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Home My WebLink About20220034.tiffC O L O R A D O WELL PERMIT NUMBER 185084 - Division of Water Resources RECEIPT NUMBER 0379538 ORIGINAL PERMIT APPLICANT[S] APPROVED WELL LOCATION WEBER JOHN P Et NADELIN PrISTER Water Division: 1 Water District: 2 Designated Basin: N/A Management District: N/A County: WELD Parcel Name: MARTIN RROTHERS PUD Lot: 12 Block: Fiting: Physical Address: N/A NE 114 SE 1(4 Section 12 Township 1.0 N Range 66.0 W Sixth P.M. UTM COORDINATES Meters. Zone: 13. NAD83) Fasting: 523812.1 Northing: 4434987.6 See the original well permit file for permit conditions of approval and additional details. The Original permit file can be viewed ising the Well Permit Search Tool at www water.state.co.us Date Issued: 2/23/1995 Expiration Date: 212311997 Issued By PERMIT HISTORY 03-28-2018 CHANGE IN OWNER NAME/MAILING ADDRESS CHANGED TO FELIPE QUEZADA ' 03-28-2018 CHANGE IN OWNER NAME/MAILING ADDRESS CHANGED TO MONICA LOUISA OUEZADA 03-04-2015 CHANGE IN OWNER NAME/MAILING ADDRESS Printed 03-28-2418 For questions about this permit call 303.866.3581 or go to www.water.5tate-CO.u5 Page I of 1 Scanning Cover Sheet for Septic Permits Permit # SP -9500193 Permit Type: Health i Residenuai r New Situs Street Address 17723 CLARA LEE ST u Viva % iI%y .JI1 , 4I SeclTownlRange: 12-01 N -66W Application Status: Annlred Application Date: 04/15119 Parcel # (12 digits) 147112403012-R0225094 Owner Full Name: TURN BULL BONNIE J & RANDOLPH M Owner Address: 17723 CLARA LEE BRIGI�T0N,C0 80601 t^iil l.Oi r%i Ogies "r: Contact Name: TURNBULLL RANDY Contact Address: 7580 GRANADA RD DENVER.CO.8O221 Contact Phone# (303)427-5507 Information above has been Verified in Accola by employee noted below x July 30, 2008 Processed by: Date Report IQ- E-S00024v0D3 Print Date -Time: 7/3012008 1:51 06PM Page 1 of 1 M! t z O3d/ z ..aril ;{!' 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LAIRD, P.E., {PHESIDEIf) CONSULTANTS IN CJVH ENGINEERING 14)450 WEST VIRGINIA AVENUE J��: 2920A LAKEWOOD, COLORADn &m January 18, 1995 y231995 9995 k t Mr. Randy Turnbull _ 7580 Granada Road Denver, Colorado 80221 Telephone: 427-5507 Subject: Percolation Tests for a Proposed Residence to be Located on Lot #12, I -L LLii urvtit iiai�i�cd unit DL:'rtlu'�ii,r;-iit - eiiai Car,_LL i R1e7 i, rhre; di County, Colorado. (Address: 17723 Clara Lee Street.) Dear Mr. Turnbull: This report presents the results of percolation tests which were conducted on Jitiiiiai 12, iir.J ni UL above capttoritc �RCOLATION TESTS Percolation tests were conducted at the subject site in accordance with the Public Health Service Publication No. 526, "Manual of Septic Tank Practice." Refer to Figure 1 for the locations of the test borings. The Robert A. Taft Sanitary Engineering Procedure, which is contained in the "Manual of Septic Tank Practice", was followed for the hole preparation, soil saturation, rate measurement, and percolation rate calculation. Site conditions consist of a gently sloping area with a cover of weeds. The ground slope in the proposed leaching field area is about 1.5 to 2.0 percent towards the northeast. It is estimated that the leaching field area is located 2-0 to 2.3 feet below the lowest area of the homesite- The results are as follows: Percolation T :stJ-IoLE #1 - 36" deep (silty .sand) Percolation rate = 30 minutes per inch Percoiatio Test Hole #2 - 36" deep (silty sand) Percolation rate = 38 minutes per inch M. Turnbull -2- January ]8, 1995 Sci:..rl-�-.�:C, tob "2920A r,� t rcglation 'Ted Hole - 30" deep {silty sand) Percolation rate = 34 minutes per inch Percolation Test Hole 194 - 30" deep (silty sand) Percolation rate = 38 minutes per inch t'r.file test Hale 0'-0" - 2'-0" TOPSOIL. firm to loose, loamy silty sands, brown, moist. 2'-0" - 4'-6" S1LTY SAND, loose, medium to fine grained sands with a moderate silt content, light brown to gray or buff, slightly moist_ 4'-6" - 6'-0" CLAYEY SAND, loose to firm, medium to fine grained silty sands with some lean clay, brown, moist. b'-0" - 10'-0" SANDY CLAY, stiff, low to medium plasticity, contains 1 J ;;C crti."Fcd rlay. L.AI44 noar v:attti, iali, moist. NOTE: No free groundwater was encountered by or formed in the Profile Test Hole on the date of the investigation_ The results given above indicate that a conventional leaching field is 1_1 LL, 1. c_.,.7 ,] L.. 'd '1 •t ' L.-.T1-.-1Ll-Q V LLt;, I/t�lJli� Lil It C LlitG ttir,itLL U. L51 iiIGy L/t-. LL L 1S Vista Litt/ Iii Ll lt: recommended depth zone and if careful attention is given to the recommendations contained herein. The Held must be located exactly over the test area since less favorable conditions could be encountered in other areas of the property. Assuming that the residence will contain both a garbage grinder and an automatic clothes washing machine, we recommend that t1ii, absorption area contain a minimum of 426 square feet of leaching area pet bedroom. This recommendation is based on the following formula: A = ]6S / Z M/ /} ;; - )L Mr. Turnbull -3- January 18, 1995 Salt Ai'.r!ytics jb 2920/ Where A = minimum absorption area per bedroom in square feet Q = estimated design daily sewage flow per bedroom in gallons (225) t = average percolation rate in minutes per inch (35) 1.6 = factor for increase in size due to garbage grinder and automatic clothes washer 5 = empirical value Jniditionwrecornrnend that the fi old area contain rio less than 1.400 t ,. C ,__ � t.-_ r L -f J iiaic Acct a rcachLig area, rcFarcl.c vl 1iGVw fi' v L/ltArul11A17 arc iLi%-UL .uiuti.0 ii_th_rcsne. The excavation for the leaching field must be made at least 2'-0" deep below groundlevel in order to remove the upper surficial layer of lower permeability topsoil which was encountered in the Profile Hole. However, the excavation should not be any deeper than 3'-0" in order to avoid exceeding the maximum test depth and to provide for the presence of underlaying less permeable layers which were encountered in the Profile Hole below about 6'-0", After the lower foot of drain gravel containing the distribution laterals is installed, an overlaying backfill of suitable sandy loam materials should be placed over the gravel layer for best results. Sufficient backfill materials should be placed in all areas so that there is a minimum of 18 inches of gravel and soil over the top of the underlaying distribution laterals in order to t- L".itaL1Li II dUCl udlC ili-1UldUL'II drdlllSL iit't1.111 . 3114 tllfJ UL LI1t ileIU *,i1LJUlU lfe mounded above the adjacent groundlevel in order to shed precipitation and divert surface runoff away from the site. It is especially important that the system be not only properly constructed but ,lcn nrnnnrlxt mrlrlifnri_ri hr rlrfltlh>~1V inCtallf'A tbt' {nil fihcrlrntinn cu tr'm - 1 - 1 itself does not require much attention as long as the waste water discharged into it is practically free of settleable solids, greases, fats, and oils. This means that the septic tank must be regularly checked for sludge and scum accumulations and that the tank must be periodically pumped before there is a danger of these materials escaping into the leaching field. All owners of the dwelling must ultimately be responsible for the operation and maintenance Mr. Furnbu€l -4- January 15, 1595 ieb rr29 A of the system. The builder should acquaint the owners with the importance of this responsibility_ In planning the site development, it is recommended that consideration be gi cn to allocating a reserve area for the construction of a rcplaccmi nt sy stern^, in the event that the initial system should fail. If needed, the second system would be constructed in a suitable area at the site and would serve for waste water disposal until the first system was either naturally rehabilitated or rehabilitated by appropriate efforts of qualified experts in the field_ Subsequently, the rejuvenated system can he used alternately with the second system to minimize the loading and prolong the life of both fields. Good surface drainage of moisture away from the field area must be constructed and maintained to prevent overloading the system. In addition, all roof downspouts must be equipped with discharge extensions which divert the periodic flows well away from the field area. This report has attempted to cover the most pertinent design aspects. If you should have any questions, or if 1 can be of further service, please do not hesitate to give me a call for clarification. Sincerely yours, Michael A. Laird, P_ E. Consulting Engineer MAL /vjs enc 10615 • r' ., .. A /1 F-3 P-2 P4 PfH P-1 FiB�I FIB#Z PROPOSED HOUSE CLARA LEE STREET r� NV LOT ## 12, MAR71N�y•'•jyBROTHERS PLANNED UNIT DEVELOPMENT - AM 1 D:D PLAT, WELD COUNTY, COLORADO ADDRESS: 17723 CLARA LEE STREET TEST HOLE 1" = l0U'-#l" FIGURE 1 TABLE I PERCOLATION TEST RESULTS JOB# IQ # DATE Or SATURATION /-f1-1 DATE OF TESTING HOLE NO. (DEPTH) TIME INTERVAL MINUTES WATER DROP INCHES PERC RATE REI-WKS MIN/It1CK P SIIak ad ho4s ( K �- f (3 3Q Lill 1}' f.5S St fjGCC •��dC��o 30 Il , 6Ey/n //jrts,. 30 f.Ib Lid �{x� 3d I__ f.o6 l.OD /,Sa 3Q l� 3O D, 44_I71� 3D o 11O LJ l i VBLE I cont'd vq,PxmRates. 35h1p1 HO F fJ1, (DEPTH) T1f.fF TWTERVAt. 1}rHUTES WATER DROP I INCHES PERC RATE REMARIGS MIH/TUCK __ar1 30 /,O_______ fry ________ ________T______ _____ 13c _________ �0 3a 3a d,qS d•a 3' 30 6 lrvo .3a ar9� 1'2a hate 30 0.85 dd ��d o Profile 1Hole Log 7oP5a1L (- liM - SL) , F1RN To Loos 6 , Lo A MY Slt7V r , 5A lira 5 , Bf a VA; 1*15 T. ....' cp h' -n (<M 1 fE ! F.To Fw E =� %RA11,rFD 5wND5 /rvrn4 nIUA1 A '1oA 1 TE SILT a V7F.N7, !40T WW1/ To Crftl oA BuFF, 5L►'INTLY Mo1ST. HCL '/Ey To F►R1''1 1`1EDiti To FlIvE CSRA►NE,D 51L7y S4hri5 WITS SaHC LEAW aL/fy, 6 W4/ , MoIS- 7 PLf�5TIC/T`i, C�N"TAIh15 ;oMr ERoDF.D CLAyc70N h'EA DTTOI?, 7i#/ Mo15T. I i LMOV7— ��,►Mr r l .n-rr11.S pllrlrl (f+x�r�f1�L iJ.t.. r l A!1 ENDED PLAT WELO C.CUNTY Coto" D" FONM M0. "3' WELL CONS 1 RUMON AND I E1 1 EPORT STATE OF COLORADO, OFFICE OI THE STAIN £NNEER IM GAP/ VM _ fl T VEU y,e;�rtc,E 7LNLpS wiTEEl� pm co . WELL PERMIT NUMBER 2. OWNER NAMES} MICIiAXL Y _ _ Madutrj Addre5S —Mn u?&TOLI4.-- Cy. S. Z'Lp . Cam- P22i .+� PhQne ) 6-o8k 3. WELL QCA t N iLLED; N 1/4S Ifs, seem i2 Twp. 1 N , Farts, 66 w DISTANCES FROM SEC. UNES: ' - 2 _ [t. iraltt 16 II ,PISA -. l Iha. OA SwaDIVIS1ON$L 'P A LOT�,eLOC(FL1NQ{UN1) _-_ ,TpFET ADDRESS AT WELL LOCATION: a GROUND SURFACE ELEVATION R DU.YETFIDD R ARY DATE COMPLETED 5'5 95 . TOTAL QEPTh DEPTH G D It. 5. GEGLOG1C LOG'. sada"r d �ww ora�s. M S PIQ,Eg DV L (in.) From To (h) _S� y y a: r ��iiaTi 9 ' 1 02-11 raa x 1�1d WM 80 From(ft) To(t) • j__ _.�.__ _ .....r ... — ..,�a._._ _ 965 -- -. �.�...rr...._r. �� A IRS eC�M1 4ti staai .0_ te "- _____ ._ 76O-774 .i l tv s��d I 47O-1180- s≥ &li A2fLfl W R FXM PAGK: & PACIER PLACEMENT �YPa '0sLa SMIW 10. 380111 NG RECORD: IIIMMIII Arrwwrtl Derwily Irwrval Placement 1 c s 1- 4.S Zs1 - ip.!d c 1I fI;lNFECTlON- Type /11'1t I Z t"dELL TEST DATA' ❑ Check box If Test DMa b aubn1i11sd an msnI$ Fc n TESTING MET OO AlalJrr Sralic Level - -80 - h, Datf/Tims msmselnd - r Pr04i1etion PAs 2# gpm. Puit)pg le l ft. O,MIeff meftu d� Tilt X11 (Ts.) • r",Ne read' 10AW"nd math Aw«n and 4rwr ft ooAYnY o+rahk wo whr# awl move to uq r to d sore 14-4.004 (t�IW C.11i,. ti ,d r,r.. �larrurnn Minn ro words WRury M .MF sowww owrs Nf M pudow CONTRACTOR EOGITI SCI{IOCK 1ELL DiULLING INC. Pppw L 288-S fik Uc. No. 4C I ddsiii Address r_HONr Ntjmnejif le (Please type or print) RQGim SCilaCal[S 3ipnisura Data 5-8-95 INSTRUCTIONS FOR WELL CONSTRUCTIDN ANU Tk9T RF-PORT rl,e report must be typed or printed in All changes on rq tam must be Inkiaisd and dated. Anach aodilronal sheets it more space is required. Each edt Uonil W eat fmilat be idenitifled it the top by the well owner's name, the permit number, form name/number and a ttuindal pope nl lobar. Report depths in tact below ground surface r• This Eorm may be reprodu. ed by photocopy methods, Or by cernpubr ganeretbn with prior approval by the State Engineer Tho original and one copy of rh fofm mtaa be uiLa kad b, lthe Ss Ic`rtpYtese OIliole wit* t tlo s [[liar GOrrtPimkW wall rx 7 days after the psmts e q ratlrnt des► tMtiiaerlsr le'. Mother copy of the form must be provided in Ink[ will ow!1w 1 Complete the Well Penns Number In full. 2 Fill in Nam and M&lnQ Addrsets at Wsa Owner where COnwpundsnce should be sent, 3 Complete. the bincki tqr the U0.stf1on. of-tt!te' e i where drteed. ` # the owner has more then one wall serving this property. Provk1i the Idrrttsljcaftan (9~s ps*taltltkiary for s+'+# well, 00 NOT _THE Tl OWNER Sl IPPUELOCM1P.f unless a iurrey has been providled.• %Ar-wefiM ldc sd In aubdivleione the tot. clock and ,subdivision inionnation must also be provided t - A Report the ground surlaes elevation In feet above title — l'atrrldlsdMThis value may be'obtain*dirom a lnpugraphic map. Describe the drlltlrp method td to 0e11att+uc* tf!ls wsl and the date coirtpieted. Indicale the local depth drilled and the WCtt[t+1 con[pleled depth d the Wsfl a` 5., Fully describe the niatersats encautxered IriWilling. 00 riot tine iOrrrllit dins.. untess they ors in conaun .con with a description of materials. _ Examples s_rl duecriptrve twins include; Grain sixar`•Boulderw, grovel lend, elk, clay, _ Hardness --Loose. situ upltt, hard. very herd. - Color --All materials. Unit critical In and Resler+ rock Depth when water is ncounlfitred (k t cn be 4iIwiip _ _ r _ 6. Provide tr1'a dtametars of the drilled bore hob. 7 Thu ouisicle diameter. kirk, Well Uilcknesa and Iasrvr al a"" SVhe mu jt be indicated. El. Indicate the type and size at titter (gravo peck and the Inhwal whsa pieced. 9. lr}Mcate the type and setting do, th for any pisl*isra Walt, t C. The density of the grout -scurry rlliu#I be repotted and may be ands, ea pounds per gaNan+ ashons at water per saGit, total gallons of wash and nurnhsr at sacks ueSpay the aids piacorrlerti . 4thod, i.e.-iremis pipe or positive displacement. The psrcalftfege 01 edtJEltlee lift with the pout should be rsport*d.und*r remarks. t 1 Record the type and the amount of distinfeetlon used, how pieced and the length of time left in the hole. t'" Report well test data as requited by Rtie 10.7. Speci we provided to report elll mea$ur*fTianti made during iii test The report Should show thO." 1sat c& Isd wklt W i rovSIpM of the Mn. It a last was not lrenormea explain when it will be done. -if •ev&Ub*s, fipoii dock Intel when meaatanements were taken, 13. Fiii in Company Nance and Addrim" of Cdir'i who CarnU'uct d the welt The report must be signed by the JIL,ensed Contractor responsible for the conwruc[lon of the wet Form No. GW$-25 APPLICANT OFFICE OF THE STATE ENGINEER COLORADO DMSION OF WATER RESOURCES sib Contenhld Bldg„ 1.113 Sherman St, Oenvrr, Coiorido B 203 130ij a tti 33B1 WELL PERMITT NUMBER i�IP . - DIV. 1 CNTY- 62 WD 2 DES. BASIN MD uc Let 13 9loo: Filing: 9ubdN: MARnN BROS PIO AMENDED PLAT APPROVED WELL LOCATION WELD COUNTY MICHAEL YANKER NE 114 SE 114 Section 12 8175 UMATILLA Twp 1 N RANGE 66W 6th P.M. DENVER CO 84221 DISTANCES FROM ECTION LIF,ES (303)426-0847 2165 R. from South Section Lute 884 Ft from East Section Line PERMIT TO CONSTRUCT A WELL ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RiGHHT CONDf 1QP r OF APFFIQVAL j 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 wig 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 31"01 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 l=xaminere of Water Weil Construction and Pump installation Contractors In accordance with Rule 17. 3) Approved pursuant to CRS 37-92-602(3)(b)(0 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 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 to the Laramie -Fox Hills aquiter which corresponds to the Interval between 755 ?Get and 1,045 feet below ground surface. Plain casing shall be installed and seated 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 shalt 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 above. APPROVED JWB Receipt No. 0364278 DATE ISSUED FEB 22 1994 IRATiON DATE 2 2 1995 -R&,.. 