HomeMy WebLinkAbout20210866.tiffScanning Cover Sheet
for
Septic Permits
Permit*
G19790119
Permit Type: Health / EHS History / EHS Conversion History
Situs Street Address 16180 CR 47
Situs City, State, Zip
Sec/Town/Range : 12 -03N -85W
Parcel # (12 digits) 121312301004-R4942486
Owner Full Name: CUMMINGS RUSSELL & JUDITH
Owner Address: 12540 TUSCON
, 00000
Contact Name:
Contact Address:
Application Status: Frnaled
Application Date: 03/11/1996
Owner Phone #: 303 6597681
Contact Phone#
Information above has been Verified in Accla„b errr,Jae Holed below
X
January 26, 2009
Processed by: Date
Report ID: EHS00024v003 Page 1 of 1
Print Date -Time: 1/26/2009 8:32:02AM
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WELD COUNTY HEALTH DEPARTMENT
1516 Hospital [toad
Greeley, Colorado
PH. 353-0540
Permit No[ -AD. -19-7
'
Application for permit to install, construct, an Individual Sewage Disposal System.
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Owner ( ; ,; ^''� f Y) (2 `�, ip td ,c i `� �uC�l trrAddress 1,25 z4(3 i) [ Sr ; Phone_
Directions to site:i Htiy Rd. N mi, E mi, S_mi, W mi
Legal Description: Ptn. S %;2 Sec.
N, R -W, Sub. Ail. .•-% op Lot r Blk _
General Information
.)
No. Bedrooms c.�'-
No. Baths . Basement Plumbing ravaA _/Pr7
Size of Lot '� `j ',f;
H2O supply pf well give depth) 'f? - (.)
New Home V Mobile Home Modular Add'n
Type of sewage disposal requested:
Septic tank 4/"Privy Other
De t, Use Onl
Perc rate (avg. of 3) �,'"
Soil Type
H2O Table Depth
Lot Grade
Engineer Design Yes No
If YES -reason:
Comments;
This is to certify that the system is NOT within 400 ft. of a public sewer'r•._
Septic Tank
Other
Special Instruct
Insttion instructions; (Minimum Re
Gals. Absorption Trenches
or
Seepage Bed
Sq.
This system will be constructed and installed in accordance with the above specification
and regulations regarding individual sewage disposal systems in Weld County, Colorado.
This permit shall expire at the same time as the building permit, or, if no building per Lt
is issued_, the permit shall expire 120 days after its issuance if construction has not
been commenced.
Date:
5- -
Owner:,,_1�
)7,
Applicant:
( i +
.� .,, •
The plans and specifications as shown are approved pending parRt of
Date: �jc�i 11
Sanitarian:
The above system inspected and fours to comply with plan and descri
Systems Contractor: Dater 1'
ermit fee.
Engineer Review:
(Date)
r' DG
Permit Fee: $ /./
'OJT Sanitarian:
(Signature)
Received by:
Date:
77011.
I
140
3 ritl
3 TM
3S'
COLORADO
To
MEM AnDuni
Planning Department Date Mav 22, 1986
From Wes Potter, Health Protection Services
Subject;
I.S.D.S. - Terry Shippy___ _
OWNER:
Terry Shippy
ADDRESS: 16160 W.C.R. 47, LaSalle, Colorado 80645
LEGAL DESCRIPTION: E2 E2 SEC 12 TWP 03 RNG 65
The septic system identified above x is, is not of sufficient size to
accomodate the proposed alterations indicated below to the structure(s) served
by this system.
CURRENT FLOW:
ADDITIONS: PROPOSED TOTAL:
Persons 3 3
Bedrooms 3 3
Bathrooms 2 2
Est. GPO 0 0
Permit on Record: NAME Russell & Judith Cummings
NO. G-790119
System Size: TANK . 1000 gal, FIELD '780 sq. ft.
x However, we cannot certify A hat the system will function as intended in the
future. If loading changes or malfunctions occur to the system, we require that
our office be notified so that a review of the system's adequacy be made.
