f)E 'f',F'TL-1!:::I! I I'III:aJ F! lIv.!. 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I 111'1 11'11.:. f:f: I! r;l. l;ll 11•-111.. f"rl'j;.l.,,l.I Ci! LC,Id [il. i--1 :�':t1;f1.11•I 131 r'iY-1'i I l..I�;i'i,i f l:il'rI:_:Il It,',';[I:Ii llF'[FII :SF`'I:!? !'iF'h''k..,ll�r,l 1..111 (',P11:� TFI i !CWIL.. ',[.'!':!F3fl I- ii!: I'I::.l=;•.11.11.' i1': i'E;f; J f?111:1; I i,IfI..:I F r:i i II Lit f I'.1 [1!'+', 1 "I 11(1! , iii! 11. -11-1 . 1: C;f:!I 1al 111-1 f!WI11111::!„r,fh::III ;13!'1ITrTlIII .i [r'M WUll,I + 1,11',:1 flii(, Tr -County Health Department ® Percolation Test and Soils Data Form n Property address i -4 5 6 Ar , e S+ FL LytAOr Caie Legal description Z �' PAma!] pL Property Owner: Name Kcz re ir%A 1J ri k. (Tra.rrjL Address lio 9•-1 , 4iA A € f r i 1•,-3-¢n ( cYd)oi, Phone Note: • Percolation Test Form, Site Plan and train Size Distribution Curve of the Sample must he submitted with this form. • For all Lots €5 acres the site plan must include the entire lot. Test locations must be accurately tied to lot corners or other permanent markers. `4 Saturation and Swelling • Smeared surfaces removed: 'Yes No • Sand or gravel added; Yes _No • Date and time presoak water added: • Amount of presoak water added (gallons): /.) • Date and time percolation test is started: /c -g /.,poem • Did water remain in hole after the overnight swelling period: Hole I Yes VNo Not e Hole 2 _Yes =No N./ ,e 5 —No Hole 3 Yes I�No Percolation Rate Measurement - Percolation Rate (mitt/in.) Hole 1 .10, d rf�L E rL j• Hole 3 Hole 3 T Mat -6 L —L Na r, pu Average-" TCHD S-101 1/88 .. ncountered @ P feet. • Estimated depth to maximum seasonal - water table if not encountered in profile: • Is area believed to be subject to seasonal fluctuations which could result in a seasonal water table within 8' of surface? _Yes ✓ No Slope determination in absorption area:_L_% to the ___(direction) Bedrock: Encountered @ feet. • Estimated depth if not encountered in Profile: • Type of bedrock: Sandstone Clay stone —.S iltstane Other • Is bedrock fractured or weathered? _Yes No • Is bedrock believed to be permeable? (Pert: rate <(0 minfin.) _Yes No /Z -/k/4-38 Mile Hole Information (Cont.) (Soils must be classified using Unified System ASTM D2487) Profile Hole Log 1 3 7 I.___8 Ji ,,ir.s �I Certification 1 certify that the above information its correct and complete to the best of my knowledge and that all tests were performed in accordance with the provisions ofTri-County Health Department Regultition 1.88 by myself or rider my supe lion. /{ Original Signature Date Company Name P. O 392 fir L Address Phone Original Seal 1 ___ TRI-COUNTY HEALTH DEPARTMENT f. • Percolation Test Result Form Hale Linplhol Whir Oiplh Wiler Depth Orop In Peic*lalion 1 olr Depth Inloival (9 SIIA ( End Walii Level Rile @ Frra! No, (In.) fmin.) of lnliwal of Inlirval (in.) Inlrrwil ► (in.) (In-} (mm jak I ! o fa r0 L.__ z 2 L ¶ 2: L `'—Tp ID / 221. /O I q4Z a " 'f7 h U•h' f m a Inthis for al• • sddco s of field records may f ' eid Noise • $ be recorded on t � r m . tyP copies be submitted on this form. 'A Lour hour test must be conducted Url(etrlt ($$ water remains In the hole after the presoak In which case one 30 min. interval is stlfSi t. {b1 !'.,e fir t G' cf water seeps away In c30 minutes lit which case a one•hour :dst o; 6 : ;0 Mnu;2 lime Intervals may be used, (c) the less Is being conducted in sand In which czsa a c,r�o-hnt r W et of 8 - 10 minule lime intervals may be used, (d) three successive water:evl rto net vary by more than 1116 inch in which case a two hour test may be conduxted. TC}U S-!001/18 . • - Q LL3lC�c`,Jc TRI-COUNTY HEALTH DEPARTMEN Percolation Test Result Form Hole pth In to Q Sign *�� 0 IEnDepth Wet.' LA w.I Hole 0 Fr�ia� Ho. {In.} (n1In.) ci Miami! Ot lntsNii fin I IM#rwir tmrnfrti I Lio 3 Ip / ,3 Md10 n /''-a *Find Notes shalt be recorded an th!s term or In this (ormat; typed copies of [fold records may be submitted on this. form. *A hour hour test must be conducted ur4lefa t93 witet remains In the hole after the presoak In which case one 30 min. Interval Is itc:�zr:t, (b) !..e >'lsst 06 ct water seeps away In c30 minutes In which case a one•hour test or 6 70'nlnuta tlniti Intervals may be used, icy the tall Is being conducted In sand In which case a i;tta•i`nur lair nl B - 10 minute time IrnIarvats may be used, (d) three succasalve water lever drecs do nct wary by more than 1/16 inch In wfucn case a two hour test may be conducted. TCHD S-1001115 WL U►UiL7D— — OFFICE OF THE STATE ENGINEER Foi O. uw onN !11 r eie Crwii 61dg.. 1313 Slwmm o9.. Owwur. Coicra&. ffiso3 txal 889'35611It1EIVCUf+I PFt1OR TO COMPLETING FORM, SEE INSTRUCTIONS ON REVERSE 5NDE CHANGE IN OWNERSHIP/ADDRESS / LOCATION WELL PER fT, LIVESTOCK TANK OR EROSION CONTROL DAM 1. NEW OWN��ER hh��A NAMES) WILLIAM 0.. .i..!!�? .. f�. VSWoRT Meiling Address _ 54 _s.... f.. P '.. 7. ... city, s,. zip..._.{ ..I..G.... o... ..._. ..- ....�06o Phone (3 '3 ) '/. 2. TthiS CHANGE IS FOR ONE OF T)iE FOLLOWING: WELL PERMIT NUMBERI's ❑ LIVESTOCK WATER TANK NUMBER ... .............. I LJ EROSION' CONTTIOL DAM NUMBER 3. WELL LOCATION: COUNTY YV t. C) OWNER'S WELL DESIGNATION gli1_l f AM AI.LEt7SIuv1)1 (Adaravf (crtf) Iser.l .. 714 of 1ne ...- 114. Smc.-., - Twp-,--.....,.... © N. oar ❑ S., Rewwge,. pFa..... ❑ E. ar ❑ W. P.M. Dietanees from Section Lines......t''')5 FL from UN. a. ❑S. Lure. ... .�_Q....... Ft. from El E. a ❑ W. Line, Subdivision 11�_li rl.N .. t{a ill R - .. Lo _ �}-..... air . F -Ming (uretl)...... 4. LIVESTOCK TANK OR EROSION CONTROL DAM LOCA 1ON: COUNTY-----_------...................................._.---------.--_ tf4, Sac. . .. Twp. ...... ❑ N. or D S., Range . ❑ E. a ❑ W. P.M. 5. The above listed owner(e) says} that he (t nay) own the etructure daacneed herein, The existing record Is being amended for lfle following raason(s): 9 Change in nanre of owner. ❑ Change in mailing address. ❑ Correc ion of location. &. I (we} have read the statements made herein, know the content thereat, and State that they are live to my (our) krmwledge. ]Pursuant to Sc Icn 24.4 -104 (13)(al C.R.S:, the making-of-lalae statements herein-constiltttes'per(uiy in - - the eecon[I degree and is punishable as a class I misdemeanor.] Namav`Titla (Please type or print) Signature Date ivrLL lAM .Ji JLX3' FOR OFFICE USE ONLY AOCEp7 & AS A CHANGE IN OWN MSje A1+IWOR mAlLiNG ADDp=S, DEC -16 1994 stag Erar w. by 0" Court Case No. Div. Co. WD Basin MD Use INSTRUCTIONS CHANGE OWNERSHIP -ADDRESS LOCA'f iON CORRECTION FORM JULY 1993 NO FEE IS REQUIRED n The form must be typewritten or printed In BLACK INK Initial and date any changes you make on the form. THIS FORM MAY BE REPRODUCED BY PHOTOCOPYING OR WORD PROCESSING MEANS. INCOMPLETE FORMS WILL BE RETURNED. ATTACH ADDITIONAL SHEETS IF MORE SPACE IS NEEDED. 1. 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 dam. Besure to include the proper oermltiank or dam number. 3. Complete the well location Information. 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 actual well location must include ¼, Section, Township and Range. Cherie the appropriate boxes for North or South and East or West directions. Complete the SubdMsian, Lot, Block and Filing information, if applicable. 4. Complete the location information for the livestock water tank or erosion control dam. The actual location must Include Va, 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 Ills a change in ownership/address and/or location correction. 6, The owner of the structure must sign. Print or type your name In the first block lilt is different from Item No. 1, If signing as a representative of a company who owns the structure, then your title must also be included in the first block. Sign the second block and date the last block. USE THIS FORM TO CORRECT THE LOCATION OF YOUR WELL IF: A. Your well was permitted, registered, or first used prior to May 8, 1972 for ordinary household purposes in up to three single-family dwellings, fire protection, the watering of poultry, domestic animals, and livestock on farms and ranches and the Irrigation of not over one acre of home gardens and lawns. B. 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 by the Water Court for the correct location. tN ALL OTHER CASES USE FORM GWS-42 All other types of dlanges concerning Livestock Water Tanks and Erosion Control Darns should be submitted on the standard Permit Application form and be accompanied by a $15.00 filing tee. If you have questions, contact the Denver or the Division Office where your well is located DIVISION I DIVISION 2 , , . DMSION 3 DIVISION 4 209 ARIX BUILDING 219 W, 5TH RM. 223 422 4TH ST. 1540 E. NIAGARA 800 8TH AVE. PUEBLO, CO. 81003 ALAMOSA. OO81101 MONTROSE, CO. 81402 GREELEY, CO 80631 (719) 5423358 (719) 589-6683 (303) 249.6622 (303) 352.8712 DIVISION 5 50633 USHWY6&24 GLNWD SPGS. CO. 81601 (303) 945-5665 DIVISION 6 320 UNCOLN AVE. STE. E STMBT SPGS., CO. 80477 (303) 879-0272 DMSION 7 1474 MAIN ST. DURANGO, CO. 81302 (303) 247-1845 DENVER OFFICE RM. 823- 1313 SHERMAN ST. DENVER, CO. 80203 (303) 066-3581 TORN uo. ✓ PUMP INSTALLATION AND TEST REPORT r r omo. u.. only 11190 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 1. WELL PERMIT NUMBER 154 1790 2. OWNER NAME(S) AU.trr�5+ of ni �I LL MlA7fRQE5i)URCE$ Mailing Address 15i. 4tE City, St..Ziip 7 gt o'i Phone ( o3 ) re 3. WELL LOCATION AS DRILLED: 1l4 5 tc. 114, Sec. i . Twp. I _. RangeG DISTANCES FROM SEC. LINES: i 1≤ ft. from S Sec. line. and &' r0 ft. from Sec. tine. ..0 ar SUBDIVISION: IYLQLTIA) 2 .s .LOTL.. ..BLOCK FIL1NG(UNIT) STREET ADDRESS AT WELL LOCATION: }� 57S RRbr� 4. PUMP DATA: TypetdJ Installation Completed Pump Manufacturer ACu -r. i t Pump Model No. 30 5 " !& b 3,?- Design GPM jp at IPM 3 y 5D , HP 3 •Volts Z 3d , Full Load Amps i&.' Pump Intake Depth 5 Feet, Drop/Column Pipe Size I '1'L Inches, Kind Q'#L*f M p.----. ADDITIONAL, 1NFORMATIONi FOR PUMPS GREATER THAT so GPM: TURBINE DRIVER TYPE: ❑ Electric ❑ Engine ❑ Other Design Head feet, Number at Stages , Shaft size inches. S. OTHER EQUIPMENTA Airline Installed ❑ Yes No, Orifice Depth ft. Monitor Tube Installed ❑ Yes No, Depth It. _ _ Flow Meter Mfg. �4 Meter Serial N4. Meter Readout ❑ Gallons, ❑ Triousand Gallons, ❑ Acre feet, ❑ Beginning Reading 6. TEST. DATA: ❑ Check box If Test data is subrriittdan Supplemental Form. Dale Total Well Depth rbZQ' Time at NR Static Level 'I o r Rate (GPM) 0_ Dale Measured _i Pumping Lvt. "O' 7. DISINFECTION: Type - T Id- IL f�Urn � Amt. used 1 evP s c♦ Ol W 9. Water duality analysis available. ❑ Yes { No 9. Remarks 10. 