76 COLORADO DIVISION OF WATER RESOURCES 7 7 81S Centennial Bldg, 1313 Sherman Si., Denver, Colorado 80200 PERMIT APPLICATION FORM '? ' DAN �fl_15dk� Application must' be complete where I. )A PERMIT TO USE GRODUND WATER RECEIVED applicable. Type or I71 A PERMIT TO OONSTRUCT A WELL print in Bi_ACK FOR: r>< A PERMIT TO INSTALL A PUMP I!L No overtirikes JAN 12 Or erasures unless { I REPLACEMENT FOR NO. initialed. { OTHER WATER COURT CASE NO- E€M3NaP 50.2 S a.o 1 I ACf'Llt:Al1I I - ma NAME STREET ss13 U MAT{ L.LR CITY _DEI+I J J es _ Rd7-11 lstate) IZIO) TELEPHONE NO, (3434-O9j? (2) LOCATION OF PROPOSED II L1. County— {VELD _4 of the 4E 14, Section 1Z. Twp L .& Rng- - ._. £ P.M IN.S1 SE.WI 13) WATER USE AND WELL DATA Proposed maximum pumping rate tgpml _ I S_ &r M_ Average annual amount of pround water to be appropriated lacre.feet): Number of ayes to be irrigated: Proposed total depth [feed: 9()a IODD ! �� Aquifer ground water is to be obtained from: LAAm,e F-bxId1LL_5 4LIR. Owner's wail designation GROUND WATER TO -BE USED FOR: I 1 HOUSEHOLD USE ONLY - no irrigation 101 11 DOMESTIC 11) 1 1 INDUSTRIAL (51 1 ) L VESTOCK 121 1 I IRRIGATION 461 1 1 COMMERCIAL 141 I 1 MUNICIPAL (81 ( I OTHER 191 DETAIL THE USE ON BACK IN 1111 14) DRILLER — Name LENET Street l tilt) lZlm1 Telephone No Lic. fda, FOR OFFICE U5E ONLY: DO NOT WRITE IN Tl-lj COLUMN 5 Receipt Na ,.ft fir••.;-.a-{(I�jr.. Basin O_L 11u Diac.L. r rt.s+ltef - t Mi J artl�ra' °t l? Mrq CONDITIONS OF APPROVAL � '4j er 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 waterpa !r right or preclude another owner of a vested water_ right from seeking relief in a civil court action., �- Be$t CapY y��allable APPLICATION APPROVED PERMIT NUMBER ________ DATE ISSUED_________ EXPIRATION DATE BY ID I {STATE NGINEER) COUNTY L a D A Wsufd 6e saw as (5I THE LOCATION OF THE PROPOSED WELL and the eras on w'hLch the meter will be used must be i .cited On Tie darn below. use the CE NTER SECTION (1 saetion, 640 aaasl for the well location. !4..____1 MILE, S2$d fEET Pr I T + "'>i' + + + +; I r� C 1 { — NOIll SECTION LINC i = a + + V f � I M n.~6 st i I I 1 � 1 I 1 alVV rn rrn tin ufE +r - I -j- ; + - The sole of the diagram is 2 inches v I mile Each small uare represents 4O aeres WATER EQUIVALENTS TABLE Ipound Fqurnl An rCra.Ioei emarl 1 aCa of lentl 1 lope deep 1 cubic four ply fecund (ch) . - - •49 pallom Lai minuu lm1 A Pinny or 5 will rea'dire seorbkirnetely I acre-fGaL of water per Yoir, t rcrllent . _ A3.5S4O eubie Iw:.. _ 32$,9pd pleem. .000 epm pumwd oantinuously for one dry prodpce • a2 rife-fwt. (BI THE WELL MUST BE LQG6TED �ELOY r 7f - by distances from section Iirli}s. f1. from t stet. line next er lout I R ft. from LAST 5 -LA 9K. line (w11 a wren LOT_L_BLOCK — FILING. SU$DIVtSION MA2t N I3Re5 Pub-AMFfiDED PLAT (71 TRACT ON WHICH WELL WILL BE LOCATED Ow11er-kmom.. 444ICEft No. of acres: ° �3 . Will this be the only well on this tract? (BI PROPOSED' .CASING PROGRAM Plain Caning lr • Ii MI to r j46 ' gE10W in. from ft- to f1, in. from ,_,_ft. to ft. f ertofated ring TD 99 t� M�Le 1EA A.T LA tilt F0)I(H) L L5 I 11TARVA _ in. from ft. t4 ft. in. from ft. to ft. (9) FOR REPLACEMENT WELlSgiuedistance and direction from old well and plans for plugging it: 1101 LAND ON WHICH QR u NO WATER WILL B I SED< Owrtt:.rlSl: !11r HAEL 1}Ersu a 4 EIIF;N II. A Ii 1 _ No. of acres: Legal description: T (11) DETAILED DESCRIPTION of the use al ground water: Household use and domusic wells must ilndicase type of disposal Hstem m be used. - cif TLI (1) ACAK tVC r a.Rfli'ta5 AMf7 LAw1SS. A Safr_iC T,tl1K A LE,ELf4 _ ;1&,Q L3 PQ.S - S)! 1Ef4 ilu r L Rr a r[ L r Zs L. _ ('12) OTHEI WALTER RIGHTS used on this land, including wells Give Registration and Water Court Case Numbers, 'Type or right Uied tat (purpose) Description. of land on which used (13) THE APPLICANT IS) STATE(S) THAT THE INFORMATION SET (FORTH HEREON IS TRUE TO THE BEST OE HIS KNOWLEDGE_ llse a0d'rtconpl s+Leets of paper if more space is required EXEMPT WELL DATA MET - DENVER BASIN. COLORADO APPLICAlil: YA YER RECEIPT NO- 364278 LOCATION: NFIj4 Of SE1/6 OF SEC_ 12, 1'14 R -66W. (2165 SSL, BBO ESL) PROPOSED AQUIFER; SURFACE ELEVATION: 5025 NLMBER OF ACRES IN TRACT: 5 IS PROPERTY WITHIN SERVICE BOUNDARIES OF MUNICIPALITY S -B-5 CONSENT MAPS? NO_ YES_ !F SUBDIVISION U is UNDER ADNENTATION PLAN, CASE N0. Is D!. IF SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY THE WATER RANAGENENT BRANCH, DATE OF LETTER iS INFORMATION ON SUBDIVISION OR TRACT OF LAND/SPECIAL RESTRICTIONS, evaluated by JWB on FEBRUARY 1?, 1994 ELEVATION DEPTH tO ANNUAL ......-•-•--... MET ---------•----- APPROP STATUS hW1fER DOT. TOP SAND SOT. TOP A -F UPPER DAWSON ---- --- ---- ` LOWER DAWSOM ---- ---- ---- DExVFit ---- ---- ---- UPPER ARAPAHOE .... ... .... .... .... --- L 4684 4416 96 109 0.616 NNT )75 RAMIE -FOX HILL 3480 4276 1H (1045 1.140 lIT note: E indicates location is it aquifer boundary and values may be more approximate. * indicates the proposed egeifer. AlL values are interpolated from the 5.5.5 data be assembled in Royeaber of 1486. r Historical Septic Permits Cover Sheet Permit # G19940040 Permit Type: Health 1 EHS History I EHS Conversion History Situs Street Address 17803 CLARA LEE ST Situs City, State, Zip FT LUPTON, CO 80621 SecrrownlRange: Parcel # 147112 - Application Status t~inaled App Date Owner Full Name: YANKER MICHAEL Owner Address: 8175 UMATILLA ST DENVER,CO 80221 Owner Phone #: 303 4260847 Information above has been Verified in Accela by employee noted below x I i � . A;: ast 2a, 2009 Procj ji Date r , FIII]1:4'I:€)l_J i_. `. 1:::.iels"E C)I ;!Cii l__ 11 'T': iE,1"t F'F=F="I[I i,l07 E- r E:i FF'EE', iii.r-C CI•!',)11;:0!'•If1E,f,IT'HI_ HE 7L (I1 3517 1i5114 A'vEF1LIE i.'U1.1H1., 13FCEl_E't. 1:_I.1 I:156.'11 O5N1=R 1(ANKFf;, I IH F!1 A[]L+h:E'E. 117 llM 1I:[!__i_l•; ST FR ( +!-:"l 42E. -UF i SE IVrEI: CO Hr1:71 -I I,!! 1'Fil if I1:IF:t7 ��"; 1 k. �1 {.`v„HF{r` H ES S f rii FT I_. I s T [: r,9 Eli i__Cbi-L UL5CF:1I1- I iur 'DF :�.t—F '.�Y: L I lul`' .I r-;IJIc+ i_� L}1-11f1vr' 4I.CA4. L1-1 rs I:;i_[7C.F . FILINEE fU JcrF 1 'r'FE: F:E;-�IL1L-.N 1 [!'tE_ EHUu'-D! i_E EC) ECL; r -E. F5 sL' J- [ I -II- ITf1M `•il', 1i 1':' ;; 7.F, ., u:r €`i'FtiF C1 HEDllL71N1E. 4 D: '`SENENT F'LUMELiNII; N'.:! Wi4'I"r..:E SI_IF'I='I.Y' 1:'W1=LL. �tF'F[..TCfaIICJN FE_ :;.X :i F?F I" _P TE 1: NI)1' r,f. Ti i'-ii E (Si 115/54 ShI NEC ST MI CREEL YAE'JE`=1�F; DA1L rkL`�G •o F•E:Ft1;ClI.__'AIILl!',4 H'I;IL:: 1s:-,1 NIH PEF: INLI-! 1_11°111"fill'; i_C0NE E:i Fr'_ fl SJ.IIJ I Yf'F: Fl_13:: F•+PLE PEF::,EU`J f f_f:C:11_il'JD SL-UF'E 17. DIF:ECT1-DN PJ F.HlII1iI[z]=G• EIS LilELt IJLLIL;i-,11 i*iLj Its l=HFZ 1=1_LIICI 1='i..r'4I;'v r;L)FJE1 I'Ii' I=-E1IIIv1 1 HI=: IFPFI_ILATFIk: N 'CFJF4Jf•;i'!�T':C{11`d ;-i,lF'f'I_'[F']' AND "FHiT ':.1N—SETE Sr_iL_ FEPL Ot,.(yl'IUN DAi A THE FOL_L[1WING MINIMUM D'IS, Va•' 1LEii1UIJ 1 F:C11 ILETILINH t RE KEL1LIikI--D� [ SEE F,tl: Jff! i,:l E.C)l._L.UNii "EL ,J 11{f= TfC11V TRENCH 735 1 Sill. F-1-„ :=tE SC1F !a EIE-;"�' C� :[) 11 ii. F] . 1 . II•i A1)1.!l i:PJI;. 1-H1:L_ F`!_ri'!I';'JDJ1:=I. TIE iH,=I rift . _lAIIJt=; A'ADCuTT{1Ni-i TEl-;I'[5 +:.thi I .rftd3:�ITInl fE;,: o� Vic, P _ ?, iV1A^1l�u A\ L :krLC (t L' S`''ay e 1A 1 H:[', 1=ERMi:1 115 CiFF[V f ,3 [EMS L3! 21 {I_4' I U dwl_ t_t:]E+t CSiNiS I fELI{ 1 ICf? -f'[] X11 7SHNI J-_ THIS I t,F:{ 1',f I h1AY €E,E F E'VUEED O[`; USPENDED 1T THE JE_.]) EICIUNI w }{[:;I=L„ 11! SEPC)RTNIE NT FOR F=sCrl�l'? iET [[11:1H -1 IN THE WELL) C;1=LINTY SHIl[VED..1F;E .:3 =ff t=E U1.3P(JFIPL SYSTEM I• .'E_GIJL..A'I'I0N'; TNf:[_t?DIN'S F r,IICF:F FE1 i'1E:C F r'1€d'; CE:FIN Of CCII',ICI'i"C:11! II if USE 1? ?'Hr.EEC_ IS I OFPJCJ 1 [111L)RE L]Fr F.ii',fril_.. AI-Fh'{7'Jr=11_, THE 155 UNOEI OF 1 -HI F ENM:ET [SEES 155 i lL1'•JSTITI_.J ! F Fa_};_'rJMF' f [UI4 k;1' 1 111:: MINE OR C [Li EJ`Zr1fl {E_E_';li CF- 1_Ir1Pif_ ITT ris 1 RE, r' i-:>TL_URC. f_iP Ir44DFCIUrE',L'.Y OF THE. i l::NNiIEE DISPU„- EL 5'+"5 [EM. -- � t� {� EVE IHi LIH RL'Ll Ei I [t, -:/}E1 ;. } L11i11F,:'LINEN iHI --FF_Llf)l,,.,fr.l L?(-ll FR 19 h=E='F'h1IT IS N11 -I 1F.A IHEiFEFF5LE ANT) 3114L,L EIEL_I.]ME VOID IF C\STEP`I CONS; 1-1-IL'ION'I HH ; NOT CC[MMEI-CED 01-FI-]iN ONE YEAR fat- 1'1; I Cll.JAIJC`I'_. I:<r:Ff:1 F; F: ISEL,1I!'d5 RillV'11, 4RF'F:LI';Ci[_ OF THIS FERI"EIT THE NEC L L.;1.11.'IVfY FfEf1t_.IH DEF'IER['hE:ltk-I Fwl:_ili[.:1[i4'Eii 1'Iii::. f';TISIIT II] INF11]:[ 4551- I [UNEL TERMS AND [iOhli)171DNS F:EIT€J]RED -1 D SELF 111.111 F:EI I.IL_A] I0l,NS ON r, Lt]h111L 11.1:i`JL ii-' 1S- [NiL_ 1''Cl-h'i ! PP11,LIVl=L 1 C:LIIII'1r'•JIE;h]-[ III''i:ill 1M!= F=1N1EN C CCi"11'd 01 IHE-_. FCit1_ I_ETED E`f5TErJ 11' THE WLL,.Il L1_1LJNII' ' 1-ICIL""I f! DFiI='SFs'1I°iFi`!"I I i';111`J !li`;rail.t 1:1; Sej4 ......4i Ir,I'E'1 {:ITf,'J.ar: c ,S I FM Fr+iCEJ ILf—F4 ,F 1=E,L`JFi! Y! I_. U = i r _, I Ir_NN IN 'I I L LE:I? !-J f 'I ]I'.fh11-, {'11 .._ f='L! AL.IS"I' _iHF I:_ lLJANECE Dr II-EC1 I'ICRf'fl f DOES NUT Th111I,...Y ! 11i1F'1,...7(]!'lf' L: ill Ft J;.J I I IE:_f•; 1:101 !T.=;CJ{_! •! T flil; !__[:.PI_'II_ PELT FCJFt'' DR PL.[I..-[ INC; REi:1IJIRl:..:rl1=.I'l Ys". ISUP 51—lOL.L IT AI:.T 1 ❑ '_::EF; !'?k`1' I FLAT f HE URJ C.-1 . Y W; 1-E:M NFL t_ C1f='FRA 15 I!'•I C SI F'[_1F`!I ft'F WI F H Of=I'LILF-J I rC A 1 E-" ;...L]i kI; ,r' Mr_) LOCAL iZF_L;UI_ATICihIS SI)UF'1'Li7 I C: IJCNi fIi C11';l'I[,';..F 1:, TITLE.. :.",5, UPS 1:' :'1 0',:a EX'CEFT FOR THE F'LIRPU }: UP FE I1-5 I_1 }1IP•]i; F]hlril_. iF'FtCivAL OF EN IlNETIELFEli IISISTEM F UF. ILISIJE N LIE OF d-; LOCF4. C)LC;IIF'IAhl?"; i FIlINDli T I'L!ri'-;1.1r=19'd I ILL [. :'r3 i °I : 1.3-1 i"[='1„ t,1!�:1LCi:l11EFN. r,h'F=•I ?Cr,,Ill k I_L1'Y UIC'}!fi 511155 1,1:11 i ME(., l CII f L Sc "' 1 r C (A A- 40 r flSF'iCafiF' INDIVIEFU(7L SEbf 4[ E SISROBAL SYSTEM PERMIT ND. U—=�4Ei_Ic_Igt-F WELD C:DLJNTT HFF,i-TH tEF'HF;TI"IEN? NEW FE_.RM.i CT FNVIRCJrJMENmL.. HEALTH SERVIGEE 1517 1f�TH A'VENIJE COUF'T. GREFLE' . Cr.) 8.1 --6„` ET. O1JNEF: YANI--_E=-R. t-II(HAEL ADDRF S 017'5 UMATILI_A ' T PH (,_,(-I.'.} 4:?6—DO47 LI;fJEFC ED L221 ADDRESS GF FGF-C)SED EYSTEM C!_ARA LEE ST & RD 37 FT [UPTON CO EEFO621 U --DAL DESCRIPTI❑N OF SITE. SEC 12 TW11 F:bIG 6 ❑LIBDTVIST❑H: LLIT A BLLJLV=. 0 FILING ': LUSE TYRE,. 1'E:,SIDFNTIAI_ HOUSE 'Ef=;t.:IE;EG' F'EP:ECJI'-1 ' 5 BILTHF,'GIDI"I._f LOT DICE F.LtO ACREE: HEDI-UOMS 4 HASEl-TENT F'LUM 'INC3 ND WATER 5UEF'L.1' F'WELL APFLILATILIN FEE_ l5!a!JCa F;E:G'l) ITY f:I:)NO I;AE_..ALFC,' DATE c.-11./„:0/'74 SINNED BY MICHAEL YAN!<EF: DATE E:L/2l/94 F'E:F:LOL,ATION PATE b.}y MIN F -'EH INL=:H I..IMITING ZONE FE:E.T NULL B Y PLu'. I I_HLJUNI} SL_IJr-'E is 011 -ILL ! J LJI l f ..C11Ill E;! ENGINEEF: DEEIC:N ao IN f.t VF,AR k.0OD 1'L..DIN '.7c -1E. 1*U_..... FROM THE AFF'LTL'A'[`I,CD1V [NFORNATIEJN SLJ1-'f'E_IED AND THE LJN-3]TE= S0:[I._. PERCEIL. TIU!N DATA THE f-OL.[._i:WIN❑ HINIMUM INSTALLATION SF'3 LTFIC:FtilIC1tJS ARE RF:C1UIF1'E. Lea SEPTIC .TANK t- DALLON':N. AE?SORFT1ON TRENCH 75 NIL FF _ OF; ,- n I N ADO I IILtl. 0-ll:- PEF:MIl T _SUHHJFC F ! Ii THE I Ul L-OWINL ADDS [ICiNAL TFF NS AND LCINDII ICJrarc- � s Co I. {ac FrrEMIT F. 1r L. nl.I r rrJ- rr,i cr• I I N I n r'nr1F-TET r'• THIS ;[_,-MI- LfAY FE F;EVCKED ❑R SUSPENDED DY THE WEE-Lti COUNTY HEALTH DEPARTMENT FLUE; F;C_A'S❑N`.SET FORTH IF -I THE WELD COUNTY INDIVIDUAL SEWAiaE DISPOSAL SYSTEM REGULA'f IC-1NE, TEC_ILU)ihII FAILURE TO MEET ANY -FEF'M OF: CONDITIGN IMPOSED IHEF:E❑J ULJE1F-DE TEMPORAH:Y OR FINAL AF'IkID/AE-. 1 -HE I: 3tIONLE OF THI i PERMIT DUES hlu-I CLIMSTI IU[I- r-ULIITI- FILIP•1 S 'H 11 E,.FAF 1 MEN LIP 1T EMFLL.Uvk=E'.E OF LIr,EILiFY FUR 1HE FAILURE UP :tNAUELDLJ )L.f OF HE EEWA E Tl! IL I,( ssl-UN r } f1 �� E9'Jl 'F;l7h•1L h•lTAL.Gf'EC:CF;L_I DATE TH?E E'EF;M.l IS NOT 1 F;F�NSFKF LLE AND SHALL EELCJ €E VOTE) I1= YSTEM IOUNSTT UC'TIfEN HAIn NOT COfINENEED WITHIN ONE YEAR OF IT-; 3ESUANCE. BEFORE Ie ELILNl3 FINAL AF'PR(-IVAL OF TILTS PERMIT THE WELD COUNTY HEAL F HJ DEF'AF;I i`I IVT RESEF:•JEE THE RIGHT F❑ IMF'❑SE ACID EIONAL TERMS AND COP,101TIUNS RFCuLw]:RED TO MEE1 LIJF; REGULATIONS ON A C.❑1%JTINUIIIE El -- SIB. FINAL PERMIT CNF'F'R0JVAE. T CONTINGENT UF'❑N THE FINAL rNSI'> C1ILAI OF THE COM-- F'L.ETE D SYB 1'EM FAY THE WELD COUNTY HEALTH DEF'r;R I MENT. ;RI1= I{JriL_ FF'l_ECAF.1T: fl:i)F'Y—LaJCHDD WC=:HO—EH: MAT. 1Y'E,4 WELA COUNTY HEALTH DEPARTMENT ENVIRONMENTAL PROTECTION SERVICES SITE EVALUATION OWNER: fV 1 C' HAF ' r,X ; _ APPLICATION NO. :4-{oc'-Ip S1Te: (., i- 'y , 3 PT S1 TOI R -Cow DATE:____________________ SUBDIVISION: rS_A LT______BLR 3 FLC ------------------------------------------------------_____.._-__-__----------------------------- PERCOLATION TEST DATA: Start Time: y- -- Hole No. Hole De th HO Remain c45 „ min. 'M45 Ip min. oSS , in. rro5 o min. min. minj miry. min. min. min, 1 T1i ?c' 300 aq 1 �,�" ' / fr p Ia re 35 315 i5 is 5 b S t 30 3czS +' 2S,(� _ I6 Ip r0 �`5 • 2 Z f -f ky dos tiC'7 r-3ao q5 .X43 /''}u r 5 2 3 v 5 4 Wa ___ z5 a5 c f¢„L .° zCc. _€s �-s 5 5 J ' 1 ? 15 335 r7 3A C7 3fD +�1O rz41� li. __ __Vj_ All measurements in .mm unless otherwise indicated. * - Add H2O Total ! ZZ- Environmental Specialist Average Rate► f !� SOIL PROFILE IAA RA4' F? asn'L i4rJu w✓� jAJ Ti' 'L1 -y L04k& x71711{7 f r?iC • - ,T.� E1=` 1.; ?I' r`IT:'6'I_ TL_(';'T" I.I'11Fui': 1'#•#'l7T1V1:1)Ur`IE ` [:WE. f?3...SF'(k:..111.. y :3T I::I`V Ni), Uiil..iY (�(JLJI 1"z' I -k -1.. T1-1 Ill::Il='i'1F: T1'11: III I I'-IF::IJJ s'11 'i- l._ TC(.17 =L Cif' -I f—I£;:r"1L.T'I•II::;k: I I i'J I:.1^lt iy-;. I..IJI..JL', I., ., CltJJP•1i=1:' ri;TTk;E:1?., I*l1(::FTr'1L.l... lrIIJJI:T.; S 01. EJITlr)T:I:!.C.(I ::3'I F'ii ';),{t} r-[I)17fa':::T'rz:i l:ii 1f{11='I 1I::I) ::iY':B'TElI 1111._(^'Ir 1. -El:. 5?' & II) / I..IiL(-.k'jl.. r)Ii::lJGI :.11:,'T IL A-1 131 #3:I: f (: Ei::C: J.:: "T'I+JI:1 F.:11f'•I r:rl Tl:<I):1:'-J:I,5I DIA L[i'T (? r.? L _C)C! O F :I, l,."{:IIL• [:, (.( l::. i' 'I'I::: c 1.:1:i :, 1: iAl J,l l"C: r"1l... (It ]LJfiII ' PA I FiF ia(.Ll'11:' „ r',{) 1..1Iii '.3 1, LL:, :5 .. C)C; J^+{_ F I:: s lli:''I)1'�Csl'ii'1t:> 1'1 Iii'1'cil-:l•Ilc:hlf E'L.11!°11l.L!'JI:J hl1.J wr"fi(:.:I: ;s(#'1=1I.,,Y 1—hil::f..,1. rFFl.i:T:11I 'f i"i;ILh LIiLJli:I)i:F. '.; T l•Ir-'1"1 T 1 II : f;E)E"}1='I_ F I F::hl1_-; iC:i I :: T'Fl] 1:-i !l-t'I..1"l`J T 7:(.I I :CC C(:lhID:[ (.JI 'I)I'I f l )I :`f 1(1 J1: I1A1'IT)A'I'(:i(ti r' r"i('ll) ADDITIONAL T"1:T `.3 Gill f :I T'CJl=. t t:; r,`i II?( ViJ- F:I:: F.lk.1:cI:zl":J) Ia Y T I ₹[:. P[i...II I I)E:.F'rIE; fl If:1wl'T Tf) ISI',: )YlrI}I: fit -IT} [:"i.Jl;ll:I:a`sFlE:J) TE"i' 'f"k lL:: 1l'F'!.. "i:(:;r`Ihk'i c:'l-: IC il•iL-- WF..1.T) (":(:11..111![`( I•TI-i I..,TII 1)1::1='rd211"IIEIT E-#]1; I LJIa'S1.,E "=i C1l":' TF1E_ !'_'•.,^d.,i.Jr1"1'[1:1{5! C'11: 11.11;:: 111 'I'L...C(a T'.(11`! r^;I'-LfI ii i[,: I kt::;tiLJr`IhlI;F 1JL !H6 l E:Ftt ! I: T T.; f,:t(.Jlz{l l'-i:; T I{ [ `3TJ(:Lf T F::l 'i- i r i! !f) C,::(:11•ll. [ f: (- N'."'', r l; ₹•lF:.i l:. ss111':'r T('i :I hif:iiJF:[ [';t.I!'ll;'f..:E: (1,1 Ifa' (d a 'I'I I i";L.JI Ii:J (711,1(! I -:f:: ()llt.-r"1 T :[ (jI'l: f i iI)(:JF' T LII) LIl IIF1'; 111 _ I f;I_ k: ('>„ TI: ti .J: C': „ F 1 I E') i!li'll:i,l�ll!!:"I) . 1111_. FI(=I ! Il F"III I l .l l' lli';.+ Jf{i:JT TIEI,. T='1ail=:'(!'iI `i'';.1TF!°I !x1'11_ -I... 1-IL11- IisI L.OPAI t) IJJI-11111,1 BOO I €=:1:_T {:II': r1 I:0111II11.-II'-1 [ T'Y sF'."t+J(ICi1 '.:3Y i11iiI'i (FIE I,EFII5I:,R I l 11i> IIIj ::1•:•Y (-li I'ti 1 tE l:-::1 TII+T r -11_I.., S'i AT1:=! EM I''i !''I +I)E-., LhIFlIlli it TL)!'•I r^d•II) 1Trl'I:l:T'1'1) 111.11117: x)11 fll r1I 11} I�:E::GI4.J:I:1,:[',C) TO Xirl::: S1,[I"Jt (i:I: i' 11= D II' 11-1k ( F I:•I...:L4:;id,1'1 fvE=_F..., (7I=; l+i''.I i_, Cis E:E"f'1',E';1€::ii[Fi:)'> i I:*I IILiiii 'ii L(((TI,a;l'E.:I Ti:T 1Fii TB:::iT{ 1)1 Irl'r' TC{J(JRJl...E.I7l.al::: r+hf:) L1:I I1) r' f;1:, II ,:IIihdl:L ff IE: I I I) ON 1:i'r` TILE::: W1::1.(i ((Jill IT III ::F'[I..III TJi::a r"RE;iIll ::III (:II FII lJr'1I'I:I-IC1 TI lT `E-f-il ll.: F f)1III:i: Iz C,:Ftii"i:i f d -,I i:'f II;f F C11•: I Ifi:[.I: 'll I _ I I(IL ':TY 1#"'F', i il11iF:1"•: i ;I'IL 'sEEFti'T' (I Ii FAL_HI! II'1T:I:O1'1 (.)I:': ICI:1:;'ill! '1:'';Ei;;:TF;:I r`I'I"I:(:'El #'ii1Y F:L::;i3i.li..,'I :I:F1 ..(III L'1F:a1Tiii 'IF : knit.: I::'F:'I.-.111:'1",-I1::1(,1 Cli:? I:;F::`)L1(:::Fl1-:tHU OF AMY F'1:':Ill `t:'1 liii(1IHI::_U F<FialiC1) III:'I'W '. giI:1,1 AF -17'!U i'I-i-J:iILI r'll-�Tli 111 L.IFJ r'1!. +'I( l-LIII F1111 I C,:I;,.TLIF;'r' A1y 3 f';:.:{1vi:P1::11 I,,- I_r'1lrJ„ UN ELF, G 1. ,5+:i , t)f) l=;1: c.. I) Lr-, f::I1,113Y '1, c)_. I1F. Uii1I:hle-tl., id '1 'L. -:C.