The existing septic system requires the following to accomodate the proposed
alterations to the structure(s) served:
Replacing mobile home with larger mobile home,
6 79 0 i
�4
INDIVIDUAL SEWAGE DISPOSAL SYSTEM EVALUATION
Date Received
Evaluation Date _
OWNER: e{�
MAILING ADDRESS:
\. O?D . 756
Received by
Done by
cif '4? , i.,0,4/ p $`G6 HONE: a�Y moo7
LEGAL DESCRIPTION: P1,Ca P2
Sec
Subdivision: Hijtfn (614, Lot _
WATER SUPPLY:
Use Type:
P(11041
P5Id e -(1:a
TWP 03 RNG b�
Lot Size
Block
Filing
The septic system identified above is, is not of sufficient size to
accommodate the proposed alteration(s) indicated below to the structure(s)
served by this system.
CURRENT FLOW:
Persons J3
Bedrooms a,
Bathrooms
Basement Plumbing ()
Est. GPD
ADDITIONS PROPOSED TOTAL
r,7
O
Permit on Record: NAME_ ty-1 ,r l Urn.y�ocO NO. F? Dfl
System Size: TANK/04703 gal. FIELD ? gelq.ft. ABSORPTION BED sq.ft.
Percolation Rate
MIN. PER INCH
Engineer Design: Yes No Soil Type
f/+
�M-
Percent Ground Slope 21 Direction `<-4.
The existing septic system requires the following to accommodate the
proposed alterations to the structure(s) served:
ADDITIONAL COMMENTS AND DIAGRAMS
reel/AC-4A if)
eY 1-ra. elr.
COLORADO
Division of Water Resources
Department of Natural Resources
WELL PERMIT NUMBER 320525 -
RECEIPT NUMBER 10008659
ORIGINAL PERMIT APPLICANT(S)
SHARON SCHENCK
PERMIT TO USE AN EXISTING WELL
APPROVED WELL LOCATION
Water Division: 1 Water District: 2
Designated Basin: N/A
Management District: N/A
County: WELD
Parcel Name: MILTON LAKE ESTATES
Lot: 1 Block: Filing:
Physical Address: 16160 COUNTY ROAD 47 EVANS, CO
80645
SW 1/4 SW 1/4 Section 12 Township 3.0 N Range 65.0 W Sixth P.M.
UTM COORDINATES (Meters, Zone:13, NAD83)
Easting: 532307.0 Northing: 4453832.0
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 this permit does not
ensure that no injury will occur to another vested water right or preclude another owner of a vested water right from seeking
relief in a civil court action.
2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval of a
variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in
accordance with Rule 18.
3) Approved pursuant to CRS 37-92-602(3)(b)(I) and policy of the State Engineer under the following conditions, for a 29 acre
parcel known as Lot 1, Milton Lakes Estates Subdivision, more particularly described on Exhibit A in the well permit file.
4) Approved for the change in use of an existing well constructed under permit no. 107127. The issuance of this permit hereby
cancels permit no. 107127.
5) The use of groundwater from this well is limited to ordinary household purposes inside two (2) single family dwelling(s), the
watering of the user's own domestic animals, and the irrigation of not more than one (1) acre of home gardens and lawns.
6) Production from this well is limited to the Laramie -Fox Hills aquifer.
7) The pumping rate of this well shall not exceed 15 GPM.
8) The annual withdrawal of groundwater from this well shall not exceed 3 acre-feet.
9) The return flow from the use of this well must be through an individual wastewater disposal system of the type so that not less
than 4% of the total amount of water withdrawn is returned to the same stream system in which the well is located.
10) This well shall be constructed not more than 200 feet from the location specified on this permit.
NOTE: This well is withdrawing water from a non-renewable aquifer. While the withdrawals from this aquifer are administered
based on a 100 year aquifer life, water level declines may prevent this well from diverting the permitted amounts for that 100
years.
