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Home My WebLink About20220033.tiffF64 No. • ✓ PUMP INSTALLA77ON AND TEST REPORT For o1Aaa u•. ony tt5 72„ r t1/9J STATE OF COLORADO, OFFICE OF THE STATE ENGfI+1EER EQ1 1. WELL PERMIT NUMBER J 7 1 d 2- OWNER NAME{S) Mailing Address 2g L City, Si. Zip o -Phone( ) 3. WELL LOCAT1ON AS OAILLED: hi t.i 1/4 114, SeC. Twp._ / A/ Range Z — fc� 0[STANCES FROM SEC. UNES: 1__D ft. from Sec, line. and 9D ft. from Sec. fine. nxv. or as A SUBDIVISION; }N� a R7 r r t E e LOT _ BLOCI{ FIL!NG(UNIT) STREET ADDRESS AT WELL LOCATION: 7 4 - 4. PUMPDATA: Type rn c. Inctaliation Completed �z �? 1' Pump Manufacturer `~ a Pump Model No. .3o2.3 frill 3 f -.5 Design GPM I b at RPM . 45O HP Vohs 23 0 - -, Full Load Amps =,s Pump fntake Depth " 1SL -_ Feel, Crop/Column Pipe Size_J' '' Inches, Knd (, ADDITIONAL INFORMATION FOR PUMPS GPEATER THAT 50 GPM: TURDINE DRIVER TYPE: 0 Electric Q Engine El Other Design Head feet, Number of Stages Shaft size inches. S. OTHER EQUIPMENT: �--t Airline installed El No, Orifice Depth it. Monitor Tube Installed El Yes No, Depth h.T_ Flow Meter Mfg. Ati Meter Serial No. Meter Readout ❑ Gallons, O Thousand Gallons, ❑ Acre feet, ❑ Beginning Reading 6. TEST DATA, L._.I Check box if Test data Is subrn tt d on Supplemental Form. Date L _______ Total Well Depth 11]Or� Time }— i- _______—` Siatic Level ti1,SIp ` Rate (GPM) t Date Measured I n - .0 i - mping Lvi. 1 °° 7. DISINFEC1ION. Typo k -1`T t- w k -.o R i4 Amt. Used 3 r r v a yf - e't,� E B.I Water Quality analysis available. ❑ Yes 9.1 Remarks 0. I have read the statements made herein and know the contents thereof, and that they are true to my knawledg (Pursuant to Section 24-4-10}4 (13)(a) C.R.S., the making of false statements herein constitutes perjury In the secor degrea and Is punishable as a class 1 misdemeanor.] CONTRACTOR Mailing Address 2( envt.c?- Inc. Phone ( J 6 -1 84 tic. No.?/5__ 27 ft. upt.crt, v. 0621 Name/tie (Please type ar print) Tom Ul. ,Spain P—Edent Signature �Q ��,r Date rr. 3 l yY is 143° am Ile f WELL CONS T RUUCT ION AND TEST REOR 1 Fo Qmo. Use only eat' STATE OF COLORADO, CFF10E OF THE STATE ENGINEER RECEIVED 1. WELL PERMIT NUMBER NOV 1 4.94 2. WNER NAME(S) Tight Stoppel _ 1141 Mailing Address 12594 Clara_T Street City, St Zip Bri�hton. Co. 80601 COLD. Phone( ) 3 WELL LOCATION AS DRILLED: NW 1/4 SE 1/4, Sec. 12 Twp. 1 N . Range 66 w DISTANCES FROM SEC. LINES: 1800 tL from 5 Sec. line. and 2290 ft. from E Sec. line. OR SUBDMSION: Niart1t r.Bstates LOT 7 BLOCK FIUNG(liNll) STREET ADDRESS AT WELL LOCATION: 17594 C Tara Lee 4. GROUND SURFACE ELEVATION ft DFtIWNG METHO€} mat r DATE COMPLETED 10--17-94 . TOTAL DEPTH 1000 ft. DEPTH COMPLETED 1000 S GEOLOGIC LOG: 6. HOLE DIAM, (In.) From (ft) To (it)-- — Depth Oa.erlptan of Material (Type. stre. Color. W.14r Locaton)'- ^8 316 _ a 3 6 1/4 _3 rnaa. 7. PLAIN CASING OD (In) itlnd Wag Size From(ft) To(fl) - 6 5 _IS teP?1SE ... 4,? .30 4 1/2 Steel _ _ 3(� ____nr PERF. CASING: Screen Slot Size: 3/16" torch cuts 4 1/2 •Steel .18.8 790 100SL Ill DISINFECTION: EL FILTER PACK: Material N/A Si Interval 9. PACKER PLACEMENT: Type Haliburtan bas] )laced at Depth 790' 1&. GROUTING RECORD: Material Amount Density Interval Placement cement 500ga1 7gal/bag 0-790 Pump thr� �� Am . Used 4 cups dissolved i,n, 5_aa ] l n, t WELL PEST DATA: ❑ G� Test I]ata 1"stpmon nt 4�u h e Wrest TESTING METHOD Air Static Level 450 fl bate/Tlme measured 10-17-94 _. 4: oopm , Production Rate 17 gpm. Pumping level .. Jetting ft DatefTime measured , Test length (hrs.) 3: Ohre Remarks at 1000' 13, t have reed the atetemerrts made hamin and know the comerthereat, and that they are eue to my knowledge. IPu warn to Sectlan 244-104 (1 C.RS., the maldng al tale. ataemeft herein oonadhAes perjury in the second degree and In punishable as a claaa t mledemaarwt.] CONTRACTOR John's Drilkin Inc. Phone 3( Q3 ) 423-5246 Uc. No. 827 Nametfltle (Please type or print) Signature { 3 John Owner/President Date ti INSTRUCTIONS FOR WELL CONSTRUCT1ON AND TEST REPORT The report must be typed or printed In j3LK 1NIC All changes an the loan must be Initiated and dated Attach additional sheets if more space Is required. Each additional sheet must be identified at the top by the well owners name, the permit number, form name/number and a sequential page number. Report depths In feet below ground surface, This form may be reproduced by photocopy methods, or by computer generation with prior approval by the State Engineer. The original and one copy of this form must be submdted to the State Engineer's Otlice within 60 days after cornplating the well or 7 days after the permit expiration dale, whichever is earlier. Another copy 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-biocksfar-ttte-actual location of the more than one Well - serving this property, provide the identi[iratlon (Owners Designation) for this well. NOT USE1HE..O.1NER SUPPLIED LOCATION unless a survey has been provided. For wells located in sulXlivislons the lotblock 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 at the well, 5. Fully describe the materials encountered In drilling. Do not use formation names unless they are in conjunction with a description of materials. Examples of descriptive terms Include: Grain size --Boulders, gravel, sand, sift, clay. Hardness -Loose, soft, tight, hard, very hard. Cdor--Ail materials. Most critical in sedimentary rock. Depth when water is encountered (if it can be determined). 6. Provide the diameters of the drilled bore We. 7. The outside diameter, kind, wall thickness and interval of casing lengths must be indicated. B. Indicate the type and size of filter (gravel) pack and the interval where placed. -� _.$ Indicate theyand. tting;depth-loc-. any packers 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 minced 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. It a test was not performed explain when it will be done. It 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. GWS-25 APPLICANT OFFICE OF THE STATE ENGINEER COLORADO DMSION OF WATER RESOURCES a1a Cenl"nlal Bldg., 1313 Sherman St, Denver, Colorado 80203 {3031 946-3581 WELL PERMIT NUMBER 17!265 - -_ DIV. 1 CNTV. 62 WD 2 DES. BASIN MD Lot: 7 Block: Filing: Stbdiv: MARTIN MATES APPROVED WELL LOCATION WELD COUNTY DWIGHT STOPPEL NW 1/4 SE 1/4 Section 12 2800 W 116TH PL APT 105 Twp 1 N RANGE 66W 6th P.M. WESTMINSTER CO 80234 DISTANCES FROM SECTION LINES ( 303)438-8382 1800 R. from South Section Line 2290 Ft. from East Section Line PERMIT TO CONSTRUCT A WELL ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS 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 Wall Construction and Pump Installation Rules 2 CCR 402-2. unless approval of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in accordance with Rule 17. 3) Approved pursuant to CIS 37-92-602(3)(b)(I) and policy of the State Engineer under the following conditions. 4) The use of ground water from this well is limited to ordinary household purposes inside one single family dwelling, watering of 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 me Laramie -Fox Hills aquifer which corresponds to the interval between 790 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-feet. 8) This well shall be constructed not more than 200 feet from the location specified an 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. A C J c APPROVED DWR I 4 J I.cre sae. €giro.. Receipt No. 0365779 DATE ISSUED JUN 2 3 1994 EXPIRATION DATE JUN 2 3 1996 1 WRJS Rev. 76 COLORADO DIVISION OF WATER RESOURCES RECEIVED 818 Centennial Bldg., 1313 Sherman St., Denver. Colorado 80203 Apt 26'94 PERMIT APPLICATION FORM_ Application must V a be complete where I I A PERMIT TO USE GROUND WATER applicable. Type ur 4APERMIT PERMIT TO CONSTRUCT A WELL print in BLACK FOR: I r() A PERMIT TO INSTALL A PUMP CE Ffl -cINK. No overstrikes ff u or erasures unless { } REPLACEMENT FOR NO. initialed. I I OTHER JUN2 0'44 WATER COURT CASE NO. • (1) APPLICANT- mailing address NAME * T e STREET • 1Ut L. 105 CITY 1�^N4��Mi5fQ1 Co- IStatet (Z+PI TELEPHONE NO. (2) LOCATION OF PROPOSED WELL County 1 - V JA) 'L of the ! st., Section 1_2_ Twp, I Rng. lb W. _ P.M. IN.SI IE.WI (3) WATER USE AND WELL DATA Proposed maximum pumping rate (gpml { Average annual amount of ground water to be appropriated {acre-feetl: x�1ticro 7�'°1 Number of acres to be irrigated: (P Proposed total depth (feet): j Aquifer ground water is to be obtained from: _fl owner's welt designation GROUND WATER TO BE USED FOR: I HOUSEHOLD USE ONLY - no irrigation (0) I i DOMESTIC I1) ( ) INDUSTRIAL (5) I LIVESTOCK 121 ( ) IRRIGATION (61 I I COMMERCIAL 141 I ) MUNICIPAL (8) I 1 OTHER i9) DETAIL THE USE ON BACK IN (11) (4) DRILLER Name Street City f+ �(Stet IZIDJ 'p 3 J Telephone No. ��'VLiC7_ No. FOR OFFICE USE ON 4 T WRITE IN THIS COLUMN Receipt Nod 7 f f J Basin Dist, - --- CONDITIONS OF APPROVAL {° This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of the permit does not assure the applicant that no injury will occur to another vested water fight or preclude another owner of a vested water right from seeking relief in a civil court action. �a�D 12 ILIf $Zr l q, no 9L. 2?,rru F — 14 U. S sotp 4 = Best Copy Available APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION DATE (STATE ENGINEER} BY I.O. ( GOUNTY' 4 Th5) THE LOCATION OF THE PROPOSED WELL and thearea on which the water will be used must be indicated on the diagram below. Use the CENTER,SECTION If section, 640 acres) for the well location, I4 1 MILE, 5280 FEET ----1 + + + -- + - +" I I I I — I Npp1'H SECTION LINE --I I I j t+ m 0 z I— n SOUTH SECTION LINE I The scale of the diagram is 2 inches - 1 mile Each small square represents 40 acres. WATER EOUiVALENTS TABLE (Rounded Figured An acre -tool cowers 1 acre of lend 1 foot deep 1 cubic cool per second Icfs) . , . 449 gallons per m1nute Igpml A family Of 5 will require appro ximiltely 1 acre -toot of water per year 1 acre-foot .. 43,560 cubic,, feet - . 325,90p gallons 1,000 gpm pumped tgntknuousry for one day produces 4 42 acre-feet (6) THE WELL MUST BE LUGAT EU'BELVY" by distances from section lines. F30L7 ft. from Sec- line (north or saute LZ ft. from ,rte s sec. line I cuter wait) LOT _BLOCK___FILINI SUBDIVISION �6 (7) TRACT ON WHICH WELL WILL BE LOCATED Owner' ` t1J1g� No. of acres Will this be the only well on this traC1? (8) PROPOSED CASING PROGRAM Plain Casing �� -- in from ft to ft. 141 -L • in. frorn 1C ft- tq ft. Perforated casing in. from � ft. to S__ ft. in from ft. to ft. (9) FOR REPLACEMENT WELLS give distance and direction from old well and plans for plugging -if (10) LAND ON WHICH GR UND WATER WILL BE_USED: W i W'F S Ownerfsl� Pik Iva. of acres:. Legal description w 1 i- _S!ri 4 C{ 1t5Yt1 12 -r- (P A 0111) DETAILED DESCRIPTION of the use o€ ground water: Household use and domestic wells must indicate type of disposal system to be used. 4 Cdr (12) OTHER_WATER_RRHIS used on this Land, including wells, Give Registration and Water Court Case Numbers, Type ��or jj right Used for (purpose) Description of land or which used (13) THE APPLICANT(S) STATE(S THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS1cNOWLEDGE. OF APPL IgANTIsI Use -additional sheets of paper if more space is required. IIRKPT RILL DATA SHOOT - DENTIN BASIN, COLOBIDD APPLICb1T' DW1GIT STOPM RIC11PT 10. 161T19 LOCATION: 111/4 Of 511/4 OP SOC. 12, T-11., How. (1100 SSL, 2290 ROL) PIOPOSID 111R1: Ld1AD11-101 KILLS S0914CI ILIY4TI01: 5045 10NE91 or MIS 19 TRACT: 5 --------------------------------------------------------------------------------------- ---------------------- Is PI;OP19T1 1ITIl1 SOIYIC1 1009041115 00 1011CIPALITT S.1.b CONSENT RAM 1O— YES_ IF SODDIP1SI09 IS 09011 40GIIITATIOI PLAT, CASE 10. 13 , OIY. If S9BDIFMS101 NIS IICOKMIBD1D POI APPIo41L BT TAI 1ATi9 ELILG1It1T B11ICI, DATE OF LITTER IS INJOIHATIOK 01 S0SD1TISI01 09 TRACT OF LAID/SPECIAL 1RSTEICTEOES: eia1mated by b1 on I1BY Z3, 1194 ILIVAT101 DIPT1 TO 1N194b --------------- III --------------- APP80P STATDS AQOITII 10T. TOP 5411 10t, TOP A-9 PPYMB 040000 ---- ---- ---- ---- --- L01111 DA1f50A ---- ---- ---- ---- --- 0I1P1>d ---- ---- ---- ---- — ---- --- OPPIR &RAPMI01 ---- - ---- ---I --- L6111 A91PAS01 4894 4934 141 351 109 0.859 1lt SLI161lO-TOR GILLS 3941 4886 151 1074 TT9 1.155 It note: II indicates location is at aquifer boundary aed slues gar be more appro:Late. r Lndicatea the proposed aquifer. All ,ales are Interpolated from tie S.D,5 data base aaetmbled is lovember of 1986. Scanning Cover Sheet for Septic Permits Permit # G19940382 Permit Type: Health I EHS History I EHS Conversion History Situs Street Address 17594 CLARA LEE ST Situs City, State, Zip SeclTown&Range: 12-01 N -66W Application Status: Finaled Application Date: 0311111996 Parcel # t12 digits) 147112403007-R0224594 Owner Full Name: STOPPEL DWIGHT Owner Address: 2800 W 116TH PL #105 DENVER,CO 80234 Owner Phone #: 303 4388382 Contact Name: Contact Address: Contact Phone# Information above has been Verified in Accela by employee noted below x a4AfAugust 13, 2008 Processed by: Date Report ID: EHS00024v003 Print Date -Time: 8/1312008 3:54:58PM Page 1 of 1 /I t if:aF`a.I)f�l:' IND]:V:I:DLIAL SEWAGE DISPOSAL SYSTEM PEI I'I1-1 NO. WELD [:ntM Y EIf: r,l.'1I I C)E"F'FtF4'T'I•fE.hlT NE'J F'EI;l1T'T I;::NViF+UNr1EhiTAL I-IEFIL.TH `.SE:RVICi 3 1'51'2 J.6—ri-i AVENUE COURT ,. orr'UEuE:Y _ CO S0)b_T1 363 Lxi OWNER STOPPEI_ I)WISHT ADDRESS 28OO W 1.16 Ti -1 FL #11.O a PH (3O3) '4 3-- T3:.iF:3 ! ,7f9C/p,pCo E302,:z-4 MDDFSS O F'f�IJf'[:lF, ED SYSTEM .. rmpf LEGAL DESCRIPTION OF si'rr S:3EL :1.2 -TWF' i RNO 6 SUBDIVISION: MARTIN I.SROTHE:E,3 LOT '{LOCK O F''xL:l:NIr 0 USE TYPE. RLSIw:I*11]:AI... r1L:)DLJL(F� T"F:R YCE:S:, PERSONS 3 B ATEIRC)OMS 2.OO 1O1 SIZE i..OO ACRES SELDROCTIIS 3 E sEi1LNT PLUMBING NO WATER SUPPLY APPLICATION FEE: -iO. "O.OO REC'0 T( CHAD YOUNG: 1)A T -E O3/O1. /94 :I6NED BY !._ANA F.srLiPF'I=i_ D)ATIE: OO/O1.194 PERCOLATION RATE `3.O !`LFl PER :I:isrl H LIMITING :ZONE 8 SOIL. TYPE SUITABLE PERCENT C;Iti[:J[.JI'IT) Sal._[3F'L 1% 01RECT]:ON NI:: F:G::f:IL.JIF;L I:.''Nt:•):1'NI:::E:Fti I?1:$:i'f3h! I[O IN 1.OO YEAR FLOOD i-i. :[h1 ZONE:: ND FROM THE APPLICATION :i: NFORIIA1 oi AND T4.1I_ ON-S:LTE SOit. IRt:)L.A'T EDW DATA THE FC)L„I,,,OWING MINIMUM INSTALLATION SPECIFICATIONS ARE rE::GTU:I:REI)% SEPTIC TANK #.OOO OAL.L.ONS,. ASSORF'1I:IAN TRE1'l[::H 1.O'26 SO. FT_ OI: ADSOI F'TION BE: 1) 1 :I so. IN ADDITION„ 'rHls F'i_:Rlrl:FT i SUlU�rF::C;T TI] THE FOLLOWING ADDITIONAL TI:I r'1S AND COND I11. ONO THIS 1!'W'F.M1:i it GRANTED TEMPORARILY T-[] AI...L.OW CONSTRUCTION TO COMMENCE _ THIS PERMIT MA BE: REVOKEI) [JR SUSPENDED LA' THE WELD COUNTY HEAl TH DEPARTMENT L::or REASONS SET FORTH :I:I-I T -1 -IL WEI...1) CCJL.INTY INDIVIDUAL SEWAGE D:I:SPOSAL, SYSTEM I<EOUL A'T IUNS TNCL.UDTI10 1= AXI..LJRE TO MEET ANY TERM OR C:IJNDT T ION _LMPOSI :D i HEI";E:ON DURING TEMPORARY OR FINAL AF'F'ROVAI._,, THE ISSLJANCE OF rH:I:::; F'F:F�I"lIT DOES NVV ECINSr:ITLJrI:: ASSUMPTION BY T1 -IF DEPARTMENT OR :LTS EMPLOYEES OF LIABILITY FOR THE FAILURE: OR _INADE:EJUAC::Y OF THE SE WACaI.- 815 C.)SAL SY L 3I Eli. . PAM SMITH O8/:1.1/914 ENVIRONMENTAL SPECIALIST DA1 [•.:: nI EI:s FERMI[ [ ,I:;,'r NOT i RANSI-r:RADLE ANI)SMALL BECOME VI) i:1) :EF SYSTEM CONSTFtUC;T iu1 F'IA s NOT CL?I•u-iENCE.Dy W'I1'F•1:[N ONE YEAR O1 :I.T 3 I .+SUANCE R BLIN E:FORE : 6 F NAl... (:_AL F' _ O III L- PERMIT iHI =: WEI._F> COUNTY Iii :::AL..Iii DE GAR'T'1•II NT ' RE.SERVET. TI IL RIGHT TO :I:MPOt:ii ADDI T ZONAL TERMS AND COI-IDI.T]:ONS REOLJ:J:RF:I) Ti) MCLI [JLJF{ ICI:GJ-JL_A'T'I[:N•IC ON A CONT•INUIFIG BA --- s is. F':CNAL 1P'ERII:[T APPRCJVAL_ IS [ ONT]:NOE::NT UPON THE FINAL.. INSPECTION OF T1'-IE OO11--- F L_F....ED SYSTEM BY THE WEL.I} COUNTY HEALTH DERARTMEN'T ,. S:;YSfi,T� M :I:NSTAI_.I._Ek CjI F- :l:NA.._ ]:11 J•1 ..>Y,.rrJ..M I:::NC, .[III EF::E4 .