{11.1! F („!)F'1 11,I[I-IL {):I.. .?8.'l I1i1JJF'IIF/FBZF 1 III1i('lt'TIIE! TllsIV. i�T(::[111 I I i'_3 I`11"t',, F0A1�1 rfO. i' oaeta STATE OF COLORADO OFFICE OF THE STATE ENGINEER Far ( s (!.r ury eia G.r*s wild 91dg. 13rn 43 eftf.n &. D.nwr. Cororjdo 142O REGJ YEO (30�11yAti1e! r PRIOR TO f MPLEf1NG FORM, Std INSTHUC1IOON REVERSE SIDE CHANGE IN OWNERSHIP/ADDRESS I LOCATION WELL PERMR, LIVESTOCK TANK OR EROSION CONmOi_ DAM 1_ NEW OWNER NAME(S).Tt IC (.( a,w ........ Miling Addreae .......S . Z 3 _. Cr f..c c _ e . . .. . _ Olty, St. Zip 8 r c. h. .11 r.... 7 I S F c o t foax M4- I WELL CONSTWJCIIONN) i3T F {-tr cl 1 STATE OF COLORADO, OFFICE O Th A* DER WELL PERMIT NUMBER 2. OWNER NAME(S) IC.$. IWTJJPI rf ERFws 1i Ii Mailltit Address . C,ty, Si. Zip ieiFiC3a»N. G0�- _-- •coLO Phone (303 ) 280-2977 :. w E LOCATION AS D ILL ; 9 _ 414 SE i14, Sc Lz TWp. 1. N Raid ,6b �W MSTANCES FROM SEC. UNIES: ! Pt. kom � /+e. Yrtia. sr0 7fl IL frorrl _$so. Iles. OR SUBDIVISION: II BRc. PYD LOT _BLOCK RUNO(LINIO STREET ADDRESS AT WELL LOCATION: -1 GROLNC) SIIAFACE ELEVATION f! DULUNG METHOD WrARY GATE COMPLETED 4- -95 TOTAL ?TH5J DEPTH C PlET O Sb S. O€OLOGIC LDG Pm1L.FIrom M - To (f) wwu o..en ibQ * . x�*I++nI� 0 30 0- 10 salad b41 ( sazuitoas_ __ - 2 . 66-667 -iiiIto� 7. I,AIIGA$ING 50-26 and s Qglfd WM 8tp Fram(ft) To(h) 2 5 a e - e It'.'T 2 p L25L rovi ate , .�Q,, a ' ahuh. ^ NI lli0: coil _ st 5 , - -- S. ILTER PACK: 0. PACKER PLACEMENT- IrIM1�1W Type 1 I.-615 c+ 10 ONOIJTWI G RECORD: 6T-62�ii � Dins y Intarvsl placement l}2 1A S- '� c-skont 40sscks 14.5 0-7?S PusF� r)I t1w IFECTLON: TYP! nK MT1. �_ 41tas. WELL TEST DATA: ❑ Check box I Test Ds a Is fwbndrd ftn $L Isr in Form. TESTING METHOD Suc Lever 375 h, Dslaf f lms me IwSdT12995 9�1II Product m Rgts 20 Opm. PL,+npOg ee 4�0 h. DatWTlrrls iflsasuvsd - , r. ct wrlglh {hrs} t "' Ri•I11arks - - - 3. 11.. Y. idad Ihs IIUilm 4s mid. NIlilll arw k77WY h a111�1* flrrMir ow I. s" pe M fo or UT * M wom 144- M 111E U CM. tr •,� i.�,.: )in.nu h.l.. uIM p.rlury In vu i.*Ii Re r 1 1-.1 CONTRACTOR W1swL1.T�C. - --- ----MW1Ii 30 } t.Ic.No. &Lt li y Ad[1u3SS Nirlte17ule (Please type or print) Signar / DS ROGER SCHNKE ��.� / /��f--� / 4- 30-95 INSTRUCTIONS FOR WELL CONSTRUCTION ANL1 TEST REPORT The report ;nust be typed or printed In I„ All changes on the form mu ya be Initialed and dated. Attach adr�rtional sleets if more space is required. Each edd ions sASht miMl to ideiiillid at the top by the well owner's name. ine permit number, form name/number and a $bquentiel pugs number. Report•depths in tact bd10w ground Thrg form may be reproduced by pholocol rnothods, or by Computer 9snsrstlon with prier approval by the State The on r}inar and one Copy d this foml inlet be gubntb ..' It to ttttu BLele ErtgYtesre Cmos weF4i 50 ideya aAer Carnpk'ting Lhhe wi?rt ri 7 days altar tths psiTni elrpwadm iim•ylllidltilt to gw1w. Another copy of the term must be provided rn thb welt owner Conplete the Ws4 Permit Hun of In ruts. 2. FBI? ui Jane and Mailing A kL Of WaS Owrt+r wtwri cor!MpondsrIce anorald ba sent, 3. Cornplei a the bit Cka icr to aotitel ioCn of the *nA M w dAMd. ` M the owner hair more than one wall serving this progeny, provide tyre Idr•-it_Mtcadfrl �OrrrMrra b rL T1 N£fi S(IPPUED LOCA7 ON unless a sunny hM been WVYM d. [�,1SCatsd h a bW..'cnIthi tot, block and subdr lssoll inlormatiOn must alto be p4o lded - - A. Report the ground surface s8avation In till about rat I m$ 1 walobb. This value may be obtained from a lnpagraphic map, Describe the Orlaktg msII d used irui*jtjwsl 1 the data canplatOG. Irulicate thQ rota+ depth dulled and the arCtur,t Cer-Meted depict d 1i w4 , _ - - 5. Fully describe the materials encOWrtamsd In duhng. Do rcpt i to n rtartlos unless they are In cor function with a description of materiels. LLamptes of descriptive terms tnduile: .•. Grain sire• t3ou!era. gr*wl, &and. iS, day. - Hardrwrs-Logs*. salt. ti tt, Iterd.,vrny herd. - Coior--All material. Most crrtical in sdirtterSary It7dt. - - Depth when water is encountered (k k cart be dam, 6, Rrourde the diameters of the dined bore hoe. - - 7 The outside diameter, kind, wall thlCltnese and lrMsrvai of caeirt0 liegtfts muss -be indicated. - 8. Indicate the type and size of Ater (jra o pi and the irtiwr when placed. Ind,L:ale tyre type and setting depth td' any ptdters Ind. - t 0- The density of the grout Siuny trust be ripcltid and mfiy t* Mtdgad es pounds par gallon, iknrts of water per sack, total gallons of water and number d stiles us $, tsgo. Spa* the gin t placement nrstho!i, Le. fremie pipe or positive displacemera. The psrceneape of .dtflMuee meted wlh the grOttt should be rsportad accost remarks. 11 Record the type and the aalOur7t of dlSbttecalon used, how placed avid the fer�th Cf lima left in The hale. 12 Report well test data as required by Rule 10.7. Specie are pros ded to report all neratureRwIs made during est. The report should ihow the ttie hit Coiii$id wilt p1e prprrieiofns d ttw idles. R a test was not reriormed explain when it wig be dons. -If p#ibbls1 mpcvt dOdt Orris tw+tan miasurenenls were taken. 13. f ill in C4„rtpany Name and Mkas i d Csrmtrtiowwho conslnietsd the well The report must be signs i by the I.oensau contractor responsible for the cannntctlon Q its wsL Form ND. OFFICE OF THE STATE ENGINEER c{WS-25 COLORADO DIVISION OF WATER RESOURCES 818 Centennial Brtlo„ 133 Sharman St., Ora. Colorado 80243 (303) 86139581 APPLICANT KS INVESTMENTS 1006 W 104TH AVE #148 NORTHGLENN CO 80234 (303)2B0-2577 PERMIT TO CONSTRUCT A WELL WELL PERMIT NUMBER f 1144"7 - DIV. 1 GNTY. 62 WD 2 DES. BASIN MD LIC Lot: t4 81ock- Filing: SubdN: MARTIN BROTHERS PVC APPROVED WELL LOCATION WELD COUNTY NE 114 SE 114 Section 12 Twp 1 N RANGE 66 W 6th P.M. DISTANCES FROM SEC11ON LINES_ 2340 Ft. from South Section Line 720 Ft. from East Section Une Cf0ND93 NS OFAPPfOVgl� 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 Mules 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 10 ordinary household purposes inside one single family dwelling and the irrigation of not more than 15,000 square leaf of home gardens and lawns, as recommended by the Division of Water Resources to the county commissioners. 5) The water from this well may be used for the watering of not more than four (4) large, non-commercial domestic animals. 6) Production from this well is restricted to the Laramie Fox -Hills aquifer which corresponds to the interval between 740 feel and 1 D30 feet below ground surface. Plain casing shall be installed and sealed to prevent production from other zones. 7) The maximum pumping rate snail not exceed 15 GPM. 8) The annual amount of ground water to be withdrawn shall not exceed 1.1 acre -feat. 9) This well shall be constructed not more than 200 feet from the location specified on this permit Note; To }nsure 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 . RAN State Engirww receipt No. 0379209 DATE ISSUED FEB 1.5 1995 EXPIRATION DATI` 1• E B_ 1 51991 oP14vD �I-x$•54 COLORADO DIVISION OF WATER RESOURCES 918 Centennial Bldg., 1313 S#nnnan St., Denver, Color !ECEIVFD Application must be complete where app ieaite. Type or print in !ACK lU, No oversvikes or easurn unless initialed: - mailing PERMIT APPLICATION FORM I A PERMIT TO USE GROUND WATER I ) A PERMIT TO CONSTRUCTA WELL FOR: I ( A PERMIT TO INSTALL A PUMP I REPLACEMENT FOR NO I OTHER WATER COURT CASE NO NAME KS St'REET 1oa6 1v /Dc' C1TY._SY_iiI ISutel zi TE LEPHONE ND. County[ IG at the _S h, section . . Twp. _ , R n9•_____P.M IM.$) IE.WI (3) WATER USE AND WELL DATA Ptoposeed maximum pumping rate i9pmi Average annual amount of ground wa*er f { to be approp paced C .-feed: I J Number of acres to t e irrigated: Proposed total depth feet): j Lfr Aquifer ground water is to be obtained from: trti 4e Ownr's well desegnetion GROUND WATER TO BE USED FOR: I I HOUSEHOLO USE ONLY - no irrigation 10) (J.flOMESTIC (1) 1 1 INDUSTRIAL (51 I LIVESTOCK (2) 1 1 IRRIGATION (B) I. I COMMERCIAL (41 1 1 MUNICIPAL (6) [ I OTHER (91- - - DETAIL THE USE ON BACK IN (111 WD I L LtcewtS Name Siren City FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN Receipt No_ 31 -)-D ! 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 issuanceof 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. o Mmu— ay.1 #� v 1.it•fd 2ilo-, 4 ra ! ,.ana 50'D I l�r L H4 r `' F13es:�tCopy Available 'l* f4--1040 APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION DATE (STATE NCalN ERl By Telephone No. Lit. No. -- !! t.D. _____T. COUNTY �— �-- (S) THE LOCATION Q,THE PIIQPOSEO WELL and the area on which the water will •44sgd irpls ndicated on the diagram below. (he the CENTER SECTION Cl action, 640 acresl for the well location_ 1.4- '• :1•MIL6;AM } -� i- + + + + + C � + -4 - NORTH 6ECTIOak LINE moltT 7 i � x I- ! 1 i i ! I� WVV i'I ic41IVte uric + + - - -+ 4- +''. I The scale of the diagram is 2 incites 1 mule !mach srnalI square represents 40 acr@S. WATER EO{1IVAL£NTS TABLE IRotinded Figuretl An avr-foal covers 1 acrr of land 1 toot deep 1 Cubic foot per second lcisl - .. 449 gallons per minute lgprrl1 A family 01 5 will reaulra epproximer.Y I acre-ioor of water par vaer_ 1 arsefoot ... 43,e60 euoit fs t ... 125900 pions. 1.000 9cfm avmGed conf inuouriy for ono deg p.oduae 4.42 aoe.Iwt. (6) THE WELL MUST BE LOCATED BELOW by distances from section lines, �3 © ft. from see, line north Of I0tth) ft. from - I Sec, line Iean or wait! LOT. BLOCK FfLING a SUBDIVISION 1"lame'," gfPt)j (7) TRACT ON _WHICH_WELL WILL_13E LOCH ownef:'/CS' ,rrr wjZ ag No. of acres Wilf this he the only well on this tract? L% (8) PROPOSED CAING PROGRAM _ Rain C)ding ( in. from .f f ft_to ft, in_ fromfrom_JOto Perforated using .fit n f,1jjf} . In. t101n _ ft. tO LO ft. in_ from ft- to ft. (9)'FOIR REPACEMENT WELLSgivadistance and direction from 04d well and plans for plugging It - \(10) LANDQN WHICH GROUND WATER Ownerlsj: - ji_frnrtJ'_1e.l'S' No. of acres: r Legal description: L at" / /i'}arti,n_ (11) QETAILED OESCf1IPTION of the use of ground water' Houeahold use and domestic %!telIs muff inlfieaft type of disposal system to be used.. 4 t (12) OTHEI WATER RIGHTS used on this land. including wcfls Give Registration and Water Court Cate Numbers. hype or rift Used for 1purposel Oescription of land on which used (13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS I(NOWLYDGE. r S/GNA TUBE OF APPL ICAIV T1S) r 1 i r-!4 Use addditional shuts of paper if more space is required. EXEMPT BELL DATA SHEET • DENVER BASIW, COLORADO kPPLICAINT. (S EMVES7MENTS RECEIPT N0. 379204 LDCATIOM: NEI/4 OF 5E1/4 OF SEC_ 12, T.1N., R•66d. (2340 SSL, 720 ESL) PROPOSED AQUIFER: LARAMIE•FOX FILLS SURFACE ELEVATION: 5010 NUMBER OF ACRES ill TRACT: 5 I5 PROPERTY WITHIN SERVECE BOUNDARIES OF MUNICIPALITY S.9.5 CONSENT NAPS? NO YES — IF SUBDIVTSION LS UNDER ALIGIEWTATTOM PLAN, CASE MO. 15 , OOIV_ IF SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY THE WATER MANAGEMENT BRANCH, DATE OF LETTER IS INFORMATION ON SUBDIVISION OR TRACT OF LAND/SPECIAL RESTRICTIONS: evekueted by RAN an FEBRUARY 10, 1995 ELEVATION DEPTH TO ANNUAL ----•------- MET -'-----------•• APIROP STATUS AQUIFER OCT. TOP SAND BOT. TOP A -F UPPER CASON --- LOWER DA1SON .... DENVER _ .... .... - UPPER UPPER ARAPAHOS ---- ---- LOWER ARAPAHOE 4684 4915 95 326 95 0.808 NUT *LARAMIE-FOIL MILLS 348E 4772 153 1028 73b 1.148 NT note: E indicates Location is at aquifer boundary and values Nsay be sore approximate. indicates the proposed aquifer. ALL values are interpolated from tIC S.B.5 data but ,sled i Wov ' ler of 1986. y Scanning Cover Sheet for Septic Permits Permit # G19940579 1 Permit Type: Health I EHS History I EHS Conversion History Situs Street Address 17883 CLARA LEE ST Situs City, State, Zip SeclTownfRange: 12 -01N -66W Application Status: Finaled Application Date: 03/1111996 Parcel # (12 dkgitsl 147112403014-80225294 Owner Full Name: K S INVESTMENTS Owner Address: 1006 W 104TH AVESTE 148 ❑ENVER,CO 80234 Contact Name: Contact Address: Owner Phone #: Contact Phone# 303 2802977 Information above has been Verified in Accefa by employee noted below ti x August 08, 2008 Proces ed by: Date Report ID: EHS00024v003 Print Date -Time: 818!2008 1:47:57P M Page 1 of 1 H::il^h06 TI LiI 'il +iF`1- ,:3TIML Li =' ,: .;•f'-. I EM E-i Fd—i:.,.1- NM. 14--' 1 M..:•_, iI I,..,1:J ii II`I ' ' HF_ - F _• ,.I ! c]:E"r l= }hiE:lli P4r:.-F-! 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JMral TF [ IUF-1_; EFJ - Ll t 1Jn!_ 11 =IEN. r.l I'." ! f ,f.11 Jf 1F.:14 IL. ,.. -F'E F ..f.'.:i l ra I fl-I'!F Ff•F L';IF FM -Illi F' N.'-4I'.I'ILI EI.l L-: r1G!!> I"1hti{- k&COMF" ')'I D :IF -ml'E- 1I= I rfll!11E,,'LII,II!, F_-: f -FU I ROMM1 NI'FU 5H I FIN UNE YEAR ME F FM 1=- LI,,t,iiL,'E E;Ii-- OF;I-; T,a;Iii_J.F11=i F'_LIr1L F+! -F' ?La k! {f' [Eli 1 i- -'L F I HE [�JL!_U CUt. .PL FE-rI:THE I'I"F F -E: -_E kVE F THE HEis!-E F 1r11-'L]L= r�DC,r_ fl[1'JF1F FEF'1;-; C`I-L; hEtl'•JLII.LIIIFF F.-JL+RE_l1 Fii I'ILI--! L.!.C_Iii F-II131 s!'Tl1!'•.i:, i:JFl r: LLIl`rl1FIL{11vi'. iir'I-- MI_ . 1-1IN_IFFE 'Ii F AP I:U-' ,L. I IDYL, INUENi LL[ -[D-! THE 1=-EILIFd._ TE'J'FI'I-I IJII I.3!_1Jl4 F'1m:G:. ! L -:I;• •`{;�DI E i"1 BY I f III !'J Ii -;L-:17 I.:CJI..FJJ ..r'II- , .. 17F.!FIFCT F•.E.: i�.T. I F ftL.,.k l Ct1A4 vYl!!J r IF•L=,L._. 1'JLai'r I I r I `1YC 1-_!"I Fr [I'JLLI ci._ f�_ -I ;; FI:Ii Ih1' i (LE_i i, Nl °L 'Dt fiI I I --T!. i THE Jl_,L:;L,EI':(?E Li- TI"11FF F'L-4NTF LITF-; NH FNDL'r' CTFM['I_.T_,-!'ICL-,: WIT'-! I::TL-IER. E,T. )F-, [HIil-IIY OR L i,CA r,E Lt 'ii Jr f Ii Li IT 1=',--i:IJLR1 1 ITNI1�:. IMF 11-I .L L Arl CFP TFr I K I I_ll-If F;;LJf•151E DI., f3T:-FTEM LJIL_.[. I]FF'iF'FI-f Ii -LIl'II L..F-•st`-N E !,II:''H UF-I--LIC:EEL'E '.ITPIT:I, r...lI.JN IY U1'•II} I,.,UC,:f-,L... l=;:Ir._4'.L.'t_r; I IIs.: r'a;i?!:]F='•T"I:'I? F FFlJlC) ryr'�:`F':i:(.-;L.L 1I'k-U:..I]� ..:.':_.� !:;F11� 7 r' Ir'iE:!J3:,E 1�. E':FF-!' E' IF !HI'- f•`'IfF. FI;`.,E' LIE FE- Ur---- -I-IIi11-e F_iNi-L. IF----k1:EI.... f_U (II INSTALLED ,'YI' l-fF FLtF'I 1 li ii IE Li 1`, i_OCAL If LI.JI'RI'II=:RME! I Lii LJii1 I FO ERA ' ; 7 I!:; Ii JF;1F�I,i'IL, ',!m`F-L.FLt11'IT' i;L! 's `'1L':EI'c.! :'I 1'- '1: EIr?Ii, ..•.',".. r ' Th.71 ?II'Lir='!. SENEE R'; I I._I„! FEI-: .L i fl. C WILL13 i_;!IFL1;'13 v HE!. TH } 'r='s'',�;'T1KI 1`c'I NE!%J FE_,i-NN'" f`J'4'f l-[I'r-Ii 71=:I'd ! A i lF-fi!.f r ;f IL -2 I- i ;: 1 I .i.`}TE 1 A'V, ENt.JL CC.JIJRI G F:E ELL(, CL! a° ... -rL''. -:Xi.IT''2l. :2 tINFJ.ER €. .[NVE?TMF,NIT N LF_)F._Es�-s NIr?D":E -N O!- f -'F! iP',PNF-L S's" I I I' WCP .. l.• i HVJ , F 1- UF! LJN L_IUiAL_ BCSCkIFTifti 11- CJ:TE: LE4 E. I+.) t,',f(_TC}I.l;• r;ARTI[N {F:[[TNPEFL: FLIT; Ir:r-I6 F J'?a IF- r iE.._,-L,_ 1 iF F--+ (3031 -7-�- {iE'F--!-I-•lGLUNI i'_i_I ;L?tY�:::: r; J.:1__ r,.l,r I NJ'JIN F::. i._L? I i-I La[... F-1 C: !`. -:> F -,I lu.i1'•Y:' Jr _i'._FE= 4YI`' Rk 1i�l-NTI L 1-10L_i'_vl- • E1- -,,F.r,.sl !FFi- 1"d;.. 1• af''IARP�fil`i:.. LL:•._il,r ?.i_I}E-;CJCIk!q ESEMEI.1'!' F'I_Ul BIND r'ES WA TER I4LiF'I L F'L'JEL!_ NIL FEE 4i I: l.rI[I LILNEJ_r Fi'i ;1AWN R. F._i_[-'.il.;i'..1 FN IF :12/2 .. El # UL- ,a I1 RiEE t MINI F'I I JN1ikt 1 1 rll;Ea i{al![ FELT NEIL 1FE 1il �'✓Jf PERCENT 1==r 'L1!`-IIi 4 ..tleE •i.:; ril:EE-1I':i Al RL_OUIHF_=r NP[fl-!-F' JF i1G!'J M0 IN I N-1• rill TUNE= '=Fa-lr1 "k HE APP'LI[T ,',TI N JNI NEM 1 ENN ii.IF'F 1._ IF/i! f 11'• D Ti -IL [II -I -NIT LI LUll.. 1= LI Ct1r:l., f r 11N ? ; T'o THE r13Li_NWI:NE QN11M+"I'I J:M !- TAI 1 r FTE�I1 ', Fi.:I:1F• It ATi,,1`I Til E- FEEL.':' GI1 � NE:.I 3J!-- NNI':_ [Z� r7r'1_Li]rl , i Dc —o }ii r�l''1 F3k=ICF F: tt; f_If,,l...,T_IU.NN I:IE:il � -,. •_C-i. ;A.,F. TN EDDI';T'INN. TE-I:I PERMIT IS LLJE..iE[. Y 10 THE F' I....1._UNNJ:,.NG (.1)01 ril:!IFE._ TEEMS ;p•-!vr I`.Lci€fit—_..�..—,..._...__.._.�.,___...,,..,...,.,._.. 1!-II`c: E'l:_FP1.IF J:'._i LLRf4'1fED I EJ'1PLJR1L.IL' TO A LNN LLTNE RUt. IL:!f-i TI) Ef❑#C`iiMi1F-l-ICre 1131'. -r MI I :HE Rc VOV l _'. :�U 1 EN ]DE:in BTIi Y 'Hi=: h€_L_D I ( HrNI{1 PfI {':-t_;-lL!-!'`_:_'I'I ::r='lya�:.., l:__ l = N. RE A 13!d _i = E FOE!H N HE WFL_) ,.ul.IT'Y 11.41.111:Io4L.iN.. SEVIOH . .F?I:..PubAlk. ;=i' ,. iEM NEITi.lL.A1ICIEI'FE !NF::;LUL.F!! r--t�'TL L PIT TD I-1EET r,ii - TI/FIN! 'l'I i r h4F'!