HomeMy WebLinkAbout20192101.tiffWeld Coun Environmental Health Services Department
1555 N. 17th Avenue
Greeley, CO 80631
Phone: (970) 304-6415
Fax: (970) 304-6411
Web: weldhealth.org
Septic Permit - Final
Application Number: SP -1300120
Owner Name: SIPRES MARY D
Site Address: 1490 CR 27
BRIGHTON, CO 80603
App Type: Health\Commercial\Repair\Septic
MARY SIPRES
1490 CR 27
BRIGHTON, CO 80603-9332
Parcel #: 147129000064-R6272886
Legal Desc: 15989 PT NW4SW4 29 1 66 W OF RR RAN EXC UPRR RES
App Specific Info:
Einaled
Application Status:
Ready to Final
Applied Date:
05/29/2013
Issued Date:
06/05/2013
Finaled Date
Location Description
Repair Reason Type
Associated Building Permit
Application Date
Septic Permit Expiration Date
Waive Fees
Number of Persons
Number of Bedrooms
Basement Plumbing
Full Bathrooms
314 Bathrooms
I1/2 Bathrooms
Public Water Supply
Private Water Supply
Parcel Acres
1490 CR 27
Repair for Upgrade
No
0512912013
05/29/2014
No
292
2
Yes
1
0
0
No
Well
.554
Actual Installation:
Septic Tank: , 50D gallons
Design Type: yPe:
�
la - ,
Chambers
Absorption Trench: sq ft
Absorption Bed : 01'/1-"40 sq ft
Chamber Model
NOTICE
The issuance of this permit does not imply compliance with other state, county, or local regulatory or building requirements, nor shall it act to certify that
the subject system will operate in compliance with applicable state. county and local regulations adopted persuant to Article 10, Title 25, CRS as
amended, except for the purpose of establishing final approval of installed system for issuance of a local occupancy permit persuant to CRS 1973
25-10-111 (2).
This permit is non -transferable and non-refundable. The Weld County Department of Public Health and Environment reserves the right to impose
additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval was contingent upon the final inspection of
the completed system by the Weld County Department of Public Health and Environment
c
l/ilcvi �Z4/ll
Environmelpfil Health Specialist
Report ID: E H S 00033x006
Print Date Time: 6/27/2013 2:45:01 PM
7-r 3
Date
Page 1 of 2
Application Number: SP -1300120
Owner Name: SIPRES MARY D
Site Address: 1490 CR 27
BRIGHTON, CO 80603
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Report ID: Eli 0003 3v006 Page 2 of 2
Print Date Time: 6/27/2013 2;48:01 PM
Jun 30 13 09:53p GREN EXCAVATING, LLC
303-659-6041 p.1
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Cei HIGH puma a ERIN & DESIGN. LLC
7214th STREET, SUITE 0, FORT LIPTON, CO 80621 • PHONE: (303)-857-9280 • FAX: (303)-857-9238
June 29, 2013
Sipres Lounge, Inc.
1490 County Road 27
Brighton, CO 80603
RE: Observation of the septic system for the existing building located at 1490 County
Road 27, Weld County, CO.
Job #13-3639
To Whom It May Concern:
We made a final observation on June 28, 2013 of the septic system at the abovewdescribed
commercial site and found that it was constructed in an adequate manner. The
topography of the site and septic design required a lilt pump design and high water alarm
Two 12504 -gallon tanks were installed with a A Hp Gould effluent pump installed in the
2nd chamber of the second 1250 -gallon tank. Risers were provided to the surface from
each septic tank. A pressure relief valve was installed.
The rock and pipe system consists of four 4 -inch perforated lines spaced at 6 -feet on
center with two vent risers.
Please call this office if you have any questions or concerns.
Sincerely,
Todd M. Schroeder, PE
Copy: Governing Health Department, file
This report was prepared for the exclusive use of our client and is not intended for arty other purpose. Our
report is based on the information made available to us at this time. Should additional. information become
available, we reserve the right to determine the impact, if any, oft the new information on our opinions and
conclusions, and to revise our opinions and conclusions if necessary and warranted by the discovery of
additional information.
In Account with
Art's Septic Service
Arthur C. Beierie/Bradley A. Beierle
PO Box 387, Platteville, Colorado 80651
Prompt, Dependable Service Every Day except Saturday
Metro: (303) 659-2355
Platteville: (970) 78543335
Septic Tanks Grease Traps Lift Stations
Holding Tanks Electronic Locator Service
1-2 People: Every 3-4 years
Recommended Septic Tank Cleaning Cycles:,
3-5 People: Every 2 years 5-7 People: Every year 7+ People: Every 6 months minimum
Serviceman:
Record II
Name:
Date:
Phone:
County:
Billing Address:
• tic/ reel
City, State, Zip:
,r p
Job Address:
jr-::—
Glean: Septic Tank kir Grease Trap Lift Station . Holding Tank S OtherTank Size. Gallons Working Capacity „50 Gallons Removed Building: Vacant ___-- Occupied Ara -
Tank Construction: Concrete Plastic Metal Other
Structurally Sound & Water Tight: Yes No Compartments:
Ratffles/Tees: Inlet: Good Bad Missing Outlet: Good Bad Missing Lift Pump Functioning: Yes No
System Working Level: NorTrial Below Above Solids Extra Heavy:
Drain Field Running Back: Yes No How Much? Any Other Problems Observe4 :. h .
Reason for Service: Maintenance Real Estate Sale Emergency/Backup I Other /943/1 M ' eiroentrefeer kiaa Up,n,zc,s c bid
Er /3 Lt /ift4
Additional Services:
[ ] Service Call
[ ] Inspection Service: NAWT [ ] Standard [ ] Diagnostic [ )
Cost:
[ ) Digging Labor
a S .00 per 1 Hour
[
] Locator Service to locate septic tank and mark approximate location of access lids
[ ] .Extra Equipment/Extra Pumping Time:
[ ] Other:
r2
Credit Terms: ....3
i
Toldt cost:..k
.00
.0O
.00
$ .00
$ .00
$ .OHO
r.9,r
All services shall be due within the above state terms or 30 days of not stated. Any accounts that are 30 days Past Due will be charged a monthyly tate fee of twenty-five dollars
($25.00) or 5% of the balance, whichever is more. Any accounts 90 days Past Due will be turned over to a collection service. The customer will be responsible for all costs incurred
in the collection of the Past Due account, including attorney and court costs.
Signature:
Damage Waiver
Art's Sanitation Services assumes no responsibility for damages inside of the curb or property line where damage may occur to:
(
I acknowledge die Damage Waiver and authorize the driver to cross the property as referenced above.