�� APPROVAL - _-....,._ TYPE': OF SYSTEM INSTALLED f]..,._ f:.hIV :I:CII IE::1+1'rr,1... ; I=i I (Al..:I:#iT THE ISSUANCE r:i, TFHI:LS r r:r IIT:T DOES NOT IMF.L_Y f OIvIi:t. I ANCE WIn'I O I-ii::i- STATE.. C[:JLIN1Y OR LOT O1 R'L::fA.JL..0ITOk'1 OR BUILDING RI [JO -I hIHE NT NOR HA[...I... :I: r ACT TO C ERTI:i Y [HAT' THE HUBJEL:T SYSTEM WIL_L.. OPERATE IM C OMPL..IANCE WI : fl -I AEFI... 1 CABLE STATE, OOU141Y AM]) LOCAL_ REGUI...AT:I.ONS ADOPTED PERSUAI-IT TO ARTI.CI...EL: :1O, TITLE 20„ CRS 1971., AS AMENDED., EXCEPT I OR TI--IIY: I'IJRF'[:]S,E:: CIF EI ABE Ii:HING FINAL.. APPROVAL O1= AN IN 3TAL..L.k=O SYI:STEM F [.)1- If:Ml; UANCI:'.: OF A LOCAEI... OCCUPANCY 1='lFtil'I:I:'T' 1=''URSI.JA1•I'r T -O Chip 1973 25--:LO-•••11:1. (2). C3F;:I:CJ:I:l4AL.. PF!=L.:I:CPI-In Lsf:JFY--JCFID WCl•II')-•E:I;I5 MAY, I=== � k I1SF.06F' :[IIDIV]IDUA!_. SEWAGE- DI:S1: OSAL... SYSTEM PERMIT NO. WELL3 COUNTY HEALTH DEL:'ARTME:NT NEW PERMIT i:::IIV.T.R€JNMEINTAL HEALTH SL::k&E LES 1.517 16T1-1 AVENUE COURT., C;F:E £':L -.k Y . CO 80'3I 3 06..1 .a E: ..2 223 OWNER a TC1F'F'1E.L. DIJ I CIH1- ADOFCE : ES 2800 (Li 116111 F'E 1.1105 PH ( 303) 4.:F13 L -1 3C#a:'. WE STt1I NT'IER CO B0231 ADDRESS IJF F'RT.JF'OSI:_D SYSTEM WEE ,37 Fr. b2 FT L..LJr'TOH CO 80621 !._I:=:(f3t... DESCRI.rT-:CON (7F i:CTll_: SEC TLC_TWE' :1 RN(3 6 SIJJL{TDTVISION :: MARTIN E{FOTHERS [.OT 7 BLOCK 0 FILL-.INC-1 O USE TYPE : RESIDENTIAL. IlODLILAR SERVICES: PERSONS .s BA 0-IkOOME 2 . 00 LOT SIZE 5.00 AEF:ES BE.DR(:)OMS 3 BASEMENT F'I..IJI1EEE:1 P i(i NO WATER SUPPLY !='Wf L.. L_ Api 'L.. I L,AT ICIN FE E. $110.00 RIO ' I) 8Y CHAD YOUNG DATE:: 08/01./94 EICINE.A) F.iy L.ANA 9111 F'EIL DATE OU/01/9'4 PERCOLATION RITE ,3 .0 49TH PER INCH LIMITING ZONE Es FEET SOIL_ TYPE SUITABLE: F'ERCEN T ORC.IUND 61..01 '1=.' :LTT I)IF.F't; T I:(:IN NF RE:OUIE:E:-S E=NrINE:E:R DE'SIG 1 1io IN J.(}0 YE:A1' FLOOD l:1,AIN ZONE NO FE0M T'HE APPLICATION T:NL ORMA'TION OIJF'PL_IED AND IRE: ITN--SITE_SOIL F'ERC:OLAT:EON DATA T I'-11::: Eli] _.I...014I:NG Il I NTMUM IHSI AI_.1.,.AT IONSPECIFICATIONS ARE RE:C7LJI RE1".D: SF.IT:E:C TANK 1000 GAI.._L_ONS, AI:{'.• ORi-'T1UN TRENCH :LOL'tfL SC] - FT.. UP AB53OF+h'T ION BED 1311 .317. FT_ 10 ADOT31'1., TI•TTf3 F'E::kill :T 1:> ;3L1C:s,rl:c: T' T(] rIII I:01 I_OW:I Iii AT)DI:"I'T€:JNAL_ TI RMS AND ITOl1DIlIE0NE : TI-II:S PERMI! IS GRANTED TEMPORARILY TO ALLOW COI'ISTF:UCTION TO LOF*IE'IEi'ICE:::,. THIS PERMIT MAY BE REVOKED OR SUSPENDED BY THE WELD C00NT-Y HEALTH DEPARTMENT FOR F,,f]:r'1f:OFFS; OE::"T FORTH IN TllE-: WELD C'OUNTIY INDIVIDUAL. SE(JIOE DISPOSAL SYSI'lilI PEY.'(:S(JI...ArIONS :I:NCI._IJDIHO FAILURE: TO C'1ELl ANY TERM OR CONDITION IMPOSED FI-IE:F:EON DURING T IIPUPMt Y OR I=II•IAL APPROVAL _ THE ISf:rUAHCE OF THIS PERMIT DOES NOT CONSTITUTE A£3SLJl'EF''T:F.ON BY THE DI:IART!*ME�:NT' OR IT'S EMPLOYEES OF I...TABIL,I:TY FOES T1 -•1E;= FAILURE OF: :I:NADE:OUACY OF THE SEWA(3ET I)I`.SE'OSAI_. ;:;' s1F::M, FA1*I $111' TI-! 08/11./94 ENVIRONMENTAL SPEC:TAI.-T 13T DATE TH:I':; F'ERIlI F :E8 NUT TRANSPIONASL.E AND SHALL_ BECOME VOID IF SYSTEM CONSTRUCTION HAS NOT (::OMI1ENCEI) WITHIN CIhIE- OF ITS ISSUANCE, BEFORE ISSUJ:NB IT NIL. APPROVAL OF TH:F'..3 PERMIT THE WELT) COUNTY HEALTH DEI�'AI•sr1MENT REb.:RVEL THE R:I:C71•I1' TO IMPO.)SE' ADI)I--- 11Ot•IAL.. TEENS ANT) C;CINL)1'1IONS I.EC`EIJTRLI) TO II1 CJIJI-. ERU1_A1:IONS LIN A Ufit-IT'INIJTNC, BA- - FINAL._ 1='EERI'1IT APPROVAL IS LON1'IN(3Eh1T UPON THE F INAI... INN15F'1-:C:TI(:)N OF Ti -IF: COIN--• F'L-.ETEI) SYS'T'EM BY THE: Wl:'L1) CX)I.JJA'rY HEAI...TH DEPARTIIF:NT. r� SYSTEM INSTALLER _......._..._...__.._�Lar-iS�'^.---.....----------FENAL. TNEi_.'.....,^ SYSTEM ENGINEER �... 1Itr Af'FROVA1_ TYPE CJf SYSTEM IHSTAI_Li:ED j u`�.... E:t-IV:L.LIEl'-r !TF4E._ f3F'E[s:LAL'!ST TI••EE ISSUANCE: 1W THIS PERMIT DOES NOT IMPLY EOMF'L.IAI4CF. WITH 01 HER STATE„ COUNTY OR LOCAL_ REGULATORY OR BIJII...DII•IS REDO _EREMENTf3, NOR SHALL IL l ACT TO CERTIFY T1-lAT TL -1E SUBJECT SYSTEM WILT_. t:3F'ERATE IN COMPLIANCE WITH APPLICABLE STATE., COUNTY AN]) !._01 Al... IS SIJLAT ii INS ADOPTED I ERSUANT T(J ARTICLE :I.0, TITLE L,L;, ELS .1913 AS h1IL'-::NO- 'D._, EXCEPT FOR THE Pl,I5F'D SEI OF ESTABLISHINGFINAL_ APPROVAL.. OF AN INSTALLED SYSTEM FOR I HOIJANLE OF A LOCAL OCCUPANCY F,E:RM:LT PURSUANT TO ENS :L9'/LI 21-10- 1.11 (2 .. of III III:NAL- AFF'1.[C:ANT e (;C31'Y-WL:HD W(.'HI)--F:HEi I'IAYa :1945N •15P1O6P INDIVIDUAL SEWAGE DISPOSAL_ SYSTEM PERMIT NO. U -94O382 WELD CCOUMTY I-1EAL._TH DEPARTMENT HEW PERMIT ENVIRONMENTAL HEALTH SERVICES T17 16TH AVENUE CCItJF+'r, GRI=IILEY, CO 80631 :a53—O63EXT.2 22;� OWNER STOPF'EL, DWIGHT ADDRESS 28OO W .116TH PL #105 F•H (.a0.�) 438'B3S WESTI"IINSTER CU 80234 ADDRESS OF PROPOSED SYSTEM WCR :,7 & 52 FT L.UF•TON CO 80621 LEGAL I}I�SGRIPTX00N OF SITE: SEC 12 TWP I RNG 66 SUBDIVISION: MAF,TIN BROTHERS LOT 7 BLOCK 0 FILING 0 USE TYPE: RESIDENTIAL MODULAR SERVICES: PERSONS 3 E4ATHIRDOIIS 200 LOT SIZE 5.00 ACRES BEDROOMS 3 BASEMENT F•I.._UIIBING NO WATER SUPPLY F'WELL APPLICATION FEE $1 0..O0 RE:C'D BY CHAD YOUNG DATt(f/�1 SIGNED BY LANA STOP .3.� DATE 06/01/9'4 PERCOLATION RATE MIN PER INCH L.IMITI1'I i ZONE>8. FEET SOIL TYPE Sce:ablE PERCENT GROUND SLOPE- DIRECTION .4J RE:OUIF.Lt ENCJU*ER DESIGN ,)n IN 100 YEAR FLOOD PLAIN ZONE, FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON -SITE SOIL .F'ERCOLATIC)N. DATA THE FOLLOWING M:LN:triuM INSTALLATION SPECIFICATIONS ARE REI:IL)IRE:D,y - SEPTIC TANK •,lam GALLONS, ABSORPTION TRENCH 15O,..FT... AIiSORF'TjON BED .1 S.O. F7'_ IN ADDITION„ THIS PERMIT I£' SUBIE ..T TO HE FOLLOWING ADDI'r ON L TERMS AND - CONI}I T.IONS THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT MAY BE REVOKED OR SUSPENDED SY TIDE WELD COUNTY H1 AI...,TH DEPARTMENT FOR REASONS"SET FORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE -DISPOSAL SYSTEM REGULATIONS., -INCLUDING FAILURE TO MEET ANY TERM OR CONDITION IMFOSITD' T1-IERREQN 'DUJRING TEMPOIARY OR FINAL APPROVAL_ THE 'ISSUANCE OF TI-IIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOb..rHE FA LURE OR NADEQUACY OF THE SEWAGE DISPOSAL. SYSTEM . 15 ENVIRONMENTAL SPECIALIST � — THIS PERMIT IS NOT .TRANSFERABtL.E AND SHALL. BECOME VOID .IF SYSTEM CONSTRUCTION HAS NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL.. APPROVAL OF THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI- TIONAL TERMS AND COHDITIC)NS REOUIRED '1-O MEET OUR REGULATIONS (:)14 A CONTI1-4UING DA- SIS. FINAL PERMIT'AF'PROVAL IS CONTINGENT UPON THE FINAL INSPECTION of 'rHE COM- F'L.ETED SYSTEM BY THE: WELD CC)UNTY HEALTH DEPARTMENT. URIGINAL--AFPL,ICANT; CQPY--WCHD . WCHDMEHS. MAY.. 1 QA4 JISF' 06E' APPLICATION FUR 1NDIVIDUAI... SEWAGE DISPOSAL SYSTEM NO. G--940392 WELD COUNTY HEALTH DEPARTMENT NEW APPLICATION ENVIRONMENTAL HEALTH SERVICES 1517 16TH AVENUE COURT, GRF:ELEY. CO 50631. 353-0635 EXT.2225 OWNER ST(IF'PEL. , DWIGHT ADDRESS 2500 W 116TH FL 14105 F'H ( 30,3) 4,;,S•-U.-iB2 WESTMINSTER CO 80234 ADDRESS OF F'Rur'OSD) SYS•rl :M WCR ,:i7 & 52 FT LUPTON CD 80621 L.EGAI_ DESCRIPTION OF SITE: SEC 1 TwP i RNLa 66 SUBDIVISION. MARTIN BROTHERS LOT 7 BLOCK 0 FILING, 0 USE TYPE; RESIDENTIAL MODULAR SERVICES; PERSONS 3 BATHROOMS 2.00 LOT SIZE 5.00 ACRES !3EDRU(TMS 3 BASEMENT PLUMBING NE) WATER SUPPLY PWF:LL A 'F'L_ICANT ACKNOWLEDGES THAT THE CCIM'=L-E=TfENEss OF THIS APPLICATION IS CONDITIONAL UPON FURTHER MANDATORY AND ADDITIONAL TESTS AND REPORTS AS MAY BE REQUIRED BY THE WELD COUNTY HEALTH DEPARTME;:II'T TO BE MADE AND FURNISHED BY THE;: AF'PL_ICANT OR 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 CONDITI'UNS AS DEEMED NECESSARY SARY TO IN SI.JRE COMPLIANCE WITH RULES AND REGULATIONS ADOPTED UNDER ARTICLE 1O, TITLE ORB 1973, AS AMENDED, THE APPLICANT CERTIFIES THAT THE F'ROF'OSED SYSTEM WII•.L HOT BE LOCATED WI•I'HIN 400 FEET OF A COMMUNITY SEWAGE SYSTEM. THE uNDE:RS:CI"3NED HEREBY CERTIFIES THAT ALL STATEMENTS MADE. INFORMATION AND REPORTS SUBMITTED HEREWITH AND RE€1(JIRED TO BE SUBMITTED E-lY THE APPLICANT ARE, OR WTI, -t.. BE, f�1=:F'FiE_GENTE1> TO RE 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 SANE FOR PURPOSES OF ISSUING THE PERMIT APPLIED FOR HEREIN. I FURTHER UNDER -- STAND THAT ANY FALSIFICATION OR M:E sREPRP_SEN'TATIOI4 MAY RESULT IN THE DENIAL. OF THE APPLICATION OR REVOCATION OF ANY PERMIT GRANTED BASED UPON SAID APPLICATION AND IN LEGAL AC T:WN FOR PERJURY AS PROVIDED BY LAW. APPLICATION FEE:. $:L54.OO REC ' D BY CHAD YOUNG DATE: 05/01/94 ORtOI1'IAL--AP'P'LICANT ; C[JI='Y -WCHD 414E AGENT 916 AlLiRE _.._�... - `&.i -_- OB/o! DATE WCHD---EHS MAY, 1954 - I SOIL ANALYTIC$ AND FOUNDATION ENGINEERING, INC. IUCIN1EL A. LAIR P.E.E8ICENT) CCJ18'A.TANih M1 E!]11Na 10460 WEST VIRGMYA AYSJRIE LAR9WOOD, COLORAoo cams p03] JOB. 2856A August 4,1994 Dwight & Lana Stoppel 280-D West 116th Place No. 105 Westminster, Colorado 80234 Telephone. (H) 438-8382 (W) 452-4845 Subject; Percolation Tests for a Proposed Residence to be Located on Lot #7, Martin Brothers Subdivision, Weld County, Colorado. Dear Mr. & Mrs. Stoppel: This report presents the results of percolation tests which were conducted on July 29, 1994, at the above captioned property. 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 0.0 to 0.5 percent towards the northeast. It is estimated that the leaching field area is located nil to 0.5 feet below the lowest area of the homesite. The results are as follows: - 36" deep (silty sand) Percolation rate = 28 minutes per inch Percolation Test. ole_ #2 - 32" deep (topsoil) Percolation rate = 86 minutes per inch Mr. & Mrs. Stoppel -2- August 4.. 194 Soil Analytics Job #2856A Percolation Test Hole #3 - 48" deep (silty sand) Percolation rate = 10 minutes per inch Percolation Test Hole_#4 - 28" deep (topsoil) Percolation rate = 86 minutes per inch Profile Test Hole 0'-0" - 3'-0" TOPSOIL, firm, loamy mixture which locally may contain a slight hardpan below 6 -inch level, brown, slightly moist. 3'-0" - b'-0" SILTY SAND. loose, medium to fine sands with a low to moderate silt content and some lean clay near base, buff - brown, slightly moist to moist. 6'-0" 10'-0" SANDY CLAY, firm to stiff, very sandy at top, low plasticity, some calcareous material present, brown and white, 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 acceptable in the area tested and may be used if it is installed in the recommended depth zone and if careful attention is given to the recommendations contained herein. The field 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 the absorption area contain a minimum of 525 square feet of leaching area per bedroom. This recommendation is based on the following formula: (Q) (t) A = 1.6 5 Mr. dx Mrs. Stoppel -3- August 4,1944 Soil Atkalyttce Job 82856A 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 (53) 1.6 = factor for increase in size due to garbage grinder and automatic clothes washer 5 = empirical value The excavation for the leaching field must be made at least 3'-0" deep below groundlevel in order to remove the upper surficial layer of low permeability topsoil which was encountered in the Profile Hole. However, the excavation should not be any deeper than 4'-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 establish adequate insulation against freezing. The top of the field should be 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 also properly monitored. Once properly installed, the soil absorption system 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. & Mrs. Stoppet -4 August 4.1994 Soil AnalylCs Job J2856A 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 given to allocating a reserve area for the construction of a replacement system 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 be 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 I. 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 MALlvjs enc JEST HOLE LOCATION PLAN I" = Io0'-0" ,►LEE EET _ LOT #7, MARTIN BROTHERS SUBDWISION WELD COUNTY, COLORADO FIGURE 1 TABLE I PEPCOLATIDN.TEST RtSULTS JOB# A DATE OF SATURATION_________________________ �¢ HATE OF TESTING '7 91 HOLE NO. (DEPTH) TIME INTERVAL MINUTES WATER DROP INCHES PERC RATE MIN/INCH REMARKS Rr3" .3a 3.10 3O 2,0o dd /XO 2.30 125 Aid l :o 30 2.0606 3d 140 1.10 20 Al n" 3O a•' 30 a. fo 50 dos 30 445 30 0640 30 a.3s' 30 o•3s 30 a$ TABLE I cont'd ,Ivtrec ` 53'�'14tts prr in HOLE ?a O. (DEPTH) TIME INTERVAL 1.1ittUTES I4ATER DROP INCHES PERC RATE MIH/IUCH REMARKS F 3Q 4.s04d4 Ik 30 3.4 30 2{4s d d 30 3.15 �.� add a 24t1 41d fin' Ff 4 _2B" 30 4.75 30 0.�►0 a a d,4S 30 0••_0 3o d3 3o a.35 Profile Hole Log -ToF6oiL L611-sc.), FIRM , LO,4MY k11XTc.4QF 41N1c+l y 1oc4LL*/ MAY CoWT4M/ A SLIGHT /44RoPAW F- I1 BELOW 714E (-1AX4 LEVEL, BRow< , 5L1kHTLY MccT. S!L1Y SID 15tl , Loa5E I MWDIUH To FINE SIML WIT44 A LoW To HODEI ME 5U -T CONTE'JT AMD I-. :.SG11E LEAN CLAY WCji13iSE, $uFF- BROWAI) i 5I+4TLY ML5T Ta s ySAWDY CLA'I (cL ), ''RM To 5T, , vEle� SAVOY f-7 AT TbP, Uhl PLA ST rrj, oM F c4 LC41.€O /S LI 1A714L PR@SEjj , WWI AND IIH�TC, MaoT. 10 LOT 'I, f14l'il/ B1Zo5, sugDV., WELD CouNT', Co, SOIL ANALYTICS AND FOUNDATION • ENGINEERING, INC. MICHAEL A. LAIRD. P.E., {PRES4OENT) CONSULTANTS IN CIVIL ENGINEERING 10460 WEST VIRGINIA AVENUE LAKEWOOD. COLORADO BClV6 (303) D2S422 Dwight & Lana Stoppel 2800 West 116th Place No. 105 Westminster, Colorado 80234 5't n iiiAug s -t' L r. Cf.-J _ Subject: Soil and Foundation be Located on Lot County, Colorado. Dear Mr. & Mrs. Stoppel: JOB: 2855A August 4,1994 Telephone: (H) 438-8382 (W) 452-4845 Investigation for a Proposed Residence to #7, Martin Brothers Subdivision, Weld As requested, we conducted a soil and foundation investigation at the subject site on July 28, 1994. The foundation investigation was performed by drilling two test borings to depths of 20'-0" and 20'-0" within the planned construction area. The locations of the test borings and the logs of subsurface materials are enclosed. The discussion and recommendations presented below are based on the results of data gathered during the site investigation, observation of general field conditions, and previous experience in the area with similar materials. Based on conversations, we understand that a modular residence will be placed at the site. We also understand that a basement level will not be constructed below the residence and that the foundation excavation will range in depth from about 2-1/2 feet to about 3 feet below the existing ground surface. The groundlevel floor will be structurally supported over a crawl space. Foundation loadings for the proposed structure should be relatively light. The site of the proposed construction is a slightly rolling and sloping lot in a residential area. The structure will be placed over the area of our two foundation test borings, whose locations are shown an Figure 1. Generally speaking, the ground Mr. & Mrs. Stoppel -2- Augudst4,1994 Soil Analytics Job R2855A surface in the area of the structure slopes towards the northeast at about 0.0 to 0.5 percent. The existing ground cover consists of weeds. Soil conditions in the area of the two test borings are fairly consistent with depth below groundlevel. Foundation Boring #1, which was drilled near the northeast corner of the building site, encountered firm and slightly moist topsoils from groundlevel to a depth of 2'-6'; loose and slightly moist to moist silty sands from 2'-6" to 6'-0"; firm to stiff and moist sandy days from 6'-0" to 11'-2" and firm and saturated sandy clays from 11'-2" to at least 20'-0", the maximum depth explored. Foundation Boring #2, which was drilled near the southwest corner of the building site, encountered firm and slightly moist topsoils from groundlevel to a depth of 2'-6"; loose and slightly moist to moist silty sands from 2'-6" to 6'-0"; firm to stiff and moist sandy clays from 6'-0" to 11'-5" and firm and saturated sandy clays from 11'-5" to at least 20'-0". Free groundwater formed in Boring #1 at 11'-2" and in Boring #2 at 11'-5" on the date of the subsurface investigation. The subsoils at the site were carefully inspected as the cuttings were recovered from the test borings, and the resistance of the materials to the advancement of the drilling augers was noted. In addition, Field Penetration Tests were performed at selected depths to assist in evaluating the allowable bearing value of the soils and to provide undisturbed samples for precise examination and for testing in a one-dimensional consolidation unit. Based on the results of the investigation combined with previous experience with similar subsoil conditions, the most pertinent foundation engineering characteristics and considerations at the site are as follows; The sandy soils which were encountered by the test borings at and below planned bearing levels are non expansive materials with a low bearing capacity. 