-�IJN [. J _I: EIF T!i[ FLE.ON DURING IN 11'�.J>;NI- r.IR. F::NAL 4F'F'i-.l3'JFSL . IL -FE !N11JTJr'1IEF: IF T INF -'FF 41I r DIEE=•. l it IT CUINF;T T TL1I'- L1MF'T/I N D"' THE _'E[- -ih.1 MEIVI _E 1 rS I- Mn-LU F E`i LF i_1NI ILt F, i LiE —UHF r Nfl_'i_IF'F UFI-lNi,Lr cll!_Ir-'f_ t ,;r.- l IF3= E: J(4T'., r `rr '.'I'FL7h•;''F!!'rl_ FGti- r'I3 T kill IHEL FEE! 1/I T_; '`Ji7T 4F;NiII_! E F:/,L'1_E FIND SHALL BECOME VOID IF N NEILEN LUFLI= . r, i=:T [IN I IA'_LF €'•IC7'I (Ih'1I1iiF 2i i THEN iFLIT- TE F. OF :r 2 1!.•-,Ni[-, A.E FIN._ L.3!_ 111.1 FA Ll] TI -EEc FEEl...IT TIKE !-JEI_I) Ci={UNT... HC`ALTH DEF'FR; rMII'-.IT RESERVES _r1ILl F:1'IILT Ti: IMF'CEI[: F-i)EL -i!.Jr•INI.. r\lN AND ELFIN.! [ E,Dr-IN I-.Ei.FJifi' i O MI/k-7 PUP FE ii 1! :115 EN N C".:Fi I [ 11erPa'., LJr,. F Il!f l_. I -El' fT-II-'PHUVNL i -I f_ I,JN F INUL_LI) {J!=TM I! -it. I-`lI-4i-AL., 1N;> F I -1 i'OF' T l i _.Dli •, F='I_i:'T D F IT T L•_1*1 61' THE I,'J!:-a_Ii C;CuNT'r' HEL .T_H E'NP',uH-1.1,1,,.:rl..[ ! F.,[�':[I`IIAI r'f-1_ IL .'•1 . L .II..:, y,Ji ._i} WELD GOUNTY HEALTH DEPARThENT_ ENVIRONMENTAL PROTECTION SERVICES V.. a �� SITE- 9VAL'JATION OWNER: L11A11 APPLICATION NO. t I SITE: NfA L( 7 PTSCq S EZ- TT____R TE DA: -Zi + 5URDIVI5ION: k� t,_ j ( LT 6LK� FLG_ PERCOLATION TEST DATA: Start Time: Hole No. Hole Depth H2 Remain min. mm. 10 rttin. id min. min. min. min, min. min, min. TREK �q 'Z< 2-gC) 3 o C1 1.3 2 •1 3 30 215 V V.e a 4,0-b 5 4 -4,3 o L 3O 2 2? �.Z Ni. 12, 4 .lJ 5 b All measurements in .mn unless otherwise indicated. 2 CJ * - Add H2O Total r 3 Environmental Specialist Average Rate PLOT PLAN Aa L c. . 4 f*� tv -nil. PPnVT1.F PPt 1:C`'',•U.LI,'1,1.!I�r_ S 6�Elr ._ 3'rI'�i-D =ri. ,S EM 1 G-5400"? WE !- El rT,_,_J%? i `r' E-IE. vI_ E,_' LL'_ i -! FJ E� r r i �. .. __. ii FlEE . - . r•�� ..t..11'.J t's•7v.JF°l_I'•IIiJ-i'F_ l-fcrF_Tr. '.-t.-:.l^"',•3lc� t;l�IIAER M: IT-EYIc;-;1`h1!:T 'Tr} ADDRESS DF F'RCIE'Jl-3EEl E` 01 lI Hi VE :': ,t F kGJ'c' F T i--H} TE.',•p 1 Fv i" -r . l i ('F.ET.T LI F'1- 0 !J ..i':) ., �,+.r...y S I: F. :v:1 i,l},lSI'rl: IlkFJ: i'!F'F.'FIN E;RF_li'HF:F: + FIND LOT 1'I EILOCE (1 T11_'_!'.Ilb El _iF i1'[ RESIDEATi4L HOLiFiL .7t.FILE-.._,• ....,... Li.#"1. E]:ZL =,or? PLUMPING YES Jt'iTEf,' IJPF'I_Y FIi'J!_1!._L. OF'F'I 3.0(111 I DE LI.!EIF-Ji.EDO TO T! -DT THE !;.'E!I 'r'L. Fl f. 11F at•, OF HISri;'Fi_'LF: [ION 10 PUNOITIRIN `rJ. lil'Oll {IF= {l7L.F; !`iF;l'111i`:: LIE-'( Il'I1) r;iis:FT.[ _[ iL I !_' 1 s FiI.ItF.I:l [iF'cl ,',i AT I';o [. E�FIll Ill-I-•i, �JFLL' F. l.!llltl l ( HEALTH L)LF,;F I ELF LFF f f ! FE E' 004— FiNi: F LIINISHF-D Al THE HI I -1 ii hil'-' LIE- F LIE- -1_EJ OfIJLIPJ l H HF- f l I OFE HIl 1E NI F HO i-' lf01 i"1LL:0 [1 THE ELI L.0 [ION CF 1!F f -f 'I'L TI =a 1LLN r_i I HE I' ,;L'r !' E OF THE FT MIT IS . L,JH JIw,.C_I. !.:. ,U{:H TERMS 11'.10 C-fhlr E1 iC�E;-. '-Er CrF=1::Hf NL-'EE:.,.,.]Nr'i PLI I!'1{ URE LiTir11-LIONEE WIT `R,ULI S AND FLIL_OTIE'w!l_; hiPTF'TEK, LI!'!1:11-1-; r7U:' lZLE_ 3.'..', 'lL._F' :' 1;'F.!: ,;o. 0 AMEI'.IDE[i. THE ARPLJEIDNT LEO "!3: iE:r:; IHl IH I- F'C;'S.EF . ViL I ELM 6'.111 I._ • II s F 1_;E 1 HL OTED WI :FUN :T0, , F E I LIE hi E IN'Ji._.l!`.1 I r' r=;l LJr'lLii_ [FILL {'! -4: UNIFJLi EIDNED HEI_R`s' CERTIF .L S. TWIT ALL 0 'k1 E MEN F''W;: rI- HE -:9 JO-DEl--It I&M PILE ,HI,! L:IIFI'r r ELI k REWJ T'II FLIT E0':L' Ti.' EE UBMIr'TE:aI a�''r' THE. fiF-F'LJ.Crhi4l' ARE, COR i-lJ _L :E -E. F: 6'F;W,:i F;lED TO BE TRUE AND [TORRE'_:: ! T[l THE BE ITT LIE 'I' 1.UI11Jl_E s?1 1. (Till HE) JF F F•:...IEHF 70 FIFE ! .ii.-.IFLI ON UY FIEF L i i_ L! LION! 'r HE -HI i 1!i_ l-'ol-'Tf'm I— _I E .'A!_E r7 r o l[: THE '-H"1[- iLIE P F.f-'L; E` OF Il LiINI 11 -HE FE 0111 I i l''F'l..IE- ['i ELF'. HEFTE:IN. ! µURi.-HEf-': UNDER— STAND I Li I Fahat' !'-�'il_ :iIF-.S'E':'fi'I"ELah! OR HL TF:EIEL:' L:h.I H i iC i1 Li' !-! ',?:l.!1..T lf) THE IMEN'IAL. C: TT ICE 01'-'Fl.IC:rs-l1'-WN LJR FC-YLEFOT'-I-IN OF ;I-Ei- PEERF'IIT ORrIr TED BASED UPON SAID HF:'LICATIi]P,', AND F:LiPil AUFfCI`E i-ill;_ PERJURY Ala !:.'.J 'Elf B't' I__OWWl.. HOE --Li i I :uf•J EE i 1`_''J.::}H EHPi4N i-. �:;iilCl I FC;"! F; t` (.1 0.ILJt,lr •i!.1l_;II'Lii. riEI,L.i[.-,rIrIT:: ! (,if-''' -511:='1 Fr) olive WELD COUNTY HEALTH DEPARTMENT COLORADO 1517 16TH AVENUE COURT, GREELEY, CC 80631 (970) 353-0635 EXT 2225 FAX (970)35-496 SEPTIC LOAN APPROVAL Closing Date: 7/2/1998 Request No 98-053 New Loan : Y Date Received: 06/26/1998 Re -Financed . N TO WHOM IT MAY CONCERN Review and inspection report regarding water and the sewage disposal system for an existing dwelling: SEND TO: LESLIE WILLIAMS Realtor Phone 17883 CLARA LEE Owner Phone(H): (3D3)857-0384 BRIGHTON COLORADO 80601 Owner Phone(W): INFORMATION: Address: 17883 CLARA LEE FT LUPTON CO 80621 Legal: MB -14 L14 MARTIN BROS PUT) - AMESec/Twn/Range:83 C Subdivision/Legal: Property Owner: WILLIAMS LESLIE Tank Pumped On: 06/26/1998 By: CARLSON SANITATION SERVICE Licensed: Y PERMIT ON RECORD: Permit No: G199405'79 SOE(Y/N): N Year Installed: 1994 Original Owner: K S INVESTMENTS Bath: 3 Bed: 3 Acres: 5.00,' Date of Final Insp: 03/16/1995 Water Supply - Public : Utility Name; Private: Y Cistern: Well: Y Permit Number: Tank Capacity: 1250 gallons Field Size: 969 square feet INSPECTION FXNDINGS: Date of Inspection: 6/29/1998 Soil Conditions - Dry: XX Saturated: Snow-covered: Residence - Occupied: XX Vacant: Sewage Disposal System - Satisfactory: XX Other: Bacteriological Water Test - Acceptable: XX Other: COMMENTS: Date: Signature: Envron tal Protection Specialist Neither the County of Weld, nor any of its agents or employees undertake or assume any liability to the owner of thw abrv0 property, to any purchaser of the above property or to any lending agency making a loan on the above property in connection with either its examination of the property or in the report. This inspection was conducted solely for the purpose of detecting health haeards observable at the time of inspettidn, and does not ponetitute a warranty that the system is without flaw or that it will continue to function in the future. Inspections requested during periods of snow cover and high soil saturation may be of questionable value to potential buyers due to adverse conditions. water sample reports reflect the bacteriological quality aE the waltz avpply at the time the sample waa taken. Evaluations based on Statements of existing {SOE) relies on information the property owner provides, under oath, indicating current status of the syiteS and tepteaenting to the best of his/her knowledge the system is not tailing to function properly, .. hive r fr1T ,nR A nn 4 } SEPTIC LOAN APPROVAL Li / C'517 SPECIALIST INE'F DCTTOKS: / J f Need: CLOSING DATE: 1 1 FAX FEE ($2.00) NEW LOAN F + C TO WHOM IT MAY CONCERN: Review and inspection report regar disposal system for an existing dwelling: REQUEST NO : + 0153 DATE RECEIVED: L4 2k q S' FEE $90.0 105.0 :LP iR ding water and the sewage PAX TO: _ Fbx NO.: MAIL TO: n'1 P 4 I. ALTOR NO.: /' (1Y'_rin '7 F ilj / I �Yti�t7Y1 CWNER NO.: 30 ' 7O(fl] PICK-t1P: OWNER NO. f pi INFORMATXON! Address Age of Septic:IIa' 1 Legal: PT: PT: [ ESC: l.� T3nTN �N RNG: fa CP w Subdivision 'i 4ilok5 4 P(4 LOT_____ BLA: FLG:_ Property Owner: 1 r 'l ' S rF On final Owner: .{f 7i frc• Tank Pumped on: c By: ` [ rJLicensed: /l PERMIT ON RECORD: Name:_ J L']lIP4A Permit Na.:9 Q5! S.O.S. _ BathroomsA Bedrooms: Total Acrea:,Q Date of Final Inspection: Water Supply: I2Y N ' Y Well permit No,: Tank Capacity: �1�-� gallons Field Size:'- Square feet INSPECTION FINDINGS: Date of Inspection:__________________ 2 Soil Conditions; Dry G Saturated Suw-cavered Residence: Occupied_ Vacant Sewage Disposal System: Satisfactory Other Bacteriological Water Test! Acceptable other COMMENTS: DATE: SIGNATURE: Environmental Protection Specialist Neither the County o€ weld, nor any of its agents or employees undertakeor assume any liability to the owner of the above property, to any purchaser of the above property or to any lending agency making a loan on the above property in connection with either its examination of the property or in the report. This inspection was conducted solely for the purpose of deteo„-log health hazards observable at the time of inspection, and does not constitute a warranty that the system is without flaw or that it will continue to function in the f:ture. Inspections requested during periods of snow cover and high soil saturation may be of questionable value to potential buyers due to adverse conditions. Water sample reports reflect the bacteriological quality of the water supply at the time the sample was taken. Evaluations based on Statements of Existing (S.O_E.) relies on iriformatio_, the property owner •provides, under oath, indicating current status of the system and representing to the best of his/her knowledge theldya*26 aLtli to function pr_.pexly. fd}z -1r�o H -' ! t ir t' rash :.,. PUMP INSTALLAT]0N AND TEST REPORT For oAto• 'iia only WS 32 ff/40 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER fECEW 'D 1, WELT. PERMIT NUMBER I`i5a43 7gt� 2. OWNER NAME(S) GMLIf I ruA Mai'ing Address I fo3 Et~ City, $1. Zip I 1 Phone ( 3p, ) , !'4a.; 3. WELL LOCATION AS DRILLED; 114 .. 114, Sec. $ Twp.I _Al , Range DISTANCES FROM SEC. LINES; 2c0. ft. from 5 Sec. tine. and . a0 tt. from Sac. line. SUSDIV1SION: /Y1 2 r ,d LOT 1LBLOCK FILING(UNIT) STREET ADDRESS AT WELL LOCATION: PUMP DATA: Type 5 81FI'ERS r 13 Insiairatlon Completed + /9941 Purr.p Manufacturer �Ti#C'.r.+..2- Pump Modal No. 3o 35 u ra31— s - Deslgn GPM o at RPM 3L 50 — , HP 3 ..� ,Vihs , Full Load Amps - ....� Purnp Intake Depttr Feet, Drop/Column Pipe Size fly Inches, Kind GALL AODmONAL INFORMATION FOR_P_UMPS GREATER THAT 5D GPM: TURBINE DRIVER TfPE: ❑ Electric O Engine O other CosIgn Head feet, Number of Stages Shalt size inches, OTHERl=QU1PMENT, Airline Installed El Yes c, Orifice Depth ft. Monitor Tube Installed O Yes E No, Depth ft._ — Flow Meter Mfg. N Motor Serial No. Meter Readout EJ Gallons, ❑ Thousand Gallons, ] Acre foot, ❑ Beginning Reading TEST DATA: O Check box if Test data is sutlmitted on Supplemental Form. Date Total Wall Depth $ r' S Time __R Static Level 3 P,_ Rata (GPM) Date Measured .2- __..q Pumping Lvl. { — 7. DISINFECTION: Type /l7 /,1 _ N Amt Used -l.. 8. Water Quality anaysls available, ❑ Yes 421 No Remarks 0. I have read the statements made herein and know the contents thereof, and that they are true to my knowtedg (Pursuant to Section 24-4-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury In the secor degree and Is punishable as a class I misdemeanor.] CONTRACTOR S ain'n .Senvrrc Maiiing Address X021 27 Narneffltle (Please type or print) 7om f I. 5paLn Pne�iLdent Phone f __j_59-/58' LIZ. No.Z 0621 Signature q ( Data srte t V, }� 8 `^r,t,� to !c I 1 !1 FORM NO.. +/ WELL CONSTRUCTION AND TEST REPORT For Olflcs V.f. Drily stirs -3; STATE OF COLORADO, OFFICE OF THE STATE ENGINEER RECEIVED t. WELL PERMIT NUMBER 175243 i g 494 2. OWNER NAME(S) Mailrr�g Address we tfsoulw Cy, St. Zip STA1EE 1TPLT 0110 Phase 3. WELL LOCATION AS DRILLED: X1/4 E 114, Sec._, Twp. 1 �Range_ � DISTANCES FROM SEC, LINES: 2'-50 ft. from S Sec. line_ and 300 It. tram E Sec. line. OR {Worry, ar aoudif l- a SU DIVISION MARTIN B Og FUD LOTTJ BLOCK_ _ FIUNG(UNI'r) STREET ADDRESS AT WELL IOrATInti• 4.I GROUND SURFACE ELEVATION 1t. DATE COMPLETED DRILLING METHOD R0TARY TOTAL DEPTH 5. GEOLOGIC LOG: Depth Deecip*on o! Mi�lriy crypt. Size, Caior, W., Louv&m) 0- sand sandy clay 0 - 10 sand 25- 0 shale 510-530 shale _9fi- 15 flt.tnd 5E-12 l ray $, :art;` - - DISINFECTION: Tvne HTH DEPTH COMPLETED HOLE OLAM. (in.) From (ft) TO (ft) _____ 7. PLAIN CASING 00 (in) Kind wall Size From(It) To(ft) sel 1 q (a-.-.-- steel 691 PERT, CASING: Screen Slut Size: �' 1 —� 4t�a1 : n1.ic 71c 8. FILTER PACK 9_ PACKER PLACEMENT. Material Type Size Interval ❑anth 10 GROUTING RECORD; Material Amount Density Interval Placement I' cement Becks J..4.5 _ e ..� F�sl Amt. Used 1lb, . WELL TEST DATA: D Check box if Test Data is submitted on Supplemental Form. TESTING METHOD AIR-LI?T Static Level 370 fl. Date/Time measured Pumping level 700 ft, DateiTime measured Remarks Production Rate 15 gpm. Test length (hrs,) 2hrs 1 J. I have ievd the a ettd yna r a4a tarein end M11ont the conlamh, ltrsnul, t11M Cud Cray an hue tp my knawledpe. IPuP4ueni to Secron 2a-4-104 (11J l) G.RS., the makirM of laise +leerM1erlis 4 heir corusailules pe4ury In Inc eeoantl dearw end ie Rvibi. Y e elm I rh6den'ieeflor.l CONTRACTOR 130GER SCH0CKE YELL DRILLING INC. Phone ( 3 ] 288-5474 Lic. No. Mailing Address 8 H .- Narne/Title (Please type or print) Signature Date SCHOCKE - -,_i;;:'_:' 1-1�-.— H0UBT INSTRUCTIONS FOR WELL CONS 'I RUCTION AND -i E;iT 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 lop by the well owner's name, the permit number, form nameinumber 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 Seale Engineer,` The original and one copy d this form must be submitted to the Stale Engineer s Office within 60 days alter completing the well or 7 days after the permit sxpitatkn date, whichever is earlier- Another copy of the form must be provided to the well owner. 1. Complete the Well 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 the owner has more than one well - serving ttti3 prope'ty,-provide the-identiflcati ;n (Owns -s O ignatkxt)_to(_this_well. DO NOT USE THE_OWNER SUPPLIED 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. 0o not use formation names unless '•ciey are in conjunction with a description of materials. Examples of descriptive terms Include: - Grain see --Boulders, gravel, sand, silt, clay. - Hardness --Loose, soft, tight, hard, vary hard. - Co4or.-All 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. 8- Indicate the type and size of filter (9ravel) pack and the interval where placed. 9. Indicate the type and setting depth for arty packers installed. - - 10. The density oFthd: riiut slurry tniast be repelled andmay"tre iiidicatad-as p4urwtis per gallon, gailoris of water per sack, total gallons of water and number of sack$ used, etc. Specify -the grout placement method, i.e. tramte pipe or positive displacement. The percentage of additives mixed with the grout should be reported under remarks. ii. Record the type and the amount of disinfection used, how placed and the length of time (eft 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- It 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. - 4WS-25 APPLICANT OFFICE OF THE STATE ENGINEER COLORADO DIVISION OF WATER RESOURCES 9tg Centennial Bldg.. 1313 Sharinan St, Denver, Colorado 110203 (303) 83591 WELL PERMIT NUMBER 175243 _ - DIV. 1 CNTY, 62 WD 2 DES. BASIN MD 827 wt. is oioce; ruing; 7uoarv_ r.wJ1urY bIL YUU APPROVED WELL LOCATION WELD COUNTY GARY & DIANA GOCHANOUR NE 114 SE 114 Section 12 12145 BIRCH ST Twp I N RANGE 66 W 6th F.M. THORNTON CO 80241 DISTANCES FROM SECTION LINES (343)450-5272 2250 Ft. from South Section Line PERMIT TO CONSTRUCT A WELL. 300 Ft. from East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDm NiS OF APPROVAL 1) This well shaft 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)(b)o) 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 to the Laramie -Fox Hills aquifer which Corresponds to the interval between 755 feet and t,040 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 20D 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 above, l?/l193 APPROVED _______________ — /fr JWB ema cirn. Receipt No, 0362177 DATE ISSUED DEC 14 1993 Pi TION DATE DECinnr WRJ.5-Rev. 16 Application must he complete where applicable. Type or print it BLACK INK. Naoverstrikes or erasures unless initialed. COLORADO DIVISION OF WATER RESOURCES 816 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80243 PERMIT APPLICATION FORM (XI A PERMIT TO USE GROUND WATER CXI A PERMIT TO CONSTRUCT A WELL FOR: C)) ) A PERMIT TO INSTALL A PUMP (1) APPLICANT - mailing address { I REPLACEMENT FOR NO. { OTHER WATER COURT CASE NO. NAME Gary & Diana Gochanour STREET 12145 Birch Street CITY Thornton 80241 CO .80241 I State} (ZFp) TELEPHONE NO _ - _45Q-5272 (2} LOCATION OF PROPOSED WELL County Weld '4 of the SE f., Section 12 Twp. 1 _N , Rng, 56 _ JL, 6th P.M. EN.s} IE,W3 (3) WATER USE AND WELL DATA Proposed maximum pumping rate lgpml 15 Average annual amount of ground water to be appropriated {acre-feet): Number of acres to be irrigated: 2000 S. . f t . Proposed total depth Ifeet}:___g5Q_' __._..._.. Aquifer ground water is to be obtained from: _- Larime Foxhill Owner's well de6gnation GROUND WATER TO BE USEDF0R: { I HOUSEHOLD USE ONLY - no irrigation I0) { X) DOMESTIC {11 i ) INDUSTRIAL (51 { ) LIVESTOCK I2I ( ) IRRIGATION (61 ( )COMMERCIAL (4) ( )MUNICIPAL (81 I 1 OTHER {91 DETAIL THE USE ON BACK IN 111) (4) DRILLER Name John's Drillin Street 8000 Indiars Rt.1 Box 640 City cki.Lden CO 80403 (SR stet t IpI Telephone No. 423-524h Lic. No. 827 REcErtEo WWo8'9: 8' 3 -a WE Et INEEP - / 7≤7 FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN f� S rt 5 ReceiptNo.3 'r /�f / I /tr /'wit t7{ Basin _ °,, a�M1f Dist,,i[n9?