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Home My WebLink About20190407.tiffCENTRAL. h- F ti... 1. NT '`FR DISTRICT 1;:11!','7, ... \- Ii't1C -1111 - C- `_l `': • Rti - ;1iti Dar \li t\ i:_t(LiTi'j€_ [Li." de.sc", $ ti r presently I the `ti d 's }'. tar r'urti r ? I U_ „ lJeied at Co RL 4- 7,5AMY. can he Il:a..'e ai,aLiblc, to this FJtu{;FQii-t?, 'e!1[s ` !'.i:"1: 1 \,tal l), _,..ti. \C'i.hei L S. Bt_„ Z� ,..:i -....• r s S li d C:91-2.1%; 11.c,[ 'I?. i !)t I';'..',I'.? 1 IirUn on le,:. .:' tbe dale o1 This rE`: U: this eT, e\tenii d :Ii `t-.:... _7 r', the [).kiln. Please Contact the f_ ti'. a: 1, li:: �' _, i..t. r is C'..? ',t L:: [' per i. CENfitkl. 1)COI .i it X4.1 11 1)I IRI(. 1 (;C;!e: -. PA.7., .. i.. �1 f.. ... /1d:'. :.e,e7d1 Nit!:;3,:p.!! JV1r'1AL• CENTRAL WELD COUNTY WATER DISTRICT 2235 2nd Avenue Greeley, CO 8063 INlV(.)1('Ii I;N('1.()SIJ) ::: Eddie & Brittany Wright & Rita Giant 17483 County Rd 44 La Salle, CO 80645 IIl1111111111 1IuIfl1IluIIIRill US POSTAGE PAID GREELEY CO PERMIT NO. 74 Full]"JI11'IlIljjijiEt1jl5ll�Fulijllllittllij'jli'li1'jrliltl Print Date -Time: 9/5/2008 9:34:50AM Scanning Cover Sheet for Septic Permits Permit # Permit Type: Situs Street Address Situs City, State, Zip SE -9600079 Health / Residential / Statement of Existing 17483 CR 44 SectTown/Range: 13 -04N -66W Application Status: RECORDED Application Date: 07/30/1996 Parcel # (12 digits) 105713300067-R6905498 Owner Full Name: Owner Address: Contact Name: Contact Address: SCHAEFER WILLIAM L & BEVERLY J 17483 WELD CO RD 44 LA SALLE,CO 80645 Owner Phone #: SCHAEFER WILLIAM L & BEVERLY J 17483 WELD CO RD 44 LA SALLE,CO,80645 Contact Phone# Information above has been Verified in Accela by employee noted below 1-frfo Probes d September 05, 2008 by: Date Report ID: EHS00024v003 Page 1 of 1 WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970)353-0635 EXT 2225 FAX (970)356-4966 Permit #: Statement Of Existing Septic Permit SE -9600079 Sec/Twn/Rng: 13 04 66 Location: 17483 WCR 44, LASALLE CO 13-04-66 Parcel No: Legal Desc: APPLICANT OWNER Date: 07/30/1996 1057 13 000027 17077 E2SW4 13 4 66 EXC BEG AT SW COR OF E2SW4 17483 44 CR WELD SCHAEFER WILLIAM L 17483 WELD CO RD 4 SCHAEFER WILLIAM L 17483 WELD CO RD 4 Description: HOUSE Town: Commercial (Y/N): N Number of Persons: Number of Bedrooms: 4 Water Public (Y/N): Y Water Private (Y/N): N Water Permit No: & BEVERLY J 4, LA SALLE CO 80645 & BEVERLY J 4, LA SALLE CO 80645 Residential (Y/N) : Y 4 Basement Plumbing (Y/N): Y Bathrooms-› Full: 3 3/4: 1/2: Utility Name: CENTRAL WELD Cistern (Y/N) : N Well (Y/N) : N Septic Tank: CONCREgallons Absorption Trench: 400 sq. ft. Absorption Bed: 800 sq. ft. Acres: 4.00 Tank Material: 1500 Year Installed: 1977 NOTICE The property owner/agent has certified BY NOTORY SEAL that the above described septic system is in fact installed as described, and exists at this time on the parcel identified above by the parcel number and/or legal description, and further states that the system Is in good working order and/to the best of his/her knowledge IS NOT failing to function properly. The property owner/agent further understands that any falsification or misrepresentation may result in the revocation of any permit granted based upon this information hereby submitted and in legal action for perjury as provided by law. The Statement of Existing Record relies on information the property owner or his/her representative 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. Issuance of the Statement of Existing Permit for any system does not constitute assumption that the site was evaluated or inspected during any phase of construction by this Department to meet regulations. 