2. The non expansive materials encountered in the borings at and below planned bearing levels are acceptable for standard spread footing foundations which are properly designed and constructed in accordance with the recommendations and requirements of this report. 3. The sandy clay layer encountered below 6.0 feet in Boring #1 and Boring #2 is a low to non swelling material. Its depth with Mr. & Mrs, Stoppel - - August 4,1994 Soil Analytic job 0255SA respect to the depth of proposed construction should prevent it from adversely affecting the planned footing foundations. FOUNDATION RECOMMENDATIONS Based on the subsoil conditions and geotechnical considerations described above, it is our opinion that the proposed residence may be founded on standard footing foundations placed in and on the natural soil materials located below the frost depth level of 3'-0". The foundations should be designed using a maximum allowable soil bearing pressure of 1,000 psf. All continuous footings supporting perimeter concrete foundation walls should be at least 14 inches wide. All disturbed soils should be completely removed from bearing areas. Foundation walls should be well reinforced with at least two #5 bars, top and bottom, and under windows and blockouts. All concrete foundation walls should contain sufficient horizontal reinforcing to enable them to span an unsupported distance of at least 15 feet. LATERAL EARTH PRESSURES ON FOUNDATIONS We assume that the native sandy soils located below the upper topsoil will be segregated and used as backfill for foundation wails. If they are only moderately compacted using hand equipment to the extent that they do not settle after construction, we recommend the use of an equivalent lateral fluid pressure of at least 40 pounds per cubic foot for design. Care must be taken not to overcompact the backfill or to operate heavy equipment above the foundation wall backfill since this will result in excessive lateral forces on foundation walls. Care must be used in the preparation of all foundation bearing areas since excessive settlement may result if incompetent materials are present. Prior to foundation construction, the base of the completed excavation should be thoroughly inspected for loose, disturbed, frozen, and otherwise unsuitable materials including improperly placed fill. All disturbed and unsuitable foundation materials must be completely removed and the resulting excavation should be backfilled with good quality, non expansive, structural fill materials compacted to at least 95 percent of standard Proctor density at optimum moisture content or else the foundations must be extended Mr. & Mrs. Stoppel -4- August 4,1994 Sod Analytics Job M2855A sufficiently deep to bear on the underlaying natural undisturbed soils. All structural fill must be compacted in 8 -inch lifts to the stated density level and moisture content. The compacted backfill must extend upward to the level of all structural foundation elements. We understand that the floor of the residence will be structurally supported over a crawl space. The following recommendations should be followed for areas, such as a detached garage, where slabs -on -grade may be constructed in the future. The slabs may be placed directly on the natural subgrade materials or on a stable, properly compacted non expansive base layer. The natural subgrade soils should have a density of 92 to 95 percent of AASHTO T-99 maximum density at optimum to optimum plus 2 percent moisture content for a depth of at least 8 inches. If a base layer is used, it should be compacted to the same density level and moisture content. Separate the slabs from all bearing members and utility lines to allow their independent movement --construct "floating" slabs. Provide positive control joints at the junction of the slabs with foundation walls, and also provide frictionless sleeves for all utility lines and columns which pass through slabs. 3. Contraction joints having a minimum depth of 1/4 of the thickness of the slabs and a width of at least 1/8 inch should be scored or sawed at spacings not to exceed 15'-i)" on centers. 4. Construct a minimum 1.5 -inch void space above or below all partitions on slabs. In finished areas, all furring strips, drywall, and paneling should stop 1.5 inches from the tops of the slabs. The 1.5 -inch void space can be covered with a molding strip. In addition, flexible connections should be used for all slab bearing mechanical equipment to provide for at least 1.5 inches of free vertical movement. In order to optimize long term foundation performance, the underlaying subgrade materials should be protected from excessive moisture fluctuations Mr. & Mrs_ Sevppel -5- August 4 1994 Soil Analytics Job N2B55A following construction. This can generally be assisted by using a relatively impervious and non expansive backfill and by compacting the backfill sufficiently so that it does not settle significantly following construction. The backfill should be free of debris and should be moistened and compacted to the extent that it does not experience future consolidation. Sufficient water should be added to the backfill to permit proper compaction; however, the backfill should not be puddled. If compaction is not feasible, a berm may be constructed adjacent to the foundation walls to allow for a good slope away from the building even if some settlement should occur. If significant settlements should occur in the backfill, they could adversely affect utility lines which transmit fluids and pass through the foundation walls. It is not uncommon for such piping to shear at the foundation walls due to movements in the backfill. It is recommended that the pipes pass through slotted openings in the foundation walls or that flexible connections be used to compensate for shifting of the foundation wall backfill. It is also recommended that all water lines be carefully pressure tested prior to final acceptance and that any leaks detected be repaired. The final grade should be sloped well away from the structure on all sides. A minimum slope of 12 inches in the first 10 feet is recommended. All downspouts should discharge into extensions which slope away from the foundation walls and extend beyond the limits of all backfill. The point of discharge should be at least 5 feet from the foundation walls and good drainage should be maintained at this point. All future owners of the residence should be advised of the need for keeping moisture away from the foundation and slab -on -ground areas. In no event should an automatic sprinkler system be installed next to the foundation walls. There should be no watering or irrigation within 5 feet of the foundation walls. The ground surface in the area may be lined with a suitable geotextile fabric to control plant growth. The area next to the structure may then be covered with gravel, bark chips, or other materials requiring no rainfall or irrigation. The results of the investigation indicate that a subsurface underdrain system is not needed for the proposed non basement construction, assuming that good surface drainage of moisture away from the house is constructed and maintained. Any deviation from the planned construction or failure to maintain good surface drainage will obviously negate the preceding Mr. & Mrs. gtoppel - August L ]994 Soil Aaalytics Job 92555A statement. The client may therefore desire to construct an underdrain system as a safety measure to protect against unpredictable developments. A functional underdrain system may consist of a 3" diameter slotted plastic drain pipe encased in a gravel filter or filter cloth and sloped to drain at a minimum grade of at least I percent to a sump pit equipped with a pump for removal as required or to a suitable daylight outlet where the effluents can be discharged by gravity action. In addition, the underdrain should be placed at bearing level and around the outside of the foundation walls. LIMITATIONS The above recommendations are based on the exact location where the test holes were drilled, the proposed construction, and the assumption that the subsurface conditions do not vary greatly from those encountered in the test borings. In the event that any unforeseen conditions different from those described herein are encountered, the soil engineer must be notified immediately. This report has attempted to cover all pertinent design aspects. If you should have any questions, or if I can be of further service, please do not hesitate to give me a call for clarification. Sincerely yours, 7711 Michael A. Laird, P. E. Consulting Engineer MAL/vjs vjs enc U 10615 `tr. 'h tit E (See Figure 1 for Test Hole Locations) DEPTH DESCRIPTION FOUNDATION TEI BORING tl 0'-0" - 2'-6" TOPSOIL. firm, loamy mixture which locally may contain a slight hardpan below 6 -inch level, brown, slightly moist, 2'-6" - 6'-Q" SILTY SAND, loose, medium to fine sands with a low to moderate silt content and some lean clay near base, buff - brown, slightly moist to moist. 6'-0" - 11'-2" SANDY CLAY. firm to stiff, very sandy at top, low plasticity, some calcareous material present, brown and white, moist. 11'-2" - 20'-0" SANDY CLAY, firm, low plasticity, calcareous, may contain eroded bedrock fragments or pockets, light brown, saturated. *NOTE; Free groundwater formed in this boring at a depth of about 11'-2" shortly after drilling was completed. (shill) (. s) is IS M (See Figure 1 for Test Hole Locations) FOUNDATION TEST BORING 2 - 2'-6" TOPSOIL, firm, loamy mixture which locally may contain a slight hardpan below 6 -inch level, brown, slightly moist. - 6'-0" SILTY SAND. loose, medium to fine sands with a low to moderate silt content and some lean clay near base, buff - brown, slightly moist to moist. -11'-5" SANDY CLAY. firm to stiff, very sandy at top, low plasticity, some calcareous material present, brown and white, moist, 11'-5" - 20'-0" SANDY CLAY, firm, low plasticity, calcareous, may contain eroded bedrock fragments or pockets, light brown, saturated. 'NOTE: Free groundwater formed in this boring at a depth of about 11'-5" shortly after drilling was completed. NOTES 1. The exploratory test borings were drilled on July 28, 1994. 2. The locations of the test borings are shown on Figure 1. It is not warranted that the subsurface conditions given above are representative of conditions at other locations and other times. In the event that conditions different from those described herein are encountered during construction, the soil engineer must be notified immediately. 3. Free groundwater formed in both borings on the date of the subsurface investigation at the depths listed previously. 1. Field Penetration Test at F-6" in Boring #1: 16 blows/foot. 2. Field Penetration Test at 3'-6" in Boring #1: 4 blows/foot. 3. Field Penetration Test at T-0" in Boring #k1: 8 blows/foot. 4. Field Penetration Test at 9'-Q" in Boring #2: 1.5 blows/foot, I. lEST HOLE LOCATION PLAN V. = 1001-4" QARA LEE STREET LOT 97, MARTIN BROTHERS SUBDIVISION WELD COUNTY, COLORADO FIGURE 1 A 11111111 11111111_11111111_11111111 11111111 11111111_1111111 • •i:iii.hiiii;IinE.IuIIH1I Elliii!IIIIII1IF�1nm iwma1 I$I11IHUIIIIIIII SIIIIIIIL.mnL 11111111 11111111' 11111111 iIII1II. 1111110 m�■1k1iImW1nuui ____ 11111111i��ii�iw�i ` 6 SEPTIC LOAN EVALUATrO mot • . SPECIALIST INSTRUCTIONS I ID C //�� yy��-yy clNG nATE: REQUEST No, : _ �Z COLORADO 2 DATE RECEIVED/SEC FAX NEB: ($2.00) (ICJ Srjc, p+)i f NEW OAN OA REFINANCE FEE $100.00/$120.00 TO WHOM ITMAY CONCERN: Review and inspection report regarding water and the savage disposal systam for an existing dwelling: J � /y Mail To; P C.lhia rd ►mot • C-jMC> _— Owner Ila. i 2I t) - (c - 3 1 -- 12191 F a1:7 lrlr_ri_' J owner No.:_ (W) Realtor No. s ape- 3oz_.te:`oc' Fax To: Iraz ;�4. �. • 942 _ .i_ i D�nVTln .. 'i Li INF0ENaTION: Addre99, ( ? If CLa.i & {.£P J Lt1-OA Age of Septici 9 I' Legal: PT;________ P- SEC: N AEG: (..Cr N subdivision LOT: BLEC t aLG, wa Property Owner Original Owners rfDf J a L4 Tank Pumped on: _ 1_OSf By; — Li eneedsYes_ o_ PERMIT ON RECORDS Mane: Permit Na. __________ B.O.B. Yee/ o Bathroomnt Bedrooms: Total Acra :��.p0 Date of Figal Inspection: 2F� ef1 Water Supply L- Well Permit Mo.s Tank Capacity: !gyp gallons Leachfield Sire: IS«, Square Peet INSPECTION YINDIN'GS: Date of Inspection: }>l i.4jb7 �^ SOIL CONDITIONSt Dry ii"- Saturatedw-covered RESIDENCE: Occupied • Vacant X. SEWAGE DISPOSAL, SYSTEM: Satisfactory K her BACTERIOLOGICAL WATER TEST: Acceptable Other _ COMMENTS: DATE: g. ( p. /t_ vir ntal Wealth Specialiat Neither the County of Weld, nor any of Its agents or amployeas undertake or 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 detecting health hazards observable at the time of inspection, and does not constitutes 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 maturation 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 information the property owner provides, under oath, indicating current status of the system and representing to the best of his/her knowledge the system is not failing to function properly. aLs 3'Q. • I UMP INSTALLATION ANC) TEST REPORT 11/9a STATE OF COLORADO, OFFICE OF THE STATE ENGIN�yEER RECEIVED FEB 0294 i. WELL PERMIT NUMBER / r `� 77j I T i'•1! 2 OWNER NAMES) tr T . Mailing Address W � Clry, Si. Zip Phone ( ) 3. WELL LOCAT1ON AS DRILLED; t/ 114 9114, Sec./ Twp.I , Range DI T NCES FROM SEC. LINES: N. from S Sec. line. and n O tt. from . Sec. line. was or "M x wassF SUBDIVISION',` 14r'tr; rasPt Arn,i.,1p LOT BLOCK FILING{UNIT) STREET ADDRESS AT WELL LOCATION: 4, PUMP DA�Typ9 m� :, 1�,'• a Installation Completed /-1.-9i' Putrrp Manufacturer Pump Modal No. Q uj O T1 -S Design GPM / at RpM_j., HP , Veit s , Full Load Amps Pump Intake Depth _ '7 S b Feet, Drop/Column Pipe Size j '_ 9 Inches, Kind { 0 ADDroNAL INFORMATION FOR PUMPS GREAT R THATO_GM: TURBINE DRIVER TYPE: ❑ Electric ❑ Engine ❑ Other Oeslgn Head feet, N;.rmber of Stages Shaft size inches. 5. OTHER EQUIPMENT: Airline Installed ❑ Yes I�I,��Iuo oridlee Depth ft. Monitor Tuba Installed t�l Yes IJ nro, Depth ft._______ Flow Motor Mfg, _ Meier Serial No, Maser Readout ❑ Gallons, ❑ Thousand Gallons, ❑ Acre feet, ❑ Beginning Reading 6. TEST DATA: ❑ Check box H Test data is submitted on Supplemenlaf Form. Date Total Well Depth =i, 0 Tme Static Level Rate (GPM) - Date Measured J Pumping Lvi. 7. DISINFECI1ON: Type I ✓ 7 1 Ip r i y�r L Arnt. Used I t i Ct. p i � I l+.kil 8. Water Quality analysis available. ❑ Yes Ls No 9, Remarks 0. 1 have read the slaternents made herein and know the corrterrts thereof, and that they are trua to my knowledg [Pursuant to Socilon 24-4-104 3){a) C.R.S., the making of false statements herein constitutes perjury In the socor degree and Is punlshadte as a class 1 misdemeanor.) CONTRACTOR ,S1ca4xe 'a ,lenvLce Inc. Mailing Address 2021 b 1 27 J t.. L Namejlitfe (Please type or print) Tom W. ,SPai.n 1 aeaLcfeat Phone (3()3)_65-58 Lic. No.7 r 5 621 Date fI S roar ++o. cvs 31 11l90 ' WELL CONSTAUCZION AND TEST REPORT STATE OF COLORADO, OFFICE OF THE STATE ENGINEER f . o nly u.. CEIVEI) 1094 1. WELL PERMIT NUM6ER 174771 2. OWNER NAME(S) r`arnl vn SY Aar' Mailing Address City, St, Zlp fit .r , �� r _ rt fl .2 Phone { } 659-2945 3_ WELL LOCATION AS DRILLED: t1W 114 S1/4, Sec. 12 Twp, 1 N Range 5 14 DISTANCES FROM SEC. UNE5: 1 sa n n Li from Sec. line, and 2 0 0 It. from E Sec. line. OR SUBDIVISION: Martin Bras . PCE7 Amended tOT A BLOCK FILING(UNIT) STREE=T ADDRESS AT WELL LOCATION, 4. GROUND SURFACE ELEVATION ft. DRILUN4 METHOD Racary DATE COMPLETED I2--20-93 . TOTAL DEPTH 920 1t. DEPTH COMPLETED X20 h, S. GEOLOGIC LOG: o.w, t)..uipdor+ d 14r.rW (Typo. $ x cam, waf.r L ^ d -1 Il-�fi B. HOLE DIAM. (iro.