�, &4 — I 1•I 4i/r f<c CONDITIONS OF APPROVAL This well shall be used in such a way as to cause no material injury to existing water rights. Thee issuance of the permit does not assure the applicant that no iniury will occur to another vested water right or preclude another owner of a vested water iz�ri..Ky. right from seeking relief in a civil court action. APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION DATE BY I.D. (STATE ENGINEER) COUNTY 6 - (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. J -4- 1 1 MiLE.6280 FEET - + + - + + + -f- + I i I I -4 NORTH 4 + 1 1. ._ -3co4. r — —r — 4 r I + t I I -F + 4 4- --4- -l- -I- The scale of the diagram is 2 inches - I mile Each smal I square represents 40 acres. WATER EUUiVALENT57ABLE sounded Figures) An acre-foot covers 1 acre of land 1 Poor deer 1 cubic loot per secorrtl Ichl ... 449 gallon§ per minute IeP+n} A family p# 5 will require approximately 1 en-efoot of water per year. 1 sere -foot .. - 43,56[1 cubic feet - - t25900 gallons. 1000 grim pumped continuously for one day produces 4.42 acre-feet. (6) THE WELL MUST BE LOCATED BELOW by distances from section Ines. 2 2 5 0 ft. from S sec. line ;north or wultil 300 ft, from _— E._ — sec. line feast or wont) LOT 15 BLOCK FILING +r SUBDIVISION Ma rt_i n Rrns . PIID (7) TRACT ON WH WELL wru.8E LOCATED Owner: Gary Gochanour No. of acres 5 a - Will this be the only well on this tract? yes (8) PROPOSED CASING PROGRAM Plain Casing 6-5 6 in from 0 ft. to _ft. 4 -min- from 40 It. to 650 ft. Perforated casing 4—½ _in from 650 ft. to 900 ft. in. fram - — ft. to ft. (9) FOR REPLACEMENT WELLS givedislance and direction from old well and plans for plugging it: N/A (ID) LAND ON WHICH GROUND WAFER WILL Ownerisl: Gary & Diana Gochanour _ No_❑facres_� Legal description: Lot 15 Martin Bros. POD, Weld County _ (11) DETAILED OE$CRIPTION of the use of ground water: Household use and domestic wells must indieafe type of disposal system to be used. - - (12) OTHER WATEfl HLGflIS used on this land, 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 THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE. APPL (CANT(S) Use additional sheets of paper if more space is required. E EXEMPT WELL DATA SHEET - DENVER BASIN, COLORADO APPLICANT: GOCNANO(JR RECEIPT NO. 362177 LOCATION: NE1/4 OF SE1/4 OF S€C. 12, T.1N., R.66W. (2250 SSL, 300 ESL) PROPOSED AQUIFER: SURFACE ELEVATION: 5025 NUMBER OF ACRES IN TRACT: 5 -----------------------•----------- .---------------------------- -I...... IS PROPERTY WITHIN SERVICE BOUNDARIES OF MUNICIPALITY 5.8.5 CONSENT MAPS? NO YES IF SUBDIVISION IS UNDER AUGMENTATION PLAN, CASE NO. IS Div, IF SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY THE WATER MANAGEMENT BRANCH, DATE OF LETTER IS INFORMATION ON SUBDIV151oN OR TRACT OF LAND/SPECIAL RESTRICTIONS: evaluated by dWB an DECEMBER 9, 1993 ELEVATION DEPTH TD ANNUAL --------- -- NET --------------- APPROP STATUS AQUIFER ROT. TOP SAND ROT. TOP A -F -•- ---•--- ---------------------------- ....... UPPER DAMSON .. LOWER DAWSON ---- ---- ---- DENVER UPPER ARAPAHOE ---- --• LOWER,ARAPAROE 4679 4907 94 34d 118 D.799 NNT iARANIE-FOX HILLS 3964 4271 152 1441 (75'J 1.133 NT note: E indicates iacatian is at aquifer buurdary end vaLues may be more approximate. * indicates the proposed aquifer. All vetoes are interpolate from the S.3.5 data base assembled in November of 1986. Scanning Cover Sheet for Septic Permits Permit # 3/9930416 - I Permit Type: Health 1 EHS History 1 EHS Conversion History Situs Street Address 17963 CLARA LEE ST Situs City, State, Zip SeclTownlRange: 12-0IN-66W Application Status: Finaled Application Date: 0311111996 Parcel # (12 digits) Owner Full Name: Owner Address: Contact Name: Contact Address: 147112403015-R0225394 GREIN KEN 13565 WCR 2 BRIGHTON,CO 80601 Owner Phone #: 303 6593969 Contact Phone# information above has been Verified in AccJ_by employee noted below x September 02. 2008 Processed by: Date Report ID. EHS00024v0d3 Print Date -Time 9/2/2008 1102:45AM Page 1 of i 1111):):11:1}(3F11,. ".iI.WAG:: I}1: ".:il'Cl.Jr71.,- ;sYS;iT'IT`! I"'ll':Ev :.1 hl[a.. ['•i••'i''i{?r!Iies wli:.i,3) (.'IIU J `r I-iF:'AI-- I I.1 ≥;':tEF''p1L:i"fh11:J-LI is11::W F'I:I.I''I:L T I:#hi+lf.I0JIlt"IEJ-IIAI.. 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OFf=ICE OF THE STATE ENGINEER Ill CrrmY.l Bide-, 1313 aib.rnrn 01. Durwr. Cabndo ai0pa3 a�i are�a4e� COMPLE11NG FORM. SEE'IN$TRUCBONS Ot t F $4DE PRIOR TO 07 '94 CHANGE IAN OWNERSHIP/ADDRESS / LOCATION WELL PERMIT, LNESTOO( TAM Oct EltiOSiON CONTT4OL DMA 1, hfEYY O R 1AME(S) ... r... e l rf,'i,.. OW.... ., Malang Address .. /0�Q_ _1 , , f'I4 '...... Cfy, Si. ZIP T2 � ±-f ...,._ ...._....Qa ........ Phone (.343) . " 4 ' .. _ . . 2. ILWEIS FOR ONE OF TH _FOLLOWINGLft WELL PERMIT NUMBER ...�.I'....,. +� ❑ LIVESTOCK WATER TANK NUMBER..-...--..._ ................................. El EROSION CONTROL DAM NUMBER 3 WELL LOCATION Y COUNTY . i i OWNER'S WELL INSTRUCTIONS CHANGE OW NER5HIP.ADORESS LOCATION CORRECTION FORM JULY 1993 NO FEE IS REQUIRED ' , - 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 raw.oWner's name and Include the mailing address and phone number. 2. Indicate h the change In ownershipladdress is for a well permit, livestock water tank or erosion control dam. Be sure 10 include the proper permit. tenk or dam number 3, Complete the well location information_ it the address of the well location Is different than the mailing address of the owner, include the address where the well is located. It the owner has more than one well, provide well name or number as designated by the owner; i.e. North Well, The ectusl well location must Include Y4, 14, Section. Township and Range. Check the appropriate boxes for North or South and East or West directions. Complete the Subdhrision, Lot, Black and Fliiftg Information, if applicable. 4. Complete the location information for the livestock water tank or erosion control dam. The actual location must include ¼, 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 location correction. 6. The owner of the structure must sign. Print or type your name in the first block if It is different tram Item No, 1, If signing ma 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 throe single-family dwellings, firs protection, the watering of poultry, domestic animals, and Ilvestock on farms and ranches and the Irrigation of not over one acre of home gardens and lawns. 8. 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. IN ALL OTHER CASES USE FORM GWS42 All offer types of dry concerning Livestock Water Tank3 and Erosion Control Dams should be submitted on the standard Parmil Application form and be ar contpanied by a $15.00 fling fee. If you have questions, contact the Denver or the Division Office where your well Is located DIVISION 1 DMSION 2 DMSION 3 DIVISION 4 209 ARIX BUILDING 219 W. 5TH RM. 223 422 4TH ST :1 ` 1540 E. NIAGARA: 800 8TH AVE. PUEBLO, CO. 81003 ALAMOSA, C0 91101 MONTROSE, CO. 81402 GREELEY, CO 806.31 (719) 5423368 (719) SB9-6683 (303) 249-ss22 (303) 352-8712 DIVISION 5 50633 USHWY6&24. GLNWD SPOS. CO. 81601 (303) 1345-5885 DMSION 6 32o LINCOLN AVE. STE. E STM BT SPOS., CO. 80477 (30) 579}4272 DMSION 7 1474 MAN ST. DURANGO, CO. 81302 (303) 247-1645 DENVER OFFICE 1313 SHERMAN ST. DENVER, CO. 80203 (303) 866-3881 x/ r°AH ro. ' PUMP INSTALLAT10N AND TEST REPORT bus -32 Few Q u.. any 11190 ISTATE OF COLORADO, OFFICE OF THE STATE ENGINEER Vee i. WELL PERMrr NUMBER 144a 4a 11995 2 OWNER NAMES) ` Mallfrsg Add ss City, Si. Zip chcxt TL . tn Phone( ) 3. WELL LOCA11QPr AS DRILLED: il4 SE 114, Sec / Twp-I Rangeta-"'Lj _ DISTANCES FROM SEE. LINES: _______, ft, from Sec. line. and _ ft. from Sec. line- « « «� SUBDIVISION: LOT FLOCK FILING(UNii)____ STREET ADDRESS AT WELL LOCATION. C- Ljj 4. P?IP D9TYpe Installation Completed Pump Mantrfac1urer Pump. M9deI No L4LDesign GPM at RPM HP Volts r�ull Load Amps f_ Pump Intake Depthl Ej Feet, DroplColumn Pipe Sizo Inches, fc)ndy — ADOfl1QNAL INPQRMATTQF4 FPMFPMT THAT50 GP • TURBINE DJ rVER TYPE: El EleetrIC ❑ Engine ❑ Other Design Head feet. Number of Stages , Shalt size Inches. 5. O,1 EQUIPMENT: Airtlne Instatled ElYes[L3[NV , OrMce Depth ft. Monitor Tube lnstatled ❑ Yes No. depth ft._ Flow Meter Mre. .J1F 14 Meter Serial No -_yip _ Meter Readout O Gallons, LI Thousand Gallons, O Acre Tact, C] Beginning Reading $. T,$T RATA El Check box if Test data Es subtnitt d o�i Supplemental Farm. Date Total Well Depth 9Q Time _ - _. ___� Static Lever Rate (GPM) Date Measured Pumping Lvl. 7_ DISINFECTION. Type aT I _ _._Amt Used i CLi.I d ssolva 8. Water Quality analysis available. 0Yes No 9. Remarks d. I have read the staterneftts made herein and know the contents thereof, and that they are true to my kno+vledg (Pursuant to Section 24-4.104 (13)(a) •C.R.S., the making of raise statements herein constttutlis perjury in trio secor. degree and Is punishable as a class I misdemeanor.] CONTRACTOR - —,� atn'4 SeavLce. Inc. Phone E )--65_?-/58_ Lie, No,7!5,__ Melons Address 2 t . u ton v . Du21 NameJTitle (Please type or print) Signritcrre ti Date Torn W. Spain /nn en Edent : brN_ c I Fam Ne• ' WELL CONSTRUCTION AND TEST REPORT For omt. U.. mly x`31 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER ltrso 'RECEiVED f. WELL PERMR NUMBER 1747 27 94 2 OWNER NAME(S) WATER hdaiiing Address, City, SL Zlp tar on. O. SU U1 17D1D Phone( } 3. WELL LgCATION AS QRILLED,- NW 1/4 SE 114, Sec. 12 Twp. 1 - N Range 6 6 W DISTANCES FROM SEC. LINES_ 1785 . {t Irani S Sec. line. and 14 00 h, from E Sac. line. OR SUBDIVISION: Martin s . PUD Amended LOT? b _ BLOCK FILJNG(UNiT] 4.1 GROUND SURFACE ELEbAT1ON ft. DRiLi1NG METHOD Rotary DATE COMPLETED 3-31-94 . TOTAL DEPTii 980 tt. DEPTH GO MPI ETED 980 5. GEOLOGIC LOG: 0"th Dn.crlpdci. ar M.e.rw (ryp., t. cover, wWr L"a7lon) 0-10 Brown sand 10-30 10-4. Brown £ndy c.14y as -ti sn- - a1ii Blue 'shale 1ayer5 of coa -75n E1ue .. hale s�lndstone_ ledges -rsn_QAA Eng till Sands Water 6. HOLE DIAM. (In.) From(It) To 2 ft) 8 3/4 0 .7. PLAIN CASING OO (In) Kind _ Wall Size Frorn(ft) To(tt) 1 Steel l88 25 i PERF. CASING: Screen Slot Size;3 / 16" torcTc 4 1/2 Steel .188770 9U I3. FILTER PACK 9. PACKER PLACEMENT: Material NIA TyPsHaliburton -- Sze_- ^� basket placed at Interval Depth ' 10. GROUTING RECORD: Material Amount Density lntor aI Ptacement REMAFIKS; en oni e r calcium ernent 550cTal 7gal / 0-770 pump chloride added cement. " baq' 1 O1SINFECT1ON; Typo Granular Chlorine Arrrt. Used 3 cups dissolved in 5 gallon o water, poured roue r pipe. WELL DATA:❑ Check box IT Test data Is submitted on Supplemental form. zone with, air. TESTING MET'}iOD Mr Static Level , 44Ott. Dated me 'measure -J.94 4 0 0pm Production Rate rn. 20 9R Pumping level. Jettiniit. Datedilme measured lest length. (hrs"Y Remarks ' 3. I MW had Itk k brmMO made h~ and Waw V% awdwo t.*c. and th dwi No hm to n'W I Mdoa- LPur.u.rs fe 5.cdow 244tH [13j{y G.R&. qtr m.Sdn d fala..lwo+an4 h.r.In oon.11trdr p.rlury In d•u .a and d.pr.a and I. m�h.bI. a. a al... I m6dun.arnr.I CONTRACTOR John's ❑rilling INC. Phone30 MaRIng Address - o r _43-5246 [.J. Na. 8 2 7 Name/flue (Please type or print) Signature Date Lloyd John Owner/President 4-7-94 =CR WELLCTp.t1G;;O:1 AMID TEST REPORT The report must be typed or printed in CK E1c All changes on the form must be initialed and dated, ' Attach, additional sheets f mare space Is required. Each additional sheet magi be identified at the top by the well owner's name, the permit number, form nametnumber 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 Slate Engineer, The, original and one copy d this form muss be submitted to the State Engineer's Office within 50 days after completing the waU or 7'deys after the permptratlon date, whichever Is earlier. Another copy of the form must be provided to the vlell owner. 1. Complete the Well Permit' Number In. full. 2 Fill in Name end Making Address, of 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 serving this property, provide the Identification (4wnes Designation) for this well. DO NOT USE THE OWNER sttJPPuEU LQCATIQN unless a survey has been provided. For wells located In subdivisions the lot, block and subdivision lnformatfon 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 das&tptlon of materials. s. Examples of descriptive terms include: Grain siz-8ouldars, gravel, saAd. Silt. clay. HajnMsZLoose, soft, tight, hard. very hard. Cesar --All materials. Most critical In sedimentary rock. f)gpth 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. 8. Indicate the type and size of titer (gravel) pack and the interval where placed. 9. Ind;Cate the type and setting depth for any pacl4ers 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 pipet or positive displacement. The percentage of additives mixed with the grout should be reported under remarks, It. Record the type and llioamount 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 at1 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. ForSa No. OFFICE OF THE STATE ENGINEER GWB-25 COLORADO DIVISION OF WATER RESOURCES 816 c*rrtrnnl. Bldg., t313 Siwrman St, Danvar, Colorado 60263 827 APPLI ANT CAROLYN SPEARS 17782 WC RD 12 FT LUPTON CO 80621 (303) 659.2945 PERMIT TO CONSTRUCT A WELL WELL PERMMT 14UVEER ra.'ie rr[ - DIV. 1 CNTY- 62 WD 2 DES. BASIN MD Lot: 16 BI ck; FIIIngSubdIV; MAIMN BROS PUC AMENP€0 APPROVED WELL LOCATION WELD COUNTY NW 1/4 SE 1/4 Section 12 Twp 1 N RANGE 66 W 5th P.M. DISTANCES FROM SECTION LINES 1785 Ft. from South Section Line 1400 Ft. from East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CQHtNTIONS OF AQP4iQYAi 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 tin another vested water right or preclude another owner of a vested water right from seeking relief in a cMI court action. 2) The construction of this wall shall be in compliance with the Water Well Construction and Pump Installation Rules 2 OCR 402-2, unless approval of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in accordance with Rule 17. 3) Approved pursuant to CRS 37-92-602(3)(b) (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, 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 wall is restricted to the Laramie -Fox HiMs aquifer which corresponds to the interval between 770 feet and 1060 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 -lest. 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, perforated casing should be set through the entire producing interval of the approved zone or aquifer Indicated above Ev/r9IS3 APPROVED DWR - Ev,p Receipt No. 03608548 DATE ISSUED NOV 2 '� 1001 P TION DATE rat 1641 � RECEIVED - tiw'R�•5�[ta�, 76 l COLORADO DIVISION OF WATER RESOURCESa 3-0 �E1�Centennial BEdg•. 1313 Sherman St., Denver, Cararadl PERMIT APPLICATION FORM ApplleatiAn mart be cwhere omptets'' ' 1 7tl A PER�IIIT TO USE GROUND WATER NW Q 1 W WATER R✓:St#Ilf srAlE It�It ,s { applicable. Type or print -BUCK i K) A PERMIT TO CONSTRUCT A WELL° FOR: (XI A PE#;MI1 TO INSTALL A PUMP - o or oragurti strikes # ■rer4rer unlecf Initialed, f I REPLACSMEhIT FOR NO, __ - ( i OTHER t[ WATER COURT CASE NO. Sp3s'� U LI NAME STREET LV a LtiC I CITY zI {etat�l ;Slo) TELEPHONE NO, - (21 Lf AILN..1 Pf1-QPg5EQ W County N JW _ 1A of the -_-'I, Section„ f52 l wp.,L._- i Rte^ ! ` P.M. 1631 WATER USE AND WELL DATA Proposed maximum pumpin9 rata {9pml /a _ Average annual amount of Around waitr to be appropriated (ecre•feeti:—�— FOR OFFICE USE ONLY; DO NOT WRITE IN T{-45 COLUMN ,'/t'�rr � �- � � 3 � L F4�' RdeelplNo, /2t4 b ( Ixllyra�� r+spK- � L4d0-rtop' Boon 7Lia�ROia-_P flift. _a.i JJ {�nonlrAi I.f rtIvaltar CONipIrWSOP_APPRQtV This welt shelf be vied In such a way as to cause no mater3:l :r1urj to existing water rights. The b itsuanceaf the permit does not assure tho applicant (L ;hat no inlu, V will occur to another vested water right or preclude another owner of a vested water t'Tght from seeking re&ieff ina civil courA actiort.