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 sewn degree and is punishable as a class I misdemeanor.l CONTRACTOR O d12 Phone ( 43 1 {— /5SV Luc, No.'] iS Mailing Address aZ txJ C S D 6 Z I NamelTdle (please type or Tint) Signature r Date INSTRUC17ONS FOR PUMP INSTALLATION REPORT The report must be typed or printed in BLACK INK All 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 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. The orlgal and one copy of this form must be submitted to the State Engineer's Office within 60 days after completing the well or 7 days after the permit e>ep&udbn date, whichever is eae tor. Another copy of the form must be provided to the well owner, It this form is submitted in conjunction with the Well Completion and Test Report. form number GWS-31, ONLY THE PERMIT NUMBER AND OWNER NAME NEED TO BE COMPLETED in items I and 2. 1. Complete the Perms Number in full. 2. - —Fill-in lama—d.6Aar�ng.Acidress.of Wed.Qwir where.correspondence_should ,be. .sent. _ . . 3. Complete the blocks for the actual location of the well Far 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 installing pumps greater than 50 gpm, complete the additional info rnatian 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 13.9. Spaces are provided to report all measurements made during the test. The report should show that the test compiled with the provisions of the rules. II a test was not performed explain when it will be done. It 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 and submit a copy of the report if available. 9. Use the remarks area to note arty additional information including additional equipment installed, water supply Construction problems. 10. Fill in Company Naime and Address c* Contractor who constructed the wail. The report must be signed by the licensed contractor responsible for the Installation of pumping equipment. Gwsa V WELL CONS FFIIJC l ON AND TEST REPORT For Qrff0* Use on y raves STATE OF COLORADO, OFFICE OF THE STATE ENGINEER RECEIVE 1 WELL PERMIT NUMBER (.Zgt)4T- 1+ S4 2 WNERNAMES) Grien Construction Inc. 0 Marling Address P 0 . Box 381 tI11111�t City. St Zip Brighton Co. 80601 li E Phone( 303 659-3969 a. WELLLOCATION AS GRILLED: S 1/4 SE 1/4, Sec. 12 Twp.l N Range_'6 DISTANCES FROM SEC. LINES. 1275 1t, from S Sec. line. and 2410 8, from Sec. line. OR SUB DMSION: Martin Bros. LOT 4 BLOCK FILING(UN]T). STREET ADDRESS AT WELL LOCATION: F4-1 GROUND SURFACE ELEVATION ft. DRILLING METHOD ot�y DATE COMPLETED R-4-94 TOTAL DEPTH jo2p It DEPTH COMF 5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft) Depth t}escription of Msteriai (Type, Sire. Color, Watat Location) 8 3 / 4 a —20 Brown sand 6_.1/4 20 REMARKS: DISINFECTION: B 1 Granular Chlorine sand 7. PLAIN CASING OD (in) Kind Wall Size coal 6 518 ,tee, .1:88 4_1/2 Steel .188 Water PERF. CASING: Screen SlotSlot Size' - 12 Steel .188 To (ft) 20 1020 From(ft) To(ft) +1 20 20 840 16" torch cuts 840 102 8. FILTER PACK: 9. PACKER PLACEMENT; Material A Type 11alihurton baske Size Interval 11 cod at D I 840' 10. GROUTING RECORD: Maienal Amount Density Interval Placement cnt 560aa1 7 al bag 0-840 Pump Ate, Used 2 cups dissolved in 5 gallons of I I 1NELL TEST DATA: Lf Check box if Test Data its submitted on Forrn No. CIWS 39 Supplemental Well Test. TESTING METHOD n;- Static Level 465 It Date(Time measured 8-4-94 33:00 iProduction Rate 25 9Pm Pumping level ,art t T a fit. Datums measured____________________ Test length (hrs.), 3.0hrs Remarks �---- 3. E have read the elatemerrlx made herein and know the corners ef,ereo1, and that U+ey are true to rrty knowledge. [Pureuan1 to Section 24.4-104 (13) CPS., ft making of false etetemerrm herein constlhrtes pariuryr in the .cons degree and is punishable as a oleos 1 misdameenor.] CONTRACTOR Tc r- Phone 3Q3 423-5346 Lic. Nn.: 827 MailirtnAddretc Rt_ 1 Box left. Co. 80403 Name/Tide (Please type or print) L1tJyd John President/Owner 9-12-94 INSTRUCTIONS FOR WELL CONSTRUCTION AND TEST REPORT The report must be typed or printed in BLACK INK. All changes on the form must be initiated and dated. Attach additional sheets if more space is required. Each additional sheet must tie identified at the top by the well owners name, the permit number, form namelnumber 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. The original and one copy of this form must be submitted to the State Engineers Office within 60 days after completing the well or 7'days after the permit expiration date, whichever is earlier. Another copy of the form must be provided to the well owner. 1. Complete the We Permit Number in full, 2. Fill In Name and Mailing Address of Well Owner where correspondence should be sent 3. Complete the blocks for the actual location of the well where drilled. If thq.oymer,has,more_than_ane well ` _ serving t isle provide the identlFcatIon Owners for this weld. DO NOT USE HE OWNER 9 P p8Ity, P I desi9nasion) -- - SUPPLiED LOCATION unless a survey has been provided. For welts 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 the well. 5. Fully describe the materials encountered in drilling. Do not use formation names unless they are in conjunction with a description of materials. Examples of descriptive terms include., Grain size -Boulders, gravel, sand, silt, clay. Hardness --Loose. soft, tight, hard, very hard. Color --Alt materials. Most critical In sedimentary rock. Depth when water is encountered (if it can be determined). 6. Provide the diameters of the drilled bore hole. 7. The outside diameter, kind, wall thickness and interval of casing lengths must be indicaled_ 8. Indicate the type and size of filter (gravel) pack and the interval where placed - 9. Indicate the type and setting depth for any packers installed, to. 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 disinfection used, how placed and the length of time left in the hole. 12. Report well test data as required by Rule 10.7. Spaces are provided to report all measurements made during the test -the report should show that the test complied with the provisions of the rules- If a lest 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 well, ..Form No. OFFICE OF THE STATE ENGINEER GWG-25 COLORADO DMSION OF WATER RESOURCES 81e centennial Bldg„ 1313 Sherman St, Denver, Colorado 80203 (303k88&681 APPLICANT GREIN CONST INC P O BOX 381 BRIGHTON CO 80601 (303)859-3 69 PERMIT TO CONSTRUCT A WELL WELL PERMIT NUMBER 17904 5 - DIV. 1 CNTY. 62 WD 2 DES. BASIN MD $27 Lot: 4 Block: Filing: Subdrv: MAITI1N Race APPROVED WELL LOCATION WELD COUNTY SW 114 SE 1/4 Section 12 Twp 1 N RANGE 66 W 6th P.M. DISTANCES FROM SECTION LINES 1275 Ft. from South Section Una 2410 Ft. from East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITOM OF APPROVAL 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 vested wader 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 CCR 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 under 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 non-commercial domestic animals and the irrigation of not more than 12,000 square foot of home gardens and lawns, as recommended by the Division of Water Resources to the county commissioners_ 5) Production from this well Is restricted to the Laramie -Fox Hills aquifer which corresponds to the interval between 800 feet and 1060 feet below ground surface. Plain casing shall be installed and sealed to prevent production from other zones. 6) The maximum pumping fate shall not exceed 15 GPM, 7) The annual amount of ground water to be withdrawn shall not exceed 1.1 acre-feet. 8) This well shall be constructed not more than 200 feet from the location specified on this permit.eb,t1 Note: To insure a maximum productive life of this well, perforated casing should be set through the entire producing interval of the approved zone or aquifer indicated above. APPROVED DWR BoM Einar Receipt No. 0367106E DATE ISSUED JU i 7 1994 EXPIRATION DATE JUN 1 7 1996 WRJ-s.iZev, 7d COLORADO DIVISION OF WATER RESOURCES B18 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 fl>l PERMIT APPLICATION FORM g Ceti ,r j L tl Application must R[CE! be complete where I I A PERMIT TO USE GROUND WATER EVE applicable. Type or I I A PERMIT TO CONSTRUCT A WELL print In BLACK FOIR: I I A PERMIT TO INSTALL A PUMP JUN 0 1 '94 INK. Na overstri kes or erasures unless f I REPLACEMENT FOR NO. gd.! 7 initialed. { } OTHER WATERR60Ur:I;,E. WATER COURT CASE NO. CDLV STATE rlu�rrl�tl (1) APPLICANT - mailing address NANhErQl+nyh.�- STREET ;} CITY 151e e) ILIA) TELEPHONE NCI. c7_ 3 T 6c (2) LOCATION OF PROPOSED WELL County+ W v. of the! � f Ya, Section _— Twp. L Lf .3 H ng. 4 Gr - r 6 a_ _____P.M N_Sk IE.W (3) WATER USE AND WELL DATA Proposed maximum pumping rate (gpml _—! 5 - Average annual amount of ground water to be appropriated (acre-feet); / Number of acres to be irrigated, U y 5' . Proposed total depth (feet): qS o Aquifer ground water is to be obtained from: /?1 F GIB// Owner's well designation GROUND WATER TO BE USEDFQR: (,t HOUSEHOLD USE ONLY - no irrigation (a) { DOMESTIC 1I ( I INDUSTRIAL 154 I j LIVESTOCK 12) ( i IRRIGATION (61 ( I COMMERCIAL 14) { I MUNICIPAL (81 I OTHER (9) DETAIL THE USE ON BACK IN 1111 (4) ORILLE Name i>-4f r Street ��7'D 4d'-'� o city 6C, C� SO 0 tL ] �C I tetel (ZOO) Telephone No. V3 3- 5 L1c- Na. Y 2 7 FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN Receipt No. ?,67ic -131 Basin Disi CONDITIONS OF APPROVAL 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 vested water right or preclude another owner of a vested water rfght from seeking relief in a civil court action. S() I2 iOno I1 6,v, t•► Airti boa, . 10So APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION DATE BY I.D. (STATE ENGINEERI COt}NTY 6 2 C'] (5) THE LOCATION OF THE PROPOSED WELL and the area on which the water will be used must be indicated on the diagram below. Use the CENTER SECTION (1 section. 640 acres) for the well location. - - — + — i -- 4- -- -•1- - + -- ;4 - 1 M1LE, 5280 FEET ►l f + + - -4— + + + ' i # + — NORTH SECTIONLI _ ME No TH + -F I________ y I 1 - — —�- -I. WUTI. SECTION LINE The scale of the diagram is 2 inches = l mile Each small square represents 40 acres - WATER EOUIVALEriTS TAGLE (Rounded Figured An acre toot covers 1 acre of land 7 Foot deep I cubic Poor per second {cisI ... 449 gallons per minute Igpml A family of 5wi11 require approximately 1 acre-foot of water pet year. 1 acre -fowl .. 43,566 cubic Is , . 325,900 gallons, 1 006 gpm pumped continuously for one day produc#s 4.42 acre•fegi. (6) THE WELL MUST BE LOCATED BELOW by distances from section lines, ft_ from sec. line (north or South) 2 O ft. from Gf sec. line least ar west] FILING v LOT_,_By ,CL�QCK / SU1DIVISION - I`?