Issued By DEBRA GONZALES
Date Issued: 2/18/2021
Expiration Date: 2/18/2023
Printed 02-18-2021
For questions about this permit call 303.866.3581 or go to www.water.state.co.us Page 1 of 1
I I °I
WJR-2G-77
THIS �qRM-MUST BE SUBMITTED
WITHIN 6U DAYS OF COMPLETION
OF THE WORK DESCRIBED HERE-
ON. TYPE OH PRfNT IN BLACK
INK.
F
COLORADO DIVISION OF WATER RESOURCES -
1313 Sherman Street - Room 818
Denver, Colorado 80203
WELL COMPLETION AND PUMP INSTALLATION REPORT,
PERMIT NUMBER 1071.2'7
WELL OWNER _Russell Cunnings
ADDRESS
1254,0 Tucson,
Anderson, Colo 806ip0
DATE COMPLETED
WELL LOG
RECEIVED
JAN 171980
WIER RESDUNCit
SINE ENGINE
SW Y. of the SW Y. of Sec 12
T. 3 t R 65 W 6 P M.
, 19 HOLE DIAMETER
From
To
Type and Color of Material
Water
Loc.
Use a
TOTAL DEPTH
dditional pages necessary to complete log.
in. from to
in. from to
ft.
ft.
in. from to ft.
DRILLING METHOD
CASING RECORD: Plain Casing
Size _ & kind from to ft.
Size _-___ & kind from to ft.
& kind from __ to ft.
Perforated Casing
from to ft.
from to ft.
from to ft.
Size
Size & kind
Size & kind
Size & kind,
GROUTING RECORD
Material
Intervals
Placement Method
GRAVEL PACK: Size
Interval
TEST DATA
Date Tested , 19 —
Static Water Level Prior to Test ft.
Type of Test Pump
Length of Test
Sustained Yield (Metered)
Final Pumping Water Level
PUMP INSTALLATION REPORT
Pump Make Goulds
Type Cub.
Powered by Elect.
Pump Serial No. E093614
Motor Serial No. G 79
Date InstaIlea 10/22-79
Pump Intake Depth 294'
Remark
HP
WELL TEST DATA WITH PERMANENT PUMP
Date Tested
10/22-79
Static Water Level Prior to Test 185'
Length of Test
2 Hours
Sustained yield (Metered) 14 GPM
Pumping Water Level 210'
Remarks
TOTAL. DEPT
WATER
C TABLE
ur 1
CONE CIF
DEPRESSION
CONTRACTORS STATEMENT
The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or
pump installation described hereon; that he has read the statement made hereon; knows the content
thereof, and that the same is true of his own knowledge.
Signature ����k_ , License No
State of Colorado, County of SS
Subscribed and sworn to before me this /s�day of , 19 id.
My Commission expires: 7 j �, 1/9 �,2,,
Notary Public 777a7
FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM must be an original copy on both sides and signed.
WHITE AND GREEN copies must be filed with the State Engineer. PINK COPY is for the Owner and YELLOW COPY is for the Driller.
WJR-26.77
FITS EORM MUST BE'SUBMITTED
1THIN'6f1 DAYS OF COMPLETION
�F THE WORK DESCRIBED HERE -
N. TYPE OR PRINT IN BLACK
INK.
WELL OWNER RUSSELL CUMMINGS
COLORADO DIVISION OF WAFER RESOLIRC
1313 Sherman Street - Room 818
Denver, Colorado 80203
WELL COMPLETION AND PUMP INSTALLATION REPORT
PERMIT NUMBER 107127
ADDRESS 12540 TUCSON HENDERSON. COLO.
DATE COMPLETED SEPT. 14
WELL LOG
SW '/a of the
T. 3 N , R.
, 19 79 HOLE DIAMETER
778 in, from 0
From
To
Type and Color of Material
Water
Loc.