} From (h) Te {ft) 0 3 / 4 ___ _ _ ' _ G id fl .sand 7r,-37 Arnwn c]y 7. PLAIN CASING OD (ln) Kind Wall Size Krarn(ft) Ta(h} 5/A St—i '1 „. _1_ +1 _ _ _ 4__i1.? �� 1 AR _n 75(1 PER_. CASING: Screen Slot Stze:3 / 16" Torch cu 41/2 Steel .188 75 0 77_i7n Fit iia ctna 1 /J i n 1 . yFrs sand 7 Yl—a SAn 1„p �n�1 -04-- ��7L,,a chain -_-- 8. FILTER PACK; Material N/A Size Interval 9, PACKER PLACEMENT; TypeIial if�urton basket placed at Depth 75n' 10. GROUTING RECORD: Material Amount Density Interval Placement cwt 5o0 l7va11 0 -75th I7um� boa REMARKS- 5% Benton zte, 2% Calcium chloride added _to cement. OK 740' top amended 1 DISINFECTION: T e Granular Chlorine Amt. Used 4 cu s dissolved in 5 gallons WELLTEST DATA; water, poured through drill pipe, & agitated .roug zone ❑ Check box if Test Data Is submitted on Supplemental Farm. with air. TESTING METHOD Air ----- Static Level 445 ft. Datums measured 1,2 - 2 0- 9 3 2: 0 0 P t , Production Rate 20 gpm, Pumping level Jettincr It. Date/Time measured ' , Test length (hrs_)3 .0hrs Remarks at 920 3. 1 F rem I rat* mad. nan[n and 1mOw th cOr>4.ns lh sd, &s th ri.r an trw b my ImowirdG.. EPurvi r 47 S.ci on 74a•m04 (i�1(m1 GR., n,. n,irm N laity .mn mwtlnrtw p.0 r In th. 6I brd I. pjrth u - a 1 ml�d.rtrrior.I CONTRACTOR Phone 30 423-5246 Uc_ No. Mailing Address Name/Title (Please type or print) Lloyd John President/Owner Signature Dale 12-31-93 d.LUi L, J1141 SI t L1 -, '-A" SPaG 13 IS fUL4Ull pu, Cdl..11 dU(;ILiuiIai St Ieti4 If1,45L G$ IU ieI it IItt$U d4 LI IC IL4 Jy LI: .l II Ur.+ I name, the parmil number, farm name/number and a sequential page number. Peport depths in leer below ground sul face. This form may be reproduced by photocopy methods, or by computer generation with prior approval by the Stale Engineer. The original and one copy ol this form must be sui miUed to the State Engineer's OfTk a within 60 days after completing the well or 7 days after the permit expiration data, whichever Is earlier. Anther copy of the form must be provided to the well owner. 1. Complete the Weil 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 gwner has mote than one well serving this property, provide the identification (Owners Designaition) for this well. ¢O NOT USE THE OWNER US PPUE,Q LAi1ON unless a survey has been provided. For wells located in subdivisions the lot, block and subdivision Intormatlon must also be provided. a_ 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 narnes unless they are in conjunction with a description of materials. Examples of descriptive terms Include: Crain se -Boulders, gravel, sand, sib, clay. Hardness-LooSe, soft. tight, hard, very hard. Color -All materials. Most critical in sedimentary rock. Depth when water Is encountered CO 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 (graver) pack and the Interval where placed. 9. trtdicata the type end 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 disirrfection used, how placed and the length of time left In the bole. 12. Report well test data as required by Rule 10.7. Spaces are provided to report all measurements made during the last The report should show that the test compiled with the provisions of the rules, If a lest was not performed explain when it will be done. If available, report clock time when measurements were taken. 13_ File In Company Name and Address of Cort[ractor who Oortstructed the well. The report must be signed by the licensed contractor responsible for the construction of the well. Form No. GWS _25 APPLICANT OFFICE OF THE STATE ENGINEER COLORADO DIVISION OF WATER RESOURCES 819 C.r r.nnlal BldQ,. 1313 Sharman St., Denver, Colorrdo 50203 t3ts3t 6&381 WELL PERMIT NUMBER - DIV 1 CNTY. 62 WD 2 DES. BASIN MD 827 LOU 8 Block: Flllnp, Subdrv. MARTIN BROS PUD AMENDED APPROVED WELL LOCATION WELD COUNTY CAROLYN SPEARS NW i�4 SE iJ4 Section 12 17782 WC RD 12 Twp t N RANGE 66 W 6th P. M. FT LUPT0N CO 80621 DISTANCES FRCM SECTION UNES (303) 659-2945 1800 Ft. from South Section Line PERMIT TO CONSTRUCT A WEl1 2600 Ft. from East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF AETMVAL 1) This well shall be used in SUCK a way as to cause no material injury to existing water rights. The issuance of the permit does not assure the applicant that nu 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 ho in compliance with the Water Well Construction and Pump Installation Rules 2 CCR 402.2, unless approval of a variance has been granted by the State Board of Examiners of Water Well Construction and Purnp Installation Contractdr5 in accordance with Rule 17 3) Approved pursuant to CRS 37-92-602(3}(b)(l) and policy of the State Engineer under the IotOwing conditions. 4) The use of ground water from this well is limited to ordinary household purposes inside one single family dwelling, the watering cA the user's noncommercial domestic animals, and the irrigation of not mare than 12,000 square feet of home gardens and lawns, as recommended by the Dtviston 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 140 -'&ieet and 1,080 feet below ground surface. Plain casing shall be installed and sealed to prevent production Irom other zones. 6) The maximum pumping rate shall not exceed 15 (3PM. 7) The annual amount of ground water to be withdrawn shall not exceed 1.1 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 at�oveybff{,q{qy CONDITION OF APPROVAL NO. 5 ABOVE IS HEREBY AMENDED TO ALLOW PROOUCTION TO BEGIN FROM 740 FEET BELOW GI IOUND SURFACE, INSTEAD OF 7B5 FEET, PURSUANT TO A REQUEST BY TELEPHONE FROM DRILLER, MR LLOYD JOHN (LG# 1327) ON DECEMBER 21, APPROVED DWR Receipt No. 0360854A DATE 1SSl;ED N0V 7 140 xPt TION DATE N0V 1 35 y I I Wi-5-Re..76 ��' , ' COLORADO.01 ASTON OF WATER R�SOU. ICES 3 -� E;48 Centennit+ d4,. 1"� 3 hermrn St. Dint -Co rado 8203 REA RECEIVED Applicetlon mutt "ECEIM PERMIT APPLICATION FORM + CT 0 1 '9 te ere be complewh y r !>M 1 7 L4 A PERMIT TO USE GROUND WATER J Q 1 '93 applitabfe. Type or print in LAPK b4 A PERM(T TO CONSTRUCT A WELL wTQ I4 A PERMIT TO INSTALL A PUMP w. ►rIt7ER STATE E -110 No overstrikes lil t yTh EMpI f R€P.LACEM FOR NO. rnlr+ or erasures unless Initialed. ( I .NT ( )OTHER / 7/ ,7' WATER COURT CASE NO. (1) A#PLICANT - mailinggaaddrress -- NAME��Jl1I STREET L7 7g2 C.AC1fS ! - CITY i� 4, C4LQ o_tO i Tf-t,-ErH0NM- 9_ �y5 (2) LOC T 1+ON OF PROPOSED WELL CnuratY_� 4 of the E. -- K, motion _, CAS43ii rr� Twp k. Rng. SQ/ 1 L. Jp P.M IN.51 IE,M q3) WATER USE AND WELL DATA Proposed maximum pumping rote (ypm1 I Average annval amount of ground water to be appropriated (acre-feetl: Z. 0 C.S . Number of acses to be irrigatetl:. to 2e" Proposed total depth Ifeetl: 9.22 Aquife ground water is to be obtained from: Qv.r er`: welt designation GROUND WATER TO USED FOR: {1Q HOUSEHOLD USE ONLY - no irrigation (0) b4JJOMESTIC (1I I I INOLiSTRiAL (51 C LIVESTOCK (2l ¢st}IRRiDAT1ON (el I I COMMERCIAL (Ql 1 1 MUNICIPAL (8} i IOTHER 191 f &I �__ _id_ DETAIL THE USE ON BACK IN i I If (4) ❑ ILLER NamjL -Inv c DSO kry street . i3.07c 14 Q__ City-rn v n1 Telephone No_� �. Lie. Na- 0421 FOR OFFICE USE ONLY: DO NOT WRITE IN TI -ft 5 COLUMN �d MI5 fciw� il ReceiptNs. ___________ J - 33rfi/i1) Basin ?lowl.�. til l to is 1. 4lld . 4..,.. w.1L1 .I a,9ac rt 1 r iur a !.t wC/741a7 GONOfTIONS OF APPROVAL. This well shall be used in such a Oay as to cause r10 material injury io existing water rigtrt . The issuance of the permit does nit assure tl>,e applicant that no injury will occur to another vested water right or preclude another owner of a vested war right From seeking relief in a tivif court action. -/J(/ J• _..L.. , / r1, 006*/r-r Best Copy Available APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION GATE (STATE ENGINEERI 8Y I.17 COUNTY b �_ C (g) THE LOCATIPN OF THE PROPOSED WELL and the area on wlri the water will be 4swd must be lndt On diagram below. use lfv a CENTER SECTION (i hessian. 640 aadsl fofthewell locatlon- + - .-.- .- - + - --I-- -- + - +11 +,_ �-�- I i 1 MILE. 15"0 FEET 4- — -4- N0f1TH+- t ---± NORTl4 SECTION INE I I � N .I z I a y rn O w n � � µ H r I i z � r I I I SOUTH SECTION LINE —t—+ - - -- -- 4 + The scale of the diagram is 2 inches - I mile Each small Square represents 40 acres. WATER EOUIVLLENTS TABLE Ino.r+.ded fq�re,l Ar• acre -loot coven 1 We Or line 1 1001 artO I evbrc 1001 pt+s*co.,Olrfd . - d49 paiianl air ,,mule ipornl A limdv of 5 .o11 r fswre 80040, maifiy I ace! loO1 ti watt, air ytie. I •Cr•-IOO, 43,560 ,5c IIII 19134gaSSdnf, 1,000 qpm oumaatl ronunuouSly lo e ane bay proOuelu 4.42 ■cre.fesl )10) LAND ON WHICH GROUND W6—TTLR WILL BE USED: Own erffr C,1Rw Legal description: (6) THE WELL MUST BE LOCATED BELaw'_. - by distarlicta frgnl iecti&i lines. r !J' f t. from ___',C. +iae 4 9$ �7 nOrlh Or�iaall Y (r� ___ __ t, from . {.are •hail. L sac. tine LOT BLOCK _FILING a SUBDIVISION (7) TBACTNWHICH WELL LOCATED prrner:CAroly o .rs No. of acres - Of7'7 Will this be the only well on this tract? d p14 (8) PROPOSED CASING PROgB&M Plain Casing _ in. from -yr— ft. to r-� r� +Z it from - 25 ft to 715 ft. 4 erforated casing +��7 '.�� y -E- in hornt-.1-- f t. SQ ([_ infrom ft to__________ It_ (9) FOR REPLACEMENT WELLSgivedistance and direction from old welt and plans forplugging Noof acres- f + (11) pETAlLED DESCRIPTION of the use of ground water. Household use and domestic :tells nust indicc;c typo of disposal System to i used, + La LL M _ _ t-, 11 f n ►� r 1 (12) OTH.Eh WATER RIGHT used on this land. inciudirg wells Give Registration and Water Court Case Numbers. Type or right Used for 1pufl>oW Deseription of land an which used (131 THE APPLICANTS) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE. SIGNATURE OF Use additional sheets of paper it mQie space is required LENT TELL DATA SHEEP - OENYER BASIN, COLORAbO APPLICANT: SPEARS RECEIPT NO- 360854-A LOCAT[ON_ HWt/4 OF SET/I. OF SEC. 12. Till., R.66S1. CISC0 SSL, 2600 E5L5 PROPOSED AQUIFER: SURFACE ELEVATION: 5050 NUMBER OF ACRES IN FRALT: 5.007 IS PROPERTY WITHIN SERVICE BOUNCARLES OF NUHIC]PALITY S.8-5 CONSENT MAPS? NO_ YES - IF SUN01v151OW IS UNDER AUG$ENTATION PLAN, CASE O. IS , D1V. IF SUBDIVISION WAS EECOMNEIIDED FOR APPROVAL Sr THE WATER MANAGEMENT BRANCH, DAT£ OF LE -TER ES INFORHATIOH ON SUBDIVISION OR TRACT OF LARD/SPECIAL RESTRICTIONS- FvaliaAred by JS G on NOVEMBER 18, 1993 ELEVATION DEPFP TO ANNtkAL --------------- NET --------------- APPROP STATUS AQU;FEE BUT. TOP SAND B0T, TOP A -F UPPER LIAISON .... ---- .... .... ---- LOWER DAWSOW ....................... .... .... . . .-. DENVER ---- ---- UPPER ARAPAHOE ---- ---- ---- ---- .... .-. ARAPA 4697 4941 102 �.�13F5�3 1 6.868 DINT LAB IF -FOE HILLS 3970 4265 155 eS 1.164 NT note. E indicates Locat1on rs a. aquifer btiu,dary antl values may be more approximate. * indicates the propostd aqui1er- Al. values are interpoLated from the 5.9.5 date base mssembled in November of 1486. L? ,-i. &-' -/ - z4 C-AJ 24e MARTIN BROTHERS PLANNED UNIT DEVELOPMENT RECEIVED 001v w x �� _ la •s r .:e Tr.+t.F'iGk�s'rsv'? riz:E �o�d, o� 1 1 i 1 r�1_.ci_ � ti •a�..r �. ds !• ± I k- - --_�a.-rp.,, 5 i -.:rr„ _� .r•,. - -r-r r- f -y.,-,---"TI`.->.� Ir -_ 'I- f 1 i ,fl i' _____ [ U{� 171 r.1•— — ---ur' Y„y-�. -gem-' I x'7., .f.�.'_. n � 4 - �� •tie R' �P ! I � b.�„y.• ---- ._ _ .ate � .,1d7'�`-fS •l,r a, w" -r r' f tr-#: rr .t,... ' - ..!;_. '9'-1-- __________ •-. ,d?'rJ?3%43" I✓.., w�l� it iJ�7 -iv ar' �•' I — —. r < c i P�: n z n Q I L 1 I I 1 L - iyxs45 n1--------,� - - - - --- -.Y _..,,f,f .s:tr e'- - --- 1 } �f/OdLW 1��1 Iy�C I ; C LJIIi �' IR-7171 j�1a i 1 �, i 4JNNY ACRE5 suct)] isION i ,Best C�Available STATE OF COLORADO OFFICE Of fink: STATE ENGINEER Dvrsion of water Resou rres RECEIVED deparmcnt of'valur,l Re ource5 MV V # 111 15nerma- SIreet, Roam H1 H Dnvfr, Cnigrado 80201 Phon. 303) (.3581 Y.ViFRR Y FcYRamer FAX (30.1} 945-3589 r„A Governor Kin Sa�.:ar ExPc.uwe Director Hal U Simpson Su reFrtg��ee. TO: Carolyn Spears FROM: John S. Gabert RECEIPTS NO: 360854-A&B DATE: October 22. 1993 Your applications for permits to construct wells are being returned for the reason(s) listed below. The amendments and/or additional information or documentation requested is required before we can proceed with the evaluation of your 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 tree to contact this office. A Ny Under Item 2 of the permit application forms please state whether the township is "north" f or "south." Under Item 3 on the app#ications you have stated that there will be "lawn and garden" ,45pD watering, but put "zero" next to the number of acres to be irrigated. Please state the p% number of square feet of lawn and garden you intend on watering under Item 3 of the Lpermit application forms. sA Flease furnish the distances from section tines under Item 6 of each of the permit Fa, application forms. 5/dn Finally, please submit a copy of the county -a_ Peroved plat mia of the Martin Bros. (P.0 D `Amended) Subdivision so that your proposed well locations can be verified. STATE OF COLORADO OFFICE OF THE STATE ENGINEER Division of Waler Resources f7eparlmenl of Natural Resources i 3i 3 Shermar, 5treel, Roam t111� Derwer. CoIcradc 8[213 Phonei3031A65-3501 FAX (3031866•.7584 TO: Carolyn Spears RECEIPT NO_: 360854-A RECEIVED NpW 17 Q) xorner ��,�Q,�pIk:E9 Gnve.�or 1EryryE7yylt'aiNEif Ken Sato Ear �C" Exet �I ire {7rrCtir�r oral ❑ Sirr,psrX Srate &�g�nee� FROM: John S_ Gabert DATE: November 8, 1993 Your application for a permit to construct a well is being returned for the reason(s) listed below_ The amendments andlor additional information or documentation requested is required before we can proceed with the evaluation of your application. All amendments made to the application must be typed or printed in BLACK INK. Please initial and date all amendmenrts made than return the application and all attachments to this office. If you have any questions, feel free to contact this office. Item 6 on the permit application form needs to be completed before we can evaluate your permit, A distance of 1800 feet from the South section line and 2600 feet from the East section line would place your well in the center of lot a. Please complete Item 6 to reflect a well location within your lot. COLORADO DIVISION OF WATER RESOURCES EMERGENCY VERBAL REQUEST INFORMATION GWS 2S 0 to be nplrated in INK DIV CO TNT ` oo ,BAS ,MD , verbal receipt ;« FAXEDATE CALLED `� ,N , ai . C?o,A TAKEN BY f` ,NAME OF CALLER L\ t4L.{ Apa+<.i+len 1 1 : Given By (WrI1LS) 1N -S) APPROVAL- GNEN TO tom, oc p+n ! , . APPLICANT; CONTRACTOR: t�l� If7f 7 S& 1 LIII J C -T ADDRESS: 171 k2 W C 2 COMPANY ADDRESS: I c�j phone: L30 ,5 7 � S (H) 1 (O) APPL RECEIPT S 8 DATE USE OF WELL pMIT # / 74S 7 1 ; C PROPOSED LOCATION OF (new) REPLACEMENT WELL AUG PLAN NAME 1r(1 114, 1f4 Sec- f _ TwP- ._�_ , Rny. 6 14J lv PM- DIST. X012 Ira„ N , ssc. line. (O ft W sec. line; County ('k distance & direction from old well to new well site _____" DEEPEN (circle it deepen) ■ubdMilon info: }�J total # ac. 5 _ ki(s) bik. _ - - si lbdv. _! I ! /Lf-1 I } additional psroel into, I AODtiESS Of WELL II dMIS(MR 1f *Wcwg add: FAsow Fats Emm3EP CY: OUT OF WATER OCCUPIED RESIDEN E? (yes f no) STOCK ON PASTURE CROP IRRIGATION lcircls) OTHER _ { CASING INFO: DEPTH OF OLD WELL? ; PROPOSED DEPTH? 2 Z - ; AQUIFER? CASING? plain plus i '- pert. '-fc — Z DATE TO START? 0 'P FIELD INSP. RE0.? ( YES) ( NO ) aver for fieldirrmmpection report iteation; cal ad in? - date f 1 �' EVALUATING STAFF COMMEMM: ?- _ �`� 1J CONDmONS OF APPROVAL o ' 2 ,) /JI. =* r 7 7?( Li s VALUATED BY; 0ATt: /,*i ; APPROVED BY; ; DA Z.