^ �j [fir°5 r �� (7) TRACT ON WHICH WLLWILL E LOCATED Qwner: f� •- most. J:c. No. of acres j . Will this be the only well on this tract? f e�- (S} PROPOSED CASING PROGRAM Plain Casing / �� in. from ft. to 17L _ ft - f Z in. from I/o ft. to 6 5 6 ft. Perforated casing / in. from L` 5.6 ft. to 5O ft. m. from ft. to ft. (9) FOR REPLACEMENT WELLSgivedistance and dbrection from old well and plans for plugging it: (10) LAND ON WHICH GROUND WATER WILL BE USED_ �t Ownerls): is __ ___ No. of acres: Legal claKrip ion: `�' f `t (11) DETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of disposal (12) OTHER WATER RIGHTS used an this land. including welts. Givn Registration and Water Court Case Numbers. Type or right Used for (purpose) Description of land on which uted ('13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE. SFGNA PORE OF APPL ICA - &1'tL1 " C. ,el r, V . �J✓�¢� . Use additional sheirts of paper if more space is required. y BIINPT YELL DATA SUIT - 0111l BASIN, C0L0NAMI 1PP1JCIIT: GREIN C0JIST. IBC. RECEIPT 30. JSTt06-B LOC1TI0U 50114 OF SIAM Of SIC. 12, 7.11., 36. 11275 SSL, 1410 ISLI PT0P0SED AQNI1il SIVIC1 ILIIITION. 5041 001111 OF IC1;15 IN T1ICTM 5 15 FROPEUTY 111111 SONVICI B00NDIlIIS 01 N011CIPbLIT1 5.0.1 COOSIIT NIPS? 10 165_ [T 500111I51O! IS 01010 10613NT1t30N PLA1, CISI 10. 15 _ . piV. - IT 503D11ISIO1 115 51C0110NODIR VON APPROVAL 11 TIN WITH 1111GRNBIT BR19CR, DATE OF LITTBN 1$ 1H000ITIOR O1 50$DIT1SIOI ON TRACT 0T L11b/SPIC111 11STNICTI0IS: avalmated by Ii om 11T 8, 1894 ILIIITION DIPTN TO 11101E --------------- NIT --------------- IPPI0P STITOS 190[100 BOT. TOP SAND 007. TOP 1-1 0PPU 044501 ---- --- _-- ---- - - -- LOWER 044501 ---- ---- ---- ---- - DIIVIN - -- -... ---- ---- - IPP1R ARMPMI0I ---- ---- ---- ---- - - --- LONER HAPII01 1861 4933 103 41 114 0.816 1117 LIRINII-141 RILLS 3961 4269 152 1080 TNT 1.133 1T ! note, I Imdicatee Iocatlam is at agmlfer bomadarl ad valcee may be more approximate. * IDdicates the proposed agalter, III volute are Interpolated from tie 5.0.5 data base asaemblei is tareiber of 1916. Weld County Environmental Health $9rviCas Department k86r 1555 N. 17th Avenue Greeley, CO 80631 Phone (970) 304-6415 Fax €970} 304-5411 Web weldhealth org Septic Permit - Final Application Number: SP -1300O66 Owner Name: ANEMAET WENDY Site Address: 17575 ARGIE ST BRIGHTON, CO 60803 Finaled App Type: Health\Residentia1,New1Seplic Application Status: CYNTHIA SULLIVAN Final Pending SULLIVAN SEPTIC LLC Applied Cate: PD BOX t 288 04/03/2013 LONGMONT. CO 60542 issued Date: D4/OB/2C3 Parcel N: 147112403004-R0224294 Finaled Gate Legal Desc; MB -4t4 MARTIN BROS PUD -AMENDED PLAT App Specific Info: Location Description 17575 ARGIE ST BRIGHTON CO 60603 Application Dale 04/00/2013 Septic Permit Expiralion Date 0410312014 Waive Fees No Number of Persons 2 Number of Bedrooms 3 Basement Plumbing Yes Full Bathrooms 2 314 Bathrooms 0 t12 Bathrooms 0 Public Water Supply No Prvate Water Supply Well Parcel Acres 5 Actual Installation: Septic Tank. r' }7 gallons Absorptions Trench sq ft Chambers f G Absorption Bed 1 sq fl Design Type ( ft Chamber Model NOTICE The issuance of this permit dOes riot imply compliance with Dirtier slate. county, or local regulatory or buiitling I eduiiertlents. nor snarl it 501 10 certify tear the sunlect system win operate in mrnpsance with appira0le stale county and local regulatlort5 adopted pursuant to Article tit). Trhe 25. CRS as emenCed catepl for'he puroofe of asfiablishing anal aprrooai cf ,nt talled systerxr for issue is of a local oratpancy ttf'Ttlit persuanI to CRS I52 25-10-11' t2) 'fais__oermir is non-transfpriWs and non-refundable- The Weis County Depanrrent of Punlic }team+ Ord Environment reserves the right 'o impose afieitroriai te•rrr9 are cAndilbrlS tdqurre0 to meet our' *001111i0n4 OSn a ddClinuiny ba515 Prat 051e1d at HOval rr53 COog5M ,upon Iris f'r insrlaCEiot 01 th oprrtrI5ted system 4y the Idol) County Department 01 aubIIO health and Envi ion runt Environment, Health Specialiai Date Report ID EHS00033v00€ Page 1 of 2 Print Date Time. 4/30/201310 05.00AM Application Number: SP -1300066 Owner Name: ANEMAET WENDY Site Address: 17575 ARGI E ST IJV BRIGHTON- CO 80603 11 y+�7 . J7975 / 1 77// ,P.c-y't% Report 1D EHSOD033v006 Print Dale Time: 4130J2013 10 05 00AM Page 2 of 2 = Address of Pumping:.* /.7E7 S /tr4'J e (IF- Pumping Date: 71 �U// J 1. Tank Size: ...Y Crallons Pumped. A Q0 2. Lift Sta iorr Yes No1I lfyrs, functioning: YegNo 3. t xce5.Rive water running back into tank from c1d? Yes No J If yes, estiruste in gawns: 4 Liquid level in tank over inlet line? Yes No 5. Tank Construction (check one) Concrete Metal Brick Plastic or Fiberglass — Cesspool or Seepage Pit Other _______ - 6. Tank Construction Observed: One ConVartment Two Campertrnent 7. ]nletloutkt tees andlorbafifles in good condition? Yes_1-- No 9. Filter on outlet cleaned and inspected (if applicable)? Yes.— No__._ IV 9. Access to clean -out lids within 8 inc s afgradc? Inlet: Yea No_ Outlet: Yes X No 10. 20 mlplastic replaced and seated aver tank lid (flood plain only)? Yea__ 11. Tank/lid structurally sound and water tight? Yes j No 12. Obvious crackslleaks observed'? Yes No2L If yes, explain area. ----._-- 13. Other conditions noted which may affect proper functioning of system? 14. Reason for Service, Maintenancc ... Real Estate Sale Emergency/Backup Other 15. Notes:_. SiiIIivan Septic LLC Lc rci ront. C0 H05(12 P11onc (103) 772-3019 su11.�dplIC(as3DLcrn}i Fnx (470) S .S-9424 www.suijivaIIEcP11C 1101 Bill To Wendy Anelnael 7575 Argic St Bnghrfiln CO sobuw i_ ay8C1lpt4ol� Pump put I 00IJ.gallons Invoice sr4f3W20i pats Ticket j... —.1a-I 112_10 Total $0 no PaymantstCredlts WOO Balance Due 50.00 Wold County Environmental HeaIU SygrviccDepartment t555 N. 17th Avenue I6� Greeley, CO BD631 Phone {970) 304-64i5 Fax (970)304-641t Web weldheallh org Septic Permit Repair Application Number: SP -130008E Owner Narne: ANEMAET WENDY Site Address, 17575 ARGIE ST BRIGHTON, CO 80603 App Type: Healtl,0Residenlie1/ P5Septic Application Status: CYNTHIA SULLIVAN In Review SULLIVAN SEPTIC LLC Applied Date: PD BOX 1288 04103/2013 LONGMONT CO 80502 Intake Person: Parcel Number: 1 471 2403004-R0224294 SCERRILLO Legal Deacr MB -4 L4 MARTIN BROS PUD - AMENDED PLAT Permit Expiration pale: 0410312014 El -IS Septic General: Location Description 17575 ARGIE ST BRIGHTON CO 80603 Application Date 0416312613 Septic Permit Expiration Date 04)0312014 Waive Fees No Number of Persons 2 Number of Bedrooms 3 basement Plumbing Yes Full Bathrooms 2 314 Bathrooms 0 1/2 Bathrooms 0 Public Water Supply No Private Water Supply Well Parcel Acres 5 Report ID: EHS0D026 009 Print Date - Time 413/2013 1 16:56PM Page 1 of 2 Application Nurnber- SP -1300066 Owner Name: ANEMAET WENDY Site Address: 17575 ARGIE ST BRIGHTON- CO 80603 Percolation Rate 9% i Limiting Zone ry in Description eh, Ground Slope � t Direction _ - Soil Suitable&-OPN) R __ Engineering Design Required [` 13,E _ In 10D Year Flood Plain Il&j T i1 From the applrc�hon infonnaliort supplied and thepn-Srte rypil perco3alion dare the fpllpyy'ng m,Nnrum inslaltabon spec frCalions. re requveb — Septic Tank jDs Absomtion Trench { t st1 ftor Arsorgtibn Bed S-) ChambersStandard BicDiffuser rsgJft Trench Bed 7 r infiltrator Quidtd Standard or Hi Capacity rr Trench Bed 6L q flrodrffuser Arc 36 Standard or Hi Capacity Trench Bed InfiltratorOuick4EO35 Trench 7l.r5 Bed Infiltrator Quick4 Plus Standard Low Profile Trench Bed All Weld County 1SDS regulations apply In addition, this permit is subject to the following additional terms and conditions iiC1G {L ; /2 �t t r ,�rz�.f'CI ill .r 7L L'� '/ lit .1 r 'd`N T CE 1•t r7 t This petrol is granted temporarily to allow canslruchar to commence, This germe may be revoked or suspentled by the Weld Ccunry clepanmenl of Public Health and Environment tot reasons set forth in the Weld County Individual Sewage Disposal System Regulations including failure to meet any term at Cdr'drtioi imposed Moron during Iimporery or trial approval The i59uanCe 01 fib permit door r5Dl c.BileLkute aaaurnptron by the department or its errployees of liability for the railuw a- inaOequacy of the sewage disposal system This perrni! to tsar-trartsfsrsble and flOn-cerundaele Before issuing trial approaal of tills permit the Nerd Go unty Depanlnptt of Public Health and Enwronrnenl reserves the right to impose additional terms and conduions required to meet our regulations an a continuing Oasis Final potful appiopal is Contingent upon the final tnepeoiron at the C6rnpleted system by the WOIO Gounty Deped-rent of Public Health end Envnonmeni This oarmit gxr4rSI one Year from -tire appli atlpfl ¢ale. Environmental ealth Specialist Date f�1k, ,tj f3 A. J it Page 2 of 2 Wald County Environment l Health Services Depa tmeni 1555N 17th Avenue t Greeley, GO B0631 Phone (970)304-6415 Fax (970) 304-6411 We tr www oG.welilhealth.org Septic Permit Application Application Number: SP -10t705 4t' App Type: Health\Residential \Septic CYNTHIA SULLIVAN SULLIVAN SEPTIC LLC PO BOX 1280 LONGMONT, CO 80502 Owner Name: RNEMAET WENDY Parcel N: 1471124133004-84224294 Legal De#c: MB -4 L4 MARTIN BROS PUO - AMENDED PLAT Site Address: 17575 ARGIE ST BRIGHTON, CO 80603 App Specific Info: 112 Bathrooms 0 314 Bathrooms 0 Basement Plumbing Yes Full Bathrooms 2 Location ❑escripbor 17575 ARGIE ST BRIGHTON CO 8011 Number of Bedrooms 3 Number of Persons 2 Parcel Acres 5 Private Water Supply Net Public Water Supply No TERMS AND CONDI11ON9 A perms lee. as set by fa pirate ortllarr_e of [he Board of Weld County Commissioners, shill he rCgUired pt appllranls tpr new rndr.rdudl sewage disposal systems tIStISI, payable at lime of appl,catien. Permit lira ar non-refundable; pamrit ■ppiicetiona are non -transferable If loth a burld,ng permit and an 15O5 are issued for the same turuperly and currCtrudron is not cornmnynoed prior to Inc erpeetton date of the but ding perm! the ISDS permit shall expire or the sarne time as the owldirtg permt_ If an 13O5 permit is issued nor a property that does not require a building permit, the 35O$ permit stroll evpire ane year aft -r IN ssn toe if CoesSurien on the septic system has riot commenced i,ny change in plans or snec,t,ceuers slier the permit has, been issued invandetee the permit unless approval Is secured trvn+the HeutH, glfcer or hrsrher dart -Sled agent Enparad perrmts can be renewed by payment 01 the pertr t fee only it A There has been no charge in the plans and spenfirallons of the proposed System as set out in the original application or such Change is noelewed aNt epplevod Ly a Draision Representative. B The surrounding land_ its use or iorrng has not charged so -as -re cause the nngirel application not