7-30 ` 76 tal Specialist Date -arCOUNTY HEALTH DEPARTMENT ENVIRONMENTAL PROTECTION SERVICES 1517 16th Avenue Court Greeley, Colorado 80631 (303)353-0635 OWNER OF RECORD: Health Department SOE 0 .E., 16060 '7 . LOAN 0 ISDS + 0334;u, REPAIR 0 PIERISIT I STATEMENT OF EXISTING FOR SEPTIC SYSTEM FILL OUT IN BLACK INK ONLY) Sever (y PHONE: Cc ha 4€ " MAILLNG ADDRESS: 19 4 S3 fit i C k 44 F_Q Sot. (r ., City SITE ADDRESS: (PLEASE ;Mem L, SQLe 9'1,- 4-- l yt-o7 State So 4c Zip LEGAL DESCRIPTION: PT: SUBDIVISION: NUMBER OF PEOPLE: PT: SECTION: City State ra TOWNSHIP: _i LOT: BATHROOMS: 3 LOT SIZE: RESIDENTI or COMMERCIAL BASEMENT PLUMBING: SYSTEM SIZE: Tank is constructed of cone k,e,(-e. and (material) FIELD: Bed gOO sq. ft. or Trenchp sq. ft. BLOCK: Zip RANGE: CQ 6 FILING: BEDROOMS; WATER SUPPLY: e c i.. ,(D has /6-00 gallons capacity DATE SYSTEM INSTALLED: ItALOP'1 f 127 You are required to draw a diagram of the system on the reverse side of this form in black ink only and indicate location, length, width, and distance from the dwelling. The undersigned property owner hereby certifies that the above described septic system is in fact installed, as described, and exists at this time on the parcel of ground identified by the above legal description and further states that the system is in good working order and to the best of his/her knowledge is not failing to function properly. I further understand that any falsification or misrepresentation may result in revocation of any permit granted based upon this information hereby submitted and in legal action for perjury as provided by law. , Sub erib'i'1 and ,iitorri to b by Witness Date fore cial seal. STATEMENT OF EXISTING REVIEWED BY: day of ' Y.tc , 199('9. Environmental Protection Specialist BLACK INK ONLY! N w S E LEGAL DESCRIPTION: PT: SUBDIVISION: \, J/ WATER SUPPLY: 0 REQUEST NO: (--) 3 I - 9 (, INDIVIDUAL SEWAGE DATE RECEIVED: `1 ( / 9 DISPOSAL SYSTEM EVALUATION RECEIVED BY: 1 -lc Weld County Health Department FEE 0.00: 9 c.a OWNER: R+Ql 1 i AJ.Qfr\_, x MAILING ADDRESS: \ LA LOA DATE INSPECTED: -1 / t 711 `i / PHONE: 1 -16) - L 1.A Say en 7mo Li. CITY STATE ZIP SITE ADDRESS: L\ 1--p._ \ O s - CITY STATE 1ZIP PT: SEC: ) a TWN: N RNG: / n I 0 w LOT: BLK: FLG: RESIDENTIAL COMMERCIAL TOTAL ACRES: {-I. V aC , PERMIT ON RECORD: Name: ...an_I vp ) System Size: Tank: / Soo gallons Trench: i/g749' square feet Bed: SOO square feet Permit 7,1 5.0.E.: N Percolation Rate: 10 minutes per inch Soil Type: Sur►d 7 10 AM Engineer Design: Y Percent Ground Slope: Direction: El The septic system identified above / IS NOT of sufficient size to accommodate the proposed alterations(s) indicated below to the structure(s) served by this system. CURRENT FLOW Description: Persons: L Bedrooms: Bathrooms: Basement Plumbing: Y�5 ADDITIONS Description: PROPOSED TOTAL Description: The existing septic system is REQUIRED / RECOMMENDED to have the following alterations made to accommodate the proposed alterations to the structure(s) served: Neither the County of Weld nor any of its agents or employees 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 