- MWTURQ owe -24 A raNs7} COLORADO VMS/ON OF WATER RESOURCES EMERGENCY VERBAL FIELD INSPECTION REPORT Pletae cort�plete this to n in INK N, WD DAlE OF INSPECTION: 1 I APPLICANT' EXISTING WELL LOCATION: 1/;, OiST apps. receipt no(s). PURPOSE OF INSPECTION_ LATE REG_ OTHER person contacted it not applicant W.C. name d phone !: 1/4, See_ - -- , T. , Rng. from N I S sec.line, (d ►apt. give disc & dir. 10- new well silo — from E I W recline; County P.M. circle type of e.Usfing well: DRILLED. IL4ND DUG, SPRING WELL, GALLERY WELL, GRAVEL PI(. OTHER arrry other walls are lof a1ed on this Parcel? (ms) rny (no) pr,rit/.ryrrl.ure? EST. DATE WELL CONSTRUCTED DATE OF FIRST USE TOTAL, * OF ACRES IN THLS TRACT/PARCEL ACRES address t7fpropmy (Ifditferontltien applicantaddress): hdd. subdlparu�el info-_ v acres irriget d (non mrerrrlat/cnop irr-) NAME OF AUG. PLAN? EST. PUMPING RATE gpm ISE OF WELL ____hod use in (indicate how many) . _ _ . single family dwellings) watering of poultry andtor domestic ardmels amestic enirrrelswould include a few cows, horses, etc.) watering of IAesmck on a farm or ranch - ap�prrnc how many heart? is thus a Bard kX? ; how mere+ head? _ . (If is inw.nf ro speci y es mated historic Iawnlgarrlen irr-) w squam foet/acre of lawn and/or garden tns pmmction comvrrerrial - drinking 3 son. only? (write derails in'comments' section) otter (write derails in -cnr vnon section) vas I no ""'*' WERE THE USES CHECKED ABOVE INIFL47ED PRIOR TO M4Y 8, 1972? NOTE: IF ANY CHANGE 1N. THE HISTORIC USE OF THIS WELL HAS OCCURRED SINCE MAY 8. 1872please indicste the c(s) the me add and discuss this c > %Id/r r )no of the c mof/or prrposod use in the %atratp s'_sectlon of this farm poseb dditionei nommen and/or inforrrta ion. - dated_ / / ; celled in by- STATE OF COLORADO OFFICL OF THE STATE 4NCINEER Divi for cf Water Resources Department ci Natural Resources 1J I J Sherman Slfeel Room 1I berwet. Caforado 80201 Phone 1303! 866-3581 F AS I J03> 866 3589 MS CAROLYN SPEARS 17782 W CR 12 FT LUPTON CO 80621 �wer�o. Ken Salaw txcru,ve )i erra, December 21, 1993 Sid o S. ,,'p,.&•, s:ar� Ena�r�r Re: Well Permit No. 374771, Lot 9, Martin Brothers PUD Amended, Weld Crtty. Dear Ms. Spears: On this date, Mr. Lloyd John of John's Drilling, called this office and requested permission to install perforated casings beginning at 740 feet below ground surface instead of 785 feet as required in Condition of Approval No. 5 on your permit. Mr. John was on site and was encountering a productive sand at 740 feet below ground surface. He felt this was the l3egrrudng of the Laramie -Fox Hills aquifer, which is the approved source. After reviewing his request, we felt this modification to the permit could be granted. Therefore, your pertnic has been amended accordingly. A copy is enclosed for your records. This replaces any previous copies you received, If you have any questions, please contact this office. Sincerely, !7 GYr;�.0 f f �GtcG JohnW.Bilisoly// North Region Watr Supply Branch JWB/jb Enclosure €c. Division I Mr. Lloyd John c"13 I lc- Ili 1tT' S �s Yau Sc c I A3B PROP!! RTY OWN] MAILING ADDRE HOMF. P1{ONF 3O - ¶7- 4f i4 WORKPHONE '3Da- q972, SITE ADDRESS___ .5Fjrn rO . — WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVE COUNT; GREELEY, COLORADO 80631 970-353-0635 970-356-4966 (FAX) DIRECTIONS TO SITE, E 5T 0 gam} ,- --Td Lcc�- 37 — nOl- 7G C2j.e LEGAL DES CRIPTI. Ntii T PT SEC-- TWN SUBDIVISION V) D 521 LOT CENSUS TRACT C) PARCEL NO: THIS N1IMR ERI ❑iFFERENY FROM TH L AALD'SC'RIPnOM LN 100 YEAR FLOOD PLAN? RESIDENT ACRES CALL ASSESSOR AT353-3845 EXT 3650 2 NUMBER OF PERSONS BASEMENT PLUMBING A NUMBER OF BEDROOMS BATHROOMS FULL 2- 314 112 WATER PUBLIC YIN WATER SUPPLY WATER PRIVATE YIN_Y CISTER1d Y/N WELL YINY___.__ PERMIT # NEW PERMIT REPAIR PERMIT PERC TEST 5150 5125 IF THIS IS A REPAIR PERMIT, PLEASE LIST PREVIOUS OWNERS OF THIS PROPERTY 5115 APPLICANT' / MAILING A1)I)RIE, 5 CITY SF ZIP HOM11'U()'i; t' `1 1VORK I'[1(}NI, Scanning Cover Sheet for Septic Permits Permit # FSP-9700001 Permit Type: Health I Residential! Repair Situs Street Address 17544 CLARA LEE ST Situs City, State, Zip Sec/Town/Range: 12-01 N -66W Application Status: F1naled Application Date: 0110211997 Parcel # I1z ei $ 147112403008-R0224694 Owner Full Name: MARTIN KATHLEEN A & KELLEY A Owner Address: 17544 CLARA LEE ST BRIGHTON,CO 80501 Owner Phone #: Contact Name: MARTIN KATHLEEN Contact Address: 17544 CLARA LEE BRIGHTON,CO 80601 Contact Phone# (303)857-4095 Information above has been Verified in Accela by employee noted below x July 15, 2008 Processed by: Date Report ID: EHS00024v003 Print Date -Time: 711512008 9:24 46AM Page 1 o€ 1 WELT} COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREEL,EY, CO 80631 (970)353-0635 EXT 2225 FAX (970)356-4966 Permit # : SP -9700001 Sec/Twn/Rng: 12 01 66 Status: ISSJED Permit Type : RA E P C commercial, it=residential W. REPaiI. tiauLT Applied; 01/02/1997 Parcel No: 1471 12 403008 Issued: 01/09/1997 Finaled: Location: 11544 CLARA LEE BRIGHTON COLORADO Legal D - C MP -8 TRH MARTIN RPC1.C ❑rm - kMFNnFn PLAT 17544 CLARA LEE ST WELD APPLICANT MARTIN KATHLEEN Phone: (:303)857-4095 17544 CLARA :,BE, BRIGHTON COLORADO 80601 OWNER MARTIN KATHLEEN A & KELLEY A 1.7544 CLARA LEE ST, BRIGHTON CO 80601 SEPT-INSTI, (REIN CCNSTRTTCTTON TNC P} -r r Ctio, l 9 - Qti PO BOX 301, BRIGHTON CO 80601 Description: MODULAR HOME Commercial (YEN): N Reaidential (7/N): Y Acres: S.00 Number of Persons; 2Basement Plumbing (Y/N): N Number of Bedrooms: 2 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: Perouldtion R6te: 14.0 Limiting Zone: 500 ft 0 in DesL:: GRC NDWATER Ground Slope: Dir:. Soil Suitable (Y/N): Y Engineer Design Req'd (Y/N): N In 100 Yr Flood Plain (Y/N): Minimum Installation Septic Tank; 1000 pal Absorption Trench; sq. ft. Absorption Bed: 810 sq. ft. Actual Installation Septic Tank:1000 gal Absorption Trench; -sq. ft. E,STu+.'(r Absorption Bed: �) sq. f t . NOTICE Tie iaSaonce of this permit dose not imply compliance with ether state, county or lorrai regulatory or huiloing requiremenla, nor shall it act to terrify that the subject system wt11 operate In ceInliance with appLicable state. county and local regulations adopted persuant to .Article 10, title 25, xcept [or the VuoN se of est6bht fciny final approval of installed sysceirr for issuance of d local occupancy permit Fer.ananL to CRS 1973 25-il-111 I2i 'This permit is not transferable. 'rho Weld County Health Department reserves the right to impose additional terms and conditions required to Crcei our reguiatl one on a continuing hasis. Firal permit approval was contingent upoo the final inspection of the completed system by the Weld County HealLh Oepartment- 1 VY f7jl L/t-- X r Envir,9Jltental Specialist Date WELD COUNTY HEALTH DEPARTMENT 15'17 16TH AVE COURT, GREELL'Y, CO 80611 (970) 353-0635 EXT 2225 FAX (970) 356-4966 Permit 0 : SP -9700001 Sec/Twn/Rng: 12 01 66 PERMIT Permit Type : RREP t'=commercial, R=residential . NEW, REPair, VauLT Applied: 01/02/1997 F tiCei Nu: 1471 12 4Q3OCO Expires: 12/28/1957 Location: 17S44 CLARA LEE BRIGHTON COLORADO Legal Desc; MB -8 LB MARTIN BROS POD - AMENDED PLAT 17544 CLARA LEE ST WELD APPLICANT MARTIN KATHLEEN Phone: (303)857-4095 T 7544 CTAPA T,RF, 'WPTt(ll-ETON ( nLOPAr)n Rn unl OWNER MARTIN KATHLEEN A & KELLEY A 17544 CLARA LEE ST, BRIGHTON CO 80601 SEPT-INSTL GREIN CONSTRUCTION INC Phone; €303) 559-3969 PD BOX 381, BRIGHTON CO 8060,1 Description: MODULAR HOME Commercial (Y/N}; N Residential (Y/N): Y Acres: 5.00 Number of Persons: 2 Basement Plumbing (X/N): N Number of Sedroerns: 2 Bathrooms-> Full: 2 3/4: 1/2: Water Public (Y/N): Utilit' W stcr Private (Y/fl Y Cistern Water Permit No: Percolation Rate: I'j Limiting Zone: % Ground Slope: — Dir: — Soil Suitable Engineer Design Req'd (Y/N):�1 In Name: YkCll l 1 rl itF 1 ft in Desc:_Q_ (Y/N) 100 Yr Flood Plain (Y/N): 8ron the application in[ormation supplied and the oo-site soil percolation data the fullawioq minimum installation epecificatisase are raquirtdl Septic Tank- gallons, Absorption Trench sq. ft. or 1 Ah nrnrin1Xp ;11� 3 in addition, this permit is subiect to the following additional terms and conditions: NOTICE This permit is granted temporarily ro allow can struction to commence. This permit may bu revoked Gr 4udpeoded by the Weld Cot-nty Health Department far reasons set fortis in the Weld County indi vtdual sewage disposal system regulations inc]udiny failure to meet any term or condatiun rmposed thereon during temporary or final apprc"al. The sssuance of rhie permit does no conntuture assumption by the department or its employees of liability for the failure or inadequacy uE the sewage dispofa] system This permit is not transfe.rahle. Bee€ore issuing final appr''al 01 this permit the Weld Cquuty Health Department reserves the right to impose additional rerm-v and condirions required to meet our reguiations on a con d oning hasiS, Final petmiz approval is surd ogemC upon the final inspection of the conpleted system by the weld County Health Department. Environmental Specialist Nato WELD COUNTY HEALTH DEPARTMENT (970) 353-0635 RECEIPT ***t** * * * k * * * t * * * * * # * * t * * * * * * * * k * it *k** I I * * * * * * * * * * t * * * * * t * * * * * * # * * # * * t * * Receipt Number. 97000002 Amount: 125.00 01/02/1997 11:34 01/02/97 11:35 Payment Method: CHECK Notation: 5439 Init: RBUSTILL Owner Name: MARTIN KATHLEEN A & KELLEY A Applicant Name: MARTIN KATHLEEN Permit No: SP -9700001 Parcel No: 1471 12 403008 0224694 Site Address: 17544 CLARA LEE ST MAR Location: 17544 CLARA LEE BRIGHTON' COLORADO Total Fees; 125.00 This Payment 125.00 Total ALL Pmts: 125.00 Balance: p0 Account Code Leecription Amount 256041400-9221-40D New Septic Permit .00 256041400-4221-400 Repair Septic Permit 125,00 256041400-4221-400 Vault Permit ,00 256041400-4221-400 Site Evaluation .00 256041400-4730-400 Potable Water Sample .00 ❑escription: MODULAR HOME Commercial (Y/N): N Residential (Y/N}: Y Acres: 5.00 Fumber of Persons: 2 Basement Plumbing (Y/N): N rT jmher -f Bedr 'ou 2 i at_hrnnme- ti F,_ill : 2 3/4: 1/2: Water Public {YIN)-. Utility Name: Water Private (Y/N): Y Cistern (Y/N): Well (Y/N): Y Water Permit No: NOTICE Applicant acknowledges receipt of the individual sewage disposal system guide and that the completeness of this application is conditional upon further mandatory and additional tests and reports aN may be required by the Weld County Health Department to be made and furnished by the applicant or by the Weld County health ❑eparteent_ for purpoene o€ the evaluation of the appLication. and the i5ivadte of the pernit ii Subject to such tetras and conditions as died necessary to insure compliance vith rules and regulations adopted under article 10. title 24, CRS as amended. The applicant c0rtifiaS that the proposed system will net be located within: 400 fear cf a community sewage sysren_ The undersigned hetehy certifies that all statements made, information and reports submitted herewith and required to be submitted 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 he relied on by the Weld County Health Department in evaluating the saran for purposes of issuing the permit applied for herein. I further understand that any falsification or misrepresentation ray rroeulr in the danial of the application or revncatien of any permit grantsd Caned tmpnn came npplicari.on and in legal artien for perjury as provided by law. _ __ _ - - - -- - Q ' 97 OWN R/APPL CANT Date lC:II Is,'',I I.l),I Ji:i.'riI i:ll,tr;l (. !'Il::ii1. :r:;1I:!'I e l:E11I T Ilu, I) i f llII I I' I It_ r='1[ f Ii IL III'i ,I' , I'II:I•I I III: (J rlL�Ik.IF I s II_FJ1`r r:1T}X.I .I , ' •''.•T' h.1L'Ir J ;. 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I 'r I_I-UI, -Ii.::. 91:1,". )., ;)r,, I u1 1k r!d I'!,ill-' iTh ' 1) Xr (:1.1TL.r1i` firiI.,.:r,la I •' I>,', II k I- r 1 i, '1 :`; I !IJL I a 4 l II : l: i:; it", I,JI •_11:: l?r`e 'f iE:: Ijlin.1h111!,-;^,J:>I"J-!r:rli•iI :, t r1J-'i Ir1(i-i.1? 1111, 111.1' J: J I •':i 11,11 . 11.3.-i t'✓ 5� Willie COLORADO RE'. UrST TO REVIEW FILES DEPARTMENT OF HEALTH 1517 - 16 AVENUE COURT GRREELEY, CCLGRAGO E0631 ADMINISTRATION (303) 353-0586 HEALTH PROTECTION ()03► 353-0835 COMMUNITY HEALTH (303► 3530639 NAME;' liV t J -COMPANY: L aLIL ADDRESS; E 57-L -7Z MAILING ADDRESS: c 1! 4 PHONE NUHBER ; D O FILES REQUESTED: REASON FOR REQUEST: r� GS. �7/°Trr l�11 5 /'�.��f� �� clf 1/ c. /1• a. 1 tit / There is a $15.00 minimum charge for all file requestslaudits, additional time is charged at $15.00 per hour, all copies are .10 each. Payment in full will be remi ttPri at the Pnd of the regi e t laird i t . FLEA SF' - Do N(1T RF.MnVR AV CORRESPONDENCE or CHANGE THE ORDER OF THE CORRESPONDENCE in the file. If you would like copies, stickies will be pr vided for you to flag the correspondence. The copies will be made by the folio 1 Friday, and mailed to you. Signature• Date• Approved by:(_� f/_,% Date' Diri tQ]Env' nrnental Protection Services Time Start: Time End: ($15.00 minimum - $15.0O1hr thereafter) Copies; Copies: (-TO_Cents per page)_ Time;,._-_ - TOTAL: Weld County Treasurer Statement of Taxes Due rlxnunt t[ernhcr It022-16') I I'ura•1 4.1-1121 . 14)5 Dili -5 1 S �r1K I IN IOU". 1'! 1)- V.11 ki)I 1) 1'1 11 175.41 t.l 11 :1 I I I SI \9-F LI) Account- R02246i94 MCGOW'AN MICHAEL CI I75 l4 CI •ARA LEE ST URICI-I [ON. CO BOG1i3.9579 Ytal iu 1rlJti.rincrn, ul.rc,1 I c:. ! 11Ir!clIE, I1Janc_' 1_i 4 I;nrec 2!121, 5Q74 14 511 )11) y[I Ip1 41).) I t`1,487 62) I:»1.h,uxc- Fl;'. I l all Uur a, 'ni 11 ;'; i !'117 ] Scenr:d 114.1 1)uc I.II Ii'. 