to be accEnrable under Inane rCfJt•Wtr9ns. NO,10E T1e cr7mplelerress f this applicallan is conditional upon further mandatory and addrilonal tests and reports as may Ise'equ;reo by tht Weld County ❑apartrnanl of Putrlro Hearth and Environment {WC,I3PHEt Tne issuance of the permit is subteci Io such terms and tonditrons as deemed necessary to rrrsurt elmpIlance write rules and regulations adopted under artrOie •a Mlle 25 CRS as arntndciad The apptrranl certfies that the proposed system tell rio be located within 400 feet of a commurnty sewage system The undersigned Gerbtes that all statements madeintarrrtatoru arttl reports sairmilled herewith are, hl Will be, represented to be true and correct to the hest of hislhe knowledge and are destgned to be relied on I the WC ❑PHE nor evaluation foi purposes of issuing the permit applied for herein_ Applicant Further understands !hail Falsltic$tAd Cu rri srepleiCrtla lion may result in the rienial of the appIn Galion or rsvoratton of any perrniii grdrited. and in legal aeon or penury as provided by law r' Air + 3 / Owner pplicant Date Repoft ID- EHS00056v003 Print Date Time- 413/2013 1 09 45PM Page 1 of 1 fl SEPTIC PERMIT INFORMATION FORM Ilk COI,1RADO lo o1iii ticI S -D. S. pcntiil, unc inusi NIL ;t' "tpp etttititr for Intltvid al SLwagc Dislxoe'I t yslum at Ux Wcld County Lnviionmcntnl I lcillh Service: unite and p iy the ip hication Ice A "relator" Ice �hnII he charged for the ckpantiiUn, icplaccttunl, or, repair of ,ut exLS(rt g,•yti em The folIcn� FIig informs ition Lutist hey prow'tticdl an iIt 'cptiu iofurnuuion loan, COMML:ICC.IAL Ph,IlMIT RL-SIDENI IAL I'L=RM1-!" NI,W or REPAIR 'x$50 00 NEW or REPAIR 75O.00 VAL'I.l FIRM fl MINOR REPAIR PI-.RMI I" NL:W or RI-VAIR $?5U -f11} ____}0 PARCEL NO P (12 DIGIT NUMLiER) '� ,� })" LI.OAL DESC RI1' LION Si CI II)N Ti)14'NSllll' O!N[ 1t.ANCiI' W AC'R1:ti _ 00 SUBDIVISION - -- _ - LOT BLOCK PILING -- TIiIS INFORMATION C. AN HF {JRTA1NI"F) FROM TI IE ASSF�SOR'S OFFICI: AT ()70) 353-3x45 EXT 3(5() SIT! .ADDI�F.y;S_L S1S Ay . ► Y� �C Dlltf:('I'](�N51'CJSIfL; 61'] 5 E{Cr ,,Aw IGLCi -�eY'T C."(\••ti Z P rt T �1V'�1� •"lqi� JT. PROPFRTY ()WNF.1 l l l - ____— MAILIN(iADDRESS V\5.15 L C CIPI")&YSo]I'St`^'•Sl C fll' gu d3 11[Iivfl: [tmEION - {1n+ ! I ' ]� VvOR PI ION!- ( } J FAX f..._ -E EMAIL ADDIU::SS APPLICANT NAMI. 111 Sp jui 1v c y MAII..INO ADDRLSS 10 �y�j �� 1? K 4 CITY ! Y L ,} S1 zli' HI'U ()ML U11::', f LI Qi] WOR1'F(M {NII _L12 _ _t. __ LAX I-MAI1. AIN)R1FSS: S [ Epf1C..Ir C',C r r - - - - - - - DF SCRIPTIUN OF lIII.1)1NO 1EX: I1O11SF, MODII F IfUMIl, MODULAR, 511O1', I)J'FII_F) 11-(.)I3TAININ{i A RLI'AI-t PERMIT. WI -EAT IS 13E1N(i RLP,IIRL:D:' J cNIIMISLI((1P PERSONS Nil M13LR (.IL l31iDR(l()MS 3 i3ASIIIMIf Ni i'i_t!M1iL O YI;S N{1 LSA LEER{)Oh45: FUl 1. PUBLIC WATER SUPPLY YES O NAM[ PR1VA1'LWAIEI&SUPPLY Y S {1 WI:LI. CESI-Litti �ILf )rrilP �) P IN FLOOD 1'LAIS' AR['A'' )'IIS NLJ I'I'ICCI]I.A I I(IN II(HA,.S MUST BIT MARkf.1) IOU INSVI.;C" I'ION OR A 5511.00 I EE WILL. HE C'IIARi.I:D C'LNSIIS I RAC'-! !' I' R M II' hti71.1 DFPAR1 MENT OF PLJ13LIL IiIiAl I I I & I:NVIRUNNIENT 1555 N. 17 Avenue oGreeley, CO 80631 1A1 �f�'EBSITE_: t: l4 c1l l'l li� ADMINISTRATION; (970) 304-6410 FAX: (970) 304-6412 PUBLIC HEALTH EDUCATION & NURSING: (970) 304 6420 FAX: ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415 COLORADO FAX: (970) 304-6411 AUTHORIZATION FORM RE;: 1ERM1T APPL1(-A ]-ION = I.S.D,S. EVALUATION SALE s3F E'ROPF.RTY 0 WATER SAME'LE c�tl ( for the property (AgcntAppllcat 1) Owner) locatcil at ,i �� LJ _ *. . 0 LEGAL DESCRII'T'ION: SEC j7_ -TTWN 01NRN(i_LU_ SU[3DiV1SLON NAME: A 1.(l1' BLK I can he contacted at the following phone kf'ti: Iicunc _ ifl Work" 11 LLt- Fax The properly owner can he contaclerl at the EEll Iuwntg' phone '3 I Io11H' 71 Q 3q --1 L -IS T W Or Fax T4 Correspondence nsalted to (only one): Agcnl/Applicant 0 PTClperly 0%%IIcr DA'rE O'J 2 3 OWNER'S SI:GNATURF. INDIVIDUAL SEWAGE DISPOSAL SYSTEM REPORT MAJOR REPAIR Prepared for Sullivan Septic A] 17575 Argie Street Brighton CO 90603 Weld County County of Boulder Prepared by Wade Coleman. P. F. 5000 Butte Street. # 133 Boulder. Colorado 84301 (303)530-1125 March 6, 2013 .,o, �.'' \I '!:: c;r 9 OWS Rcport County: Weld Property Address: 17575 Argie Strcet, Brighton CO SOGU1 Property Owner: Wendy Anernact Numher of Acres: approximately 22 acres, more or less. Well and Septic Density: Water provided by Water District Slope Determination: The existing ground near absorption field is relatively flat. Profile Hole Characteristics; Light colored sandy loam. Bedrock: not encountered. Potential contamination factors and probable migration: low. Soil i'exture Tesi; The soil did not Moroi a ribbon, this is sandy loam. Expected effluent quality: The native material is suitable for filtration material_ Soil Pere Test: The average of the 5 perc tesi 24.5 MPI. I will use a pert rate of 25 MPI. Soil Pere Test (Mill) Ll tole ] Hole ? 11o1e 3 Llolc 4 l Iole 5 22 _Average 24.8 24.8 131:1) SYSTEM CAl CUI.ATIONS Profile hole Feet Description I Light colored loam 2 Light colored loam 3 Light colored loam 4 Light colored loam 5 Light colored loam 6 light colored loam 7 Light Colored loan.. 8 Light Colored loam f 1T Ptrtnhilioii 12ti MI'{ it <lt [idraonls ( C1P[)I - I5ti gaL 1.5 4Si1 C�II� -- II Rcll size I53( III — 311 ;i?C Ialli U-2 4tl:i 11r,1 e €l X 3 Aral L!_' ( 1 I,6) Years cc 2-5] �5 I iSa ! 24' !ic[I.,izc 74' k 52 2 ' (ircyllivalc:nl 1.754 t1 (; ricral doles: I . Tic sv,,tclll ,,hall he impeded by 111e (Ic. ii cilyi3ec :alliI the ( (nn tv I leallll Ikartillcnl Itlei lllilcerttnt .11'thc Ic11tie titnlc,;Ilhli lchore hakfillilll. 2. l ltc do ii it til tllk tcnl i.4 vnidc(l it the (I;lily [lclw cxLccds II (kills}ns I'er []IIY (C ii'F) I hr ccrlilieati m I}I the dc,�ign is .'{)I(IL(I Il the ilwllel' cli+caa not ovide nlniiltct1Elncc. of iile tiytiltnil in ae (,1'llmac "Ph till Iiiclietdiial Se41':age I)15j n .al ,ystcill IZct!llfiilioii aiid I1c itli .W1111i.. hall[; I,ullll3cd.il lead every 1 y.;ur71 l7r SIN rc(lnireil_ l'unlpine rll�th,t11 !lc matte :l ,iilahle 1u the Aunty I Icalth [)chr[iileI1t t. I-i11x SyOCIIL in lily ollillioi1, will Ilot pullute ',toiinll water il'iisstalled, u5Ltl. ;IIILI ill:unt,liiicd in ICOI,.IalicL %k ill) llllti 4. 111 7 ownci IS ie u11531hic i tr iusi lllaliuii itt Ilie Sytitclll Li'ilhlll tllc' 11rolicr[y houll[lal lcs illll! olt,crviil properly lilts tit:tly;ick ,. J 41 ype Pt[N IQ)R S5 ~ewer Dille. Iii c s llres 1 e tltiiii . lcilt I'(Ir l rc o iire do tng u.. c 3' tiI)R .t5 Hills Filtiatiun material: J iIive aiiaie'1I;iI. I'oi ad(IIlii)nal lill nlalcl1211 use I.(}tli'Cri canal, Soil C' rrltiJ),1CliiIn: The Sill] ill the LNC,IY;N1ilil shn1I he colllp i (Cd 1+1 n Siiiiilar Icll, iii' Lit ill urriluniliiIL aril Silt Sped tie C'otlinlenls: ttieit c(I exl.'title' I.(1{117 tilicill 2 chhai1111t'rl'L} tieptie tank >iilvc, Maintain 10 f�1o1 scl back hroni prohcrty line. I Iictllove Ia t itcr rock t6pcaler than S- } hiwl lillratuln nlaicriai, 4. Locate divcrtcr valvc w'illlili 10 Vul of lank. C'k'arlyy mark en! ye, I I' crlr�ily drainage cualiot he: I lien: • Provide 500 gallon wet well with 1,000 gallon septic tank or equivalent 3 chambered septic tank. • Provide Little Giant 0.5 horsepower pump (95 -1 -IM series. 115 Volt) or equivalent, Provide 150 gallons per dosing cycle, * Providc audible and/or visible warning; devise when septic tank reaches 80% of capacity. Locate sensor where it can he seen when the lid is lifted. Fable 30-2 Subsurface Absorption Area for 1)wellin a Use percolation Rate Trench Absorption Area Bed Absorption Arc per (lvlinllnch)i!LT1t_ 418 30 352 458 35 380 491 40 407 529 - _ 45 431 _ ! 561 50 455 591 55 477 620 (0 J 498 647 r<5 hate (minuteslinch) Typical Soil "l cxture_ Gravel 2 1.5 -______________ Coarse to medium sand 6.10 __ Fine sand to loam sand -- 1-20 Sandy loam to loarn 21-3(1 Loam 31-40 loam to Silty sand 41-60 — Clay Loam to Cla ' Over 60-- Silty Loam Clay1Silty Loam Soils without highly expansive clays Design by Registered 1'ruiessional F✓r ricer required -- 4 r � a WN /NOTES: b Gu i P5arnLE r[xlo GL 2 nWBRf9 'FfnC r4K. I 1 7rh SHE 1 251 kYL T!H I a .AGiE �Emrn vK� wxlw 1d a wn1 nF�mr uiWM0, �. 5fE cm xtpata Fax rnws. 1 / ❑ �� ;f) F1<tl ARGIE S—. � 1 �rJfr1 " = S00' ` \\ ElSHEET l GF 1 • • •• II NOTES: awll E 1 GIG ll. i L! -MI PE: SC T. F1u SSE' TfE FEE A. SFE CAM'+ YLVE IN 1� GF TSNK CLPRLY NM12u. I EOR WI RECEIVED APR i 1 YLlj ENTLRCNk'M17AL HEALTi SFR5ICES AFGIE S NORM No. &Y1r�92 Uaw • PUMP INSTAU ATKI)N AND TEST REPORT STATE Of COLORADO, OFFICE OF THE STATE ENGINEER Far oefo. Use artty RECEIVED OCT 09 1996 1. WELL PERMIT NUMBER 1 ?l a OWNER NAME(S) t1 a ►� Mailing Address w&IF,hC* s3 vo►Q City, St. Zip Phone (3c5)} 3. WELL LOCATION AS DRILLED; 4) ,) 114 S C 114, Sec,i.?-- Twp. /l) Range DISTANCES FROM SEC. UN S: i' 70 ft. from Sep+ se G. line, and ft. from Sec. line. SUBDIVISION: Aart t'a dd LOT_BLOCK FliUNG(i1NI'f'j_`. STREET ADDRESS AT WELL LOCATION: 4. PUMP DATA: Type .b v>t rs .,.; /. Installation Completed Pump Manufacxurer Pump Model No. / S Design GPM at RPM HP 3 Volts Full Load Amps Pump Intake Depth 7 D Feet, Drop/Column Pipe Size Inches, IUnd - 4'_o /V , ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM. TURBINE DRIVER TYPE; ❑ Electric ❑ Engine ❑ Other Design Head feet, Number of Stages Shaft size inches. 5. OTHER EQUIPMENT: ' Airline Installed ❑ Yes [No, Orifice Depth ft. . Monitor Tube Installed O Yes I] No, Depth tt, Flow Meter Mfg. Meter Serial No.-- Meter Readout ❑ Gallons, ❑ Thousand Gaiior. . ❑ Acre feet. ❑ Beginning Reading - fi_ TEST DATA: Check box if Test data is submitted on SupJamen1al Form. Date -° -Y Total Well Depth £ Time Static Level Rate (GPM) Date Measured Pumping Lvl. 7. DISINFECTION: Type _ Amt. Used 8. - Water Quality analysis available. ❑ Yes No 9. Remarks 0. I have read the statements made herein and know the contents thereof, and that they are true to my knowledge. [Pursuant to Section 244-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury in the secon degree and is punishable as a class 1 misdsmeanor.] CONTRACTOR YS Pha a ( 5) (f5 / Lic, No.c Ef Mailing Address J Name/Title (Please type or print) Signature Date 9 --z - Sri INSTRUCTIONS FOR PUMP INSTALLATION REPORT The report must be typed or printed in BLACK INK All 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 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 margins and print quality of the original form. The original term rrtust be submitted to the State Enrg"neer's Office within 60 days after completing the well or 7 days after the permit expiration date, whichever is earlier. A copy of the form must be provided to the well owner. It this form is submitted in con junction with the Well Completion and Test Report, form number GWS- 1, ONLY THE PERMIT NUMBER AND OWNER NAME NEED TO BE COMPLETED in items 1 and 2 1 _ Complete the Permit Number in full. 2. Fill in Name and Malting Address of Well Owner where correspondence should be sent. 3. Complete the blocks for the actual location of the well. Far 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 installing 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 13.9. Spaces are provided 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 and submit a copy of the report if available. 