or in the report. This inspection was conducted for the purpose of determining compliance with current regulations and for detecting health hazards observable at the time of inspection. This does not constitute a warranty that the system is without flaw or that it will continue to function in the future. Inspections requested during periods of snow cover and high soil saturation may be of questionable value to potential buyers due to adverse conditions. Evaluations based on Statements of Existing (5.0.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. WRJ•26.72 THIS FORM r O -S7 BE SUBMITTED WITHIN Sari DAYS OF COMPLETION: OF THE WORK DESCRIBED HERE- ON. -rpE I5R PRINT tN BLACK INK. COLORADO DIVISION OF WATER RESOURCES 300 Columbine Bldg., 1845 Sherman St. Denver. coloraclo'80203 - WELL COMPLETION AND PUMP INSTALLATION REPORT PERMIT NUMBER 89427 WELL OWNER William L. Schaefer ADDRESS 21275 Weld Cc. Rd. 35 La DATE COMPLETED July 30 WELL LOG - From To Type and Color of Material Water Lac. 0 . 3 top soil 3 11 fine sand 11 17 clay 17 25 sand & gravel x 25 38 clay 38 66 sand & .gravel x 66 103 sandy clay 103 106 shale TOTAL DEPTH 106' Use additional pages necessary to complete log. SE % of the SIDI Salle, CO 30645 3 4 N , R. 66 19 77 HOLE DIAMETER 7 7/8 in from t ` to 166 ft. in from to ft. RECEIVED 06'17 s1,s sU$ G 'l. of Sec. 13 P M 6 in from _ to ft. DRILLING METHOD Rotary CASING RECORD: Plain Casing PVC from C' to ft. PVC from 66 to 106 ft. Size & kind from, to ft. Perforated Casing. . PVC from 46 to 66 ft. Size 5" & kind Size 5" & kind Size 5" & kind Size & kind from Size & kind from GROUTING RECORD Material Cement Intervals 0 - 10 ft. Placement Method pour GRAVEL PACK: Size pea oravel Interval 10 • 106 ft. TEST DATA Date Tested •,uguat i to to ft. ft. 1977 Static Water Level Prior to Test- 25 ft Type of Test Pump Bailed,' Length of Test 2i- hours Sustained Yield (Metered) _- 20. gpm - Final Pumping Water Level . ft_ PUMP #NSTALLAT#ON REPORT Pump Make 'lam . Type:. installed oy fl & R WELL & PL ? Powered by • Pump Serial No. HP - Motor Serial No. Date Installed Pump Intake Depth Remarks WELL. TEST DATA WITH PERMANENT PUMP Date Tested Not tested by R & R WELL & PUMP Static Water Level Prior to Test Length of Test Hours Sustained yield (Metered) GPM Pumping Water Level Remarks S WATER yN cs a TABLE wc hW • .1 CONE OF 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. R & R ._ & PUMP 1 NG . b / 513 SignatureWELL T �"�� ^� License No. State of -Colorado, County of Wi:i Subscribed and.sworn.to.before me this 2nd day of September My Commission -expires: June 13 r 19 _7S Notary Public SS , 19_.7 . FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM must be an original copy on both sides and signed. I. WHITE AND GREEN copies must be filed with the State Engineer. PINK COPY is for the Owner and YELLOW COPY is for the Driiler, wRJ-a-7'r COLORADO DIVISION OF WATER RESOURCES 350 Columbine Bldg., 1845 Sherman St., Denver, Colorado 80203 Application must be complete where applicable. Type or print in BLACK INK. No overstrikes or erasures unless initialed. PERMIT APPLICATION FORM IX) A PERMIT TO USE GROUND WATER (X) A PERMIT TO CONSTRUCT A WELL FOR: (X i A PERMIT TO INSTALL A PUMP t I REPLACEMENT FOR NO t } OTHER WATER COURT CASE NO. RECEIVED t.PR - i377 C `1 t..41 1 f,`-.TE ENGINEER COLD. (1) APPLICANT - mailing address NAME r1 at j ` STREET l.2'5id 6. t. . rJ 4/5 (State) 1,7 D, CITY TELEPHONE NO s 7 (2} LOCATION OF PROPOSED WELL County Twp '/a of yiie .