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Weld County Treasurer's Office 1400 N 17'11 Avenue PO Box 458 Greeley, CO 8D632 Phone 97C-400-3290 Pursuant to the Weld County Subdivision Ordinance, the attached Statement of Taxes Due issued by the Weld County Treasurer, are evidence of the status as of this date of all property taxes. special assessments, and prior tax liens attached to this account Current year's taxes are due but not delinquent. Signed: ' - Date: COLORADO yyEiLpERMffNUMBER 20351D Division of Water Resources RECEIPT NUMBER 0415026 ORIGINAL PERMIT APPLICANTf5i APPRQYE0 WELL LOCATIOI! NORMAN A PETERSEN Water Division: I Water District, 2 Designated Basin: NA Management District: NIA County: WELD Parcel Name: MARTIN BROTHERS PUD Lot: 9 Block: Filing: Physical Andress: 17543 CLARA LEE STREET BRIGHTON. CO 80603 NW 1'4 SE 1.4 Section 12 Township 1.0 N Range 660W Sixth PM VT/ CQORDf$ATE5(Meters, bong; -1.3. NAPS 3I Eastrng: 523472.3 Northing: 4434975.6 fee the original well permit file for permit conditions of approval and additional details The original permit file can 6e viewex 'sing the Well Permit Search Tool at www.water.state,co.us Date Issued: 6/1811497 Expiration Date: 6/18i199 1551Jf'� t1V 09-25-2019 CHANGE IN OWNER NAME -MAILING ADDRESS. CHANGED TO JOSE F GRADO CASTILLO Printed 11-06.20111 For questions aboiJt this permit calf 393.E66, 3581 of 90 to w, ww water.stale.co.us Page 1 or 1 e Scanning Cover Sheet for Septic Permits Permit # SP -9700211 1 Permit Type: HeaEth 1 Residential I New Situs Street Address 17543 CLARA LEE ST Situs City, State, Zip SeclTownlRange: Parcel # (12 digits) Owner Full Name Owner Address: Contact Name: Contact Address: 12-01 N -66W 147112403009-R0224794 PETERSON NORM 3878 GRANDVIEW PLACE THOMSON,IL 61285 GREIN CONSTRUCTION PO BOX 381 B RIGH TON, C O,80601 Application Status: Finaled Application Date: 05112)1997 Owner Phone #: 800,621 6676 Contact Phone# Information above has been Verified in Accela by emplo ey e noted below x July 10, 2008 Pro ssed 5y Date Report ID: EHS00024v003 Print Date -Time: 711012008 10, 35:45AM Page I of 1 a WELD COtMTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970)353-0535 EXT 2225 FAX (970)356-4966 Perini.t- # SP -9700211 Sec/Twn/Rng: Status: - S IIE,II. Permit Type: KNEW c=coimrerrial, R=residential NEW FEPair, VniiLT Applied: 05/12/1997 Parcel No: 1471 12 Issued;_*05/l5/1997 4 Lk(- Finaled: 1 04 1997 Location: E TC1 WC 371 6 Legal pest: APPLICANT GREIN CONSTRUCTION PO BOX 381, BRIGHTON, CO 80601 OWNER PETERSON NORM Phone; 800 621E, 6676 3878 GRANDVIEW_ PLACE, THOMSON IL, 61285 SEPT-INSTL GREIN CONSTRUCTION INC Phone: (303) 659-3965 PO BOX 381, BRIGHTON CO 80601 Description: F4OCTSE 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 -7 Full: 1 3/4: 1 1/2: Water Public (Y/N: Utility Name: Water Private (Y/N): Y Cistern {Y/N7: Well(Y/N): Y Water Permit No: Percolation Rate: 4.7 Limiting Zone: 08 ft 00 in Desc. WATER % Ground Slope: 2 Dir: E Soil Suitable (Y/N): Y Engineer Design Req'd (Y/N): N In 100 Yr Flood Plain (Y/N): N Minimum Installation Septic Tank: 1000 gal. Absorption Trench: 435 sq. ft. Absorption Bed: 570 sq. ft, Actual Installation Septic Tank: + gal Absorption Trench: sq. ft. Absorption Bed: [.Z sq. ft. NOTICE The I, macone_ of thin permit doer nnt. imply compliance with r.her stare, county or local regulatory or building requiremeiiLi, nor shall it act m eerri€y that the subject system will operate in cc ::pl. iarce with applicable state, touns:v anri local regulations adopted persuant to Article id, Title 25, CRS as ane±odad, except for the paapesc of nmtabliahing final approval of installed system for is subnce of a local. ocuupdrlcy permit persuant Lo CPS 1973 li-LO-111 12) This permit is not rransfarabls_ The Waid County Woalrn ileparrnert reserves the right tc imcose ridditsonal terms and conditions required to eleee ovr repnlar-irn, on a ennrinuinq hs_stt. L'inAL petrr r approval was east ingenr upon, t ml final ,nmoeccaor. St the completed system by the Weld County Health Department Environmental Specialist Dat WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREEL,EY, Co 80631 (970) 353-0635 EXT 2225 FAX (970) 356-4966 Permit # ; SP -9700211 Sec/Twn/Rng: PERMIT Permit Type : RNEW c=cammer vial, R-residenttai NEW, REPaix, VauLT Applied: 05/12/1997 Parcel No: 1471 12 Expires: 05/07/1998 Location: HIWAY 52 E TO WCR 37 SOUTH TO CLARA LEE W TO SITE 12-1-66 Legal Desc: APPLICANT GREIN CONSTRUCTION PO BOX 381, BRIGHTON, CO 80601 OWNER PETERSON NORM Phone: 800.621.6676 3879 GRANDVIEW PLACE, THOMSON IL, 61285 Description: HOUSE Commercial (Y/N): N Residential (Y/N): Y Acres: 5.00 Number of Peron: 2 8asemellt Plumbing (YIN) : Y Number of Bedrooms: 3 Bathrooms-> Full: 1 3/4: 1 1/2: Water Public (Y/N): Utility Name: Water Private (Y/N): Y Cistern (Y/N): Well(Y/N): Y Water Permit No: Percolation Rate: Limiting Zone: .5 ft _ in Desc s Ground Slope: Dir: jj Soil Suitable (YIN) : - Engineer Design Req'd (Y/N): h In 100 Yr Flood Plain (Y/N): FTci the applfcatlam Intorapatice sWPP114d and M4 9A -site Poi•1 Pert9l;tisa data tl €ollatfng mfetlmum fiaatal1a419R 9P6cl ieatioAW era requlcod. Septic Tank: gallons, Absorption Trench sq. ft. or Absorption Bed sq, ft. In addition, this permit is subject to the following additional terms and conditions: 1��ig IT 1ixmcisPF.l. NOTICE This permit is granted temporarily to el1or Construction to commnnenec. This permit may be revoked or suspended by the weld County health Department for reasons net forth in the Weld County individual sewage disposal system regulations Including tailure to meet any term or condition imp¢sed thereon during temporary oT final approval. The i@ivanee of this permit does riot eonatrtute aaaurr tion by the department or its 6mpluyvea uL liability for the ₹allure or inadequacy of the sewage diapasai ayetem. This permit is not transferable. efore issuing final approval of this permit the Weld County Health Department reserves the eight to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval in contingent upon the final inapectian of the rampleted system by the Head County Health Department. x -f Envikonthe&a1 Specialist Date WELD cINTY HEALTH DEPARTMENT ENVIRONMENTAL PROTECTION SERVICES SITE EVALUATION OWNER: APPLICATION NO.: "#c SITE: �7 ❑ F C �� r. PT x,-1 s T_ R C DATE: SUBDIVISION:li.+Sa LT BLK FLG PERCOLATION TEST DATA : Start Time; ilt' Hole No, Hole Depth H2O Remain i laU C5 Mn. 115� 'S min. ilk 1 min. 12-�S is min. min. min. min. min. min. min. TIT I Zc col LofO SE.cD..IdI o -'5 r o `3 4s. S Sa 2 1 I i r qa as cr a o 3 C (4` 5 X05 Ida ^iD Co 4o rS X15 5s Ito 90 1r- s}+ _ S,I.r u.i 5c U 5 cf Lf t!5 5 c Spy Srao 1 a 6 ' (7 �a P T O All measurements in .mm unless otherwise indicated. * - Add H2O Total Environmental SperialistQ Average Rate' PLOT PLAN SOIL PROFILE c I U WELD COUNTY HEALTH DEPARTMENT (970) 353-0635 RECEIPT Receipt Number: 97000991 Amount: 265.00 05/12/1997 11:19 Payment Method: CHCK Notation: #2168 Init: VHAMILTO Owner Name: PETERSON NORM Applicant Name: GREIN CONSTRUCTION Permit No: SP -9700211 Parcel No: 1471 12 Site Address: Location; HIWAY 52 E TO WCR 37 SOUTH TO CLARA LEE W TO SITE -12-1-66 Total Fees: 265.00 This Payment 265.00 Total ALL Pmts: 255.00 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-> Pull: 1 3/4: 1 1/2; Water Public (Y/N}: Utility Name: Water Private (Y/N). Y Cistern (Y/N: We11(Y/N); Y Water Permit No; NOTICE Applicant ecknewledgee receipt of the lndividuaL sewage dispoael system guide and that the completeaeae of thin application Is conditional upon further mandatory and additional tests and reports as may be required by the weld County Health Department to be made and €uenished by the applicant or by the Weld County Health Department for purpoaea of the evaluation of the application: and the issuance of the permit is auCjeet to such terms and conditions ae deemed necessary to inure co[epliancc with rules and regulations adopted under article 10, brie 25, CRS as amended. The applicant certifies that the propoeed system will not be located within 400 feet of a community sewage system, The undersigned hereby certifies that all statements made, information and reports submitted herewith and required to be submitted by the applicant are, or will be, represented to be true and correct to the bent of my knowledge and belief, and are designed to be relied on by the Weld County Health Department in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any fa laificatien or miarepresrn tat iotr may result in the denial of the appl Lcation or revocation o€ any permit granted based upon said application and in legal action for perjury as provided by law xj z- `?? OWNER APPLICANT Date WELD COUNTY HEALTH DEPARTMENT 1517 I6TI-I AVENUE COURT, GREELEY, COLORADO 80631 (970) 353-0635 OWNER MAILING r� _ ADDRESS _17 G,§- a r F"-. CITY a4 ST 1-I- ZIP 6 I PHONE D U— z - 6 6 7± SITE ADDRESSL/Ji T DIRECTIONS TO SITE. t1," G�a�., S-2- U-' c 7 CImo_ L � CL LEGAL DESCRIPTION PT 4 T SEC .I --TWN RNG C ACRES SUBDIVISION LOT BLOCK FILING PARCEL NO: CALL ASSESSOR AT 353-3845 EXT 3650 (THIS NUMBER IS DIFFERENT FROM THE LEGAL DESCRIPTION.) NEW PERC TEST_>REPAIR IF REPAIR, PLEASE LIST PREVIOUS OWNERS S150 $115 $125 APPLICANT GREIN 00N,Tllrrmp.. ... _ MAILING BR1GHTO °. Box 381 ADDRESS cO!_ORADO 80601 PHONE NO:- --- RESIDENTIAL COMMERCIAL DESCRIPTION (ex. Haase. M.I-I., Shop) . -5 NUMBER OF PERSONS BASEMENT PLUMBING -.— NUMBER OF BEDROOMS - BATHROOMS FULL + 3/4 1 1/2 WATER PUBLIC (YIN)� UTILITY NAME WATER PRIVATEON)—y CISTERN (YIN) WELL G/N) PERMIT NO: Weld County Treasurer Statement of Taxes Due •\2c 11rrl tiuITthcr Ii17217)i I -f'. I lrll11111e1 Lcgal UescripLlon >>IU. w11§1)IOSI;0111,liiii1i I"1l)-,\ LI2I)II)11.yI I' 1_1(I•1FL1ILi "I tAII€i AcctlLfnt; R0224794 CAS TILLC7 Jost: I: (GRAL](.) I7�43 CLARA LI0i S1 BRLG] lTON, CO 80603.9597 led, ra ICs I'j it,cf, l, lrI[rLC _21)?ll $?413f) -h— -- S0SIU --� --- — 1)1 I) $Il IL fl IS I.LIIi, 21) Sl,Ilf1`.2 Cnhd 1i' L. har��r ti l rnr _' E I irst I IalI Uur ati,Ii 1)3.31 �2+121 cII ILiI Scc,mu I [CI]: I ) kk :I,, u1 111. i L I ax Billed al ?11211 Rates Ili I a3 lane 3hsh ,hsh \iV1 d1'il} till" Irt'ti' 111 iI I 1 o-lliri 1clUnl N —C —'d 1 Lr11 LlilI-Y I` It'N'Id IJi)* titi:'7 7; SIM 11 I 1 •41I R1 - - 51411"11 5111•Ijil SL Hill IL CIS' rzI S Is,iii iu)+ 51if,� sy atil) I,ti nt 11 L >I i 114A1)L) 111 1 I It 1 I IIII!HI w4 I -M l S- -S S3h 1.1'-I iL-ClL k rtfl'I:I 11'1'"1 I I_I `. r It �il LI II 111�.AHl ) I1,'i I I It 7 H' I 11111111 5,' !I I Iota! 5111_2-114; 515S') til •I11) I It I l l IpEI D" l llil 2ri7unun I C)R1 tll'11ILIIR1 IISCI'l721122 I}1"'11111ai1 1)2 Ha II V S II III tR I (ii I I -1 i n '+IHIIILIY+I 522.5 I') IIIIIII I..AIt- I IIaI Sltl' i 1YI1g11"I $11I If, I ise. ;tillc,l 2121 y2 .111e14? Weld County Treasurer's Office 1400 N 171" Avenue PO Box 458 Greeley, CO 80632 Ptlone:970-400-3290 Pursuant to the Weld County Subdivision Ordinance, the attached Statement of Taxes Due issued by the Weld County Treasurer, are evidence cf the status as of this date of all property taxes; special assessments, and prior tax liens attached to this account. Current year's taxes are due but not delinquent. Signed: Date: :.ATM rNO. aWF11 — STATE OF COLORADO OFFICE OF THE STATE ENGINEER For Ot1iw urr arW /� �. IV 7 1i� ill CwmnnW bldg., 13t3 Sho msn . Dwh., Colorado- i3 PI IO TO COM t flNG FO. WE 1R1IC11ONS ON REVE SIDE ill 10 CHANGE IN OWNERSHIP/ADDRESS / LOCATION WELL PZSMIT. LNESTOCI( TAN( OR EROSION CONTROL DAM � 1. NEW _WNER J NAME(S) •p VIA 13, k�LIS ,,, �i ) IL l MelunQ Address...�..�. -.►`. ` ._�._A 1l .i......)..E.... ._ ........_ _ City. St. ZiP _. .a ff H..'C.. S..v ( ....._.. Po. {„ , . ) .............5 l R 2. THIS CHANGE IS FQR QNE OF THE FOLLOWING: 1 75 9 5 WELL PERMIT NUMBER ❑ LIVESTOCK WATER TANK NUMBER ...................._ ......................... ❑ EROSION CONTROL CAM NUMBER 3. WELL LQCATIQN: COUNTY _ W EJ -D . OWNE 'S WELL DESIGNATION DAB/D f. i- 1 7S 83 . L..Ak A Z FE sr f3.j i e/TO )J . G a d� 114, Sec, .. 1.... Twp,............. j� 4. _! E. a © w. ............ P.M. Cistances Cram Section Lines..... Ft. from ❑ N. ar © S. Line, .. era. a ._ F1. from ® E.. ❑ W tJno. SubdIviston.. r_7... . ... ...... GD.a#4d Lot ....,J O....... Block ................ Flling (Uni}................. 4. U TQCK TANI' OR EROSIOy,CON*RCL QAM LOCAMON: COUNTY .................................................................. 1S.c TwP. ❑ N. er 1.�C S., Rsnpt} . LJ E. ar ❑ W. ... P.M. 5. The above listed awnar(a} says) that he ( 4y) awn tflw ltttu[dume dsecrlbed herein. The exiting record Is being amended for the tallawl{tg raeeon(s Chartga in name at owner, ❑ Change In mewing addreas. ❑ Corraaion of Iocmian. 6. 1 (we) have lead the statements mica hentn, know the torrents thered, end state tiler they are true to my (our) knowledge• (Pursuant to Section 24-4-104 (13)(e) C.R.S.. the making of tit statements oro&umm ptlury In the sewed degree end Is punishable as a dies 1 rnladim. ) Nbma Rlllo {Please type or pm) Signet Dale aQ"Id ?. EI .i Irc L, Errs !/� FO FICE E ONLY ALXE nM AS A 04A)M ICY OWNML%W R MAI LM ADDIIEF . DEC 191994 s ev Court Cass NO. fliv. Co. WD Basin r MD_ Lisr____ INSTRUCTIONS CHANGE OWNERSHIP -ADDRESS LOCATION CORREC11ON FORM JL(LY 1993 NO FEE IS REQUIRED The form must be typewritten or printed In BLACK Initial and date any changes you make on the form. THIS FORM MAY BE REPRODUCED BY PHOTOCOPYING OR WORD PROCESSING MEANS. INCOMPLETE FORMS WILL BE RETURNED. ATTACH ADDITIONAL SHEETS IF MORE SPACE IS NEEDED. 1. Print the new o veers name and include the mailing address and phone number. 2. Indicate If the change in ownershlpfaddress is for a well permit, livestock water tank or erosion corwtrol dam. Be sure tQjcIuda the pr0p5r permit. tanic QLdartLrIMm.kr. 3. Complete the well location Information- lithe address of the well location is different than the mailing address of the owner, include the address where the well is located. If the owner has more than one well, provide well name or number as designated by the owner; i.e. North Well, The actual well location must Include %, V4, 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 r/4, Section, Township, Range and P.M. Check the appropriate boxes for North or South and East or West directions. 5. Check the season{s} for submitting the form, whether it is a change In ownershipfaddress eradfot location correction. 6. The owner of the structure must sign. Print or type your name In the first block If his different from Item No. 1. It signing as * raprsserflath. of a mparry 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 sing la -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, 1 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 ooncemir Livestock Water Tanks mind Erosion Control Danis should be submitted an the standard Permit Application form and be accompanied by a $15.00 filing fee. it you have questions, contact the Denver or the Division Office where your well is located. DIVISION 1 DIVISION 2 DIVMION 3 DIVISION 4 209 ARLX BUILDING 219W. 5TH RM. 2S3 , , - 422 4Th ST.` ` , ,• ., ;.1 E. NIAGARA 800 8TH AVE. PUEBLO, CO. 81003 "OSA, CO (f11"G1 MONTROSE, CO. 81402 GREELEY, CO 80631 (719) 642-3368 (719) 589.6683 (303) 249-8622 (303) 352-8712 DIVISION 5 DMSIDN 6 DIVISION 7 DENVER OFFICE 50633 US HWY 6 & 24 : 320 LINCOLN AVE. STE- E 1474 MAIN ST. RM.' ti. . GLNWtJ SPOS. CO. Simi STMBT SPGS., CO, 80477 DURANGO, CO. 81302 1313 SHI`RMAN ST. (303) 945-5865 ) 079-Ui272 (303) 247.1845 D€NVER, CO. 80203 (30:3) 868-3581 FOR' >to. / PUMP INSTALLATION AND TEST REPORT F« onto. U.* ony t1/90 RECEIVED ttI90 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 1, WELL PERMfT NUMBER I575 UCII I N 2. OWNER NAME(S) Mailing Address r STAT. : r City, St. Zip PhOno i 1 3. WELkLOCAT1ON AS DRILLED 1/4 5114, Sec.!i Twp.1 , Range. --64a G)__ DISTANCES FPOM SEC, UNES; 14IQ_ h. from 3 Sec, line. and F. from 1 Sec. line_ *bs+l+ a t w vow SUBDIVISION: LOT O BLOCK FILING(UNlT),,,,� STREET ADDRESS AT WELL LOCATION: 3 0 tD 4. PUMP DATA; Type z b e C5• b Ise Inslallatlon Completed T Pump Manufacturer ca z zr Pump Model No. 4'/O3/ -S& Design GPM ) at RPM HP Volts C , Full Load Amps Pump Intake Depth Feet, DroplColumn Pipe Size Inches, Knd ADOrnONAI,INFORMATION EQRi PUMPS GREATER THAT j54 GPM, TURBINE DRIVER TYPE: ❑ Elettilo ❑ Engine ❑ Other Design Head feet, Number of Stages, Shaft size inches. 5. OTHER EQUIPMENT; 1 Airline instalIad El Yes No Orlflca Depth ft. , Monitor Tube rnstalled El Yea.No. Depth ft.________ Flow Meter Mfg. �-t Meter SerIal No. Meter Readout ❑ Gallons, Thousand Gallons, t-1 Acre feet, O Beginning Reading B. TEST DATA; ❑ Check box if Test data is submitted on Supplemental Form. Date - y � Taal Wall Depth ± 77me Static Level 3 `I Rate (GPM) _ Date Measured Pumping Lvt. U 7, 01SINFECTI0N: Type --- /L771 ('iQL Amt Used/ 8. Water Quality analysis available, ❑ Yes ® No 9, Remarks 0. I have read the statements made herein and know the cornern9 thereof, and that they era true to my knowledg [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 5paiitci .S0-rtvtce Inc. Phone ( O 659--1584 Uc.No.?/5 Mailing Address 2 F t, to t ore o. 062 f Narne[fltle (Please type or print) Signature ,� a�r Date il Turn U. .Spa.n ltnenr_dt.nt ��vy l � ► 72ioL. I4II� Fenn *0, v WELL CONSTRUC11ON AND TEST REPORT for onle. U" 0&1 rvs-3t STATE OF COLORADO, OFFICE OF THE STATE ENGINEER EEIYCV (1/tit? 1. WELL PERMff NUMBER 1.75652 0 9 S4 2. OWNER NAMES} _ ave & Julie Ellis 0 Mailing Address h Avenue y�Apg _ City, St. Zip Westmins.terCo, 8.0021_. xE Phone ( ani ) 4�[3.-i259 3. DISTANCES LOCATION A DRILLED: NW 1/4 Sir 1/4, Sec, 12 Twp. 1. N Range 6 6 W `2 fL from SECS UNE$: Sea line, and 2240 it E Sec, line. OF{ 9r sou ra.e ar SUBDMSION: Martin Bros POD Amended - LOT 14 BLOCK F1UdG(UNIT) STREET ADDRESS AT WELL LOCATION: 4. GROUND SURFACE ELEVATION ft 13RILUNG METOD , Rotary DATE COMPLETED 2-28-94 TOTAL DEPTH 980 ft. DEPTH COMP TED : 0 5. GEOLOGIC LOG e. HOLE DIAM. (in.) From (ft) To (ft) p tiwotpd.n ar t,(.a.rw frYMo., Golor, W. L-i) 8 3/4 0 29 0-20 !Br¢rwn sand 6 114 2 -27 Sandstone 1eoges 77 -Brown C av avers _Blue snare 5Kn-7fin 1i1„o Qhalpflnvibr& nffrrnal 160-470 Foshill sands Water i -4Rn P41ne s,hi' REMARKS: Chloride a e e . T_ PLAIN CASINO `QD (in} )Qnd Wall Size From(ft) To(ft) f, 9 1/2 Step1 w 58 ` 80 41f� Steel PERF. CASING: Screen Slot Size:/_16" ut s 4 1j 2 Steel .188 & FILTER PACK I 9. PACKER PLACEMENT: Msterlal NIP.Hal iburtan Size A%'Qt--Pte t -e d Interval [nth 780' 10. GROUTING RECORD: Material Amount Density Interval Placement 'ement 514.80 7gal/ 0-780 Pump - - It DISINFECTION; Type Granular Chlorine ArM 11sed3 Cups dissolved in 5 ga1Idji1 r —it. poure roug 2 EILI II QIA' ' U Check box if Test Data is submitted on Supplemental Form. With air. TESTING MEI1-oo Aix Static Level _15 Q_ ft Dater lime measured 2- Prn , Production Rate 20 •gpm, Pumping levAetting_ft Date{Time measured , Test length (}ems . 