Signature:
Weld County._ Environmental Health Services Department
1555 N. 17th Avenue
Greeley} CO 80631
Phone: (970) 304-6415
Fax: (970) 304-6411
Web: weldhealth.org
Septic Permit Repair
Application Number: SP -1300120
Owner Name: SIPRES MARY D
Site Address: 1490 CR 27
BRIGHTON, CO 80003
App Type: Health\Comme rciaRRe pair\Septic
MARY SIPRES
1490 CR 27
BRIGHTON, CO 80003-9332
Parcel Number: 147129000064-R6272886
Legal Desc: 15989 PT NW4SW4 29 1 66 W OF RR RNV EXC UPRR RR RES
EHS Septic General:
Location Description
Repair Reason Type
Associated Building Permit
Application Date
Septic Permit Expiration Date
Waive Fees
Number of Persons
Number of Bedrooms
Basement Plumbing
Full Bathrooms
3/4 Bathrooms
1/2 Bathrooms
Public Water Supply
Private Water Supply
Parcel Acres
Application Status:
try Review
Applied Date:
05/29/2013
Intake Person:
MSWAIN
Permit Expiration Date:
05/29/2014
1490 CR 27
Repair for Upgrade
No
0512912018
05/2912014
No
292
2
Yes
1
0
0
No
Well
554
Report ID: EHS00028v009 Page 1 of 2
Print Date - Time: 5/29/2013 11:23:06AM
Application Number: SP -1300120
Owner Name: SIPRES MARY D
Site Address: 1490 CR 27
BRIGHTON, CO 80603
Percolation Rate 45
% Ground Slope
Engineering Design Required
Limiting Zone ft
Direction
}
sc.
in Description
Soil Suitabl
In 100 Year Flood Plain (Y
From the ap lication information supplied and the on -site soil percolation data the following minimum installation specifications are required:
c)oM
Septic Tank gallons Absorption Trench 49 a\
Chambers: Standard BioDiffuser
infiltrator Quick4 Standard or Hi Capacity
Biodiffuser Arc 36 Standard or Hi Capacity
Infiltrator Quick4 EQ36
Infiltrator Quick4 Plus Standard Low Profile
sq ft or Absorption Bed
Trench
Trench
Trench
Tre
Trench
k klo
Ciokll Weld County ISDS regulations appl n addition, this permit is subject to the following additional tenons and
conditions:
f\DA2EZI‘SL„ ;co (\)%
krai c -As Os Et t c ofv-v (-).___A-es-ra (S.7t
Bed
d
Bed
Bed
sq ft
iThrt_57‘) rrc-/Zerr a p oc_o iv) rat ns 0 a_E_
sarr-r*s •-?Zt rk_ irk/a\ a in u "Lc
ti s c. NOTICE Lid *e\as\; ��at9 pp r 1>irc
This permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the Weld County Department
of Public Health and Environment for reasons set forth in the Weld County Individual Sewage Disposal System Regulations including failure to meet
any term or condition imposed theron during temporary or final approval. The issuance cif this permit does not constitute assumption by the
department or its employees of liability for the failure or inadequacy of the sewage disposal system. This permit is..non-transferable and
non-refundable. Before issuing final approval of this permit the Weld County Department of Public Health and Environment reserves the right to
impose additional terms and conditions required to meet our regulations on a continuing basis_ Final permit approval is contingent upon the final
inspection of the completed system by the We,, J County Department of Public Health and Environment. This permit expires one year from the
a .. lication date.
X
Environmental Health Specialist Date
Report ID: EHS00028v000
Print Date - Time: 5/29/2013 11:23:06AM
¶½1Stros„v
Page 2 of 2
Weld County Environmental Health Services Department
1555 N. 17th Avenue
Greeley? CO 80631
Phone: (970) 304-6415
Fax: (970) 304-6411
Web: www.co.welfhealth.org
Septic Permit Application
Application Number: SP -1300120
App Type: Health\Commercial\Repair\Septic
MARY SIPRES
Owner Name:
Parcel #:
Legal Desc:
Site Address:
App Specific Info:
1490 CR 27
BRIGHTON, CO 80603-9332
SIPRES MARY 0
147129000064-R6272886
15989 PT NW4SW4 29 1 66 W OF RR Ft= EXC LJPRR RES
1490 CR 27
BRIGHTON, CO 80603
1/2 Bathrooms
3/4 Bathrooms
Basement Plumbing
Full Bathrooms
Location Description
Number of Bedrooms
Number of Persons
Parcel Acres
Private Water Supply
Public Water Supply
0
0
Yes
1
1490 CR 27
2
292
.554
Well
No
TERMS AND CONDITIONS
A permit fee, as set by separate ordiance of the Board of Weld County Commissioners, shall be required of applicants for new individual
sewage disposal systems (ISDS), payable at time of application. Permit fees are non-refundable; permit applications are
non -transferable. If both a building permit and an IS DS are issued for the same property and construction is not commenced prior to the
expiration date of the building permit, the ISDS permit shall expire at the same time as the bui#ding permit If an ISDS permit is issued for a
property that does not require a building permit, the ISDS permit shall expire one year after its issuance if construction on the septic system
has not commenced. Any change in plans or specifications after the permit has been issued invalidates the permit unless approval is
secured from the Health Officer or his/her designated agent. Expired permits can be renewed by payment of the permit fee only if:
A_ There has been no change in the plans and specifications of the proposed system as set out in the original application or such
change is reviewed and approved by a Division Representative.
B. The surrounding land, its use or zoning has not charged so -as -to cause the original application not to be acceptable under these
regulations_
NOTICE
The completeness of this application is conditional upon further mandatory and additional tests and reports as may be required by the Weld
County Department of Public Health and Environment (WCOP H E)_ The issuance of the permit is subject to such terms and conditions as
deemed necessary to insure compliance with rules and regulations adopted under article 10 title 25, CRS as amended. The applicant certfies
that the proposed system will not be located within 400 feet of a community sewage system. The undersigned certifies that all statements
made, information and reports submitted herewith are, or will be, represented to be true and correct to the best of hislher knowledge and are
designed to be relied on by the WCDPHE for evaluation for purposes of issuing the permit applied for herein. Applicant further understands
that falsification or misrepresentation may result in the denial of the application or revocation of any permit granted, and in legal action or
perjury as provided by law.
45-rectr-i%
Owner/Appiic - nt Date
Report ID: EHS00056v903
Print Date Time: 5/29/2013 11:22:44AM
Page 1 of 1
SEPTIC PERMIT INFORMATION FORM
To obtain an I.S.D.S. permit, one must file an "application for Individual Sewage Disposal System"
at the Weld County Environmental Health Services office and pay the application fee. A "repair" fee
shall be charged for the expansion, replacement, or repair of an existing system. The following
information must be provided on the septic information form.
COMMERCIAL PERMIT
NEW or REPAIR $850.00
VAULT PERMIT
NEW or REPAIR $250.00
RESIDENTIAL PERMIT
NEW or REPAIR $750.00
MINOR REPAIR PERMIT
$ 100.00
PARCEL NO.: cf. ]/1) y(}0QO (p
LEGAL DESCRIPTION: SECTION CI\ f TOWNSHIP L_ 111' RANGE (a'p id ACRES d • S 541 tWIC°
SUBDIVISION LOT BLOCK FILING
THIS 1NFORMATItJ1V CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT (970) 353-3845 EST 3650
(12 DIGIT NUMBER)
SITE ADDRESS
DIRECTIONS TO SITE td,i j ',S�` ToIJQ±q�toA' ��,�U/'t''�' s ',�z.� m,), ° iu fct si De.