�1� Ping. 'Y .s ,s.tv; tion P.M. (3) WATER USE AND WELL DATA Proposed maximum pumping rate (gpmf Average annual amount of ground water to be appropriated (aere•feet)' Number of acres to be irrigated: ^/6! 71471 Proposed total depth (feet; Aquifer ground wat r is to be obtained from: Owner's well designation GROUND WATER TO BE USED FOR: 1 ?HOUSEHOLD USE ONLY - no irrigation (0) (XI DOMESTIC t1) ( ] INDUSTRIAL (51 { j LIVESTOCK (2) ( ) IRRIGATION (S) ( I COMMERCIAL (41 ( i MUNICIPAL 81 ( i OTHER (9) DETAIL THE USE ON BACK I N( 1 1 FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMNt^cC.. x� Receipt No, #f q ) / c 1 Bas;r, Dist. (4) DRILLER Name street A/5 /On S77 '9/ Iz�R // u•2 City t te) Telephone No 3 f Lie. No. 7e5 CONDITIONS OF APPROVAL This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of the permit does not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested water right from seeking relief in a civil court action. APPROVED PURSUANT TO CRS 1973, 37-92-6O2 (3) (b) (II) AS TEE ONLY WELL ON A ACT OF 35 ACRES OR MORE DESIGNA'r'iu AS 40 ACRES IN S C5? -5 1 ' x.3 - g/(l- 6-a), e APPLICATION APPROVED 89427 PERMIT NUMBER DATE ISSUED EXPIRATIATE AP I DEpUTZ(STATc ENG BY I.D. COUNTY y f� (5THE LOCATION OF THE PROPOSED WELL and the area on which the water will be used roust be indicated on the diagram below_ Usethe CENTER SECTION (1 section, 640 acresi for the well location. -j- -•- -i-- - - -- - -4-• - -- NORTHJ_ X - 1 MILE, 52B0 FEET it -�. NORTH SECTION LINE NI'1 NQ 1O3S ISVR i - + -4- - SOUTH SECTION LINE -t- -- The scale of the -diagram is 2 inches = 1 mile Each small square represents 40 acres. (6) THE WELL MUST BE LOCATED BELOW by distances from section lines. J r )D ft. from (north or toliiill 1D ft from � sec. tine ti sec. line, LOT BLOCK least or west) FILING s SUBDIVISION (7) TRACT ON WHICH WELL. WILL BE LOCATED Owner .'e - Sf 6,{, )- No. of acres the only well on this tract? . Will thE5 A (8) PROPOSED CASING PROGRAM Plain Casing in from 0 - ft to / © ft. _in. from ft to ft Perforated casing t5.-- in. from 7O ft. to C) ft in, from ft. to ft WATER ECuiVALENTS TABLE iPounded figures) A.n acre-foot covers 1 acre of land 1 foot oeep 1 cubic foct var second leis) ... 4-49 gallons per minute igpm` A family of 5 wilt require approximately I acre-foot of water per year. 1 acre-foot ... 43,560 Cubic feat .. , 325,900 gallons. 1,000 gpm pumped continuously for one day p!oduces 4.42 acre-feet. (9) FOR REPLACEMENT WELLS givedistance and direction from old well and plans for plugging it: (10) LAND ON WHICH GROUND ��}}WATER WILL BE USED: 0wnerls): inf.+.J ", 11 426° ,,,p- Legal description: S.6 -7(7-047I20,/ d/4' 6f14 /�/ fit gede /d + /►' Wp I/ - P4/1 (11) DETA LED DES RIPTI of the use of round water: Household use and domestic wells must indicate type of disposal system to be used, vese ,‘,/se , doX /.G (6,./7 t col7e.W;G No. of acres: (12) OTHER WATER RIG}ITS used on this land, including wells. Give Registration and Water Court Case Numbers, Type or right Used for (purpose) ilkf/� f/�f /1"/-7,7a71rart Description of land on which used &Pen e 674 / d 4- (13) THE APPLICANTS) STATES) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE. SIGNATURE OF APPL ICANT(S) Use additional sheets of paper if more space is required, Hello