1 h.w. read 0 d. hardn and (Glow ION 901ftnd me". WId VW OW ., m.. Io Rhy +'W9a. 1P'ua' m Sscd c 2+-4-104 (133(9) QFLS.. tlN maid, d I.I.. d. amarnIw.in Qanv Ww rl�yy h tlra s.o_d dagra. end Y punWu" a. a dear I mbdwroe er,j CONTRACTOR John s grilling Inc. Phone ( 303) 423-5245 Lic. No.827 MallingAddress ox Name/Title (Please type or print) Signature Date Lloyd John Owner/President 3-7-91 5 i C lC 1' OR WELL C0NSTRUC 1 X41 I AND TEST REPORT The report must be typed or printed In BLACK iNK All changes on the form must be initialed and dated. Attacn- additional sheets it more space is required. 'Each additional sheet rout be Identified at the tap by the well owner's name, the permit number, form name/number and a sequential page number. Report depths In feet below ground surface. This form may be reproduced by photocopy methods, or by computer generation with prior approval by the State Engineer. The original and one copy d this forth must be submitted to the State Engineer's Office within 60 days after completing the well or 7'days after the perm a $-anion date, whichever is eatiier. Another copy of the form must be provided to,the well owner. 1. Complete the Well Permit Number In full Z Fill In Name and Mailing Address of Welt 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. OO NOT USE THE OWNER l}PPUED LOGA'T1QN! unless a survey has been provided. For wells located In subdivisions thg lot, block and subdivision information roust also be provkted. 4. Report the ground surface elevation In feet above sea level If available, This value may be obtained from a topographic map. Describe Me drilling method used to constni t 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 descriptforl of materials. Examples of descriptive terms Include: Grain size—Ooulders, gravel, sand, silt, clay. Hatdness—laose, soft, tight, hard, very hard. Color —All materials, Most critical In sedimentary rock. Depth when water Is encountered (II 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 (gravel) pack and the interval where placed. 9. Indicate the type ant} setting depth for any packers installed. 10. The density or 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.a, tremie pipe or posNe 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 compiled with the provisions of the rules. If a test was not performed explain when it will be done, N available, report clock time when measurements were taken, 13, Fill In Company Name and Address d Conf actorwho constructed the well, The report must be signed by the licensed contractor responsible foe; the construction of the well. Form No. OFFICE OF THE STATE ENGINEER GWS-2S COLORADO DIVISION OF WATER RESOURCES 818 Gnt.nnial Bldg., 1313 8hermon St, D.nv.r, Cdtorsdo b0Q03 WM we -.3581 827 APPLICANT DAVID & JULIE ELLS 9616 W 106TH AVE WESTMINSTER CO 80021 (303) 460-1259 PERMIT TO CONSTRUCT A WELL WELL PERMIT NUMBER 1 : -- DIV. 1 CNTY. 62 WD 2 DES. BASIN MD Lot: 10 Block. Filing: Subdhr MAFMN BF1OS PUD AMENDED APPROVED WELL LOCATION WELD COUNTY NW 1/4 SE 114 Section 12 Twp 1 N RANGE 66 W 6th P.M. DISTAMCS FROM N LINES 2240 Ft. from South Section tine 2240 Ft. from East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT GONDITION8 OF APPf�OVPd. 1) This well shall be used In such a way as to cause no material injury to existing water rights. The issuance of the permit does not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested water right from seeking relief In a civil court action. 2) The construction of this well shall be in compliance with the Water Well Construction and Pump Installation Rules 2 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 OHS 37-Y2-002(3)(b)(i) and policy of the State Engineer under the following conditions. 4) The use of ground water from this well is limited to ordinary household purposes inside one single family dwelling, the watering of the user's noncommercial domestic animals, and the irrigation of not more than 12,000 square feet of horns 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 Hliis aquifer which corresponds to the interval between 775 feet and 1,070 feet below ground surface. Plain casing shall be installed and peeled to prevent production from other zones. 8) The maximum pumping rate shall not exceed 15 (3PM. 7) The annual amount of ground water to be withdrawn shall not exceed 1.1 acre-feet 8) This well shall be constructed not more than 200 feet from the location specified on this permit. Note: To insure a maximum productive life of this well, perforated casing should be set through the entire producing interval of the approved x0ne or aquifer Indicated above., /, / 94'3 APPROVED DWR No. 0383481 L. DATE ISSUED J 10 )99# RATION DATE 1 0 1996 I1 r�+ 1PR1S•Rnr. 76 COLORADO DIVISION OF WATER RESOURCES RECEIVED 818 Centennial Bldg.. 1313 Sherman St., Denver. Colorado 80203 W 2 093 PERMIT APPLICATION FORM Application must 1NATEft AESOij STATEENG:EFr be complete where! A PERMIT TO USE GROUND WATER ^r+rn applicable. Type or I/7 PERMIT TO CONSTRUCT A WELL print in BLACK FOR: IA PERMIT TO INSTALL A PUMP > INK. No overstrikes or erasures unless I I REPLACEMENT FOR NO. initialed. I I OTHER WATER COURT CASE NO_______________ (1) APPLICANT • mailing address NAME= NY -0ZA - .iJr,E /r STREET jOb' ,re. CITY W tr"^sf[r ?'662f Isutei IZ1p) TELEPHONE NO. 46ar (2) CAIION OF PR0POSEp ELL _'l. of the n '4 Section t L Twp. Y Fling. 1 -I. P.M IN.SI 4t'wl (3) WATER USE AND WELL DATA Proposed ntaximurn pumping rate (gpm) I 'T Average annual amount of ground water / to be appropriated lacre-feet): f ' Number of acre% to be irrigated: _ Ot) 5c. Proposed total depth Ifeet): — Aquiler ground water is to be obtained from: L.�t s~,irtA f:(/ Dwner's well designation GROUND WATER TO DE USED FOR: ( i HOUSEHOLD USE ONLY • no irrigation (0) Xj DOMESTIC (1) ( I INDUSTRIAL IS) I ) LIVESTOCK (21 ( ) IRRIGATION I6) 1 I COMMERCIAL )41 1 ) MUNICIPAL ($I I OTHER (9) DETAIL THE USE ON BACK IN (11) (4) DRILLER Name Street pi^b( 1 `. I t3 4 ','o City aka - r lever tIDO5 Telephone No. Y -Z3 -a- , Lic. N. I FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN J /'D 5dJ cJrefA.. Receipt No. 3Y ! /-J s �3$rCiahm/t4_ ti,f..-ra Oaf— Icl�l Basin F'la++ed a.Pf.,� Dist. _ •.••k- i I"I'am rr t.. fr►E ` F! f�oY CONDITIONS OF Ak y This well shall be used in such a way as to cause no material injury to existing water rights. The issuar1ce of the permit does not assure the applicant af�/ that no injury will occur to another vested water 7 right or preclude another owner of a vested water right from seeking relief in a Civil court action. - 1. 13fas# Copy Avatlab(e APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION DATE BY I'D. (STATE ENGINEER) COUNTY a 15) 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 11 section, 640 acres) for the well location. ;4- 1 MILE. 5280 FEET t 4- + - + + + + I I � — NORTH SECTION LINE NORTH +ai I4 z I a 'f— V I tu- I -+-t-+- I I I L - -I SOUTH SECTION LINE + + + - + 4 I ± The scale of €he diagram is 2 inches = 1 mile Each small square represertts 40 acres. WATCR EQUIVALENTS TABLE iRaunded Figural) An acre -took covers 1 acre of land 1 Foul deep I pubic root per second Icfsl . . 449 gallons per minute tgpmi A family of 5 w,II regiire apprS-metely 1 acre -fool 01 water per year. 1 acre foot - d3.560 cubit feet ... 325.900 gahloes. 1,[)94 gpm pWrid cont.nuoualy for one day p+educes 4.42 acro- Feet (10) LAND QN WHICHC Ownerisl: _ Jt� E// Legal descriplion, •7 /L) (6) THE WELL MUST BE LOCATED BELOW by distances from section lines, f€- from 5 sec, line (north or south} ft. from _-- - sec. line feast Sr wall LOT_LO0LOCK —FILIN�Gj • h SUBDIVISION /!!' Qt8ro3 • Pall 1�w.,.r.,frt {7) TRACT ON WHICH WELL WILL BE LOCATED Owner. W:ci E/'; N. of acres Will this be the only well on this tract? T'¢5 (B) PROPOSED CASING PROGRAM Plain Casing ry in_ from ft- to 4 a ft- Z in.from 5a tt. Perfortd casing in. from _ ft. to_?'50 ft. in, from _______ fi to ft. (91 FOR REPLACEMENT WELLSgivedistance and direction from old well and plans for plugging No of acres (11) DETAILED DESCRIPTION 01 the use of ground water- Household use and domestic wells must indicate type of disposal system to be used. 'b'15 dry--, l rrt 5%r� -.s f�r sew 4- f,',,erl�� , a1 4 c (12) QIlFF1 WALTER RIGHTS used on this and inctuding wells. Give Registration and Water Court Case t'}ulnbers, Type or right Used for (purpose( Description of land on which used (13) THE A LICANT(SI STATE{S{ THAT THE INFORMATION SET FORTH HEREON IS TRUE ro THE BEST OF HIS KNOWLEDGE. \t JA Lii 12 /&/9 f'i,A/ I SICNA Miff AE A Use additional sheets of raper if more space is required. E11ENPr 'JELL DATA SHEET - DENVER BASIN, COLORADO APPLICANT: ELLIS RECEIPT N0. 353441 LOCATION: NW1/4 OF SE1'4 OF SEC. 12, 1.1N., R.66I. {2240 SSL, 2240 ESL) PROPOSED AQUIFER: SURFACE ELEVATION: 5045 NUMBER OF ACRES IN TRACT: 5 ........... -- --------- IS PROPERTY UITNIN SERVICE DJJM0ARIES OF MUNICIPALITY S.B_5 CONSENT MAPS? NQ YES_ iF SUBDIVISION 15 UNDER AUGHIENTATION PLAN, CASE NO. IS , DIY. IF SUBDIVISION WAS RECOMMENOfO FOR APPROVAL BY THE SLATER MANAGEMENT BRANCH, DATE OF LETTER IS INFORMATION ON SURBIVISION OR TRACT Of LAND/SPECIAL RESTRICTIONS: evaluated by d5G on DECEMBER 28, 1443 ELEVATION DEPTH TO ANNUAL ------------ NET --------------- APPROP STATUS AOEIiFFA BUT. TOP SAND MDT- TOP AF UPPER DAWSON .... .... --- L0f$R DAWSON .... ---- .... DENVER .... .... .... .... .... UPPER ARAPAHOE ... LONER APANO 4700 4939 160 3+ 0,650 NT ILL 3974 4271 157 1.170 NT note_ C indicares location is at aquifer boundary and values may be more approximate. ° Trdicates The proposed aquifer. All values ere interpolated frc the 5.6.5 data be easahbted in November of 1486. Permit Number 175652 - Permit Category Residential Permit Status Well Constructed Receipt 0363491 WDID +— Leaflet C 6een3-recih72c nlributors i cOµc I,._, L) N.e ) , I • A (I( ,.nn I., sip Rem- P',9 1. RIB I 1V Well (Applicatien/l ermit} 2240 S 2240 F NW SE 12 1.0 N 66.0 W S 523533.3 443976.3 Physical Address Cily, State. Zip Parcel Type Subdivision Parcel Name MARI IN 13RU [HERS Lot, Block, Filing Lai F„A$ I53mp_ 1;uripi n_n 10 Permit Details Acres In Parcel Parcel ID I Ise(sl Domestic Permitted Limits Yield AmountDepth ('f) Depth (B) Aquifer(s) Area Irrigated Within Water Seri ice Area Water Supplier Name Type of Sewage Sywlem Sewer System Details Statute Follow up Permit Conditions Isee actual permit for more information Abandonment Required Meter Required Geophysical Log Required Rule 6.2,2.1 (Notice) Rule 6.2.3 (Floating Permit) LARANIIL FOX IIILLS 37-92-602(;) - Exempt well See imaged well permit Sce imaged well permit See imaged well permit See imaged well permit See imaged well permit Scanning Cover Sheet for Septic Permits Permit # iGi9930435 Permit Type: Health I EHS History f EHS Conversion History Situs Street Address 17583 CLARA LEE ST Sites City, State, Zip Sec/TowttfRange: Part& # (12 digitsI Owner Full Name: Owner Address: Contact Name: Contact Address: 12-01 N -66W 147112403014-80224894 GREIN CONsTRuCTION INC PO BOX 381 BRIGHTON,CO 80601 Application Status: Fina/ed Application Date: 03111/1996 Owner Phone #: 303 6593969 Contact Phone# Information above has been Verified in Accela by employee noted below X September 02, 2008 Processed by: Date Report ID: EHS00024v403 Print Date -Time: 91212008 1:29:17PM Page 1 of 1 I:1+II):R'!:[)l.Jr-"l. `,')I:::I,Jr'}iil;: I)I{ill:Ji.1. ::i41iT1:;'I1 I E.F•;I•IiIT I•I(1.. 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OWNER NAME'(S) John -L. or Earlene Susan Pfister Mailing Address 2 1 Vi ne 5t. 5Titi1 Ciry, St. Zip Thornton,C . 80229 Phone ( 303 ) 287-4Q65 WELL LOCATION A8 DRIt.LED; N1/4 SE 1J4, Sec.-12__Twp, 1 N , Range..6� —_ 1J DISTANCES PROM SEC. UNES: 2190 ft. from South _Sec_ line. and 1590 ft. from East Sec. fine. SUBDIVISION:Martin Bros. Planned Unit Development - Loll! BLOCK FILUNG(UNITj,____ STREET ADQf1ESS AT WELL LOCATION; 4, POMP DATA Type Sutmersible Inatwation Completed 1-28-94 Pump Manufacturer Goulds Pump Mode! No. 10E330412 4esign GPM 10 at RPM ,-HI? 3 , Yotts230___ -_,-Euu_Load Amps_ ,f7_. ._.__.. Pump Intake Depth 546' ' Feet, DropfCalumn Pipe Size jriches, Kind Ga 1 v . ADD1TlONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM: TURBINE DRIVER TYPE: O Electric ❑ Engine O Other _---. _ Design Head feet;,,:' Number of Stages , Shaft size inches. S. O l I M NT Airline Installed O Yes O No, OrIflce Depth ft, Monitor Tube Installed ❑ Yes ❑ No, Depth ft. Flow Meter Mfg: Meter Serial No. Meter Readout O Gallons, O Thousand Gallons, ❑ Acre feet. ❑ Beginning Reading 6. TEST DATA: O Check box if Test data is submitted on Supplemental Form. Date l24 Total Well Depth 865' lime irs.� Static Level 466�' Rate (GPM) Date Measured 1..28-94 Pumping Lvl. -.-- 7 DISINFECTION: Type HTH - Amt. Used 1 CUP 8 Water Quality analysis available, 0] Yes ® No 9. Remarks - a. 1 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 (,3}(a) C.R.S., the making of fatse statements herein Constitutes perjury in the secon degree and is punishable as a class I misdemeanor.] CONTRACTOR TP0r_ason's We11 Service Phone 3 b59-1183 Lic. No.1,76 Mailing Address P.O. Box 223 Ft. Lupton, . o._ _ NarneiTitle (Please type or print) Signature Date Ray Thoiiason Owner 2-22-94 FORM O. sys- Ya 11140 -` WELL CONSTRUCTION AND T1=8, •1ORT STATE OF COLORADO, OFFICE OF THE STATE ENGINEER RECEIVER. 1, WELL PERMIT NUMBER 1 IKI'0 , z OWNER NAMES) JOHN L. OR EA NE SUSAN PFISTER 94 mailing Address 9210 VINE 5T watr+IIJ STATf thl�# city, Sr. Zip T'H ct7~o Phone( ) 3. WELL LOCATION AS DRILLED: NW 1/4 •SE. .. 1/4, Sec.@ _LTwp. 1 N , Rartge b6 lW DISTANCES FROM SEC. LKNES: ft. from Sec Iles. and •t csg ft ttt7lu E ' - ' Sec. Ilne OR 2190— _ rora o"a - S$DIVSION: MARTIN BRO LA UNIT DV1IP LOT 11 BLOCK{ FIUN3(UNL1]_____ -�....� . i R1HOT/h1. • ..,r 4.1 GROUND SURFACE ELEVATION — It - DATE COMPLETED DRILL) •MNTNQQ; . . 5. GEOLOGIC LOG: D. -µh O CIlPJOfl of 11e.n1 (rrps I. Crpler, 0- 10 sand overburden579-59 esandst sae roc $haJ.s 171,L_175 roc a 175-178 bae ca 178-179 rock 6,L1-s1Ity sane 79-2l shale silty san _ sae bith coa 3 5 saesIly san brown coal so Finale f -7f sand roc shale sand Ub15Tfla1e T59O shale 90- OQ sand - s 500-505 0 j-507 -shale rock j07- 52.5 525-528 straal a coal 28� 2 REMARKS; 562-570. shale scI - - 570-57k -- shale 578-579 rock Fir 6 5 fI. OEPTli COMPLETED 8 _F s n• 4L PH i,E OiAM..(k) Fra14 (ft) ' To (1't) 7�.. :_ a t 7e r8 _ 3Q } !.• PLM 1 CASING. GD• ) , Mond II, b:• Wall Stns Frorn(lt) To(h) 658 steel 188 4 4o stee>!: i7— T 83 . G 8a, SI4t Sias: lye steel torch .05051a 785 a FILTER PACK 9. PACKER PLACEMENT: Saxe 10. GROU11NG RECORD: Matsdat Amount Density Interval Placement percent .?FOsaCks 14.5 0-780 pumped DISINFECTION: Type H rim v`'' WELL. 'EST DATA; Check box If Test Data Is submlttedon SURpl,MOnfal Form- TESTING METHOD Static Level 375— ft. Date/Time Pumping level 700 R, Date/lime Remarks --- Test lengtfr 3, i have read qw swewmm mode he. ll end lu.aw dw eanF.Ra brlydl rd rrtttU .rr I1 I b8acdon 2a+la (13M ±W. dx m ei iatse %te;um 11won conL1+lU I PKWr7 in win waard ds .