- {rcr,da.�. K. ra.y t/2,aooaI-.. 1 ! fist/rrc Number a1 acres to be Irrigated: Proposed total depth {faetl; 51 C 11 Aquifer grour+d water is to be obtained from: rti i'tlis Qr4A Owner's well deslgnatlon _ 1_(Q_. GQIJNDWAThR10 BE USED FOR: 17' 1 PIOUSEMOl.D USE. ONLY- , no lut a Lor4 (Oh ;s4 DOMESTIC I1)- { .1 INDUSTRIAL (51 (XI LIVESTOCK {21 Iwl IRRIGATION (61 l 1 COMMERCIAL 141 I 1 MUNICIPAL. IB) l } OTHER (9) /� r6Q as1- CETAI,L THE USE ON BACK IN {1 11 (4) DRILLER foams Street T. (Q tD•1V City . a }`TZD) Talaphane No.�� i_le, No. Best Copy Available APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EkPlptAT1ON DATE i {STATE NG4ei R} lily I.D.. 1 COUNTY _� CT } THE LUCA•1'IrJN OF FIE IOf't�ti_ WELL endtheareaon (6) T1-IEWELLMUST B]L- LOCATED BEL{_]W_ whlc� hh the witcr will bu used must be fndkied on the dtegrem below. by dts[incei from section linet, - Uae the CENTER SECTION-Il section. 640 acre;) for the well location. .r ,. -. f t. from sec. lino ++ ... + 1! _ �. __ [, nart pr loin IJ I I t t MILL5a.0 FEET —I_1 t Loa ft. from AS _, sec. line gat LOT L --I BLOCK FILING. { I T �� — NonTR SICTi8N 1N ` — + — SUIlDIVISION (7) TRACT ON WHICH WELL WILL i~lOR7H ( { I LOCATED Owner:1TolyrJ €�}$ z - + — + No. of acres 3 9.S will be -5e this I I m 1 the only well on this tract?4- + EI I. — 4- (8} ROP S D CA 1NG PROGRAM Plain Casing .}- — ± - — .�. — ,n + 10' in. from — f 1. to _ f t. I I I �]J r�� in. from . v�5 1t to,{�y[yft. L. - -4- (" �, - Perforatedc; - ioum C i _ I , - I `-__q . . _. I + - + + „I- - i- H. --+ - I Tho Male OI the diagram 1; 2 Incho; " I mile Each small sounre reftresents 40 acres. WATER EQUIVALENTS TAOLE iRounded Figurui An ■ere root covet t sera dr fond 1 loci damp t eabie toot par tatond Icesi ... 44ellone per rnlnuta teomi AsamUy of Swill .quire woroatmalely 1 iew.loat OF walir per Yeu. 1 u:rrloot ... 43140 CON leet .. , ]25,Y0Oysuoni, 1,000 pompumoid eonilnueusty for one diy,prcdtices 4.42 ierahet. (10} LAND ON WHICH GROUND WATER WILLIE JSED: - in. from__- It. to !t. (9} FOR REPLACEMENT WELLSgivedistance end direct on rom old well and plans for plugging It: Ottirnor(1: Ito. of acre;; Lags! doccAplion; {11} IP I N of the use o[ ground wt -r; Household uci end domestic wells mutt indicate type of disposal system to ha used. -f. L (12j'QTHER ATFR RIGHTS used an this land, inr:lud;np wclis. Give Registration and-4'ltigt Court Coso Nurclbert. Type or right Used for f(lurpoie! 0Cicrrpti0r5 01 land on which ustd \ fr (13) THE APPLICANT(S STATES E THAT THE INFORMATION SET FORTH HEfEON IS TRUE TO THE BEST OF HIS KNOWLEDGE. SiGNATVAE Of APPOCAty a Use additional sheets of paper if more space Is required. EHEMPT WELL DATA SHEET - DENVER BASIN, COLORADO APPLICANT: SPEARS RECEIPT NO. 360654-8 LOCATION: NU1/4 OF SEC/4 OF SEC. 12, T.1w., R.664#. (1T85 SSL, 1400 Est) PROPOSED AOt1IFEA: SURFACE ELEVATION_ 5035 NUMBER OF ACRES IN TRACT: 5.395 IS PROPERTY WITHIN SERVICE BOl1MDARIES OF MUNICIPALITY 5.55 CONSENT MAPS? NO YES____. IF SUBDIVISION IS UNDER AURMENTATION PLAN, CASE NO- IS , Dlv. _ IF SUBDIVISION 1415 RECOMMEIWED FOR APPROVAL BY THE WATER IANAGEMENT BRANCH. DATE OF LETTER IS INFORMATION ON SUBDIVISION OR TRACT OF LAND/SPECIAL RESTRECTEONS: evaluated by JSG on NOVEMBER 19, 1993 ELEVATION DEPTH TO ANNUAL --------------- NET --------------- APPROP STATUS AQUIFER WT- TOP SAN4 SOT. TOP A -F UPPER DAWSON ---- -'-- -•-- •--- --- ---- --- LOVER DAWSON ---- ---- •--- ---- DENVER ---- ---- --- ---- UPPER ARAPAHOS ---- --- { 4664 4921 99 1W 0.999 NNT ARAMIE F41S HIL 3916 4266 152 39 1.230 NT rote- E indicates locatien is et aquifer boundary erd values may be more epprOximAte. . lndicetea the proposed aquifer - All YalUea are interpolated from the 5.5.5 date base esaecf I,d in moveft r of 1986- -ar MARTEN BROTHERS PLANNED UNIT DEVELOPMENT O 1 93 1 Fr �'d9 {7�r %'i�f.,G�G1✓ 1nq'Srfd,E rS� oA - -1YJN^� r.a�— Jh a 1, rt _tr , M I I kr c r ` �v s�d33' C1_ARA LEE 5T 1iaiyT.v y •g l �fi.z,e� rat'.r.`�---i•r1r-gI -I,� I ._�.��`ti�..,�-,�.��_ ir•�.� I ,y 4 7 S � m T-Va-.f JJI � IiI I bH17 erJ - f-- �,,,,--� ---- ,>y ---gym- �-i 'r __ ,•sir ___��_�-- _- - � I 1f1E � ` '5 1Y>Q,Q^+-• ••�- �.-.� �.:s+Y+..ri t l � � } � 1tf!/�w_S If - + ,nJd9'��1'-1✓ d•au`n�.' � wry_+.l4.,.r .j a'a.:� ,I}.. - 7 A S � I � r 1l I I + }� d 1 n I +1 s `1 _ �' \-"�..y♦ 1 Y �� +� [ ��p-j-KOne „� IrL_ '. .3_-- _I� \'. .-e7aa 4'J _' :—., �.„Na,w .-.t [_�+ . � v _ _ _ • 3' CLw Sic t8. S ₹ ✓ ^ I ], . t �YJCcc ,r2 T»✓,o��.r 4'Iclt] Cany Rasp Na I � I 11 -� aUp1iY ACftE5 SU[1]IVi514� ?- • I i Scfl1Lk - 1" 'IS' joPAVa1t -- STATE OF COLORADO OFFICE OF THE STATE ENGINEER Division of Water Resources Department or Natural Resources 1313 Sherman 5aces, Room 81 t5enver, Colorado 80203 Phone 13411 666-3591 FAX (303)866-3589 TO: Carolyn Spears FROM. John S. Gabert RECEIPTS NO-. 360854A&B DATE: October 22. 1993 Roy Ra er Goxert+a Ken Sitaacr tNe ,,ine 61i[1* Hal D_ Simpson State Espro , Your applications for permits to construct wells are being returned for the reason(s) listed below. The amendments andfor additional information or documentation requested is required before we can proceed with the evaluation of your applications. All amendments made to the applications must be typed or printed in BLACK INK. Please initial and date all amendments made then return the applications and all attachments to this office. If you have any questions, feel free to contact this office - Under Item 2 of the permit application forms please state whether the township is "north" or "south." Under item 3 on the applications you have stated that there will be 'lawn and garden" watering, but put "zero" next to the number of acres to be irrigated- Please state the number of square feet of lawn and garden you intend on watering under Item 3 of the permit application forms. Please furnish the distances from section lines under Item 6 of each of the permit application forms. Finally, please submit a copy of the county -approved plat map of the Martin Bros. (P.U.D. Amended) Subdivision so that your proposed well locations can be verified. STATE OF COLORADO OFFICE OF THE STATE ENGINEER Division of Water Resources Department of Natural Resources 1113 Sherman Street, Roam 818 Denver, Colorado 80203 Phone[303186&-35H1 FAX 1303) 866-3589 TO: Carolyn Spears RECEIPT NO.: 360854-B RECEIVED N1793 Ray Renner Gove oor SMtE EMGfIVM Ken Salazar Executive Director Ha) 0 Simpson State Engineer FROM: John S. Gabert DATE: November 8, 1993 Your application for a permit to construct a well is being returned for the reasons) listed below. The amendments and/or additional information or documentation requested is required before we can proceed with the evaluation ofyouyr application. All amendments made to the application must be typed or printed in BLACK INK. Please inrtial 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. The distances from section lines that we received from you place your proposed well location North of your lot. A distance to the center of your lot would be 1785 feet from the South section line. Please amend Item 6 to reflect a location within your lot boundaries. Scanning Cover Sheet for Septic Permits Permit # SP -0500277 Permit Type: Health I Residential I Repair Situs Street Address 4366 ELIZABETH ST Situs City, State, Zip SeclTown,'Range: 12-01 N -66W Application Status: Finaled Application Date: 07(28/2005 Parcel # (12digits) 147112403016-R0225494 Owner Full Name: PLUMB DONALD D JR Owner Address,, 4366 ELIZABETH ST BRiGHTON,CO 80603 Owner Phone #: 303.857.9620 Contact Name: PLUMB DONALD D JR Contact Address; 4366 ELIZABETH ST BRIGHTON,CO,80603 Contact Phone# 303.857.9620 Information above has been Verified in Accela by employee noted below X *_-_ M2 01, 2008 y Processed by Date Report ID: EHS00024v003 Print Date Time 5!112008 9:35:25AM Page 1 of 1 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, CO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 Finaled Permit #: SP -0500277 Sec/Twn/Rng: 1201 66 Owner: PLUMB DONALD D JR Applicant: PLUMB DONALD D JR Permit Type. RREP C=Commercial, R=Residential+NEW, REPair, vauLT Parcel #: 1471-12-4-03-016 Location: 4366 ELIZABETH ST BRIGHTON Legal Description: MB -16 L16 MARTIN BRO S PUD - A Status: ISSUED Applied: 07/2812005 Issued: 0712912005 Finaled: MENDED PLAT Installer: S U U U Description: HOUSE Commercial: N Residential: Y Acres: 5.5 # of Persons: 2 Basement Plumbing: Y # of Bedrooms: 3 Bathrooms - Full: 2 314: 0 112: I Water Public: N Water Source: Water Private. Y Cistern: N Well: Y Well Permit #: Percolation Rate: 21.8 Limiting Zone: 8 ft 0 in Description: % Ground Slope: 0 Dir: Soil Suitable: (Y/N) Y Engineer Design Required: (YIN) N In 100 Year Flood Plain: (Y/N) N Minimum Installation Septic Tank; 1000 gallons or Actual Installation Septic Tank: 1 (YF)O gallons Design Type: e A Absorption Trench: 651 square feet Absorption Bed: 879 square feet Absorption Trench: square feet Absorption Bed: !� square feet Chamber Model NOTICE Chambers * 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 an compliance with applicable state, county and local regulations adopted persuant to Article 10, Title 25. CRS as amended, except for the purpose of establishing final approval of installed system for issuance of a local occupancy permit persuant to CRS 1973 25-10-111 (2). This oerntlt Is tn transferable and nn refundable, The Weld County Department of Public Health and Environment reserves the right to impose additional tetras and conditions required to meet our regulations an a continuing basis. Final permit approval was contingent upon the final inspection of the completed system by the Weld CountyDcpaJenl of Public Health and Environment. r/- x `O7 Enviotunen 1 Health Specialist Date Farm: S_FINAI, FOR' OFFICE USE ONLY 1805 APPLICATION FLOW SHEET Owner..P1lIm VYt Jr Permit#. 05O l Location 3 z (p Descrtptran_ ; HF1 Date By Comments Parc2 Number Received Information Foam Compteie Aushoriratlon Form Received Map Drawing Recarved Flood Plain? YeJJNQ Site lnapet ion Date Engineer Design? Yes/No Date Engineer Design care — Customer NotFfied? Yes/No Date Staff Approval Sent Dale Staff Approval Recd Pr c Data Enlerad'n Compute Date of BOH Approval Eng Approval Letter Sent (Letter, Permit. BOH Review) �. Date of Fn& lnspecCGn Eng Final tnepedion Leer Recd varsancaa Nseded7 Yes1No Sens Sta+_f�Am ppal yVertance 1 f l k♦ y Vadanca Staff Awwal Vananca BQH App ul Variance BQhi Approval Sent {Variance, BOH Rev9ewl AdCiti nai Canmler>ts MAENV1R0Pit.Cc3fTAL HEALTH SER' E515EPt1CF OWS1-_ T WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, COLORADO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 Permit f#: SP -0500277 Sec/Twn/Rng: 12 01 66 PERMIT Owner: PLUMB DONALD [)JR Applied: 07/28/2005 Applicant: PLUMB DONALD D JR Expires: 07/2812006 Permit Type: R.REP C=Commercial, R=Residential + NEW, REPair, VauLT Parcel #: 1471-12-4-03-016 Location: 4366 ELIZABETH ST BRIGHTON Legal Desc: MB -16 L16 MARTIN BRO S PUD - AMENDED PLAT Description: HOUSE Commercial. N 9 of Persons: 2 # of Bedrooms: 3 Water Public: N Water Private: Y Basement Plumbing: Bathrooms - Full: 2 Water Source: Cistern: N Well: Y Well Permit Number: Residential: Y Y 3/4: 0 112: 1 Acres: 5.5 Percolation Rate � -1 , Limiting Zone ?' ft in Description % Ground Slope ' Direction _. — Soil Suitable (YIN) Engineer Design Required (YIN) l In 100 Year Flood Plain (YIN) K From the application Information supplied and the on -site soil percolation data the following minimum Installation specifications are required: Septic Tank 1) gallons, Absorption Trench cm.5 ! sq ft or Absorption Bed $n __ sq ft Chambers! Infiltrator or Hancor Standard or Hi -Capacity, EQ36 or BioDiffuser Trench 9 I Beds? Infiltrator Quick4 Trench 3 Bed c Sr . Hancor Narrow (15 in) Envirochamber Trench 3O Bed, In addition, this permit is subject to the following additional terms and conditions; NOTICE This permit is granted temporarily to allow construction to commence. This perrn;t rraay be revoked or suspended by the Weld County L?epartnzent of Public Health and Environment 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 disposal system. This permit Is non transferable and non refundable. Before issuing final approval of this permit the Weld County Department of Public Health and Environment reserves the right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval is contingent upon the final inspection of the completed system by the Weld County Department of Public Health and Environment. This nermit e; ires one year from the appllatlumidaIa. Form: S_PERM1TR Env a c 1 Health Specialist Date WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411 W1 BSITE: WWW.CO.WELD.CO.US Permit Number: SP -0500277 07-28-2005 Amount: $400.00 Payment Method: Check Owner Name: PLUMB DONALD D JR Applicant Name: PLUMB DONALD D JR Parcel Number: 147112403016 Location: 4366 ELIZABETH ST BRIGHTON Account Code 2560-41400-4221-4203 2560-41400-4221-4203 2560-41400-4221-4203 2560-41400-4221-4203 Description: HOUSE Commercial: (YIN) N Number of Persons: 2 Number of Bedrooms: 3 Water Public: (YIN) N Water Private: (YIN) Y Description New Septic Permit Repair Septic Permit Vault Permit Variance Request Residential: (YIN) Y Acres: 5.5 Basement Plumbing. (YIN) Y Bathrooms: Full - 2 3/4: 0 112: 1 Water Supply: Cistern: (YIN) N Well: (YIN) Y APPLICATION / RECEIPT Initials: MS Receipt Number: HAP -05282 Notation: 1641 Amount $0.00 $400.00 $0.00 $0.00 Well Permit Number: TERMS AND OONDITIONS A permit fee, as set by separate ordinance of the Board of Weld County Commissioners, shall be required of applicants for new individual sewage disposal systems {(Bps), payable at time of application. Permit fees are norxefurrdable; irMt 8 lcatIons are rmatttransfera . If both a building permit and an ISDS are issued for the same property and construction is not commenced prior to the expiration date of the building permit, the [SDS permit shall expire at the same time as the building permit. if Sri ISDS permit is issued fora property that does not require a building permit, the ISDS permit shall expire one year after its issuance if construction on the septic system has not commenced. Any change in plans or specifications after the permit has been issued invalidates the permit unless approval is secured from the Health Officer or his/her designated agent_ Expired permits cart be renewed by payment of the permit fee only if A. There has been no change in the plans and specifications of the proposed system as set out in the original application or such change is reviewed and approved by a Division Representative. e The surrounding land, its use or zoning has not changed so -as -to cause the original application not to be acceptable under these regulations. NOTICE The completeness of this application is conditional upon further mandatory and additional tests and reports as may be required by the Weld County Department of Pubiic Health and Environment (WCDPHE). The issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under article 10 title 25, CRS as amended. The applicant certifies that the proposed system will not be located within 400 feet of a community sewage system. 'fire undersigned certifies that all statements made, information and reports submitted herewith arc, or will be, represented to be true and correct to the best of his/her knowledge and arc designed to be relied on by the WCDPHE far evaluation for purposes of issuing the permit applied for herein. Applicant further understands that falsification or misrepresentation may result the denial of the app ' lion or revocation of any permit granted, and in legal action of perjury is provided by law. t3 OwnerlApplicant Date Fa m RT-HAPP SEPTIC INFORMATION FORM To obtain an I.S-D.S. permit, one must file an "application for Individual Sewage 1111kDisposal System" at the Weld County Environmental Health Services office and pay the application fee. A "repair" fee shall be charged for the expansion, replacement, or repair of an existing system. The following information must be COLORADOprovided on the septic information form. PARCEL NO.: I -i'] / IfD 3) ! ( (I2 DIGIT NUMBER) CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650 PROPERTY OWNER: O G .v d� IJ Q !