9. Use the remarks area to 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. ,mot no. G P-31 1W94 TJWELL CONSTRUCTION AND TEST REPORT STATE OF COLORADO, OFFICE OF THE STATE ENGINEER For Of&r Levu ony RECFIVED OCT09 9 19 6 warEk Etta 1. WELL PERM Ff NUMBER I T 3 Z OWNER NAME($) Qi.Am Dr►1 Mailing Address 3b 513 City, St Zip Phone ( 03) ≤ Y7 S. WELL L CATION AS DRl D: 1 Jf4 -1f4, Sec. Twp. f n/ . Range iV DISTANCES FROM SEC. LINES: 1, 3 f d ft. from � J Sec. line, and r ' ` O It. from E-rr S T Sec. line. OR SUBDMSION: LOTS BLOCK_____ FILING(UNIT) STREET ADDRESS AT WELL LOCATION: 4. GROUND SURFACE ELEVATION ft. DRILLING METHOD ( k DATE COMPLETED € TOTAL DEPTH J Vd tt. DEPTH COMPLETED f0 }!) ft. 5. GEOLOGIC LOG; r�� oden) Depth rcripdon al Maderioi (type. S. Color. Wu er Loden)/ 6. HOLE DIAM. (in.) From ft) To �(it) —�1— .V) y1 7. PLAIN CASING OD (in) Kind Waft Size Frorn(fi) To(ft) itii 2 PF. CASItj : Soreen Slot Size: ' s r t , - re ,C1] l- a, Lff 0 -7c SMFr1LiQ.eL -1 o- o ,g- C ro S14 a FILTER PACK Material Size Interval 9. PACKER PLACEMENT: Type T Depm 10. GROUTING RECORD: Material Amount Density Interval Placement i rr! i s Ar __ REMARKS: 1 DISINFECTION: Type Amt_ t}sed %4 L1r. WELL TEST DATA: ❑ Check box if Data is submitted on Form No. GWS 39 Supplemental Well Test. TESTING METHOD Static Level t' ft DateITme measured I - , Production Rate j gprm. Pumping level _ 'ft DatefT'ime measured . Test length (hrs.)_� 4R�, Remarks ;l. I have read the elatemente made herein end krlow the ccnterrts thereof, and ttvt they am true to my knowledge. iPureuam to S.cI on Q4-4-104 (13] {a C R.S., the rriaking of ta14e st1emerds herein o rtati4+les penury :n the second degree and is punishable a4 a class t miadomeanor.f CONTRACTOR 5 k- Phone (Z2J,^a�t7✓ Lic. No.____. Mailin�i Address_1i.l_LtZii Narnefritle (Please type or print) 1Signature o nM Date INSTRUCTIONS FOR WELL CONSTRUCTION AND TEST REPORT A" ,Oct. 94 The report must be typed or primed in BLACKINK All 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 well owner's name, the permit number, farm 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 margins and print quality of the original form. The original form must be submitted to the Stale Engineers, Office within 60 days after completing the well or 7 days after the permit expiralion date, whichever is Barber. A copy of the Form must be provided to the well owner. 1. Complete the Well Permit Number in full. 2. Fill in Name and Mating Address of Wall Owner where correspondence should be sent. 3. Complete the blocks for the actual location of the well where drilled. If the owner has more than one well serving this property, provide the identification (Owner's Designation) for this well. DQ fT USE THE OWNER SUPPLIET3 LOCATION unless 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 the well. 5. Fully describe the materials encountered in drilling. Do not use formation names unless they are in conjunction with a description of materials. Examples of descriptive terms include: Grain size --Boulders, gravel, sand, sift, clay. Hardness --Loose, soft, tight, hard, very hard. Color -All materials. Most critical in sedimentary rack. Depth when water is encountered (if it can be determined). 6. Provide the diameters of the drilled bore hole. 7. The outside diameter, kind, wall thickness and interval of casing lengths must be indicated. e. Indicate the type and size of fitter (gravel) pack and the interval where placed. 9. , - Indicate the type and setdng_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 disinfection used, how placed and the length of time left in the hole. 12. Report well test data as required by Rule 10.7. Spaces are provided 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 ft 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 well. / PUMP INSTALLATION AND TEST REPORT Gus I? 11. 1 STATIE OF COLORADO, OFFICE OF THE STATE Er1GrtUEER WELL PERMIT NUMBER j 47 3&%je r,r r). 1k.. 'MWv RECEIVED { / SEP 2 7 1996 2-I - VNER NPME(S L Q �Ld JLr -p wRzsi r screw �a r.1alUng Adffre*'J -� S1A1E O^+E�p CIYy. SI Zipa '.t YLl, l'QCAMIQfy AS OFaILLEG �/ W T I4 s51 1:4 Sae JG - rvvp 1 _ DISTANCES FROM SEC LIl ES ___ h rrnm ___________Sec line arse ff frern , i7 5Pr. In1e irlrw}h n! NIA�I r+..l rr wMlr rr,13f11VISION', ` 3? �? fv LOTS 9L YT V _ F1LINfIJ►rIT1 SrnEFT ADD SS Al VrECt I�CATIOMI 4 f#r4r.P pATA Tyra ,Tv6-fr% ti>L dIiI-- - InsrallpltInn CornpletU!I 4 —JOB r n11r}It1 pA1iP11iIr:1lrrnT�v14, W - --- ---- - ---- Plump Mnr11.t No .. f.,.----- - - r3nyWp► (3PM ar RPM — Ili' 11 VrrltFull Lnarl Alnl)e r�41f}Y� I}lt lMn IrP,f1r11 _ re I, f]rnl]C {1Y 117111 l u io i2P (1, � - I#ha.5. NII111 A-NTt0".L,INFOFIMAT1Cf•I FOR PUMPS Gr�EATE17 rHAT 50 GPM TI;f IFIfl+NE Dc IVER 7YFf= E Electric El E11c;nr? [] Other Deslc9lt Ifeaid _feel. tlulllher of Slages __-- Sliah size ire Iles OTHER QMIP NT: !<IrYIIRP inSt:tltpq O Ye; r In 0 rricP Depth ll Monilnr rl rbe Insrallpd LJ Yes No. Depth h —plow Meech Mfg _ _ Meter Serial No_ Melee Read0ul LJ Gatlarls, EiThoflsand Galions, L] Acle feel, 0 Beginning Reading F TEST DATA' f^,t1Prk r-nx If TPst riata is submilred ore S1lpplemenral Farm Darn J�iP-7p __ Tnlal Wefi Depth /u O Time 2- 4 — ----- ---- Sntir: Level $. f zIe (GPM) j5 -- Dale Mealoured-d'l-7G Pttnlp.rlg Lvl -- - 7 DISINFECTfON: Type 4.S ji Alnt Used J 2 6 S Il I Walter Quality an&lygia Tvailahfe 0Yes (Z No 9I Porwirks --•-_ _-----.__,— . -----.----- In. 1 liauP. rrfirl eI1e tTatr'rrll+rlr5 rr i,-'p hr'r(!Vr TIM 1 rin:`i ¶Ii CrlrlrentS iiiprPnl .-r1€1 Tli?S iiuny aiP beep to my knowAelgo In-1llal#I in S"rune, 71 el 1(7.1 4131'(2) C I!S ltin'1lakilu] al faISN 5t�tPsne iIs llnre!rl cor15Td!jles perjury in the seconc tlr'ylnr+ Awl i5 ptuiiisll.if]la iS A Mass I ItFIP IIJ_TTT{!R1[}I - I f rfACTOf J4 a?J P?' �S x 1vW. I ifl] _ P►^a11Q { Q gS? "4 Q Lc No t__ t.I Their a rklrc is a r r ; o i — __ -o ' f l�laln°fTirlp (Plranse tyro nr r�7lly1 — — 4ignarurP — _ —_.. — Date r3R>< w" WELL CONSTRUCTION AND TEST REPORT •rr, r�++ cv5 1'• STATE OF COLORADO. OFCICE OF THE STATE ENGINEER #�ECENED I WELL PE14MOT NUMBER SEP 2 7 1996 — WATER r sfrx x' PAnAing Ad S I_fl p Cl1y, 51. Zip — Phpne 7. W T NA DRiL�7_V '!° LilI. Src fj TANCES FROM EC L S' 4. prom Sec 1irVR 'Inr1 � f from —Set lute rrr 51i8t71VlStOhf. LQ7— 1iLflr4 STREET AD ESS AT WELL LOCATF0N: ,1 +',F10L.hlf SUAFAI+E E EVAti0tl rr Qf11LLlfIG METHOD —_-- _ - - L'r=TE COMPLETED id __ TO1/tL OEP'lfi Jijil� t. GEi TFi COMPLETED /.0 O'' ri. GEOLOGIC LOG- {' (]weMll,l,.nt nl u(,...r It s,,.. r., f ]o - - -- ff. HOLE DIAM lin } Frnr„ (11) TTo rit}} REMARKS I l DISINFECTION: Type 7. PLAIN CASING 00 (in) Kind weil site Grom{h) Tnl!1) PERF. CASING Sc een Slgl Site dv}c C 6 __15__ _2zo n 1'rtTFq PACK l.Apterial 5IZR _______ f'vr - interval ___ 9 P.CI ER PLACE''gr1T 0ep1h i 10. GROUTING RECORD ,at Pr l Art,ourrt Oerlsily t,'Prval P9aCe+t7Pt7__ iiiii 21 ,7ItLJE Amt. Used [2bL T1SSrk 2 C pck ao= t TP.s1 Da is svbma[ed on Supplemental Form TESTING METHOD Aib L CP-1 SiAlic Le'R1 f K Dale/Time mepsured . q - Z6 3 RM Product c r3 Axle / 3 j'! Pu=npinQ Ievtif _1_UO --ft ❑T1e.'Ti ie rneacutred_ Test lengln (firs ) J 1 Fllltnark i 1. , K.— iird tha ,7M. n•nn ,nn f .,r m.-.r7er71S ,her.nt end rhnt rhey w.e elve In my krwwled9e IRurai.-', to t;tr '.7lp} t" rl5 r. el • ..t tMe, e44ttlnawN ti.r{'u1 "nn,r' •+, (,.l i.�rY •r !ti s �nlxl deprhi qrw} it rrr -hah •• V ■ i it ! mie'P VrI CONTRACTOR 9n� _ Phone a 3DY,VZ II c No �v _ FIimejTille IPIRa3! type rr print) SFgniilure DflI� 7- o2 a - Farm No. GWS-25 APPUCANT OFFICE OF THE STATE ENGINEER -COLORADO DIVISION OF WATER RESOURCES 816 Canbnnlal Bldg., 1313 Sharma' Si, Dsrnver, Cc orado 30203 tai 5.3581 PAUL HARM014 636 S 13TH BRIGHTON CO 80601- (303)659-&LB7 PFFWT TO CONSTRUCT A WELL WELL PERMIT NUMBER - DIV. 1 CNTY. 62 WC 2 DES. BASIN MD _ot 5 Block: Fllina: 9ubdiw: MAFr11N BAO PUB 698 APPROVED WELL LOCATION WELD COUNTY NW 1/4 SE 114 Section 12 Twp 1 N RANGE 66 W 6th P.M. DISTANCES FROM SECTION UNES 1390 Ft from South Section Line 1840 Ft. from East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT COND(TION 8 OF ?1PFROVNL 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 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 wait shall be in compliance with the Water Well Construction Rules 2 CCR 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 18. 3) Approved pursuant to CRS 37-92-602(3)(b)(l) and policy of the State Engineer under 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 non-commercial domestic animals and the irrigation of not more than 12,000 square feet of home gardens and lawns, as recommended by the Division of Water Resources to the county commissioners. 5) Production from this well is restricted to the Laramie -Fox HiILe aquifer which corresponds to the interval between 785 fast and 1085 feet below ground surface. Plain casing shall be Installed and sealed to prevent production from other zones. 