* "d w Pw • r deee 1 nid�+rFlai.t CONTRACTOR ROGER SCHOCKE WELL DEILLZNC INC. Phone F' 3) 288-5+74 Lie. No. 403 Mailing Address 987 ER GHEON AD HEN iJai ON, CO. NamefTitle (please type or print) Signature Date ROGER SCk-0CHE PRFS. ��'�� _.,AJ INSTRUCTIONS FOR WELL CONSTRUCTION ANU TE:3T IticPORr The report must be typed or printed in @L.JACI'C INK All changes on the form must be initialed and dated. Attach additional sheets if more space is required. Each additional sheet must be identified at the top by the well owner's name, the permit number, form name/number and a sequential page number. Report depths in feet below ground surtar'e' - This form may be reproduced by photocopy methods, or by computer generation with prior approval by the State Engineer. 1 The original and one copy of this form mint be stf7rrtitted to the Stele EnneWs Obits within 60 days after completing the well or 7 days after die pemmt aq* don dotle, wit i:heiltar le eerier. Mother copy of the form must be provided to the we 4l owner. Complete the Well Parma Number in fur. 2. Fill in Na re #id Mailing Address a t Wei Owner where c�rresponderice Should b+ sent. 3_ Complete the blocks for the atasiai location of the well where drilled. If the owner has more than one well - - `serVing ibis proerty, pie ice attzTicat oh 1e(s DaelMgtil3tiorIito t weIL ]Q MOT USE T}iE O NER - SUPPUED LOCAT1OH unless a survey has been provides For wells located In subdivisions the lot, block -and subdivision information must also be provided _ - 4, Repon the ground surface elevation in lest above sea level d available. - This value may be obtained from a topograpnic map. Describe the drilling method used to construct We wed and the date completed, Indicate the total depth drilled and the acttu,I completed depth of the well, _ - S. Fully describe the materials encountered in drilling. Do not us, formation names unless they are in conjunction with a description of materials. _ Examples of descriptive terms Include: - Grain se -Boulders gravel, sand, silt, clay. Hardness•Loose, soft, tight hard, very hard. - - Color --All materials, Most critical In sedimentary rock - Oepth when water is encountered {'d 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. S. indicate the type and size of filter l favelj peck and the lrtervat where placed. _ 9. indicate the type and setting depth for any packers Instip9d. _ __.i__ 10, The density of the grout slurry must be reported and may be indicated as pounds per gallon, gallons of water per sack, total gallons of water and number of sacks used, etc. Specify the grout placement method. i.e. trernie pipe or positive displacement. The percentage of additives mixed with the grout should be reported under remarks. II, Record the type and the amount of disinfection used, how placed and the length of time left in the hole. 12. Report wall lest 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 compiled will the provisions of the rules. ft a test was not perfarmed-explain when it will be done. If available, report dock time when measurements were taken. 13. Fill in Company Name and leers of Corrti'e r who constructed the well_ The report must be signed by the license contractor responsible for the construction of the well. t-ofm NO GWS-25• APPIJCAh1T urrruc ur me alriic r-iru+Elecn COLORADO DIVISION OF WATER RESOURCES 1319 Cer+tarn3el 1dg„ 1313 Sherman St., Denver, Coloeado 80203 rJA 886}3581 WELL P8W NUMBER 17533i. - DtV_ I CNT1'. 62 WD 2 DES, BASIN MD LQt; ii Block: Filing: JOHN L OR EARLENE SUSAN PFISTER 9210 VINE ST THORNTON CO 80229 (J03)874065 PERMIT TO CONSTRUCT A WELL. i) 2) I!Te Sub4 : MARTIN BROS PLANNED UNIT (WlP APPROVED WEU. LOCATION WELL) COUNTY NW 114 SE 114 Section 12 Twp 1 N RANGE 66 W 6th P. M. OISYANCES FROM SECTION LINES 2190 Ft. from South Section Une 1890 Ft. from East Section Lane ISSUANCE OF T IS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of the permit does not assure the applicant that no injury will occur to another vested water right or preclude another owner ci a vested water right from soaking relief in a civil court action. The cor;stniction 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 aminers 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 well is restricted to the Laramie -Fox Hills aquifer which corresponds to the interval between 770 feet and 1,065 feet below ground surface_ Plain casing shall be installed and sealed to prevent production from other zones, 6) The maxirrrum pumping rate shall not exceed 15 GPM. 7) The annual amount of ground water to be withdrawn shall not exceed 1,1 acre-feet. B) 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 rntm Receipt No. 03621 t2 DATE ISSUED TION DATE • WRJ-5 . 76 COLORADO OIv1SlION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 RE APPLICATION FORM RECEIVED Application must be complete where S ) A PERMIT TO USE GROUND WATER MC 1 5 I3 applicable. Type or A PERMIT TO CONSTRUCT A WELL print in BLACK FOR; {}Y I A PERMIT TO INSTALL A PUMP WAMp4JRCk5 No overstrikes 'a'Tf► P or erasures unless ( I REPLACEMENT FOR NO. initialed, ( ) OTHER WATER COURT CASE NO. i1 APPLICANT - mailing address MAME x- Id.A/ 1 . ¢Y ,Su ,A4 - Pi STREET 9-2/C) O&V— r CITY_ TKD4,7DW I3. i5Sate1 (Zip) TELEPHONE NO. _ 8� rlo�s' {2) LOCATION QF PROPOSED—WiELL county }__.L6.e — 15! :s M the - - - X. 5ecctian Two. _I N-, RN. SPC . P.M. I N.SI rLvo I3) Proposed ma:cirnum pumping sate Igpm) / S Average annual amount ui ground water to be approE.riated Eaere-feet): Number of arras to be irrigated. Proposed to" -al depth (testa' IC'o Aquifer ground water is to be obtained from' L.x tj,'/Is Owner's well designation GROUND WATER TOPE USED I�QR: { I HOUSEHOLD USE ONLY - no irrigation {p) 170) 1DOM6STIC 11) 1 1 INOUSTF1AI Ica) { l LIVESTOCK {21 { I IRRIGATION {6) l ) COMMERCIAL 14) I I MUNICIPAL (8) ) OTHER 19) DETAIL. THE USE ON BACK IN 111) cal QER Name .. _ DG V C �t c cJ c street LS I r, 4 �-Iv , R d- tY � � �1 � U sofw f( o I ex.> I io Telephone No- Lic. No- 40 3 0 FOR OFFICE USE ONLY: DO NOT WRITE IN ThI S COLUMN Receipt No 2 f f_ j• k -V r te. Basin ' k Dist. Hu /Y— CONDITIONS QF APPROVAJ. This well shall be used in such a way as to cause no material injury to existing water rights. The D6 fL 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 waterf right from seeking relief in a Civil Court action. APPL#CATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION DATE (STAY ENGINEER) BY - 1.0. COUNTY_ i a- (6) THE LOCATION OF THE PROPOSED WELL and The ereea on Which the water will be used must be indicated on the diagram below - the the CENTER SECTION (1 tectien, 64O acres) Na- the welt location. --}- — — �- — -�- -- - — + _ T 4�- f MILE, 5290 FE T ------ # { + + + + - + + l f � _ -.- I NORTH SE;CTIRN LINE } NORTH T 2' 2 G W ae I t I F JIJ Ill acti. I xvrr tans F I + The scate of the diagram is Z inthes = 1 milt: Each srnali square represents 40 acres- 9tATfft EQU)VALEI1 T5 TABLE (RounArd FIgurcsl An ecru -root Corers 1 ecru of Arid 1 fOOt OR!!Q i cwhic tool per second lcls) - - - 4413 patlors per minutt ippm1 A tem-ly of Swill req wire approulrneleiy 1 .cretpor Of morel per year. F acrrtpot . 43.560 cubic feet. 325 900 gallons. 1.0(X) gpm primved COnnnuOWay far One day proaucet 4.41 ens -feel. (10) LAND ON WHICH GROUND WATER 9WLL BE USED: Ownerlsl_ -- 1 rs -z- f t1 d tr - - 4L Elf 7tlon: (6) THE WELL M14E OCAT D BELOW by distances from section 1inBs, ft. from -1 sec. line Ilsor! ar OCutnl c� ft. from &s M. line feaii or w4itl LOT BLOCK FILING a SUBDIVISION (71 TRACT ON WHCJLWE.L- LOCATED Owner: Noof acres -r 'c'?- ? Will this be the OnIV well on this tract? f � (8) PROPQSIa CASING PROGRAM Plain Casing _in. from _C)� ft- to '0 ft. in- trom ft. tO Mo ft. Perforated casing f in. from . � ft. to_______ ft, in. from _.. _. ft. to ft. (9} FOR REPLACEMENT WELLSgiviidistance and direction from old welt and plans for plugging -S. Noof acres: .5' y"1' - (11) QFTALLEO E]ESCR)PT%QN of the ute of ground water: HoutKhold use and domesticwells mutt indicmt type of disposal system to be-used.w l a _ rr� ,� f .r L. .. _,.r io .._..G ! -i .- L n r / . _ r _ . drn. f/9 f (12) QT11R WATER RIGHTS used on this Iand, including wells. Give Registration and Water Coon Cast~ Numbets. Type or right Used for [purpose! Description of land on which used (13) THE APPLICANT(S) STATES) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO TRrBT OF HIS KNOWLEDGE. Ore additional sheets of paper if more space is required. EREMPT WELL DATA SHEET - DENVER BASIN, CCLORAOO ApPLICAMT: PFIST€R RECEIPT MO. 362112 LOCATION: W114 OF SE1/4 OF SEC. 12, T.1H., A.66W^ (2190 SSL. 1690 ESL) PROPOSED ACM FER SIJRFAtE EJ.EVATI0Ns 5040 NUMNER OF ACRES IN TRACT: 5.O07 -------------------------•-----.._--..-.---- ---^-.------.--------.....- _-._-.._ . IS PROPERTY WITHIN SERVICE Ni11INDAR1ES OF MUNICIPALITY 5.55 CONSENT MAPS? NOTES - IF SUBDIVISION IS UNDER AUONENTATION PLAN, CASE NO. IS , REV. _ IF SURDIVISI0H WAS RECtMNEAPED FOR APPROVAL 8Y THE WATER MANAGEMENT BRANCH, DATE OF LETTER IS II1FONAATION ON 51JEDJVISION OR TRACT Of LAND/SPECIAL RESTRII%T3ONS: evaluated by dub on DECEMBER 15, 1943 ELEVATION DEPTH 10 ANNUAL •-------------- NET --------------- APPROP STATUS AQUIFER DOT. TOP SAND NOT. TOP A -F UPPER DAWSOIi ..._ .._ .DOTER DAWSOri ---- DENVER - _.. .... .... UPPER ARAPAIIOE ---- ---- ---- ---- ---- L�dER A 4645 4933 99 345 1(17 0.843 WIT t RAMIE -FOX H1tLS 3976 4270 1S 1 ) () 1.164 NT note: E indicates Location is et aquifer bo4.mderY and values may be more approximate- • indicates the proposed aquifer. ALL values are interpolated from the 5.8.5 data base assembted in Moveaber of 1486. STATE OF COLORADO OFFICE OF TH# STATE ENGINEER Division of Water Resources Department of Natural Resources • w 1313Sberman 5tteei, Room 818 • Denver, Colorado &R703 PWne c393) 856-3 %$ i Ray Romer FAX (303) 861-3589 GrnTrnor Ken Salazae E euA1Yr Dvrcya Hal D. Simryon Slate Eng'vieer TO: John L. or Earlene S. Pfister FROM: John W. Bikisoly ---k RECEIPT NO.: 362112 DATE: December 13, 1993 Your application for a permit to construct a well is being returned for the reason(s) listed below. The amendments and/or additional information or documentation requested is required before we can proceed with the evaluation of your application. All amendments made to the application must be typed or printed in BLACK INK. Please Initial and date all amendments made then return the application and all attachments to this office. If you have any questions, feel free to contact this ❑ffice, In item (2), the 114, 1/4, section designation is stated as being the NE 1/4 of the SE 1/4. According to your distances from section lines as given in Item (6) on the back (2210 ft. from South and 1800 ft. from East), this 1/4, 111 section designation should read, NW 1/4 of the SE 114. Also, this will change the well location as shown on the diagram on the back of the application in item (5), to where we've placed a red "X". Please correct items (2) and (5). According to our plat map of this subdivision, your distances as given in item (6) are okay, and would plot the proposed well on lot 11. In items (6) and (10) on the back of the application, you have stated that the block # is 12. We are unable to find any block #'s an our plat of this subdivision. According to our plat of the Martin Brothers PUI), there are 23 lots numbered from 1 through 23, however, no block #'s_ if you feel that there is a "block 12" as stated on your application, please serl.d a copy of the plat map showing this block when returning your application. Thank you. RAN. 76 Application\ must be complete where. appticabie. Type,9F print in BLAG INK. No overstrikes or erasures unless initiated. (1) APPLICANT mailing NAME STREET CITVIL' `Lit TELEPHONE NO. COLQRADO DIVISION OF WATER R 818 CentgnnieI BIdg., 1313 Sherman 5t., Denver, PERMIT APPLICATION FORM I )A PERMIT TO USE GROUND WATER fr4A PERMIT TO CONSTRUCT A WELL STATE EMNED FOR: ( A PERMIT TO INSTALL A PUMP i } REPLACEMENT FOR NO. ( OTHER w�_.. 'WATER COURT CASE NO. ,� - ress FOR OFFICE USE ONLY: DO NOT W IN JHIS COLUMN 4FJ5 Receipt Na` !/ SIT Basin L1 CONDITI S OF AWPR6�IA'L (2) LOCATION OF PfQPQSED WELL County d of the %, Section . - Twp. L— .. Rng- _ Je3�-idL. __r� P.M. tN.sy (E.WI (3) WATER RUSE AND WELL DATA Proposed rnax!rnurn pumping rate Igpm? Average annual amount of ground water to be appropriated iacre-feet): I• Number of apses to be irrigated: Proposed tatw:I depth flaetj_ pQ Aquifer ground water is to be obtained from: .car iI .. / Owners well designation ( l itOUSEHOLO USE ONLY 4 E)Ok4€5TIC 11) ( I LIVESTOCK {21 ( I COMMERCIAL i4} / I I OTHER 19)_/1 (4) irrigation (0I I ) INDUSTRIAL (51 IRRIGATION (61 I I MUNICIPAL (8) DETAIL THE USE ON BACK IN 111 Name .�I� C� c] t� i-►JQ1-I4e. Street 6fTV'r/ tttatel Telephone Nti,-ci_'_ 744 Lic. No. This well shall :fled in such a way as to cause na material in ry to existing water rights. The issuanceaf th errnit does not assure the applicant that no inj wail occur to another vested water right or p Jude another owner of a vested water right fropt seeking relief in a civil court action. \/L'i fa/i3 /93 Illga'�f .rf APPLICATION; APPROVED PERMIT NUMBER _ DATE ISSUED EXPIRATION DATE (STATEENGINEER BY— -- (S} THE i COCA'1 iOISI OF Tai , Pl OPSED WELL and the area pn which the water wiP be used }ntsk be indicated on the diagram below. Use tfie CENTER SECTION 11 section. 640 acresl for the well location. G+ IMiLE,5280FEET-�I T 1 t _ + NORTH SECTION LINE + `HtC►RT + Q -a — 7 W o C + SOUTH SECTION LINE The st ale of the diagram is 2 inch = f mils~ Each small square represents 40 acres. WATER EOUIVALENTS TABLE (noun Frgures An acre-foot covers i acre of and i fgot deep 1 cubic foot per second 1cfsl . - 449 gallons per rninute prnl A family of 5 will require approximately 1 acre-foot ofitater per year, 1 acne -foot . - .43,560 cubic feet - . - 325.300 gal Ions 1,000 gpert Dumped continuously for one day produpes 4.42 acre feet. f. 1. I Ii 11i[,<Sae ._:•_.._ __ (6) THE WELL MUST BE LOCATED BELfl by distances from section lines. f `ft ft.fram_—_y3C-see-line Inotth or loath) _-ift. from Sec. line LOT 11.BLOCK FILIN w�_ SUBDIVISION �A�Tf� �lA Ne1/F �3E 17) TRACT N W1ICHWILL LOCATED O ner:_ No. of acres 6• -10 7 Will this be the only well on this act? ' e (8) PROPOSE CASING P GRi M #PlainCasinqin. from d iin. from �ft. to' Qo ft. asing in. tram ______ft. to______ ft, _ _ _ in. from ft- to it. (9) FOR REPLACEMENT WELLSgivedistance and direction from old well and plans for plugging If: 110) LAND ON WH1 H GRO ND WAT WIL E S D: Owners Rio. at acres: � , de 7 g legal deacnption: CtT / (11) UTAILEi3 DESCFJIPT4N of fie use of ground water: Household use and do estic wells must indicate type of disposal systern to be used. d •,y 5(7 DQ ` a s -!D Q QT rQC"N I�c� C12 OTHER WATIEft F4HTS used ort this land, including wells. Give Registration and Wate Hurt Case Numbers. Type or right Used for (purpose) Description of land o Which used 1 3} THE AP fj ICANTjS ST T€(S) T14AT THE INFORMATION SET FORTH HEREON IS _. TRUE Xo THE BEST'T } HIS KNOWLEDGE. A 115e additionj: sheets of paper i('nPrc sPr' is r quirerl. Scanning Cover Sheet for Septic Permits Permit # G19930378 Permit Type: Health) EHS History I EHS Conversion History Situs Street Address 17643 CLARA LEE ST Situs City, State, Zip SectTownlRange: 12-01 N -66W Application Status: Finaled Application Date: 03/1111996 Parcel # (12digits) Owner Full Name: Owner Address; Contact Name: Contact Address: 147112403011-R0224994 PFISTER JOHN L 9210 VINE ST DENVER,CO 80229 Owner Phone #: 303 2874065 Contact Phone# Information above has been Verified in Accela by employee noted below x September 03, 2008 Processed tsy! Dale Report ID: EHS00024v003 Print Date -Time 9/3/2008 6:53:1 3AM Page 1 of 1 t. L I:I Ii} I I:I)(J,if i!:bl, d3 k- A) I:J `+_? 'r - 11::!'I I•i:!-•i i 1 hIII). f. L.il" I. 1i ( LlliI-If Y I•IE iil_ 11.1 [�i I'iT.TIII'I11 l•lii�J F='IIIi`irf1: I FIT,; 1 Full•II li: I -Iii .I_ I -IF ,>,I__ III ;I I:! ' x5111 1,rI-1iLTI A..I III•:4 (-I-•I -I--I I-' L I) k:_I .............`.. i1tklllf:lt 1:'1 1 ;1FI_f .. ,?E)hl!•I (_.. 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