PROPERTY OWNER:
i WIN L e�{
iv 51' execs
MAILING ADDRESS: ���j��� � �I... � � CITYbA � h ST G►j ZIP
PHONE: -- ag— WORK PHONE ( ) FAX ( )
EMAIL ADDRESS: !M
ct)o coo &
o if 1ocoati s
APPLICANT NAME: � g-,lZ57jA*% -
MAILING ADDRESS: 1 Vit0 1ii C/rt CITY {,� �eC., Mail' ST C.) ZIP
HOME PHONE: (1�) 3 -I e`S-S)I WORK PHONE ( ) FAX ( )
EMAIL ADDRESS: (114_ etbcgat-J
DESCRIPTION OF BUILDING (EX: HOUSE, MOBILE HOME, MODULAR, SHOP, OFFICE) (3,m -n' t t c L 174 vegAl narks
igt GA3
teCkkar. Levw
IF OBTAINING A REPAIR PERMIT, WHAT IS BEING REPAIRED?
NUMBER OF PERSONS I;tJ Z IN FLOOD PLAIN AREA? YES /60)
NUMBER OF BEDROOMS o7- PERCOLATION HOLES MUST BE MARKED FOR
INSPECTION OR A $50.00 FEE WILL BE CHARGED
BASEMENT PLUMBING (VES) NO
BATHROOMS: FULL
34
vz
51-A
PUBLIC WATER SUPPLY YES I NO NAME
PRIVATE WATER SUPPLY YEii NO
'1....
CENSUS TRACT
(wE14ci STERN
PERMIT # ;T-7 30 I 9
NIGH PLAINS ENGINEERING & DESIGN LLC
721 4th STREET, SUITE Q, FORT LUPTON, Co 80621 • PHONE: (303)-857-9280 • FAX: (303)-857-9238
June 4, 2013 --- vi SE -0
The Sipres Lounge, Inc,
1490 CR 27
Brighton, CO 80603
RE: To provide an onsite wastewater system for the existing building at 1490 County Road
27, Weld County, CO
Job # 13-3639
SEPTIC SYSTEM DESIGN DATA:
The purpose of this design is to provide a septic system design for the existing night club.
The current water usage is limited by the well permit (No. 273019) to 108,600 gallons per
ear which e • uates to about 298 . aligns • er da • d
The water usage has been monitored since 2007. The establishment used a total of 66,990
gallons for 2012 which averages to 183.5 gpd, with the maximum month in October = 9120
gallons 4 294 gpd.
The club has typically been open Friday, Saturday and Sunday and closed the remainder
of the we&iilS, The water usage shall continue to be monitored and documented to ensure
that the facility stay within the limits of the permit
The percolation test for the site performed by High Plains Engineering & Design had an
average percolafion rate of 52.8 minutes per inch (mpQ.
Average water usage per day = 298 GPD
x 1,5
TOTAL MAXIMUM FLOW (Qmax) = 447 OPD
ABSORPTION AREA - (WELD COUNTY):
Abed = 2710.th x 1.3 = 1206 SF
cis
Atrench = 2ffspil
3.5
928 SF
jRock& Pipe.)_ Bed Design: One bed is required (24' x 60' OR 30' x 50') fr with 4 rows OR 5
rows (respectively) of perforated pipe in a "Rock and Pipe" absorption field per bed. The
pipe will be encased in 3/a" to 2-1/2" gravel per governing specifications and backfiiled
with in -situ sandy soil as detailed in the cross section.
The 12 -inch layer of aggregate shall consist of clean, washed, graded gravel or rock to
range in size from 3/4 inch to 2-1/2 inches with an average size of 1-1/2 inches. The rock
shall extend from 2 inches above the top of the pipe, level across the bed, to 6 inches
below the bottom of the pipe. The top of the rock shall be covered with landscape fabric
to prevent the gravel from becoming clogged by earth backfill.
Shredded fires are an approved alternate for the rock in this type of system.
Contact this firm to discuss suppliers and/or specifications.
A 10 MIL. (min) plastic liner is required around the perimeter of the bed where finished
grades are filled above existing grades (Typical).
COOL SEASON FESCUE GRASS SHOULD BE PLANTED ON THE ENTIRE ABSORPTION FIELD To
CONTROL EROSION AND AID WITH EVAPOTRANSPIRATION. THE AREA SHOULD BE FENCED
TO KEEP VEHICULAR TRAFFIC OFF THE FIELD AREA.
NOTE: The Engineer and Health Department will inspect the site when perforated pipe,
rock or shredded tires and septic tanks) are in place. A final inspection may be made
when the system is completed.
SEPTIC TANK SPE .I.FI TIONS:
447 GPO x30/24= 559 gallons
4 Install TWO 1250 -gallon minimum capacity septic tanks with two (2) compartments or units
in series.
**A lift pump may be required due to the elevation at the proposed septic field site
and/or the elevation of the existing plumbing. The pipe must provide 1/8" per foot fall
between the club, septic tank and the distribution system. (See lift pump detail).
Installer to provide schedule 40 pipe when trenching below road or driveway. The
absorption "bed" area shall be isolated from all vehicular travel, parking, grazing and
storage areas.
All construction is to be in accordance with Weld County Colorado Health Departments
Individual Sewage Disposal System Regulations.
Certification:
I hereby certify that the septic system shown on this plan was made by me or under my
direct supervision and is accuthe best of my knowledge or belief.
. Rcps*.
.......
s;
Todd M. Schroeder, PE
Attachments:
8
° AL
Profile Hole Log
Figure 1: Rock & Pipe bed section
Figure 2: Lift pump detail
Figure 3 Septic system site plan
Wen Permit
Water Usage Summary per owner
a
I
[Profile
Hole L+
ia" aaao"" lma a:A. Aa„ o arm,....may,
Mania
1
SANDY CLAY (SC)
z.serEXISTING
_ GROUND
cn
Sr..
F _
HIGH PLAINS ENGINEERING & DESIGN,. LLC
7214th STREETS SUITE D, FORT LUPTO , CO 80621 PHONE - (303) 857-9280 FAX - (303) 857-9238
24'
31
6'
r
4" PERFORATED
PVC PIPE (T 'P.) ..
3
b'
BACKFILL
61
w
3'
4" GRANULAR I
FILL
\ 3/4" TO 2-112"
GRAVEL (TYPe)
FIGURE 1: ROCK & PIPE BED CROSS SECTION
SCALE: 114" = 11-0"
NOTE: THE EXCAVATION DEPTH MAY BE UP TO 4 FEET DEEP FOR A "REPAIR' INSTALLATION
CHECK WITH THE GOVERNING HEALTH DEPARTMENT / PERMIT PRIOR TO EXCAVATING
I
q EXISTING
GROUND
GEOTEXTILE FABRIC
721 4th STREET, SUITE ID, FORT LUPTON, CO 80621 PHONE - (3 03) 857-9280 FAX - (303) 857-9238
HIGH PLAINS ENGINEERING & DESIGN LLC
22" LID er TM-
LITTLE GIANT 101 I1W ALARM & CONNECTION
BOX MOUNTED INHOI J S E (OR EQUIVALENT) ....