6) The maximum pumping rate shall not exceed 15 (3PM. 7) The annual amount of ground water to be withdrawn shall not exceed 1 acre -loot. 8) This well shall be constructed not more than 200 feet from the location specified on this permit. Nate: To Insure a maximum productive life of this well, perforated casing should be set through the entire producing interval of the approved zone or aquifer Indicated above. N0te: The ability d this well to withdraw its authorized amount of water from this non-renewable aquifer may be less than the 100 years upon which the amount of water in the aquifer is allocated, due to anticipated water level declines. _ t.a6 • APPROVED GLR 0 lr� Receipt No. 0396311 DATE ISSUED MAR 12 16 14 a.Q °i. E)tPIfiATlafJ GATE MAR 1 2 199$ wq _i pt_ 1 COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman Si, Denver. Colorado 80203 fEC: O PERMIT APPLICATION FORM Application must — be complete where r� ( I A PERMIT TO USE GROUND WATEFf LO 09 ,S6 apphcalale Type or I >q.A PERMIT TO CONSTRUCT A WELL print in BLACK FOR: I I A PERMIT TO INSTALL A PUMP w*� INK No overstrikes $_ or uwziswl unless ( 1 REPLACEMENT FOR NO. . initralerf_ ( ) OTHER � WATER COURT CASE NO_ - _ _ — � ON (1) APPLICANT - retailing address NAME STREET 13A CITY IF Slat.) (21111 TELEPHONE NO. 3p.. — —i'67 (2) LOCATION OF PROPOSED WELL County _ �1 % at the i4, Section __j2. Twp- _ k.fing. ti4L. - N, G� I E.tlrl 13) WATER USE AND WELL DATA Proposed maximum pumping rate (gpm) i be ege annual amount of ground water tQ■! r to appropriated IaCre•1Bat]: Number of acres to be irrigated: { Proposed total depth Ifeel]: Aquifer ground water is to be obtained from: Owners well designation GROUNDWATER TO DE USED FOR: I 1 HOUSEHOLD USE ONLY - no irrigation (0) b'd DOMESTIC 11) I I INDUSTRIAL (5) 1 1 LIVESTOCK 12) ( ) IRRIGATION 161 I I COMMERCIAL 14F I I MUNICIPAL (81 I I OTHER (91 DETAIL THE USE ON BACK IN (111 {4)DFULLER Name 6 %D Ve I- s Street -. l 7,24/tiic,e 3I f -- City 11[rmay .,�L TelephoneNoV 11 Lic. No. s FOR OFFICE USE ONLY; 00 NOT WRITE IN THIS COLUMN Receipt 1 Basin Dist CONDITIONS OF APPROVAL 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 vested water right or preclude another owner of a vested water right from seeking relief in a civil court action. f 840 E"a z r2lG t: CG I -;u 4r�m I aot, U :,, r . l t - 7$4 . IpgA f 1 , 2. S A4 - '�r `' ' 3 � APPLICATION &OW -6U--__ PERMIT NUMBER DATE ISSUED EXPIRATION DATE (STATE ENGINEER) BY I.D. _ COUNTY t5) THE LOCATION OF THE PROPOSED WELL and the area on which the water will be used must be indicated on the diagram below. Use the CENTER SECTION I1 section, 640 acted for the well location. + -^ -± -}- -{-- - - I- - -+- - + + -I�- rt --- 5 MILE. 52BD F'6ET -------?ri I + + + t f H- + I NORTH SECTION LIµE NOItTH 1 T t J �I L a w I j I j ! SOu7N SECTI N L1N - T H-4 - - + II 4- 4- The wale of the diagram is 2 inches m 1 mile Each small square represents 40 acres WATER EQUIVALENTS TABLE IFfounded Flames) An acre ippl Covert I acre of land 1 toot deep I cubic lour per second Idol ... 44g g•nons per minute (9i)r�rl A Iamiy of 5 will require approicimptrly 1 acre-foot of water µsr year ac I redoot .. 43.560 cub reef - .. 325.900 gallonl 1,000 apm Dumped comoouour(y for dna day produc#s 4.42 acrrF6at {10) LAND ON WtIcHGRQUND WATER WILL BE USED; Owner (sl ; {6) THE WELL MUST BE LOCP.TED BELOW by distances from section lines. I 33p. ft. (rum .5UT. . sec. line {north or laulnl Q ft from _ Lef7.dT '' sec. line (*alt or we itl tOTSBLOCK ______FILtNG t SUBDIVISION %f p (7) TRACT ONWtlICH_ WELLW.LL LOCATED f3ty€r. No. 61 acres 51 _ . Will this be the only we(( on this tract? (8) PROPOSED CASING PROGRAM Plain Casing in from.L,_ft. to ft in. from 1t. to ft Perforated casing in_ (r0eri + Ft,.to_ ft. in. from IT. tom It (9) FOR REPLACEMEPJT WELLSgiv distance and direction from old well and'plans for plugging No- 01 2:i Legal description: _ — _ (11) DETAILED DESCRIPTION of the use of grouri water: Household use and domestic walls Iflurt Indicate type of disposal system to be used. ff- —y- • .(�_ . J, {12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and UYatel Court Case Numbers. Type or right Used for (purpostI Oescriptioti of land on which used (13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE. VGNATVRE OF APpr ICANTfS) Use additional sheets of ;lager if mule space is required. EXEMPT YELL DATA SHEET - DENVER BASIN, COLORADO APPLICA+IT: HARMAN RECEIPT NO. 396311 LOCATION; IIVI/4 OF SE114 OF SEC. 12, T.1N.. R.b6a!- {1]90 SSL. 1IM40 EEL) PROPOSED AOUIFERt SURFACE ELEVATION: 5045 NUMBER OF ACRES IN TRACT: 5 IS PROPERTY yiTNIH SERVICE BOUNOARTES OF NUNICIPALETY S.R.5 CONSENT MAPS? NO_ YES_ IF SiJDDIYISION IS UNDER AUGMENTATION PLAM, CASE NO- IS DIV- IF SUBDIVISION WAS RECCFMENDEO FOR APPROVAL BY THE MATES MANAGEI MC BRANCH, DATE OF LETTER IS INFORMATION ON SUBDIVISION OR TRACT OF LAND/SPECIAL RESTRICTIONS, evaluated by LR an FEBRUARY 27, 1996 ELEVATION DEPTH TO ANNUAL -•------------- NET --------------- APPROP STATUS AQUIFER Bol. TOP SAND ROT- TOP k -F UPPER DAMSON .... .... ...- LOWER DA4WSON -- .• ._ _. DENVER ---- ---- ---- ---- UPPER ARAPAHO£ ---- ---- -.- -•- .. LOWER ARAPAHOE 4683 4925 101 362 120 0.859 NNT LARAN[E-FOX HILLS 3971 4261 151 1074 784 1.133 NT note- E indicates location is et egUiftr bojidgr'y amd Values may be more approximate. • indicates the proposed aquifer. AIL values are intcrpoletad from the S.B.5 date base esamabled in November of 1986. Permit A lication Ch a Form To he used when inswing w ilpermits based upon lnforniallon other tun at received. Please file with final Permlr Receipt No_`, 7 b 3 I Name of Applicant Pot yj H ry Summary of change(s): b lM ink ar P 2- OO o Qe `rr plat Data Sighed Print Name Scanning Cover Sheet for Septic Permits Permit # SP -9600063 Permit Type: Health ! Residentia:I New Situs Street Address 4255 ELIZABETH ST Situs City, State, Zip Sec!TownlRange: 12 -01N -66W Application Status: Finalod Application ❑ate: 01!3111996 Parcel # 112 dl 147112403005-80224394 Owner Full Name: HARMON PAUL J Owner Address: 636 S 13TH BRIGHTON,CO 80601 Owner Phone #: (970)659-6467 Contact Name: SANDERS JERRY Contact Address: Contact Phone# Information above has been Verified in Accela by employee noted below March 22, 2010 Processed by: Date Report ID: EHS00024v003 Print ❑ate -Time: 3/2212010 3 35.17PM Page 1 of I WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970)353-0635 EXT 2225 FAX (970)356-4966 Permit # : SP -9600063 sec/Tw/Rng: 12 01 66 Status; I3U Permit Type: RNEW C-CornmcrcidL, Ridenrial • NEW, REPasr. Applied: 01/31/1996 Parcel Na: 1471 12 403005 Zcj5L—(LA ]� -i Issued: 02/13/1996 • Location: LOT 5 MARTIN EROS SUB 12-1-66 FjJd Legal Desc: MB -5 L5 MARTIN BROS PUD - AMENDED PLAT 4255 ELIZABETH ST BRIGHTON APPLICANT SANDERS JERRY OWNER-�ARMON PAUL J Phone; (970)659-6467 636 S 13TH, BRIGHTON, CO 60601 Description: HOUSE RESIDENTIAL Commercial (Y/N): N Residential dY/N): Y Acres: 5-03 Number of Persons: 4 Number of Bedrooms: 3 Water Public (Y/N): N Water Private (Y/N); Y Water Permit No: Percolation Rate: 30.0 Ground Slope: Dir Engineer Design Req'd (Y/N) Basement Plumbing (YIN) : Y Eathrooms-> Full: 2 3/4: 1/2: Utility Name; Cistern (Y/N) : Well (Y/N) : Y Limiting Zone: 08 it 00 in Desc: Soil Suitable (Y/N): Y N In 100 Yr Flood Plain. (Y/N) : N Minimum Installation Septic Tank: 1000 gal Absorption Trench: 774 sq. ft_ Absorption Bed. 1020 sq. ft ActualZnetallation Septic Tank:gal Absorption Trench: sq..,ft_ Absorption Bed: - sq. ft -------------------------------------------------- ----..-r- . _----------------- NOTICE The issuance et [his permit doe not irrrply 4•pnpline Wit, other state, cot::try or to:al regLatory Cr t,,,ildrng requirements, nor Shall it ict to certify that the suhject syntero wi11 ape'.Le in ccnDLianoc .ir:h aPplicahte state, coucty and Locos regu Lotions a doptea petuant to Article 1(. Title 25, till as amended, r•-xcept fnr the i:oTpase of astanlishinq tint] approval of installed system [or issuance cf a 1nca1 oq cµpanCy perms[ persuant to CAS 19?3 25-19 Lit [Z1. 1 This per:nt is not tr ansferahle_ The Weld county Weelth Depattment reee:a.ea the right to impose additional terms and cbnllltlpn,s sequit:ed to meet our rey 1atlons on a oontinuing oasis. Final perntt appruvai -ai. contingent :pcn the fipal tr peahen CL the corpleted system by the Weld County 11ea1t`t Dena rtment. �1pJ° N7J Envi on tal Specialist Date f 4 y � WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT , G tEELEY , CO 80631 (970)353-0635 EXT 2225 FAX (97O)356-4966 Permit # : SP -9600053 Permit Type : R -NEW 0-n rour 1 reaider.tiai . NEW prtl'::,' VaLL Parcel Na: 1471 12 403p05 Location: LOT 5 MARTIN EROS SuB 12-1-56 Legal Desc: MR -5 LS MARTIN BROS PUD - AMENDED PLAT PERMIT Applied; 01/31/1996 Expires: 01/25/1997 APPLICANT SANDERS JERRY OWNER HARMON PAUL J Phone: (970)659-6467 636 S 13T1-1, BRIGHTON, CO 80601 Description: HOUSE RESIDENTIAL Commercial (Y/N) : N Residenti:dl (Y/N) : Y Acres: 5.03 Number of Persons: 4 Basement Plumbinq (Y/N}: Y Number at Bedrooms: 3 Bathrooms-> Full: 2 3/4: 1/2: 1 Water Public (Y/NN Utility Name: Water Private (Y/NY Ciste -rl (Y/N}: Well(Y/N): Y Water Permit No: Percolation Rate; 2t Limiting Zone: S ft O in Desc: Ground Slope: _ Dir: Soil Suitable (Y/N) Engineer Design Req'd (Y/N) rn 100 Yr Flood Plain (Y/N): From the application information euppiiod and tho on -site Soil percolation data the Eollavring mlmimum inatallatiou apecificetloaa are required, Septic Tank: jtann gallons, AbsorPltmon Trench '�-7' sq. ft. or Absorpt ibri Red tOzo Sq . f t . In addition, this permit is subject to the following additional terms and condition I� NOTICE his pe rn1- is granted teep:ia-i_y Lo allow costruct,o:, to co;:r;,enc-e. T;:i_, oerm,t Fray be revoked or 4u;pendad by the Weld County Reap'; C]eeartment for reasors scr €ort.h in the held Coup. y !,.dr idual srar.gr diepnsal system requlat ions including failure Lc acct a:ry Cert of Oornditi.n. 1RipoS!'i3 Lhe.-ear, dot in LCfliptCocy Cr ..r.ai ;i ppr cvu„ Thu_ -sass of. Llli3 pe: ,,it does 154', eoneklt'rte ass:.Tp:io:, by the department ar its er.ployees or lrab licy tug .Ina fan :01--: :.r lr:a-:iu.laary of the sewage disposal systec:. This perFait i:1 ri L t=aniEe rc hlc. Re[ore iSsuiny f,r.ai aU proval of c ni,. p• unit rhea weld Cc•ur.ty i4enith Depart'',ne,rt reed -ace the right ty im.pose adtliLLwna[ torso and tom, plane Lequ!tet to mare. Sot 50r1a1at1::n:, on a oo::-in,:lny basis, Final peritit appao•ra.I -o contingent upon the Final inspection of the completed r:ystem by the Wed-i .:.rnty IIealth DeparL-ient. Ervikni ntal Specialist a e / . '.*, T ate f = . � ( � \ � }6 }C 2 — ._� _ \ \\ \ \ $ l . � / ; °�a{»•( �r»mK)�!`(a$\\E . a®/E- —I �a/// �. :. HHI4(| • APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM No 3 P .s WELD COUNTY HEALTH DEPARTMENT New �ENVIRONMENTAL HEALTH SERVICES Repay 1515 Hpspit3l Road, Greeley. CO 80631 PARCEL NO. I 2+1p ln 35-O540 EXL 270 aP OWNER441I I H'$W44AJ ADDRESS 3 f! PHONE -�o ADDRESS OF PROPOSED SYSTEM N GPM Sec 1-- LE.AL DESCRIPTION OF SITE: PT S_____ 7_( n/ -- b!� L SUBDIVISION 4 I' I2S /Gi L7 LOT_,, BLOCK__—. FILING USE TYPE RESIDENTIAL - _ INSTITUTION COMMERCIAL OTFI ER SERVICES: PERSONS________ BATHROOMS r" LOT SiZE SO3 ICF21 REORCOMS 3 BASEMENT PLUMBING__________ WATER SUPPLY____________ INSTRUCTIONS CHANGE OWNERSHIP -ADDRESS LOCATION CORRECTION FORM JULY 1990 NO FEE IS REQUIRED 4 The farm must be typewritten or printed in BLACK INK Initial and date any changes you make on the formm,! THIS FORM MAY BE REPRODUCED BY PHOTOCOPYING OR WORD PROCESSING MEANS. INCOMPLETE FORMS WILL BE RETURNED. ATTACH ADDITIONAL SHEETS IF MORE SPACE IS NEEDED. 