` y m 6 J MAILING ADDRESS: f4( L24J S I CITY I,GIG-Ifrt1AJ ST ZIP HOME PHONE: 3� £ S-7 - '(Q 16 WORK PHONE (I03 ) 7- - 1) FAX L-) APPLICANT NAME: ifrrav IA MAILING ADDRESS: G _ 4jH14 r1 CITY ST Co ZIP Co HOME PHONE: [ g3j 7 94e O WORK PHONE I I ?W! FAX L J LEGAL DESCRIPTION PT PT SEC /Z TWN F'y RG1t1f ACRES 5 SUBDIVISION _ IY 010 LOT____ BLOCK FILING DESCRIPTION OF BUILDING {Ex: HOUSE. MOBILE HOME, MODULAR, SHOP, OFFICE) d _Sf SITE ADDRESS 1 (, F Gf? 47 1/ 1 AlfG-ff 1 N DIRECTIONS TO SITE 4f dN I 2 4 CxW 37 -A 76 CC -M4 f/ NEW PERMIT REPAIR PERMIT/ VAULT PERMIT $ 400 $ 400 $ 150 IF OBTAINING A REPAIR PERMIT, PLEASE LIST PREVIOUS OWNERS OF THE PROPERTY: FLOOD PLAIN YES (NO RESIDENTIAL I NO NUMBER OF PERSONS _ NUMBER OF BEDROOMS — WATER SUPPLY: PUBLIC YES ( CENSUS TRACT COMMERICAL YES / o BASEMENT PLUMBING YES I NO BATHROOMS: FULL A 3/a Ir/lul� V2 PRIVATE /NO CISTERN YES NO WELL f NO WELL PERMIT I# PERC HOLES MARKED FOR INSPECTION BY SPECIALIST S 1 O ( \ DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 N. 17'h Avenue Greeley, CO aos31 WEBSITE: www.co.eId.us ADMINISTRATION: (970) 304-6410 W1111co FAX: (970) 304-6412 PUBLIC HEALTH EDUCATION & NURSING: (970) 304-6420 FAX: (970) 304-6416 ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415 COLORADO FAX: (970) 304-6411 AUTHORIZATION FORM RE: PERMIT APPLICATION Q I.S.D.S. EVALUATION Q SALE OF PROPERTY Q WATER SAMPLE I W , represent WA1 for the property (Agent/Applicant) (Owner) located at f o(; ,ORdTII �r �l CA _. 0kf? 3 _ LEGAL DESCRIPTION: SEC_J2 TWN I ' 10A7RNG(nG- )f i SUBDIVISION NAME; ( wl) _LOT BLK I can be contacted at the following phone #'s: Home ? -_?6_1-%_0 Work ,�O?_ ___- lf3� Fax 4 The property owner can be contacted at the following phone Il's Home ?ts 2' $≤7-_ 9 Zo Work7_-7'-/(3 73C - 1(3 r Fax ff Correspondence mailed to (only one): 0 Agent/Applicant K] Property Owner DATE -1 ' f )it) OWNER'S SIGNATURE L -I Weld County Health Department Percolation Test and Soils Data High Plains Engineering 73ty Denver Avenue • Fort Lupton CO 8O621 Phone 303-857-9280 • Fax 3Of3-857-9238 71512005 FlLN. 05-4667 Property Address 4366 ELIZABETH STREET, WELD COUNTY, CO LegalLegaTDestl�n Property Owner Info Name Street City, State, Zip Phone DON PLUMB 4368 ELIZABETH STREET BRIGHTON, CO 80603 303-857-9620 ,Sa#uration'and _Sw_ e11in Wa...router.-.., Smeared Soda Removed: YES Encountered at IGREATER THAN 8 feet Sand or Gravel Added: NO ima e o maximum seasonal water tabte if not encountered in file: Date and Time Presoak Water Added: 612012005 date me Amount of Presoa Water Added: 15 allons Is area believed to be subject to seasonal fluctuations which could result in a •seasonat water table within B' of surface? Date and Time Percolation Test Started: 813012005 date 12:00 time Slope -Determination uj Absorption Arsa Did Water Remain in Hole After the Overnight Swelling Period? 2 S to the EAST direction Hole 1 NO Hole 2 NO •Bedrock ', Hole 3 Na Encountered GREATER THAN 8 feet Hole 4 NO Hole 5 NO Estimated depth if not encountered in profile: Hole NO Percolation a Measurement Deep lln Percolation Rate (minim) Hole 1 36 27.78 Type of Bedrock: Hole 2 36 20.83 Hole 3 36 16,67 Is bedrock fractured or weathered? Hole 4 36 20.83 Hole 5 36 27.78 Is bedrock believed to be permeable rcrate<60min/iin? Hole 6 36 18,67 Ave a 21.8 Weld County Health Department 7/5/2005 • Percolation Test and Soils Data Profile Hole L 0 M. w m U- C_ .C n 4 5 SANDY SILT (SM) CeiftlffCetiorl _ ' I certify that the above Information Is correct and complete to the best of my knowledge and that all tests were performed in the accordance with the provisions of Weld County Health Department Individual sewage disposal regulations by myself or under my supervision. High Plains Engineering 735 Denver Avenue Ft. Lupton, CO 80621 303-857-9280 i - :4-:. SITE MAP 43GG ELIZADETM STREET WLLD COUNTY, CO GLAKA LEE TO WCR 37 LfGEN❑ All locations shown above are based on 5pecihc information furnished by others or estIrnates made in the field by High Plains Eri neere personnel. The IpeatICn5, • Percolation bales distances, directi7i , etc. are not the result of a property survey but are ,jpproxjmat+on5 and are noL waf,ranted to be exact. It is the owner/builder'; Percolation Profrte Mole respori t ity to define. property - bon es and ensure all onsilc improvements 5oil f'rvfile hole are located with' the platted site and out of tnappropr�atr. easement;,, Ali &stances are to be verfied prior to CXGavatLOn. -- Fe3-ce L � 50 LDO 9m dl Accuunl Numhcr R2_'21494 Weld County Treasurer Statement of Taxes Due "11'CO I .1 71 1 Leal I)evCrilu,Un ' Ilu> 2dJri;: II IN 13RClti L.1)- 1'1111)1 I) I'1 :11 43661 I V.ai31 11151 lift ]) Account: 80225494 SPAULDING DI:NNIS I)AI.I: 4366 FLIZAl3ETl I ST RRf{il-ITON. CO 80603-9584 Year I ALIILLntIIdl,LS Inlrre,l Fees T°.LlIr1er1ts }tal;lncc Tp' {.Marc _ ?1)211 S2.1R1911 5(1.[1(1 ${711[1 $(1.00 IS2.27)l.9lii 5)1.111) T"ural I a' C. h;u•ar SO 11(1 frrantI Tnlal LSur as.11(13 '1I 71121 Sil.ill) I ax Ilillcd at 2)120 Rule; tl,r fat .rea 1686 - .16tih \ullw:r1}- dill I :1m,,uni "ala�, -4Ouuii y,s2e,td C I I 1 ( 111151 Gli 3Hn)hllll F[li1v.65 SIAl 11 I F 1V1 R1 5) 10.u63 S9.0-11 SC'Iio(')I I)1`,1 k1 k IR }l,i11)114) % .I rlc I 11 V Ik-L1.({I15lk:k11{] 14 •I I R I I ,0[li11l 5_k,_'i{, YINGI.i k:1\1.Rl 5- 5427.9-12 51.1510 I{ C'1� � 1111'12n1'I ti�I I�S (INIRA] (•)IIfIIt\IS1A1111 R 21�I) 11111 5417.211 Iola] S?0'_liil? 54{4a SL 1117 15(1 I. I'1f 01 1-LI{1 0 7tl,!11111111 FIIR1 L1:!'T{1N 1 C (01151) 51122 II )(,_0111(1 51 I_F,3 ,V1LIS ii 5(1)101)11-LIlil r, ili�ll1l1[I HI(�II Pf.AlNS 7 IIflt,11t1' 4 I'SIlmpn I '.1\l\ tlillud 44511 r) r111L1111J ] 7711 VIJ ti)Iii IG't'r ALL TAX LIEN SALE AMOUNTS ARE SUBJECT TO CHANGE DUE TO ENOORSFMFNT OF CURRENT TAXES BY THE Weld County Treasurer's Office 14DO N 1711, Avenue PO Box 458 Greeley, CO 80632 Phone, 970-440.3290 Pursuant to the Weld County Subdivision Ordinance, the attached Statement of Taxes Due issued by the Weld County Treasurer are evidence that as of this date, all current and prior year taxes related to this parcel have been paid in full. Signed: Date: FORM Na. awe'" STATE OF COLORADO OFFICE OF THE STATE ENGINEER For Mom Use 0* L / 7 o�. ad 818 Caorenniel aldg.. ia13 6lremren 6L, Sew,.', Colasdo- 80Q43 43O33 i RH.RVFT 2 1997 PRIOR TO COMPI..ETING FORM, SEE I MMILIGT)ONS ON REVEJ E SIDE CHANGE IN OWNERSHIP/ADDRESS 1 LOCATION WELL PERMIT, LNESTOCK TANK OR B OSION CONTROL DAM WIT EHRECj cI5 aT,►TE @NG�MEt �i COLD. 1. NEW OWNER NAME(S) S. ... r- Malling Address . Y'?5 r7 ,4r+Il C4. St. zip _R ..A? Phone( A. ) 2. THIS CHANGE IS FOR ONE OF THE-FOLLLOWING: WELL PERMIT NUMBER J!_.5.3 ........................... UVESTOCK WATER TANK NUMBER.... _-, - -- -- - ]❑ LJ EROSION CONTROL DAM NUMBER-•-•- ......................... ....... 3. WELL LOCATION: COUNTY ................................. OWNER'S WELL DESIGNATION ...,„,_...,.,..,„...„.•,.........._ ., . .... . ..._. nd...essl.. ........ ..... .......-..,..-. .... -. ... ......_ 4 }..._,.., ......-.. 1S . ......, .....,..,................ p_p1 I f 114, SeC... '�qp...._ Twp.f. ... ..... © N, u ❑ S., Range (Q . ❑ E. w © W. ....Y P. M. � 0,0 Ft from ❑ N. ® S- Line, 1 O O FL from {1 E. ❑ w. Distances from Section Utter ... ar a Line. Sutsdivisicn _ 19+TI�I% 84 Pt& ✓ . .. Lot .1_ ...... Block . ... ....... Filing (untl)._ 4. LIVESTOCK TANK OR EROSION CONTROL DAM LOCATION: COUNTY ............ ............. _ _ - - - _ _ ___ 1/4, Sec . ............. Twp.............- ❑ N. or ❑ S., Range..............._ ❑ E. «❑ W. .. P.M. 5, The above listed owners) say(s) that he (they) own the etructitre described herein. The exlstirg record is being amended for the following reasan(s): QChange in name of owner. ❑ Change in mailing address. ❑ Correction of locWon. 8. I (we) have read the statements made herein, know the contents thereof, and state that they are true to my (our) knowlsdge. [Pursuant In Section 24-4-104 (13) (a) C.B.S.. the making of false statements herein constitutes pequry in the second degree and is punishable as a class 1 mi;emearlor.] Namef%tla (Now Owner) Phase type or print S�re(New Owne Date s Y' r S14/1fb C- )C.� FOR OFFICE USE ONLY ACCEPTED AS A CHANGE IN OWM R.SE�P AND/OR MAILING ADDRESS. z 12 AUG 1997 state ngn.urr Court Case No. Div. L Co. -- WD in MD Use INSTRUCTIONS CHANGE OWNERSHIP -ADDRESS LOCATION CORRECTION FORM J'J LY 1 q93 NO FEE IS REQUIRED The form must be typewritten or printed in BLACK INK INK Initial and date any changes you make on the form. THIS FORM MAY BE REPRODUCED BY PHOTOCOPYING OR WORD PROCESSING MEANS. INCOMPLETE FORMS WALL BE RETURNED. ATTACH ADDITIONAL SHEETS IF MORE SPACE IS NEEDED. Print the new owner's name and include the mailing address and phone number. 2. Indicate it the change in ownership/address is for a well permit, livestock water tank or erosion control dam. Be sure to include the proper permit, tank or dam number. 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 wall location must include'!~, %, Section, Township and Range. Check the appropriate boxes for North or South and East or West directions. Complete the Subdivision, Lot, Block and Filing information, if applicable. -4. Complete the location information for, the livestock water tank or erosion control dam. The actual location must include 1/4, 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 location 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 _ l 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. IN ALL OTHER CASES USE FORM GWS-42 All other types of changes concerning livestock Water Tanks and Erosion Control Dams should be submitted on the standard Permit Application form and be accompanied by a $15.00 filing be. If you have questions, contact the Denver or the Division Office where your well is located DIVISION 1 DSION 2 Box 5728 DMSION 3 .Box 269 O(V191ON4 Box 456 800 8th Ave Rm 321 219 W 5th Rm 223 422 4th Si 1540 E Niagara Greeley CO 80631 Pueblo CO 81003 Alamosa CO 81101 Montrose CO 81402 (303) 352-8712 (719) 542-3368 (719) 589-8683 (303) 249-66'22 DIVISION 5 Box 396 DIVISION 6 Box 773450 OIMSION 7 Box 1880.=: DENVER OFFICE 50633 US Hwy 6 & 24 , 625 So. Lincoln Ave 1474 Main St Am 821 Ginwd Spgs CO 81601 Stmbt Spgs CO 80477 Durango CO 81302 1313 Sherman St (303) 945-5665 (303) 879-0272 (303) 247-1845 Denver CO 80203 (303) 886-3581 PUMP INSTALLATION AND TEST REPORT office use only ,State of Colorado, Office of the State Engineer: 1.; WELL PERMIT NUMBER 199535 R CEWED GWS-32--92-06 2 . Owners Name s ) ,TERRY SANDERS ;Mailing Address_705 S GRAND V� Zip FT LUPTON CO 80227 iETca m SAS Phone (303) 857-6374 3. ;Well Location as Drilled: SW _,1/4_SE-_•_1/4, Sec._12_Twp.1 N_, Range65W GTH_. ;Distances from Sec. Lines: _1300_ft. from SOUTH_Sec. line and 1400 ft. from _EAST_Sec. line. Subdivision:__MARTIN BROS. PUP. Lot_17 Rlk_F/U ;Street Address at Well Location 4. Pump Data:Type—mmSUBMERSIBLE Installation Completed_7-•27-97 Pump Mfg GOULDS Pump Model_IOGS03 Iiesign GPM 1Q at RPM_3450 HP__3 — Volts_230_Full Load Amps_17 ;Pump Intake Depth_710 Feet, DropPipe Sz_1-1/4 Inches, Kind_PVC ;Additional Information for Pumps Greater Than 50 GPM: ,.Turbine Driven Type: Electric Engine Other ;Design Neal feet, Number of Stages , Shaft Sz inches 5. Other Equipment: AirlineInst, Yes_X_No,Orfice Dpt ft.. ,MonitorTube Inst. Yes_X_No ;Flow Meter Mfg Meter Serial No. MeterReadoutGal, ThousandGal AcreFeet, Begn.Reading B.:Test Date: Check if Test Date is submitted on Supplemental Form. Date 7-27_ 7-27_ 7-27 —7-27_ :Total Well Depth_936 Time 5:00_ J5:15_ 5:30_ _5:45, ;Static Level 300 Rate(GPM) • J17 17 _17_ _17_ Date Measured _7.27-97 Pumping Lvl 301_ _301 301_ __301_ 7.; Disinfection: TypeCLOROX Amt. Used_100 PPM._ 12 hrs_, B. Water Quality analysis available._Ves_X_NO 9,:Remarks WELL WAS TESTED BY DRILLER # 403-ON7-18-97,_ABOVE IS PUMP PERFORMANCE AS OF DATE OF INSTALLATION. 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 second degree and is punishable as a class 1 misdemeanor.] Contractor_Sky Country Pump Co.,Inc. _Phone (3.03) 697-5013_Lic.No._887 Mailing Address_PO Box 746 Morrison, Co 80465 NamelTitle Signat re ; DATE David C. Wilson - PRES. 7� ��f�� 7-31-S7 WELL CONSTRUCTION AND TEST REPORT For Ohce Use on GN1S31 + STATE OF COLORADO, OFFICE OF THE STATE ENGINEER Cry *4 f 1, WELL PERMIT NUMBER 535 _ AlL 2 2 1997 2 OWNER NAME(S) ,7p'F2f2Y SANDERS INSTRUCTIONS FOR WELL CONSTRUCTION AND TEST REPORT Rev_ Qct. 94 The report must be typed or printed in 81ACK!! . 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 nametnumber 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 origin form must be submitted to the State Engineer's Office withh 60 days after completing the well or 7 days after the permit expiration date, whichever is earlier. A Dopy of the form must be provided to the well owner. Complete the Well 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 the owner has more than one well serving this property, provide the identification (Owner's Designation) for this well. DD NOT USE THE OWNER SUPPLIED 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 it 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- t-lardness--Loose, soft, tight, hard, very hard - Color -All rrtaterials, 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. --8. -indicate-the-type-and°size-of-finer-(gravel)-pack-and-the interval -where -placed. _ _ _ — _ Indicate the type and setting depth for any packers installed. 10. The density of the grout slurry must be reported and may be indicated as pounds per gallon, gallons of water per sack, total gallons of water and number of sacks used, etc. Specify the grout placement method, i.e- tremie pipe or positive displacement. The percentage of additives mixed with the grout should be reported under remarks. 11. Record the type and the amount of 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. 