UNDERGROUND ELBOWCABLE
RAM -NECK &
- GROUT
WATER TIGHT
4" PVC
INI.1ET FROM
SEPTIC :P'I'IC TANK
300 GAIJ.
TANK (MIN)
MAYARA R A S I :A I. I; D
AS- I CONTROL &
CONNECTION BOX
2" SCH 40 P.V.C.
PIPE (TYP.)
I IIGII WATER
ALARM FLOAT
GOULDS MODEL 3811
(MIN.OR EQUIV.) -_
SUBMF.RSII, r. ....
PUMP
8" CONC.
BLOCKS
l"
ALLOW SUFFICIENT
CABLE. TO
REMOVE PUMP
MALE
ADAPTERS
CONCRETE BRICK OR
BLOCK RISER 24 CLEAR
AS REQUIRED
THREADED UNION FOR
PUMP DISCONNECTION
--TM GATE OR GLOBE VALVE
2" S CI 140 P.V.C,
PIPE ('FYI'.)
BUSHING ADAPTER
2" PVC TO
SOI ,ID GROUND)
RAM -NECK &
GROUT BOTH
INLET & OUTLET
WATERTIGI IT
DRILL i" HOLE IN
,`� RO'I" TOM OF PIPE
PUMP ON LEVEL '- ,
LEVEL CONTROL
SWITCH
PUMP OFF .
LEVEL
MALE
ADAPTER
FIGURE 2: LIFT PUMP DETAIL (IF NECCESSARY)
SCALE. N.T.S.
I,
a
k SITE MAC'
S(FKES LOUNGE
1490 COUNTY ROAD 27
WELD COUNTY, CO
10' UTILITY EASEMENT FOR UNION
IN BOOK 1157, RE. NO. 021001€
TWO 125
SEPTIC
i
10
LEGEND
O -Percolation Test Hole
X'- Percolation Profile Hole
Ls -son Profile Hole
-Fence
6
95' -10th°
GAL.
KS
10' MINI
._
F
r s
3 --
1
is
r
JDB14133639
DATF: 544.23-13
\*.
All locations shown above are based on specific information
furnished by others or estimates made in the field by High
Plains Engineering & Design personnel. The Locations, distances,
directions, etc, are not the result of a property survey but
are approximations and are not warranted to be exact it is
the owner/builder's responsibility to define property
boundaries and ensure all onsite improvements are located
_within.... the . p .At.ter ......s.i.te _ and . out_of inappropriate easements.
All distances are to be verified prior to excavation, . -
Weld County Health Department
Percolation Test and Soils Data
5/7/2013
tTL$IG..HPLAIN S EN..GIN/ EE RING & DESIGN1 LLC
721 4th STREET, SUITE (3, FORT LUPTCN, CO 80621 • PHONE: (303)-857-9280 • FAX: (303)-857-9238
FILE NO
13-3639
Pro e Address
1490 COUNTY ROAD 27
ega escr
R
an WELD COUNTY, CO
Contact Information
Name
Street
City, State, Zip
Phone
SIPRES LOUNGE, INC.
1490 COUNTY ROAD 27
BRIGHTON, CO 80603
303 548-5521
Saturation and Swelling
Smeared Surfaces
Removed:
Sand or Gravel Tided:
YES
NO
Groundwater
Encountered at
GREATER THAN 8
feet
Date and Time Presoak
Water Added:
4/25/2013 date
1...:oo' fme
Estimated depth to maximum
seasonal water table if not
encountered in profile:
Amount of Presoak
Water Added:
Date and Time
Percolation Test , _
Started: i
15 gallons
4/26/2013) date
13:00 time
Did Water Remain in Hole After the Overnight Swelftg
Period?
Is area believed to be subject to
seasonal fluctuations which could
result in a seasonal water table within
8'ofsurface?
Slope Determination in Absorption Area
5 0. 0.5
a
o he EAST
direction
Hole 1
Hole 2
YESI
NO
Hole 3
NO
Hole 4
NO
Hole 5
YES
Hole 6
NO
Bedrock
[Encountered a I GREATER THAN 8 Ifeet
Percolation
Rate
_-...------- ...-_....__-heico
a ton
Measurement'
Deep
(In)
Rate
(min/in)
Estimated depth if not encountered in
profile:
Hole
36
55.56
e of Bedrock:
Hole 2
36
41.67
Hole 3
36 ............................ 55..5
Hole 4
Hole 6
CAN'T FILL DUE TO RODENT
36
55.56
Hole 6
36
55.56
Avers e _
52.78
Is bedrock fractured or weathered?
Is bedrock believed to be permeable
(perc rate <89 min/in)?
Depth in Feet
Weld County Health Department
Percolation Test and Soils Data
5/7/2013
Note: Soils must be classified using unified syste rti AST 02487
Profile Hole Lo
-
armir. 7B.
I
2
3
4
5
6
7
8
9
10
SANDY CLAY (SC)
w
I certify that the above information is correct and complete to the best of my knowledge and
that all tests were performed in the accordance with the provisions of Weld County Health
Department individual sewage disposal regulations by myself or under my supervision.
'• . f i! i` a I i
Signature
Date
High Plains Engineering
& Design LLC
721 4th Street, Suite D
Ft. Lupton, CO 80621
303-857-9280
SITE MAP
490 COUNTY ROAD 27
WELD COUNTY, CO
N
N
0
Q
0
cZ
0
(3
X X
X X X .x............x
GAS LINE
CONCRETE BARRICADE
as �-
25'
50'
0
0
0 0
O 0
-ix _
EXISTING
BUILDING
LEGEND
O -Percolation Test Hole
--Percolation Profile Hole
A -soil Profile Hole
Fence
ALL locations shown above are based on specific information
furnished by others or estimates made in the field by High
Plains Engineering & Design personnel, The locations, distances,
directions, etc, are not the result of a property survey but
are approximations and are not warranted to be exact, It is
the owner/builder's responsibility to define property
boundaries and ensure tilt onsite improvements are located
within the platted site and out of inappropriate easements.
All distances are to be verified prior to excavation,
FormNot. OFFICE OF THE STATE ENGINEER
cws-25% ' COLORADO DIVISION OF WATER RESOURCES
618 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303) 668-3581
APPLICANT
MARY SIPRES
1490 WCR. 27
BRIGHTON, CO 80601-
(303) 659-8596
PERMIT TO CONSTRUCT A WELL
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF AP PR AL
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 OCR 402-2, unless approval of a variance has
been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in accordance with Rule 18,
3) Approved pursuant to CRS 37-92-602(3)(b)(l) and the policy of the State Engineer dated 4/23/86 under the following conditions.