0
14
71
1Q5
130
135
152
154
160
163
178
190
194
820
224
296
315
14
71
105
130
135
152
154
160
163
178
190
194
220
224
296
315
400
sand
clay streaker of coal
shale
sand
coal
shale
sandstone hard
shale
coal
sand
shale
coal
shale
coal
sand
shale
shale streakes sand
TOTAL DEPTH 14)0'
Use additional pages necessary to complete log.
zc
x
I 8 1979
WATER RES0URCE$
SW VA E EhGiNEE42
1/4 of
to 232 ft.
558 in. from 232 to 400 ft.
in from
DRILLING METHOD
CASING RECORD:
Size 6s8 & kind
Size & kind
Size & kind
to ft.
ROTARY
Plain Casing
steel from
steel from
III
6 P.M.
0 to 232
223
to 243
ft.
ft.
sireeel from 358 to 378 ft.
Perforated Casing
Size & kind , st%eel from 2._43 to 358 ft.
Size 41 & kind steel from 378 to 400 ft.
Size & kind from
GROUTING RECORD
to
ft.
Material cement
Intervals constant
Placement Method pumped
GRAVEL PACK: Size
Interval
TEST DATA
Date Tested
sE,Pr. 14
Static Water Level Prior to Test 185
Type of Test Pump bailed
Length of Test 4hrs .
Sustained Yield (Metered) 15
Final Pumping Water Level 215'
, 19 79
ft.
i
PUMP INSTALLATION REPORT
Pump Make
Type
Powered by HP
Pump Serial No.
Motor Serial No.
Date Installeo
Pump Intake Depth
Remarks
WELL TEST DATA WITH PERMANENT PUMP
J
Date Tested
Static Water Level Prior to Test
Length -of Test Hours
Sustained yield Netered) GPM
Pumping Water Level
Remarks
TOTAL DEPTH
r
� r
CONE of
DOPRESsioN
CONTRACTORS STATEMENT
The undersigned, -being duly sworn upon oath, deposes and says that he is the contractor of the well or
pump insitailation described hereon; that he has read the statement made hereon; knows the content
thereof, and that the sarrtie is true of his own knowled e.
SignatureLicense No. 41Q)
SS
State of Colorado, County of
Subscribed and sworn to betore me this
My Commission exp
Notary Public
day of 19 7r
FORM TO 8E MADE OUT IN QUADRUPLICATE: WHITE FORM must ha an original copy on both sides and signed.
WHITE AND GREEN copies must be filed with the State Engineer. PINK COPY is for the Owner and YELLOW COPY is for the Driller.
WRJ• S Re ve- 76 -
Application must
be complete where
applicable. Type or
print in BLACK
INK. No overstrikes
or erasures unless
initialed.
COLORADO DIVISION OF WATER RESOURCE
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado
PERMIT APPLICATION FORM
A PERMIT TO USE GROUND WATER
A PERMIT TO CONSTRUCT A WELL
FOR: ( 1 A PERMIT TO INSTALL A PUMP
0203
( I REPLACEMENT FOR NO.
( ) OTH ER
WATER COURT CASE NO.
I!!
f)it
PtCeiv
e 979
alreft Aesootts
ANN 22
APPLICANT - mailing address
NAME ckVIC-F-A.•\--1— C.1 �1�11R�J
STREET
�►rr\��a 1n
CkTY ITS DYE Q., O � �
{State) (Zip)
TELEPHONE NO \.oq —11.OS
(2) LOCATION OF PROPOSED WELL
County VP.) j,.
t % of the 11:11, %, Section
Twp.] Vs) (.u.5... la, _
4N,S)
4E,WY
\r) -
P.M.
(3) WATER USE AND WELL DATA
Proposed maximum pumping rate (gpm)
Average annual amount of groundwater
to be appropriated (acre-feet):
Number of acres to be irrigate. . 1
Proposed total depth (feetl: n0
Aquifer ground water is to be obtained from:
Owner's well designation INC 4 1F -
GROUND WATER TO BE USED FOR:
( ) HOUSEHOLD USE ONLY - no irrigation (4)
DOMESTIC (1) ( ) INDUSTRIAL I5)
OPHVIVESTOCK (2) ( ) IRRIGATION (6)
( ) COMMERCIAL (41 ( ) MUNICIPAL (8)
( 1 OTHER (9}
DETAIL THE USE ON BACK IN (11)
(4) DRILLER
Name
Street
City
(State)
(Zip)
Telephone No. Lic. No.