1. Print the new owners name and include the mailing address and phone number. 2. Indicate lithe change in ownershipladdress is for a well permit, livestock water tank or erosion control dam. Be sure to include the proper permit. tank or dam number. 3. Complete the well location information. If the address of the well location is different than the mailing address of the owner, include the address where the weli;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 actual well location must include I&1, 1/4, Section, Township and Flange. Check the appropriate boxes for North or South and East or West directions. Complete the Subdivision, Lot, Block and Filing information, if applicable. 1 4. Complete the location information for the livestock water tank or erosion control dam. The actual location must include 1/a, 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 ownership/address and/or focatian correction. 6. The owner of the structure must sign. Print or type your name in the first block if it is different from Item No. 1. II signing as a representative of a company who owns the structure, then your title must also be included in the first block. Sign the second block and date the last block. USE THIS FORM TO CORRECT THE LOCATION OF YOUR WELL IF: I• A. Your well was permitted, registered, or first used prior to May 8, 1972 for ordinary household purposes in up to three single -/amity dwellings, fire protection, the watering of poultry, domestic animals, and livestock on farms and ranches and the irrigation of not over one acre of home gardens and lawns. B. 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 by the Water Court for the correct location tN ALL OTHER GASES USE FORM GWS 12 L AJI other types of changes concerning Livestock Water Tanks and Erosion Control Dams should be sut)mMe,d on the standard Permit Application form and be accompanied by a $15.00 filing fee. if you have questions, contact the Denver or the Division Office where your well is located. DIVISION 1 DIVISION 2 ❑MSION 3 DIVISION 4 209 ARIX BUILDING 219 W. 5TH RM. 223 422 4TH ST. 1540 E. NIAGARA 800 8TH AVE. PUEBLO, CO. 91003 ALAMOSA. 0081101 MONTROSE, CO- 81402 GREELEY, Co 80631 (719) 542.3368 (719) 589-8683 (303) 249.6622 (303) 352-8712 DMSION 5 5063.3 US HWY 6 & 24 GLNWD SPGS. CO. 81601 (303) 945-5565 DIVISION 6 320 LINCOLN AVE. STE. E STMBT SPGS.. CO. 80477 (30.3) 87941272 DMSION 7 1474 MAIN ST. DURANGO, CO. 61302 (303) 247-1545 DENVER OFFICE RM. 823 1313 SHERMAN ST, DENVER, CO. 80203 (303) 866-3581 'FOAM• HD. CWS•32 - PUMP INSTALLATION AND TEST REPORT For Os us. only rU/9a STATE OF COLORADO, OFFICE OF THE $TATE ENGINEER RECE 1, WELL PERMFT NUMBER �} 3h. _L7._-_-. U613'93 2 OWNER NAM(S) r .' c_ '? a Mailing Address 3c I City, St. Zip ! Phone { ) 6, 3. WELL LOCATTION AS DRILLED: 1/4 S lr 114, See. I - Twp._ / .Range d DISTANCES FROM SEC. LINES: e. 9 50 ft. from �SeC_ line. and 1 C� R. from Sec. line. 1J1 cr row, ..=c or SUBDIVISION: /}larDtACSt LOT _BLOCK FILING(UNiT) STREET ADDRESS AT WELL LOCATION: - 4. PUMP DATA; Type ��n rler 5 ilo�e Installation Completed 1i-'/ Pump Manufacturer 1- u2. Pump Modal No. bI35`Ij I SZ Design GPM at RPM 3 HP 3 , Vohs U ,Full Load Amps lb . Pump Intake Depth Feet, Drop/Colurrtn Pipe Giza I 1K — _Inches, iGnd b L6 q O 4 n .. ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM, TURBINE DRIVER TYPE: ❑ Electric ❑ Engine ❑ Other Design Head feet, Number of Stages, Shaft Size inches. 5, OTHER EQUIPMENT' Airline Installed ❑ Yes L +�J^ 7YQ, Orifice Depth ft._- Monitor Tube Installed ❑ Yes L'1 o, Depth ft. Flaw Meter Mfg._ , .A)/A A Meter Serial No, Meter Readout ❑ Gallons, ❑ Thousand Gallons, ❑ Acre foot, ❑ Beginning Reading S. TEST DATA: ❑ Check box if Test data is submitted on Supplemental Form. Date Total Well Depth 9 Da' Time Static Level y Rate ((3PM) Dpta Measured 11- + - 4 3 Pumping Lvl. T. DISINFECTION: Type h17_ 1` C4 ) C 1' �2 Amt. Used IV cue _ d i 55 01 y9A i . 8. Water Quality analysis available. ❑ Yes lo 9. Remarks 0. I have read the statements made herein and know the contents thereof, and that they are true to my knowled [Pursuant to Section 24-4-104 (13}(a) C.R.S., the making of raise statements herein Constitutes perjury in the sect degree and is punishable as a class 1 misdemeanor.] CONTRACTOR S ¢cn'4 5envice. Innc. Phone (9L)_659—/584 Uc. No.715 Mailing Address 20, r 2 ('t. u ton C. cO62f Narne/Tille (Please type or print) Sigrs aura i Date Tom W. Span P ,te iLdents , �N d 11,190 11140 b�i Vhrl STATE OF COLORADO. OFFICE OF THE STATE ENGINEER r8f UTT1U t 1, WELL RERMt7 NUMBER �3 $ g a OWNER NAME(S) G -in construction Inc. Mailing Address P .O. Box 381 — _ _ _ _ City, St. Zip Rright_on. Co_ 90601 ____, Phorle ( 303 ) 659-3969 3. •1 WELL LOCATION AS DRILLED; NW 114 SE 114, Sec. 12 Twp. 1 N ,ange 6 6 W DISTANCES FROM SEC. LINES: g 5 fl f. from Sec. line. and 1 a a o ft from E Sec. line, OR north of much) Ts .q ar V-MQ SUBDIVISION: Martin Estates LOT 6 BLOCK FILING(UNIT) STREET ADDRESS AT WELL LOCATION: 4345 Elizabeth Street 4. GROUND SURFACE ELEVATION ft DRILLING METHOD Rotary DATE COMPLETED 10-15-93 . TOTAL DEPTH 900 ft. DEPTH COMPLETED 900 ft. 5. GEOLOGIC LOG: D.p:h D..crrplron or M4I.Ad (ryp., 81 u, Co oi. W.lc LociI onl _711 Brown tanrl 6. HOLE DIAM. (in.) From (ft) 7a (tt) 8 3/4 0 30 6 1/4 30 � Brown sandy clay 70-120 Blue 5hacle - •7. PLAIN CASING 00 (in) KGnd Wall Size From(tt) Taft) f5,48 9t.1 1 yg�� in� PERF. CASING; Screen Slot SLze:3Tlcl=i c 4 1/2 Steel .188 30 711-170 R711Gha1Pf 1a Pre of sand - - n-5 10 R1 1in sha 1 w ? cLn= in rQ 1 11 P s h n I e f 1 a vP r 4' of ran 1 - - „_- 8 FILTER PACK Material Size__ __ Interval F9. PACKER PLACEMENT: TYPs H Burton asket Placed at Depth 7zn,- 10. GROUTING RECORD: Material Amount Density Interval Placement cement 450g 1 0-720 Pump hau `_ -- REMARKS:__________________________________ ',3% .r rh lnz dp added to cement 1 1 DISFECTLON: TYPOTyp8rpnu1ar Chlorine Arm. Used4 cups dissolved in 5 gallons W ELL TEST pATA: water, poured through dri pipe agi ❑ Check box if Test Data Is submitted on Supplemental Form, with air. TESTING MMOD Static Level 450 n Oaterrime measured pm Production Rate 30 Pumping level n It. Date/Time measured , Test length (hrs,)�rs 9Pm Remarks at 9 3, r hhrv. reed it'd M.Isrn..W male h.r.ln and imow tha.amens nh«.or, and hrid they.,. tiu. In hnr IahawMdp4. Lphnauam ro section 24.4i 04 (13j(SI ca 8., tlhr rnsdr of rd.. dal.rtnwKa h.r.ln aerodhnu. p.4wy <n tha a.cond d.yr« end 1. pumwm>1e.a ■ cwm F MW§Ma.nor.1 CONTRACTOR _ John's Dril11 0U lnc* Phone ( 3] 46 Lic. No. 827 Mailing Address Name Title (Please type or print) Signature Lloyd John r�WnezJ Fresider,t - Foals -12-93 f C Ur:5 .h15iHLJCrIUN ANL1ST REPORT I. The report must be typed or printed in BLACK INK. Alt changes on the form must be Initialed and dated. Attic' additional sheets If noe space is required. Each additional sheet must be identified at the top by the well ownerl's name, the permit nuA4er, 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. The original and one copy of .this form must be submitted to the State Engineer's Olice within 60 days after completing ttte well or 7'days after the permit expiration daze, w'hlttever Is eaftier. Another copy of the form must be provided to the well owner. Complete the Weil Perml Number In full. 2 Fill in Nam* and Mailing Address d Well Owner where correspondence should be sent. 3. Complete the blocks for the actual location of the' well where drilled. If the owner has more than one well �serrringrthls_pro�erry. provlda�pe_identification.(CwTt s-Desi,gr ort}_far this-well.YDO:NOT L'SE ThE-OWNER —. UPPtl1=D LOCATION unless a survey has been provided. For wells located in subdivisions the lot, block and subdivision information must also be provided. t 4. Report the ground surface elevation in feet above sea level it available. This value may be obtained from a topographic map. Describe thel 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 encountered In drilling. Do not use tormalion names unless they are in conjunCtIon with a description of materlats.- Exampies of descriptive terms Include; Grain size --Boulders, tgravel,sand, silt, clay. Kardrne is. -Loose, soft, -tight. hard, very hard. Color -Ail materials. Most critical in sedimentary rock.' Depth when water is encountered (If it can be determined). 6. Provide the diameters of the drilled bore hole. 7, The outside diameter, kind, wall thickness and interval of casing lengths must be indicated. a. Indicate the type and size of lifter (gravel) pack and the interval where placed. r 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, trernie pipe or positive displacement. The percentage of additives mixed with the grout should be reported under remarks. 11. Record the type and tho amount of disinfection used, how placed and the length of time left in the hole. 12. Report well test data as required by Rule 10.7. Spaces are provided 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. 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 well, Form No. OFFICE OF THE STATE ENGINEER "GVI)S-25 COLORADO DMS ION OF WATER RESOURCES 818 CRntennlal Bldg., 1313 Shotmen tit„ Dorri.r, Golomdo 84X13 (343} 86535$1 APPLICANT GF1EIN CONST INC 13565 WCR 2 BRIGHTON CO 80601 (303) 659-3969 PERMIT TO CONSTRUCT A WELL WELL PERMIT NUMBER 17?398 - DIV. I CNTY, 62 WD 2 DES. BASIN MD 827 Lot: 6 Block. Filing: Subdiv: IW1FrfN ESTATES APPROVED WELL LOCATION WELD COUNTY NW 1/4 SE 1/4 Section 12 Twp 1 N RANGE 66W 6th P.M. DISTANCES FROM SECTION LINES 1950 Ft. from South Section Line 1800 Ft. from East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDMONS OF APPROVAL 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 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)(tl)(1) and policy of the State Engineer under the following conditions. 4) The use of ground water from this well is limited to ordinary household purposes inside one single family dwelling, the watering of the user's noncommercial domestic animals, and the irrigation of not more than 12,000 square feet of home gardens and lawns, as recommended by the Division of Water Resources to the county commissioners. _5) Production from this well is restricted 10 the Laramie -Fox Hills aquifer which corresponds to the interval between r7?5-feet and 1065 feet below ground surface. Plain casing shall 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. 