4) The use of ground water from this well is limited to drinking and sanitary facilities as described in CRS 37-92-802(1)(c), for a commercial
business. Water from this well shall not be used for lawn or landscape irrigation or for any other purpose outside the business building structure.
) Production from this well is 'restricted to the Laramie -Fox Hills aquifer. which corresponds to the interval between 715 feet and 985 feet below
the ground surface. Plain casing shall be installed and grouted to prevent production from other zones.
6) The depth to the lop of the Laramie -Fox Hills aquifer is approximate. To ensure the exclusion of poor quality water from zones immediately
above the aquifer, plain casing and grout shall extend through the lowermost coal and/or carbonaceous shale that overlies the Laramie sand
portion of the aquifer.
7) The pumping rate of this well shall not exceed 15 GPM.
8) The annual amount of ground water to be withdrawn shall not exceed 0.33 acre-feet (108,600 gallons),
9) Approved as the only well on a tract of land of 1 acre(s) described as a portion of the rovii4 of the $W1 /4, Section 29, Township 1 North,
Range 66 West, 6th P.M., Weld County, reference attached exhibit "A".
10) A totalizing flow meter must be installed on this well and maintained In good working order. Permanent records of all diversions must be
maintained by the well owner (recorded at least annually) and submitted to the Division Engineer upon request.
11) This well shall be constructed not more than 200 feet from the location specified on this permit.
12) 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 trw well is located. The maximum consumptive use of ground water shall not exceed 10
1229
WELL PERMIT NUMBER 213019INNIMIMMETEMMIRF
DIV. 1 WD 2 DES. BASIN MD
rW
APPROVED WELL LOCATION
WELD COUNTY
NW 114 SW 1/4 Section 29
Township 1 N Range 66 W Sixth P.M,
DISTANCES FROM SECTION LINES
2370 FL from South
116 Ft. from West
Section Line
Section Lino
UM, R D I NATES Nret r Zone: 13 NAM
Easting: Northing:
percen
t
13) The weir constructed under permit no. 240079-A must be plugged in accordance with Rule 16 of the Water Well Construction Rules within
ninety (90) days of completion of the new well. The enclosed Well Abandonment Report form must be submitted to affirm that the old well
was plugged,
14) The issuance of this permit hereby cancels permit no. 240079-A.
NOTE: To ensure a maximum productive life of this weltf perforated casing should be set through the entire producing interval of the
approved zone or aquifer indicated above, W1/4(4) 3/2p
APPROVED
J W
Stale Engineer
Race i • t No. 3614448
A
•
I
DATE ISSUED 03-20-2007 EXRIF ; ION DATE 03-20-2009
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Lauren Li ht
From:
Sent:
To:
Cc:
Subject:
Lauren Light
Thursday, May 09, 2013 3:43 AM
'Martha Griego'
mary sipres
RE: Need Help ASAP Re Amigos Night Club
The cost is between you and your engineer. Weld county adheres to our septic regulations and we adhere to state
requirements as well. I understand that Todd and Mary Evett (who works here at our office) have communicated about
your system.
Lauren Light, M.B.S.
Environmental Planner, Environmental Health Services
Weld County Department of Public Health & Environment
1555 N. 17th Ave.
Greeley, CO 80631
flight co_ eI _co- .s
970-304-6415 Ext. 2211 (office)
970-304-6411 (fax)
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return
e-mail and destroy the communication, Any disclosure, copying, distribution or the taking of any action concerning the
contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
...........w. wa...ow*'t...,wa..n .�w. -, . — ..—....A ,........_J. A Y
From: Martha Griego [mailto hotdamm7@hotrnail.com]
Sent: Wednesday, May 08, 2013 4:46 PM
To: Lauren Light
Cc: mary sipres
Subject: Need Help ASAP Re Amigos Night Club
Hi Lauren
We were just informed by Tod the Engineer who is drawing the plans forte septic tank to be installed.
Originally they told us it would be under $15,000 for everything. Now he is saying that Weld County is asking a
lot more and therefore the cost will be closer to $30,000.
He indicated they just put a septic tank in Adams county for $6,000 and the bar was half the same size as ours
but since Weld County is asking for different things the cost is higher.
From past letters Weld County indicated that all we needed was a 1000 gallon tank and a place to install. I
don't understand...we are Grandfathered in and where are the other costs are coming from.
1
Amigos will only be opened 3-4 days a week (Thursday maybe) but for sure on Friday, Saturday and possibly
Sunday.
Can you please gives some light into why Tod is indicating that Weld County wants more for the septic tank to
be installed. I hope this is making sense to you of what I am asking.
Thank you for your time in this matter.
2
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 N. 17th Avenue
Greeley, CO 80631
Web: http://www.weldheaIth.arg
Health Administration
Vital Records
Tele: 970.3045410
Fax: 970.304.6412
Public Health & Clinical
Services
Tele: 970.304.6420
Fax: 970.3046416
Environmental Health
Services
T&e: 970.304.6415
Fax: 970.304.6411
Communication,
Education & Planning
Tele: 970.304.6470
Fax: 970.304.6452
Public Health
Frevrrit. PrOmO:t,. Pr,ntctC-
Emergency Preparedness
& Response
Tele: 970 304.6420
Fax: 970304.6469
Our vision: Together with the communities we serve, we are working to make Weld County the healthiest place to live, learn, work and play.
April 11/ 2013
Ms. MarySipres
1490 County Road 27
Brighton, Colorado 80603
Re: Opening of the Amigos Nightclub
Dear Ms. Sipres:
This letter is written as an update to the letter of March 21/ 2013, in which requirements were outlined for the
issuance of a retail food establishment license for the Amigos Nightclub. We reviewed the copy of the April 3,
2013, City of Brighton meeting minutes that you provided to us on April 10, 2013, and noted that Brighton is
not supportive of allowing the continued existing use of your property should you annex into the city. Based
on those minutes, Weld County has determined that it is not feasible for you to connect your property to the
existing sewer line. The following requirements must be fulfilled in order for a retail food establishment
license to be issued:
1. The complete retail food establishment plan review packet must be submitted to this office with all
associated fees and attachments included. The packet should be submitted by the individual(s) who
will hold the license.
2. The well water treatment system must be recertified by the Water Quality Division of the Colorado
Department of Public Health and Environment. We understand that the required paperwork has been
submitted to the Water Quality Division of the Colorado Department of Public Health and
Environment, and all parties will be notified when the recertification is complete.
3. The fire department approval form that was included with the plan review packet must be signed by
the Brighton Fire District. We understand that you have complied with the requirements of the fire
department, and so this requirement may be fulfilled simply by including the signed approval form in
the plan review packet.
4. All requirements that may be put forth by the Weld County Planning and Building Departments must
be fulfilled. We understand that you have complied with the requirements of these departments, and
the signed approval form may be included with the plan review packet.
5. The facility must be served by an adequate sewage disposal facility. The current system is not
adequate. As it is not feasible to connect to the City of Brighton's system, Weld County Code will allow
you to install a new engineer designed sewage disposal system to fulfill this requirement.