FOR OFFICE USE ONLY: DC NOT WRITE IN THIS COLUMN
/d 66er
Receipt No.
Basin Dist,
CONDITIONS OF APPROVAL
This well shall be used in such a way as to cause
no material injury to existing water rights. The
issuance of the permit does not assure the applicant
that no injury will occur to another vested water
right or preclude another owner of a vested water
APPROVED
seeking relief iny�a civil court action..
APPBV//� PURSUANT TO CRS 1973, 3? -00-60i
c(a) (b) (IT ) AS TEE ONLY WELL ON A TRACE'
OF 33 ACRES OR MORE DESIGNS D AS.32.
Amu St -4 �Y} Sc43 SE -c, 1 �
_r3N�'c�a 6erv. ,
APPLICATION APPROVED
PERMIT NUMBER 1071.27
DATE ISSUED JUN U " 1"79
EXPIRATION
�.,
Owner(s):
Legal description:
(5) THE LOCATION OF THE PROPOSED WELL and the area on
whibh the water] will be used must be indicated on the diagram below,
Use;the. CENTER SECTION (1 section, 640 acres) for the well location,
+ — - — -}- — + — + — — -- -�
!A 1 MILE, 5280 FEET ---}
I
�- + + + + + -
NORTH SECTION LINE
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- - + -
- + -
I
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I
- + - --
- -1 _. -
� I
I
L
ul m + -f -
z a
l H
1
2 co _O m (!
I', -I
U 4- --- T
w p
N 2
H r
oa
m + f
+
UTH SECTION LINE
t
-I 4
-+—
The scale of the diagram is 2 inches = 1 mile
Each small square represents 40 acres.
+- —
(B) THE WELL MUST BE LOCAT AILM
by distances from section lines. -
lD 5 ft. from ucr4 sec, line
`r)D
ft. from
(north or south
ST' sec. line
(east or west)
LOT�BLOCK FILING
SUBD1 VISION rillL*O h l.tkg.
(7) TRACT ON WHICH WELL WILL BE
LOCATED Owner: 0 —A) -1Y1 rn l n WS
No. of acres 3'� . Will this be
the only well on this tract? li!s_.S
(8) PROPOSED CASING PROGRAM
Plain C�apg
(1)7 cg in. from C.) ft. to WOO
in. from to ft.
Perforated casing
++11 t
in from —,2a-bet to
in. from
ft. to .t.
WATER EQUIVALENTS TABLE (Rounded Figures)
An acre-foot covers 1 acre of land 1 foot deep
1 cubic foot per second (cfsl . , . 449 gallons per minute Igpm)
A family of 5 will require approximately 1 acre-foot of water per year.
1 acre-foot ... 43,560 cubic feet .. 325,900 gallons.
1,000 gpm pumped continuously for one day produces 4-42 acre-feet.
(9) FOR REPLACEMENT WELLS give distance
and direction from old well and plans for plugging
it:
�- g.
(10) LAND ON WHICH GROUNDWATER WILL BE USED:
Ck.lf.L5s tAJL. ls� �� J U.1� crkr. Cv..rRm vir‘..Ces3
9,,t-tNortS
No, of acres:
31
. ,
(11) QETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of disposal
system to be used. .--., r R,
(12) OTHER WATER RIGHTS used on this land, Including wells. Give Registration and Water Court Case Numbers.
Type or right
IA D
Used for {purpose}
Description of land on which used
(13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS
TRUE TO T BEST OF HIS KNOWLEDGE.
/((�
IN' r e -
SIGNATURE OF APPLICANT(S)
Use additional sheets of paper if more space is required.
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