8) This well shall be constructed not more than 200 feet from the location specified on this permit. Note: To insure a maximum productive life of this well, perforated casing should be set through the entire producing interval of the approved zone or aquifer indicated abov 8/3o/F3 I' Note: Pursuant to a verbal request by Lkryd John of John's Pritbng Chic #W) on 10rM 93 by phone, Gonditfan of Approiral No_ 5 above is hereby amended to aflow production to begin at 720 feet ing1 CA ns twnr_ —_ i o/�nfcrr3 APPROVED DWR I Receipt No. 0357529A DATE ISSUED S P 0 2 X993 �XP71-nON DATE SEP 0 19 WRJ-5.ReY, 1t4 Application must be complete where applicable. Type or print in BLACK INK- No overstrikes or erasures UnIe5s initialed. COLORADO DIVISION OF WATER RESOURCES $18 Centennial 81dg., 1313 Sherman St., Denver. Colorado 80203 PERMIT APPLICATION FORM (pd A PERMIT TO USE GROUND WATER (,c} A PERMIT TO CONSTRUCT A WELL FOR ( XI A PERMIT TO INSTALL A PUMP I } REPLACEMENT FOR NO. i IOTHER WATER COURT CASE NO (1) APPLICANT - mailing address NAME STREET 3 JA yLR CITY �T`� (state} (Zip) TELEPHONE NO. --03— 6 9pr 3767 (2) LOCATION OF PROPOSED WELL Cou�nnty e Id A) r o of the - ( fa, Section Twp. J /., Rng. W 6 r P.M 6N.51 IE,*i---- (3) WATER USE AVID WELL DATA Proposed maximum pumping rate (gpm) Average annual amount of ground water to be appropriated !acre-feet]:— —. Number of acres to oe irrigated: Proposed total depth (feet I: [�f Aquifer}ground water is to be obtained from: 1 Y ++r+¢ tC L // Owner's well designation GROUND WATER TO BE USED FOR: L ) HOUSE�IOLD USE ONLY .Xj DOMESTIC III I 1 LIVESTOCK (21 ( ) COMMERCIAL 1LI I OTHER (9} no irrigation 101 I (INDUSTRIAL (5l (IRRIGATION 16) ) MUNICIPAL (RI DETAIL THE USE ON BACK IN (11) (41 DRILLER Name IJ{Ill Street /�++)0 1Df 54t& 1 LUf s IR 7 Ll City V of [sate( t gip} Telephone No_ Lic. No. $27 RECEIVED JUL j5'93 WkttR ' TIT ENcalEt MID 230 FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLD y Na .TE? S rfa i Receipt No. j. -c7 �! —A / ijbif s f 3: i'f KI C Sao +• �t40't Basin fro ff4n,4edI DistNu �.. J Dn f.1 a r/rLlcar (L9NDITIONS OF APPROVAL 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 3/� 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. 1444 (&.,4•++a.wrii Fa,a00A-k, 1. f APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION DATE BY 1.0 (STATE ENGINEER( COUNTY G'Q — o_ — - 1-s. (5) THE LOCATION OF THE PROPOSED WELL and the area an which the water will be used must be indicated on the diagram below. Use the CENTER SECTION II section. 640 aeres) for the well location k '4- 1 MILE, 52$4 FEET ►I ! f + — + + T _— + 1 41 I --- i 4- NORTH SECTION LINE I I � J Z I H —t t I SOUTH SECTION LINE -1- — — The scale of the diagram ss 2 inches -' 1 mile Each small square represents 40 acres - (B) THE WELL MUST BE LOCATED B.LQ by distances from section lines. b - ft. from —sec. line f^o*fn tie soutnl _ r_l� ft. from-- sec. line least or wastl LOT BLOCK _-FILING SUBDIVISION n ns e►7l.rl : i/er' (7) TRACT ON WHICH WELL Il L B LOCATED Owner: I No, of acres 5 Will this be the only well on this tract? (B) PROPOSED CASING PRQGR M Plain Casing J'?__ ft _ in from ft. to �2 in. froni ft.to 650 ft. Per(❑ra ed casing in. from 6 54 'ft. Io rq in- from — ft. to ft. (9) FOR REPLACEMENT WELLS give distance and direction from old well and plans forpluggirtig it: WA1EA EQUIVALENTS TABLE lRounded I-iguresl An acre-foot covers 1 acre of land I fOul deep - 1 cubic root per second lclsl - - 449 gallrsr s per minute I9prnl A family of 5 w$11 req+lire apnrosimatsly 1 acre-tooc of weler per year. 1 acre-foot .. 43,560 cr,b•c feet - 325,900 gallons. 1,000 gpm pumpetl continuously for one day produces 4-47 acre feet - (10) LAND ON WHICH GROUND WATER WILL BE USFP K Dwner[51: � � 1 / �' � � � _— No. of acres. Legal description: �°.r Co l V-?^ `1 �°o'ri`°��} 4n r 1� ,rC� (11 ) QTAILLDDESCHIPTION of the use o€ ground water: Household ruse and domestic wells must indicate type of disposal stem be used. •iyrvr J+r`r 'ft'ee 5 4- (ll/t__ {12) OTHER WATER RIGHTS used on this land, including wells Give Registration anti Water Court Case Numbers, Type or right Used for iipurposel Description of land an which used (13)THE APPLICANT(S) STAT€(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE, SIGNATUR1 OF APPL Use additional sheers of paper if more space is requ,red EXEMPT WELL DATA SHEET - DENVER BASIN, COLORADO APPLICANT: GRFIW RECEIPT NO. 357529-A LOCATION: NVI/4 OF SE1/4 OF SEC, 12, T.1N., R.66W- (1950 $5L, 1800 ESL) PROPOSED AQUIFER: SURFACE ELEVATION: 5040 NUMBER OF ACRES IN TRACT: 5 -------------•------__------------- -- -•---•----___--_-. ^ ...-._...____--------- -- ------`••---••--- IS PROPERTY WITRIM SERVICE BOUNDARIES OF MUNICIPALITY 5.5.5 CONSENT MAPS? NO YES - IF SUBDIVISION IS UNDER AUGMENTATION PLAN, CASE NO. IS , DIV- IF SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY THE WATER MANACEIMENT BRANCH, DATE OF LETTER IS INFORMATION ON SURDIV1SIOM OR TRACT OF LAND/SPECIAL RESTRICTIONS: evaluated by JS G on AUCRJST 27, 1993 ELEVATION DEPTH TO ANNUAL --------------- NET --------------- APPROP STATUS AQUIFER ROT. SOP SANE SOT. TOP A -F UPPER DAWSON ---- ---- ---- ---- ---- --- LOWER 08115311 ---- ---- ---- ---- DENVER ---- ---- --- UPPER ARAPAHOS ---- --- 4691 4929 100 0.842 NNT ARAMIE•FOX HI S 3975 4267 15 06 173 1.155 NT note: F indicates Location is at aquifer boundary and values may be more approximate. + indicates the proposed aquifer. All values ore interpolated from the S.B.5 data base assem6Ledd in November of 1986. o1 f Q LI'i C I O J� . — (' P -q (s ' c 3 7) / Gf 1p r 77S, 4 44j1 T / 1w' �� - STATE OF COLORADO OFFICE OF THE 5rATE ENGINEER p c division of Wailer Resources Department of uraI Resources Ilf3Sherman5Iree,Rn, 818 Deaver, CoIorndo 8020] Phone (303) 866-35!i FAX {301) 866-3589 RoyeMOF �i4>✓efnOr Ken Salazar Exetvtiue Di rector Hal E}. Simpw October 20, 1993 Swale Erginee, GREIN CONST INC 13565 WCR 2 BRIGHTON CO 80601 Re: Well Permit No. I72398 Dear Madam or Sir: On this date, your driller, Mr. Lloyd John of John's Drilling contacted this office by phone and requested that permission be granted to construct your well for production to begin at a depth of 720 feet below ground surface instead of 775 feet as required by the permit. The driller was on site and encountered a good producing sand beginning at 720 feet below ground surface. After reviewing this request, we felt that it could be granted. Accordingly, Condition of Approval No. 5 on your permit has been amended to allow perforated casings to begin at 720 feet below ground surface. All other conditions of approval remain unchanged. A copy of the amended permit is enclosed for your records. This replaces the copy you previously received. If you have any questions, please contact this office. Sincerely, John W. Bilisol North Region ter Supply Branch JWB/jb Enclosure cc: Division 1 John's Drilling ' FpAM No i = STATE OF COLORADO t t+�r and 07193 O73 OFFICE OF THE STATE ENGINEER 816 QNO@mid Bid. 1313 sh.rnw p.. Dunv. Calw.do 60263 PfdOR TO CeMPL€TMIG FORM, Sty INSTRUCTIONS ON REVERSE 5113E N(W 3'0 93 CHANGE IN OV ERSHIPIADDRESS I LOCATION WELL PERM r LIVESTOCK K TANK OR EROSION CONTROL DAM 1. NEW OWNER NAME (S) ._ Mailing Address , a Phone(O3)z.Y 2 THIS CHANGE IS FOR ONE OF THE FOLLOWING: KWELL PERMIT NUMBER........... 4J Q LIVESTOCK WATER TANK NUMBER Q EROSION CONTROL DAM NUMBER ... 8. WE LOCATION COUNTY X111 i❑ OWNER'S WELL DESIGNATION - 45ddr(sl 4 .. ...}..a.._ aes, rtie...s .._ 1/4. SoC...12: Twp.-.[........ , N N. or5., Ran�❑ E.r ILA W Dletances tram Sectiion Lin^es..- S ....... Ft. from ❑ N. or IfJ/S. Une, . I,. L7 4... Ft. from E, or D W. Line. Subdlvisian ..%Y}r!(^....:9, ro-.-_. ltl►'`-'�.. uI.ikJLot ...... ... Block 4. LIVESTOCK TANK OR EROSION CONTROL DAM LOCATION: COUNTY Wp❑N.nr❑5., i1a, sea.. ... T. Range ...................P.M. L__l E. of Q W. .. 5. The above listed owrter(s) say(s) that he (they) awn the structure described herein. The existing record Is beIng amended for the following reason($): PChange In name of owner. ❑ Change in mailing address. Q Correction of location. 6. I (we) have read the stater arAs made herein, know the contents thereof, and state that they are true to my (our) knowledge. [Pursuant to Section 244104 (13)(a) C.R.S.. the making or false statements herein constitutes perjury In the second degree and Is punishable as a class 1 mtsderancr.j Nar eMla (Please type or print) {} Signature Data ViJt+.fk C."eiw yr l" �. FOR OFFICE USE ONLY Sam Eno by Court Cage No. Div. Co. , WD Basis MD 1 Use • ` 191 OF-RCE OF THE STATE ENGINEER AMFY COLORADO DMS ON OE WATER RESOURCES t3zt Centennial Bldg 1313 Shaman SL. Denver, Colorado 80203 •r r $66581 CHANGE IN OWNERSHIP/ADDRESS CtLANGE REOUEsT WELL PERMIT NUMBER /72.'' ! 2 }_ FROM: A M2" DATE. Pus Change in OwnerslriplAddress is being returned tayou for amore comptete or a correction of data Complete and/or amend as necessary and retamas soon aspossltte. PLEASE INFHAL ANY CHANGES YOU MADE TO THE FORM. i. _ Complete the well owner name andaddress. 2 ___ Enter or verity the permit number. Our records show permit number at this Ioct4jocL 3. — Complete the blanks for the locafibn of the well where checked 3A. — The location given does.rtp ,= respond to the location on the well permit. Please amend or explain the drsa y_ (lt Esj b1ethetanewapp�cationfor :apermit to rellert the cortstnicted location wllU be • necessary) Our records ir3dicate thatthewee Is located In the _._1 f4 of 1/4 Sec Township ; Range , P.M. - - FL h m N -Dr S and FL fmrn E or W Section lines. 4. �. Complete the blanks for the location of the Livestock or Erosion Control Dare 5. _ Indictee the reason, either name or address or both. 6. The now well owner must sign the document Pint or type your name in the first block. tf signing as a representative of e c ompary who owns the well, then your title must also be included in the fist block Sign the second block and date the last block Other. Scanning Cover Sheet for Septic Permits Permit # G19930246 Permit Type: Health J EHS History J EHS Conversion History Situs Street Address 4345 ELIZABETH ST Situs City, State, Zip Sec!TownlRange: 12-01 N -66W Application Status: Finaled Application Date: 03111J19B Parcel # (12 digits) 147 112403006-R0224494 Owner Full Name: GREIN KEN Owner Address: 13565 WCR 2 BRIGHTON,CO 00601 Contact Name: Contact Address: Owner Phone #: 303 6593969 Contact Phone# Information above has been Verified in Accela by employee noted below x August 29, 2005 process by: Date r ReportrD: EHS00024v003 Print Date -Time: 8129/2008 10:47:41AM Page 1 o€ 1 II;;II'€ObF I:I•IIi:L+JrC)L_!r"�f,. ;:rl::�!,'ifii C)t:;f4)L`;Y31l!I I k.lIF.Jlll f I-•I1;1D C, Wr:l..I? CT)LJII-11`r' IIF:G�L_II-I C:i{:I`f`I;T!'tl::l•TI NEW €'L:h'I'II f I:'hh,':Ti' L11lhIl:'llrrrl.. -FEllL LtI iL{:"•'ICI -` :i :1 ' L6 f Fl VI-_i:: E;E'EL.li:''1 t11:f..l.. lil 'r ,. L; ' L1WhIL 4II.. 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