11 a test was not performed explain when it will be done, tf 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 f WS•25 APPLICANT OFFICE OF THE STATE ENGINEER COLORADO ❑MSION OF WATER RESOURCES 818 Centennial eldg., 1313 Sherman St, Dorwer, Colorado 80203 (303) 866-3581 WELL PERMIT NUMBER 199535 - DIV. 1 CNTY. 62 WD 2 DES. BASIN MD LIC Loi: 17 Block: F5ng: Subdir: IAARPN BROTHERS POD APPROVED WELL LOCATION WELD COUNTY TOM & SHIRLEY WKOMO CARROLL SW 1/4 SE 114 Section 12 BOX 1202 Twp 1 N RANGE 66 W (th P.M. 8ROOMFtFLD CO 80030-1202 (303)255-977 PERMIT TO CONSTRUCT A WELL DISTANCES FROM SECTIOn LINES 1300 Ft. from South Section Line 1400 Ft. from East Section Une ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDI tiONS 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 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)(i) and policy of the State Engineer under the following conditions 4) The use of ground water from tills well is limited to ordinary household purposes inside one single family dwelling the watering of not more than four (4) large, nun -commercial domestic animals and the irrigation of not more than 15,000 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 Lararnie Fox -Hills aquifer which Corresponds to the Interval between 780 feet and 1060 feet below ground surface. Plain casing shall be installed and grouted 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 -toot, 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 entife producing interval of the approved zone or aquifer indicated above. Note; The ability of this well to withdraw its authorized amount of water from this non-renewable aquifer may be less than the ib0 years upon which the amount of water in the aquifer is allocated, due to anticipated water level declines 1! r �.9 APPROVED . '{ RAN Receipt No. 0407548 DATE ISSUED NOY�•1 5 1996 EXPIRATION DATE= NOY 1 5 1998 COLORADO DIVISION OF WATER RESOURCES RFr`Icltfl<r� DEPARTMENT OF NATURAL RESOURCES ,t1q53s 1313 SHERMAN ST., RM. 818, DENVER CO 80203 OCT 15 1996 uhone - info: 13031 866-3587 main. (303) R66-3581 RESIDENTIALfN Y I hi t ro f c al< t=n I Water Well Permit! Lion otc. Review instructions rior to ou completing may a en uee t e 0R to app or W a. .r. As form Must be completed in black m or typed 1. APPLICANT INFORMATION 6. USE OF WELL (check appropriate entry or entries) � h.rne o t>' rrdLL 1�-4l i. s�r�f� Yi%xd�u — / � box(es)) See in#tr4Ctlons to determine u'ale) for whiolt you may qualify- D A. Ordinary household use in one single-family dwelling (NO outside use) household use in I to 3 single-family dwellings: Number of dweikngs: ❑ Home garden/lawn irrigation, not to dcceed 1 acre: area irrigated sia. ft. ❑ acre Domestic animal watering -- to mmercial( ❑ C. Livestock watering waterino on farmlranchlrangelpasturel """'Inc AdOrese•.Ordinary p I. f cit 3 n ae c Cb r -0'e "` """'"b I""{�` "°' `°"`Ii.. 2. TYPE OF APPLICATION (check applicable fZ Construct new well 0 Replace existing well ❑ Change {source) aquifer ❑ Other; 0 ❑ ❑ Use existing Change Reapplicationlexpirw well 1 Increase Use pero.r) 7. WELL DATA p"m's°s "a gpm Ar' rnowrt to b. ev tl d" ' acre-feet tad daps, 0 - n fact Aq"ra. 3. REFER TO (if applicable): Wale, court case a permit x hole aotnowiedgment f 8. TYPE OF RESIDENTIAL SEWAGE SYSTEM 8ptic tank 1 absorption leach field ❑ Central system District name; ❑ Vault Location sewage to to hauled to: ❑ Other (attach copy of engineering designl Verbal f -UE- Monitoring MH- Wall name or S 4_ LOCATION OF WELL Country Ouar!ethtune 1 V W I Quarter Y. Ninoipr Merith 9. PROPOSED WELL DRILLER (o ionaii Nrne ticaw nunber tr*cnr n T Township N or S 1X 0 Range E or ❑ 10. SIGNATURE of applicantls) or authorized agent Distance of weir Iron rant;a„ fine. ft from 0 N ►05 O ft. irnm E ❑ W V, . ,a now wdi direction LOCATED The making of false statements herein constitutes perjury in the second degree, which is punishable as a dass 1 mis- demeanor pursuant to C,R.S. 24-4-104(13)la). I have read the statements herein, know the contents thereof and state that they are true to my knowledge. Wel iaeerien eW i. I! ditreamtf.om oer c / nt addree Ill apoiityhlol . Far r 0100000 weer amfr d0 01.oe cod dractlon feet foom old malt 1A °wwft*rr"'OMW. 5. TRACT ON WHICH WELL WILL BE A. You must check Cite of the talkfwityl Subdivision: Name /1t Lot no. Block no. ❑ County exemption (attach copy Name/no. ❑ Mining claim {artech copy al deed Narnetno. Other iettach kpal description to - see n FilingltJnit of county Tract survey! neRuctiorns C er i I° lJ. L approval & survey! no. this property? - see detailed inst.l - tee detailed inet_I L P{ 1e.__I h,/c/ii OPTIONAL INFORMATION USG& .n wrt I wvFl m.v o1 31-J 9 facade . �$` Q `� P or Office Use Only y : .� 3 - 4- , m-�olt7 DIV am- r'. CO �c TPW O'?54rmy (� GREG $ 10596 BY,' L OTWR RSL!R. E BA USE MD eppliceoon} B. STATE PARCEL ID# (optional!: C. I acre. in tract I D. Ar you YES the ❑ NO owner of lit no E. Will this be the only well on ES ❑ ND (if other weft are this on tract? this tract Form GWS-44 (11195) COLORADO DIVISION OF WATER RESOURCES GWS-44 FMlNST (12(95) DEPARTMENT OF NATURAL RESOURCES RESIDENTIAL APPLICATIONS - GENERAL INSTRUCTIONS There are a variety of uses for ground water in Colorado. This form (GWS-44) can be used when applying for a peirnit for a new well or replacement of an existing well for the following types of uses: ORDINARY HOUSEHOLD USE inside one single family residence (NO outside water use allowedl OTHER RESIDENTIAL USE (sometimes referred to a$ "domestic" use) which may include use in up to three single- family residences, watering of up to one acre of home gardens and lawns, and watering of domestic animals LIVESTOCK WATERING on a farm, ranch, range, or pasture It you are applying for a NEW household use only well, or for a NEW 35+ acre residential well outside the Denver Basin or Designated Basins of eastern Colorado, please use simplified forms.GWS-49 or GWS-50, DO NOT use this form for registration of an existing unpermitted well (Use Form GWS-12), monitoring/observation wells (Use Form GWS-461, gravel pit wells (Use Form GWS-27). or for other uses not listed above, including - commercial, industrial, crop irrigation, municipal, etcetera (Use GENERAL PURPOSE Form GWS-45). FEES Applications must be submitted -with the appropriate required non-refundable filing fees. The required filing fee for most well permit applications is SGO_ The filing fees for replacement or deepening well permit applications formost previously permitted residential and livestock water wells is $20. Checks should be payable to the COLORADO DIVISION OF WATER RESOURCES. Applications are evaluated in chronological order. Please allow approximately six weeks for processing. APPLICATIONS must be corpleted clearly, and leoibh, in BLACK INK or typed. ALL ITEMS in the application must be completed. Incomplete applications may be returned to the applicant for more information. Do not change or alter the application in any way_ THE LOCATION of the well in item 4 must be correctly and accurately described. The county, quarter/quarter, section, township, range, principal meridian, and distance from section lines must be provided. NOTE: Distances are not necessarily the same distances as the distances from (your) property lines. For additional assistance in describing the location of your well, review the publication entitled "How to Determine Well Locationwhich was provided with your packet, or can be reguested from any Colorado Division of Water Resource office. - A LEGAL DESCRIPTION of your lot or parcel of land is required in item 5. For tracts of less than 35 acres approval may depend upon whether the tract was created by a division of land after June 1, 1972. If your lot is less than 35 acres in size, it would be prudent to have a dee1 or legal description that shows your tract was divided from a larger tract prior to June 1, 1972. This may be accomplished by obtaining a copy of a deed for the tract issued prior to June 1, 1972. An ORIGINAL signature must be on each application. The applicant's authorized agent may sign the application, if a letter sinned by the applicant is submitted with the application authorizing them to act as agent for the purpose of obtaining a well permit. IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call the Division of Water Resources Ground Water Information Desk (303-866-3587), or the nearest Division of Water Resources Field Office located in Greeley (970-352-87121, Pueblo (719-542-3368), Alamosa 1719-589-86831, Montrose (970-249-6622), Glenwood Springs (970- 945.5665), Steamboat Springs {970-879-0272), or Durango 1970-247-18451_ DETAILED INSTRUCTIONS ARE AVAILABLE UPON REQUEST COLORADO DIVISION OF WATER RESOURCES, 1313 SHERMAN STREET, ROOM 821, DENVER, CO 80203 PHONE 363-856.3587 {Information), 303-e5B-2561 IMair,). 303-856-3447 {Wen & Water Rights Roeordsl, 303-85&358-9 lFarzl EXEMPT WELL DATA SHEET - PENYER BASIN, COLORADO APPLICANT; WKOMU RECEIPT NO. 407548 LOCATION: SW114 OF SE1/4 OF SEC. 12, T.IN., R.66W. (1300 $SL, 1400 [Si) PROPOSED AQUIFER: LARAMIE-FO) HILLS SURFACE ELEVATION: 5040 NUMBER OF ACRES IN TRACT: 5.4 IS PROPERTY WITHIN SERVICE BOUNDARIES OF MJNICIPALITY S.B.5 CONSENT MAPS? Mn_ TES_ IF SUBDIVISION IS UNDER AUGMENTATION PLAN, CASE NO- IS , DIY. IF SUBDIVISION WAS RECOMMENOfb FOR APPROVAL BY THE WATER MANAGEMENT BRANCH. DATE OF LETTER IS INFORMATION ON SUBDIVISION OR TRACT Of LAND/SPECIAL RESTRICTIONS_ evaluated by RAN on NOVEMBER 14, 1996 ELEVATION DEPTH 10 ANNUAL --------------- NET --------------- APPROP STATUS AQUIFER ROT. TOP SAND 807. TOP A -F UPPER DAWSON ---- --- LOWER DAWSON ---- ---- ---- ---- --- DENVER ... UPPER ARAPAHOE ---- ---- --- LOIER ARAPAHOE 4678 4917 100 36Z 123 0.418 RNT *LARAMIE-FON 4ILLS 3973 4260 150 1067 780 1.215 NT note: f indicates Location is at aquifer boundary and values may be more approximate. * indicates the proposed aquifer. All values are interpolated from the 5.8.5 data base assembled in November of 1986. Scanning Cover Sheet for Septic Permits Permit # SP -97001 1 Permit Type: Health 1 Residential/ New Situs Street Address 4256 ELIZABETH ST Situs City, State, Zip SeclTownlRange: Parcel# t12di .t ) Owner Full Name Owner Address: Contact Name: Contact Address: 12-01 N -66W 147112403017-R0225594 SANDERS JERRY 705 S GRAND FORT LUPTON,CO 80621 SANDERS JERRY Application Status: Finaled Application Date: 03/24/1997 Owner Phone #: (970) 857-6374 Contact Phone# Information above has been Verified in Accela by employee noted below x July 15, 2008 Proces y Date Report ID: EHS00024v003 Prinl Date Time: 711512008 9:55:00AM Page 1 of 1 r WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970)353-O635 EXT 2225 -FAX (970)356-4966 Permit # ; SP -9700111 Sec/Tam/Rng: ��ktF-O Status: Permit Type : RNEW C -commercial, R=residential . NEW, PEPair, VauLT r ']�, Applied: 03/24/1997 Parcel No: 1471 12 `1 �+ 5' Issued: 03/281997 Finaled: f .i-f IQ Q Location: G R- 9/ELIZABETH ST FT LUPTON/12-01-66 MARTIN BROS PUD 17 Legal Desc: APPLICANT SANDERS JERRY OWNER SANDERS JERRY Phone: (970) 857-6374 705 S GRAND, FT LUPTON CO 80621 SEPT-INSTL W W BACKHOE SERVICE Phone: (970) 857-2047 621 MCKINLEY AVE, FT LUPTON CO 80621 Description: HOUSE Commercial (Y/N): N Residential (Y/N)': Y Acres: 5.00 Number of Persons: 2 Basement Plumbing (Y/N): Y Number of Bedrooms: 3 Bathrooms-> Full: 2 3/4: 1/2: Water Public (Y/N): Utility Name: Water Private (YIN) : Y Cistern (Y/N) : Well (Y/N) : Y Water Permit No: Percolation Rate: 8.0 Limiting Zone: '05 ft 00 in ' Desc: Ground Slope: Dir: Soil Suitable (Y/N): Engineer Design Req'd (Y/N): N In 100 Yr Flood Plain (YIN): Minimum Installation Septic Tank: 1000 gal Absorption Trench: 495 sq. ft. Absorption Bed: 645 sq, ft. Actual Installation Septic Tank: i25o gal Absorption Trench: 3'#3.L sq. ft .3`wtiF i - -a+L Absorption Bed: sq. ft. NOTICE The isivance 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 persuane to .Miele lQ, Tit1e 2s, CPS d9 amended, except Eor the purpeae of establishing tonal approval of inatalLed system for ighuance of a local occupancy permit perauant it CRS 1973 25-10-111 p21 This permit is not trdr,9fCtaple. The Weld County Health Department IeeerVe9 the right Lu impose additional terms and conditions required to meet our regulations on a continuing haais- Final permit approval was contingent upon the Erna: inepeetion of the completed system by the Weld County Health Department Envir rim ntal Specialist Date WELD COUNTY HEALTH DEPARTMENT {970) 353-0635 RECEIPT Receipt Number: Amount: 265.00 03/24/1997 14:23 03/24/97 14:26 Payment Method: CHECK Notation: 7244 Ifnit: CSALAZA.R --Owner Name: SANDERS JERRY Applicant Name: SANDERS JERRY Permit No: SP -9700111 Parcel No: 1471 12 Site Address: Location: CLAIR LEE/ELIZABETH ST FT LUPTON/12-01-66 MARTIN EROS PUD 17 Total Fees: 265-00 This Payment 265.00 Total ALL Pmts: 265.00 Balance: .00 Account Code Description Amount 256041400-4221-400 New Septic Permit 150.00 256041400-4221-400 Repair Septic Permit -00 256041400-4221-400 Vault Permit .00 256041400-4221-400 Site Evaluation 115.00 256041400-4730-400 Potable Water Sample .00 Description: HOUSE Commercial (Y/N): N Residential (Y/N): Y Acres: 5-00 Number of Persons: 2 Basement Plumbing (Y/N): Y Number of Bedrooms: 3 Bathrooms-> Full: 2 3/4: 1/2: Water Public (Y/N) : Utility Name: Water Private (Y/N). Y Cistern (Y/N): Well (Y/N): Y Water Permit No: NOTICE Applicant acknowledges receipc of the individual sewage dlepoawt system guide and that the completeness of this application is epnditlonaL upon further mandatary alad add#tional testa and reports as may be required by the weld County Health Department to be made and fornizhed by the applicant of by the weld County 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 necenaary to insure compliance with ruler and regulations adopted undez article 10. title 25, CRS as amended, The sppiLcant certifies that the proposed system will not be 1pCatCd within 400 feet of a ccPtrhtnity sewage 9ystnm. The undersigned hereby certifies [hat all statements made, information and reports submitted herewith and required to be aubmttted by the applicant are, or will be, represented to be true and Correct to the best of my knowledge and belief, and are designed to be relied on by the Weld County Health Department in evaluating the carne for purposes of issuing the permit applied for herein. I further understand that any falsification or misrepresentation may ee$ulr_ in the denial of the application or revocation of any permit granted based upon said application and in legal action for perjury as provided by law_ x f O APP CANT Date Ccr� 7 ACS r� _ y WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970)353-0635 EXT 2225 FAX (970)356-4966 Permit # : SP -9700111 Sec/Twrl/Rng: Permit Type: RNEW c=commercial. R=residential . NSW, REPair, VaoLT PERMIT Applied: 03/24/1997 Parcel No: 1471 12 Expires: O3/19/199e Location: CLAIR LEE/ELIZABETH ST FT LUPTON/12-01-66 MARTIN BROS PUD 17 Legal Dec: APPLICANT SANDERS JERRY OWNER SANDERS JERRY Phone: (970) 857-6374 705 S GRAND, FT LTJPT0N CO 80621 SEPT-INSTL W W BACKHOE SERVICE Phone: (970) 857-2047 621 MCKINLEY AVE, FT LUPTON CO 80621 Description: HOUSE Commercial (Y/N): N Residential (Y/N): Y Acres: 5.00 Number of Persons: 2 Number of Bedrooms: 3 Water Public (YIN) Water Private (YIN): Y Water Permit r n Basement Plumbing (Y/N) Bathrooms-> Full Utility Name: Cistern (Y/N): Y 2 3/4: 1/2: Well(Y/N); Y Percolation Rate: Limiting Zone: "'E ft O in Desc : % Ground Slope: Dir: r- Soil Suitable (Y/N) Engineer Design Req'd (Y/N): In 100 Yr Flood Plain (Y/N) 1r® the application ia£ormation supplied and the on -site soil percolation data the following m3Aiantfa installation ppecificatione are required: _ Septic Tank: /M70 gallons, Absorption Trench sq. ft. Absorption Bed (�7 sq. ft. In addition, this permit is subject to the following additio al terms and canditions:'k}- _ Vn _.1 "? 1' NOTICE This permit is granted temporarily to aLlaw construction to com.-nence- This permit may be revoked or suspended by the Weld County Health Department for reasons net forth in :he weld County individual sewage dtepoaal system regulations including failure to meet any term or condition imposed thereon during temporary or final approval, The issuance of this pe tmit does not conetitutr assumption by the department or its eer loyeee of liability for the failure or inadequacy of the sewage disposai system. This pewit is not ttansfezable Bef are issuing final approval of this permit the Weld County Health Department reserves the right to impose additional LcrmA and ronditienS required to ecet Our regu LaLions an a continuing basis, Final permit approval la contingent upon the final. inspection of the coap]ered system by the Weld Ceunry Health tepartment. x Enviro ental Specialist Date WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL PROTECTION SERVICES SITS EVALUATION OWNER:_________________________________ J f APPLICATION NO. !� O� l i SITE: cL/P7 ,4 / L. 2 Q 1� PT S . 2-Tl f R DATE - f ?4ja -7 5UBC IV I S ION : 5 "n' 6 LT BLK FLG PERCOLATION TEST DATA: TRStart Time: Hole No. Hole De th H2O Remain min. Io min. I C3 min. min. min. min. tnin. min. min. min. T iii 1 G35 it % '] I b7 4+70 d< imo - S�' 2 �j D (br _ry k '" 5as 3 tic s D 20 3D 4 0 7 ., ASS X17. Z� z 6 - 7o10 _______ ___ ___ F I _ ___ u So So All measurements in .nm unless otherwise indicated. * - Add H2O Total ` Environmental Specialist Average Rate Health L}ep�r�e 4 PROPERTY OWN f f MAILING ADDRESS S rf1w CITY 7" Lup' ST6 ZIP f WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT GREELEY, COLORADO 970-353-0635 970-356-4966 (FAX) SEPTIC APPLICATION INFORMATION HOME PHONE CO -8 `f .3 74- WORK PHONE3P.3 tS'c7b3 7#AX SITE ADDRESS X i s F 4. _ DIRECTIONS TO SITE LEGAL DESCRIPTION PT PT SEC TWN 0r RNG__ ACRES SUBDIVISION } LOT BLOCK FILING PARCEL NO fl P UMDER FS Dr .N1 FROM LEGAL DESCRIPTION 10O YEAR FLOOD PLAN? I" a CENSUS TRACT. CALL ASSESSOR AT 353-3845 EXT 3650 RESIDENTIAL? e --S COMMERCIAL?_ - DESCRIPTION ES: HOOSE S UE LE P.WODOLAI. SHOP. eU5 NSsS NUMBER OF PERSONS 2 BASEMENT PLUMBING NO OF BEDROOMS -3 BATHROOMS: FULL 3J4_ _ 1/2 PUBLIC WATER Y/ tS WATER SUPPLI WATER PRIVATE Y /N _ CISTERN YIN WELL Y/N WELL PERMIT t#_ NEWPERMITV REPAIR PERMIT PERC TEST ✓ I�AX— 5156 SILS sIIs S2 IF THIS fS A REPAIR PERMIT, PLEASE LIST PREVIOUS OWNERS OE THIS PROPERTY APPLICANT NMs1 ers MAILINC ADDRESS70 S ANA CITY ryoM1E PHONE- 3P3— 19rd.l ?) ' WORK PliON GT C A Hello