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Septic Permits
Permit # SP-99'00616
" - J
Permit Type: Health/Residential/New
Situs Street Address 9349 MCGUIRE AV
Situs City, State, Zip
Sec/Town/Range: 27-1 1 N-67W _ Application Status: Finaled
Application Date: 12/06/1999
Parcel # (12 dIa;tsp 020127032010-R8742400
Owner Full Name: GRUBER SHEN
Owner Address: 1500 W PLUM STREET#1K
FORT COLLINS,CO 80521
Owner Phone#: (970)491-8904
Contact Name: GRUBER SHEN
Contact Address: 1500 W. PLUM STREET#1K
FORT COLLINS,CO,80521
Contact Phone# 970-491-8904
Information above has been Verified in Accela b ern le ee noted below
x June 12, 2008
Processed by: Date
Report ID: EHS00024v003 Page 1 of 1
Print Date-Time: 6/1212008 10:22:18AM
toamm• j. WELL CONSTRUCTION AND TEST REPORT For Office Use only
tarsal',f' `'r STATE OF CSOLORADO, OFFICE OF THE STATE ENGINEER RECEIVED
1. " WE ;? RMIT NUMBER 221891_ -- . - - .-- . .. --- . JAN 2 4 2000 . •
•
Z'OWNER,NAME(S) Julie N. Gruber . - .- "'"rf',
scxxti,Es
Mailing Address 1500 W. Plum St. # 1K
srtirr EMciri[[li.
-- City,•St:Zip Ft. -Collins Co. - 80521' - `'°`� -- .-
Phone (g70• •)-.4.9.1-8904 - • . • - •
. _ _ . . •
3, WELL LOCAT ON AS DAILLE : SE 1/4 NW- 1/4, Sec. 27 Twp. . 1 • .N 1 Range 67 W
DISTANCES FROM SEC. LINES: . - . -
2435 • ft. from North Sec. line. and 1755 ft. from West Sec. line. OR
(honn or sown (Um or west) ,
SUBDIVISION: _ LOT BLOCK FILING(UNIT)
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION ft. DAILUNG METHOD Rotary •
DATE COMPLETED 1-4-2000 . TOTAL DEPTH 160 It DEPTH COMPLETED 160 It.
S. GEOLOGIC LOG: B. HOLE DIAM. (n.) From To (ft) •
. Depth - .Detcrtptton of Material(type,Size,Color,Water Location) 8 7/8 0 1 6 0
0-:2 , Top; sot-}.
2-17. Sand•.& ravel7fine to rock I . .
7- 5 4.1 ite & Brri- clay w ine ravel
5-50 White , Yellow & ra r_la mix . 7. PLAIN CASING _
5 - : Gra y, o o k r. e s a e CD (in) Kind Wail Size From(it) To(ft)
S a e w cos str s. 6 5/8 Steel . 188 +1 20
80-115 Shale 5 PVC . 277 20 80
115-150 White SS shale' mix
150-160 Shale - -
i'ERF, CASING: Screen'Slat Size: -035
5 PVC . 277 80 166
B. FILTER PACK 9. PACKER PLACEMENT:
Material Gravel Type
Size 3Z8
Interval 20-160 Depth
•
la GROUTING RECORD: •
Material Amount Density Interval Placement
REMARKS:_,L__.1._-_,..,_ I Cement 3 SK. 1 . 86 0-20' POur'ed '
1 - - _
•
It DISINFECTION: Type I-1TH_ Amt, Used 1#'
12. W !DATA; O Check box If Test Data is submitted on Form No. GWS 39 Supplemental Well Test.
I
TESTINGMETHOD 8a lied
StaN 'Leval' ,,I18 ft. Date me measured 1-4-2000 , Production Rate 8 y gpm,
Pumping level 14 O• it Dateffi rne measurer! 1 .4-2 0 0 0 ,Test length (hrs.}2----, - - - - .,
Remarks
t3. I have road the addemente made herein and know the contents thereof, end that they ere true to my knowledge. [Pursuant to Section 24.4134(13)0
CRS.,the making of isles statements herein constitutes perjury In the second degree and Is punishable as a claws I misdemeanor.)
CONTRACTOR R & R _Wei} j Pume Inc. Phone 970 353-31 18 Lic'No. 857 .
MailintiActtlress P.O, box 577 Greelev1 Co- 8t}632 _1
NaMe/T1tie (Please type or print) Signature r Date
✓ ,
OWNER Glenn A. Clement 1-19-2000
Form No. OFFICE OF THE STATE ENGINEER
GWS-25 COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg„ 1313 Sherman SL,Denver,Colorado 80203
(343)866-3581
LiC
WELL PERMIT NUMBER 221891 -
APPLICANT DIV. 1 WD 1 DES, BASIN MD
Lot 7 Block: 20 Filing: Subdiv:CARR TOWN OF
APPROVED WELL LOCATION
WELD COUNTY
JULIE N GRUBER SE 114 NW 114 Section 27
1500 W PLUM ST#1K Township 1 N Range 67 W Sixth P.M.
FT COLLINS,CO 80521-
..TANE5 FROM SECTIO I SINES
2435 Ft. from North Section Line
(970)491-89p4 1755 Ft. from West 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 this permit
does not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested
water right from seeking relief in a civil court action.
2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2,unless approval
of a variance has been granted by the State Board of Examiners of Water Weil Construction and Pump Installation
Contractors in accordance with Rule 18.
3) Approved pursuant to CRS 37-92-602(3)(b)(It)(A)as the only well on a residential site 010.52 acre(s)described as lot 7,
block 20,Town of Can',Weld County.
4) The use of ground water from this well is limited to ordinary household purposes inside one single family dwelling. The
ground water shall not be used for irrigation or other purposes.
5) The maximum pumping rate of this well shall not exceed 15 GPM.
6) The return flow from the use of this well must be through an individual waste water disposal system of the
non-evaporative type where the water is returned to the same stream system in which the well is located.
7) This well shall be constructed not more than 200 feet from the location specified on this permit.
8) This permit has been approved for the SE1/4 of the NW1/4 as described by the distances from Section Lines and the Plat
submitted with the application. You are hereby notified that you have the right to appeal the issuance of this permit,by filing
a written request with this office within sixty(60)days of the date of issuance,pursuant to the State Administrative
•
Procedures Act.(See Section 24-4-104 through 106,C.R.S.)
APPROVED + f
HCF rf
ErIg;noec la 1 6 'Oil 16 MI
Receipt No.0448131 DATE ISSUED — — — - EXPIRATION- OAT
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