Amigos Nightclub
April 11, 2013
Page 2
Once the septic permit has been issued, retail food establishment plan review may proceed, however, the
license will not be issued until all requirements have been completed, including installation of the septic
system.
Please do not hesitate to contact either Deb Adamson (970-304-6415, X2243) if you have questions related to
the food license plan review or Lauren Light (970-304-6415, X2211) if you have questions related to permitting
of a new septic system.
Sincerely,
Trevor Jiricek
r i ce k
Director
Environmental Health Services
Ect Michelle Williams, Joe Archuleta
Kris Krengel, Brighton Fire Department, Division Chief Fire Prevention
Weld County Departments of Building, Planning, Attorney, and Clerk to the Board
Memorandum
TO: File
From: Mary Evett
DATE: March 18, 2013
SUBJECT: Septic Permit SE -1000003, 1490 CR 27,
Brighton, CO, Mary Sipres
On March 18, 2013, Dave Hagle, with A-1 Septic Service contacted me by phone regarding
the existing septic system (Septic Permit No. E-1000003) for the lounge at 1490 CR 27,
Brighton, CO, owned by Mary Sipres..I informed him that the existing system was found
to be inadequate when reviewed in 2010 for the Statement of Existing. Also, the existing
septic tank is not acceptable because it has a metal lid. I told Dave that theowner needs to
check with the City of Brighton regarding feasibility to connect to sewer. If determined by
City of Brighton that it is infeasible to connect to sewer, then the existing septic system
must be replaced with an engineer -designed septic system. A letter from City of Brighton
verifying sewer connection is infeasible is required to proceed with permitting a septic
system.
3/19/13: Mary Sipres contacted me by phone to discuss Brighton's requirements for
connecting to sewer. Mary informed that the City of Brighton is requiring annexation and
connection to their water service also. I explained that if the sewer is within 400 ft. of the
facility, and the City of Brighton can provide sewer service, the facility must connect to
sewer. According to Weld County ISMS regulations, a septic permit could not be issued.
If determined by City of Brighton that it is infeasible to connect to sewer, then the existing
septic system must be replaced with an engineer -designed septic system. A letter from City
of Brighton verifying sewer connection is infeasible is required to proceed with permitting
a septic system.
Please note: Hazel with City of Brighton Planning Division, 303-655-2058, confirmed that
the sewer is within 400 ft. of the facility.
Scanning Cover Sheet
for
Septic Permits
R
Permit #
Permit Type:
SE -1000003
Health / Residential f Statement of Existing
S itus Street Address 1490 CR 27
S itus City, State, Zip
BRIGHTON CO , 80603
Sec/Town/Range: 29 -01N -66W Application Status: Recorded
Application Date: 02/19/2010
Parcel # (12 digits) 147129000064-R62721386
Owner Full Name:
Owner Address:
Contact Name:
Contact Address:
SIPRES MARY D
1490 CR 27
BRIG RTON,CO 80603-9332
1490 CR 27
RRI HTON, DO, 80603-9332
Owner Phone #: 303-548-5521
Contact Phone# 303-548-5521
Information above has been Verified in Acacia by employee noted below
Processed by:
March 17, 2010
Date
Report ID: EH OO024v003 Page 1 of 1
Print Date -Time; 3/17/2010 12:34:51 PM
4 -.
PA
Weld County Environmental Health Services Department
1555 N. 17th Avenue
Greeley, CO 80631
Phone: (970) 304-6415
Fax: (970) 304-6411
www_co.weld.co.us
Septic Statement of Existing
WLOR ADO
Application Number: SE -1000003
App Type: Health‘Residential\Statement of Existingtha
Applicant Name: MARY D SIPRES
1490 CR 27
BRIGHTON, Co 80603-9332
Owner Name: SIPRES MARY ID
Parcel #: 147129000064-R6272886
Legal Desc: 15989 PT NW4SW4 29 1 66 W OF RR RIW EXC UPRR RES
Site Address: 1490 CR 27
BRIGHTON, CO 80603
r
Additional Into:
Status: Recorded
Applied: 02119/2010
Work Description:
RESTAURANT/BAR
App Specific Info:
:1/2 Bathrooms
‘3/4 Bathrooms
Absorption Bed Size
Absorption Trench Size
Basement Plumbing
Full Bathrooms
Location Description
,Number of Bedrooms
Number of Persons
Other Public Water Supply Utility
Private Water Supply
Private Water Supply Permit Reference Number
Public Water Supply
Public Water Supply Utility
Septic Tank Size
Tank Material
Year Installed
7
0
210
Yes
0
1490 COUNTY ROAD 27, BRIGHTON
a
100
Well
No
750
CONCRETE
UNKN
Report ID: EH S00029v002
Print Date - Time:2/19/2010 1:38:16PM
Page 1 oil
PARCEL NO.
PROPERTY OWNER
MAILING ADDRESS Rano 1.,() C'_ /2. a 7
WELD COUNTY DEPARTMENT OF PUB LIC
HEALTH AND ENVIRONMENT
1555 N. 11T" AVENUE
GREELEY, COLORADO 80631 LOAN #
PHONE: (910) 3044415 ISDS S #_ .
FAX: (970) 3044411
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
(PLEASE FILL OUT IN BLACK INK ONLY
SOEM 1OOOJ&
ORG PERMIT #
REPAIR #
t
PHONE NO._ 1303) .S€erse5 ads
iSticii-cfrevi Cn 806O.3
City State Zip
DESCRIPTION OF BUILDING (ex. house, mobile/modular home, shop, officed -.
SITE/LOCATION ADDRESS
LEGAL DESCRIPTION
SUBDIVISION
C E N + I' S TRACT
IL
r
P
COMMERCIAL 6Th/NO
NUMBER OF PERSONS I00
BEDROOMS 0
WATER SUPPLY - PUBLIC YES!
PRIVATE
SECTION
LOT
i
LOT SIZE/ACRES 2S_:
RESIDENTIAL YES 1g;
BASEMENT PLUMBING
City State Zip
TOWNSHIP I RANGE , leV
BLOCK FILING
o r�.�a:. n�a:r.. a u� S /N0
B-: BROOMS -FULL,_ 3/4 1) 112 [
NAME
0 WELL /NO CISTERN YESWELLlCISTERN#_
SYSTEM SIZE: Septic tank material is constructed of (paw ten, and has .5gallons capacity.
FIELD: Trench /C square feet or Bed square feet YEAR INSTALLED
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 dowelling.
The undersigned property owner hereby certifies that the above described septic system is in fan installed, as
described, and : ists at this time on the parcel of ground identified by the above legal description and further states
that the syste I is not in good working order and to the best of his/her knowledge i ' i no failing to function property.
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.
DATE
Subscribed and sworn to before me this
By
Witness my hand and official seal.
sqpnwpromeilll
DATE
OWNER
STATEMENT OF EXISTING REVIEWED BY
M
ommission expires
day of - � '` - - — 20 IC) ,
y
ENVIRONMENTAL DEALT PECIALIST
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COLORADO
February 26, 2010
Mary S ipres
1490 County Road 27
Brighton, Colorado 80603
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 N 17TH AVE
GREELEY, CO 80631
WEBSITE: www.co.weld.co.us
ADMINISTRATION (97D) 304-6410
FAX (970) 304-6412
PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420
FAX (970) 304-6416
ENVIRONMENTAL HEALTH SERVICES (970) 304-6415
FAX (970) 304-6471
RE: Mary Sipres ISLES No.; 1000004
Permit No.; SE -1000003
On February 22, 2010, an evaluation of the existing individual sewage disposal system at:
1490 County Road 27, Brighton, Colorado;
Section 29, Township 1 North, Range 66 West,
was conducted by Lauren Light, an Environmental Health Specialist of this department.
The existing individual sewage disposal system SDS) is not of sufficient size and capacity to
adequately handle the proposed load. This evaluation is based on a final treatment capacity for a 100
person, per day, bar.
Based on all available data, and in accordance with the Weld County ISDS Regulations, the field is
undersized by an estimated 93 percent and is 5 feet deep, which is 2 feet deeper then allowed.
According to the Weld County ISDS Regulations, the existing septic tank is undersized by 250 gallons,
based upon a 1000 gallon minimum, and the septic tank lid is constructed of a material that is not water-
tight (metal lid). This Department requires that the tank capacity be increased and the metal lid must he
replaced with a water -tight lid.
Septic Policy 2.2.E requires that the individual sewage disposal system be brought into compliance with
current ISDS Regulations. An engineer design is required as this is a commercial facility. A repair
permit must be obtained and a soil test will be required for upgrading the existing absorption field.
Be advised, 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
RE: Mary Sipres
February 26, 2010
Page 2
BIDS No.. 1000004
during periods of snow cover and high soil saturation maybe of questionable value to potential buyers due
to adverse conditions. 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 representingto the best of
his/her knowledge the system is not failing to function properly.
If we can be of any further assistance, please contact our office at (970) 304-6415.
Sincerely,
Lauren Light
Environmental Health Specialist
LL's
•
Weld County Environmental Health Services Department
1555 N. 17th Avenue
Greeley, Co 80631
Phone: (970) 304-6415
Fax: (970) 304-6411
www. co.weld.co_us
CasORAD° ISDS Field Inspection Form
Application Number ISDS-1000004
App Type: Health\Commercia I\l S DS\na
Applicant Name: MARY D SIPRES
Owner Name:
Parcel #:
Legal Desc:
Site Address:
1490 CR 27
BRIGHTON, Co 80603-9332
SIPRES MARY D
147129000064-R6272886
15989 PT NW4SW4 29 1 66 W OF RR RJW EXC UPRR RES
1490 CR 27
BRIGHTON, Co 80603
Percolation Rate Limiting Zone
% Ground Slope Direction
Engineering Design Required
The septic system identified above IS
below to the structure(s) served by this system.
Applied: 02/19/2010
lt_ in Description
Soil Suitable (YIN)
In 100 Year Flood Plain (Y
sufficient size to accomodate the proposed alteration(s) indicated
Absorption Bed Size
Absorption Trench Size
Engineering Design
Other Public Water Supply Utility
Private Water Supply
Private Water Supply Permit Reference
Number
Public Water Supply
Public Water Supply Utility
Research Comments
Septic Permit Recorded
Septic Permit Reference Number
Septic Search
Septic Tank Size
Year Installed
210
Well
No
No
SE -1000003
Yes
750
UNKN
ENS ISDS Current Fl w:
Current Flow 1/2 Bathrooms
Current Flow 3/4 Bathrooms
Current Flow Basement Plumbing
Current Flow Comments
Current Flow Description
Current Flow Full Bathrooms
Current Flow Number of Bedrooms
ICurrent Flow Number of Persons
7
0
Yes
7 BATHROOM STALLS
RESTAURANT/BAR
0
0
100
Weld County Environmental Health Services Dej artmeflt
1555 H. 17th Avenue
Greeley' CO 130631
Phone: (970) 304-6415
Fax: (970) 304-6411
www.co.weid.co.us
C°WRAD° ISDS Field Inspection Form
EHS ISDS Research C an ! es:
Additions 1/2 Bathrooms
Additions 3/4 Bathrooms
Additions Basement Plumbing
Additions Description
Additions Full Bathrooms
Additions Number of Bedrooms
Additions Number of Persons
EHS ISDS Proposed Total:
Addition Comments
Proposed Basement Plumbing Yes
Proposed Total 1/2 Bathrooms I
Proposed Total 3/4 Bathrooms 0
Proposed Total Full Bathrooms 0
Proposed Total Number of Bedrooms 0
Proposed Total Number of Persons 100
EHS Inspection Corrections:
Approved
Corrections Comment
Field Area Undersized By
Field Undersized By
Increase Field Area To
Tank Construction
Tank Undersized By
The existing septic system i- REQUIRED RECOMMENDED to have the following alterations made to accomodate
the proposed alterations to the structure(s) served.
N -Et', Co S D
NOTICE
This permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the Weld County
Department of Public Health and Environment for reasons set forth in the Weld County Individual Sewage Disposal System Regulations
including failure to meet any term or condition imposed therein during temporary or final approval, The issuance of this permit does not
constitute assumption by the department or its employees of liability for the failure or inadequacy of the sewage disposal system_ This1
Is non -transferable and non-refundable. Before issuing final approval of this permit the Weld County Department of Public Health and
Environment reserves the right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit
approval is contingent upon the final inspection of the completed system by the Weld County Department of Public Health and Environment.
X
Environmental Health Specialist Date
ISDS NO: / 006O3'#
DATE RECEIVED: _ RECEIVED BY:
FEE:
INDIVIDUAL SEWAGE DISPOSAL
SYSTEM EVALUATION
SITE ADDRESS OR LOCATION:
PARCEL N O : _ ...
THE ASSESOR'S OF
OWNER:
MAILING, ADDRESS:
E
APPLICANT NAME:
CE AT (970) 3534345 EXT 3650
APPLICANT ADDRESS:
OF DIFFERENT FROM OWNER) CITY
THIS CAN BE OBTAINED FROM
PHONES/03'553%� �02�
19," a 0603
CET
4)-9
STATE
ZIP
PHONE: aReeicr___
ALT :
LEGAL DESCRIPTION: PT: t ,' PT: .,.S A ' . SEC:
SUBDIVISION: LOT:
WATER SOURCE: Ui
FLG:
BLK:
ATE
FAX:
ORIGINAL OWNER OF SEPTIC SYSTEM:
2
PERMIT NO:
C)
ZIP
ACRES:
ti-\
o
3/4
DESCRIPTION OF STRUCTURE
CURRENT FLOW:
tor
DESCRIPTION:
PERSONS:
BEDROOMS:
BATHROOMS:
BASEMENT PLUMBING:
lIs
ADDITIONS: PROPOSED TOTAL:
g
Ac
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siths
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.
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NAME
- t.
INVOICE
4
PIPELINE DRAIN
CLEANING
4487 E 93rd Ave., Thornton, CO 80229 • (303) 287-3699
DOMESTIC, MUNICIPAL & INDUSTRIAL
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TERMS: N T CASH
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NUMBER OF Ft CLEANED
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KNIVES USED
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COLORADO
Memorandum
TO: File
From: Lauren Light
DATE: February 26, 2010
SUBJECT: Septic Permit SE -1000003 1 D -1000004
On February 26, 2010, Lauren Light and Deb Adamson spokewith Mary Sipres by phone
to let her know the septic system wilt need to be replaced. We gave her 60 days to either
replace the system or connect to Brighton sewer. Mary Sipres indicated she would call
Lauren Light and give her the name of the person she spoke with at Brighton who told her
sewer would be available very soon.
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DISCUSSION NOTES:
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D SEE ADDIT[D1vAC. NOTE SHEET (ATTACHED)
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MEE�G SUMMARY AND INITIAL STAFF RECOMMENDATION:
1-1 T
rip
17:411
ENv1RoNMFrurat HEALTH
SERVICES
*ALTHOUGH STAFF REACTION MAY BE FAVORABLE AT THE TIME OF TI LE PRELIMINARY CONTACT
MEETING, THE FINAI. RECOMMENDATION 'ION MAY CHANGE DIE To INFORMATION UNAVAILABLE To
THE STAFF OR APPLICANT AT TIDE INITIAL MEETINGS.
Note] to Ji t
1) The City of Brighton utilizes external engineering consultants for development review and the applicant bears all costs
associated with the development review. Per the current Adopted Fee Schedule, the cost to the applicant for each
development review will be 10% above the actual cost of consulting services. Comment letters and redline plans for each
review will be released upon payment ofapplicable fees.
2) By signing this form, you attest that you have read and understood the information contained herein_
j7/2/
APPLICANT OR OWNERSIGNATURE/S: / 77,e,/,e
/f
F: Commua ty -uelopmenttPlanning1PLCts \'LC Info. & Meeting Notes.doc oc
On 4-3-13 I (Lauren Light) had a phone conversation with Hazel Leern who is a planner with the City of
Brighton. Mary Sipres and her daughter met with the city on 4-3 and Hazel was in attendance at that
meetings The City indicated to Mary they were not supportive of the existing use and that it would likely
not be supported by the City. Mary would have to apply for annexation and also apply for a conditional
use permit to allow the bar to remain. Based upon comments from the Brighton police department the
City would not support the current use. The City indicated to Mary that the current use is considered
abandoned if it has not been active for 60 days. The City would support industrial use on the property
but would need 25 feet dedicated for the road and also would need more information regarding the rail
road right of way. The number of required parking spaces may be an issue due to the small size of the
parcel, The annexation procedure would take 6 to 8 months and last year Mary would not resign the
annexation petition due to the cost. Mary told the City that her brother or cousin (?) had been pumping
the septic tank every 4 months. The City was not very encouraging to Mary and she left the meeting
over whelmed according to Hazel. I did inquire about a pre -annexation petition to allow Mary to
connect to sewer but did not want to proceed further until discussions with Deb Adamson, Trevor Jiricek
and Brad Yatabe had taken place.
Weld County Health Department
Percolation Test and Soils Data
5/7/2013
HIGH PLAINS ENGINEERING & DESIGN LIC
721 4th S I KEET, SUITE D, FORT LUPTON, CO 80621 • PHONE: (303)-857-9280 • FAX: (303)-857-9238
i
FILE NO. 13-3639
Prose Address 1490 COUNTY ROAD 27
Legal Description WELD COUNTY, CO
Contact Information
Name SIPRES LOUNGE, INC.
Street. 1490 COUNTY ROAD 27
City, State, Zip, BRIGHTON, CO 80603
Phone; (303) 548-5521
Saturation and Swelli
-
-- .
Groundwater
Smeared
Surfaces
Removed:
YES
Encountered
at
GREATER
THAN
8
feet
Estimated
seasonal
encountered
depth
water
to
table
maximum
in
if
profile.
not
Sand
or Gravel
Added:
Date
and
Time
Presoak
Water Added.
4/25/2013
date
15:00
time
Amount
Water
-
of
Presoak
Added:
15
gallons
is
seasonal
area
believed
fluctuations
to
be
which
subject
could
to,
:
.
Percolation
Date
and
Started:
Time
Test
4/26/2013
www.www-i
date
i i wr.wi:
result
in
a seasonal
water
....8'
table
of
surface?
within
13:00
time
Slope
Determination
in Absorption
Area
Did Water
Period?
Remain in
Hole
After
the Overnight
Swelling
I
0.5
Flo
to the"
EAST
'direction
Hole
1
YES
Hole
2
NO
Bedrock
Hole
3
NO
Encountered
g[
GREATER
THAN
8
feet
Hole
4
NO
Hole
5
YES
Estimated
depth
if not
encountered
profile:
in
Hole
8
NO
erco
Measurement
a ion
a e
;
Deep
(In)
Rate
erco
(minim
a ion
)
Hole
1
36
55.56
Type
of
Bedrock:
Hole
2
36
41.67
Hale
3
36
. 55.56
Is
bedrock
fractured
or weathered?
Hole
4
CANT
FILL
DUE
TO
RODENT
Hole
ff
36
55.56
Is
bedrock
believed
(pert
rate
to
be
< 60
permeable
min/in)?
Hole
61
36
55.56
Average
52.78
C,
410
Sc
a.
C,
In
Weld County Health Department
Percolation Test and Soils Data
5/7/2013
Profile Hole Information (cant.)
i _
Note: Soils must be classified using unified system ASTM 02487
Profile Hole Lo
r••
0
4 SANDY CLAY (SC)
•— a i
pit a —
•
r — —
S
pm i— o —
E�� � w 1 r o
5
6
7
8
9
I certify that the above information is correct and complete to the best of my knowledge and
that all tests were performed in the accordance with the provisions of Weld County Health
Department individual sewage dis osol.re gulations by myself or under my supervision.
r � ofiggire
<#9 4 .114
Signature
1 r 7
n
♦ r-0
4r'::ki9/66..N.,A..1C714491e-.4I-47
4
•
Date
High Plains Engineering
Design LLC
721 4th Street, Suite D
Ft. Lupton, CO 80621
303-857-9280
SITE MAC'
1430 COUNTY ROAD 27
WELD COUNTY, CO
esd
z
0
U
X _
GAS LINE
CONCRETE BARRICADE
25'
50'
0 0 0
0 0
EXISTING
BUILDING
LEGEND
O -Percolation Test Hole
X - Percolation Profile Role
1\ - Soil Profile Hole
Fence
All locations shown above are based on specific information
furnished by others or estimates made In the field by High
Plains Engineering & Design personnel. The locations, distances,
directions, etc. are not the result of a property survey but
are approximations and are not warranted to be exact, It is
the owner/builder's responsibility to define property -
boundaries and ensure alt onsite improvements are located
within the platted site and out of inappropriate easements,
All distances ore to be verified prior to excavation.
HIGH PLAINS ENGINEERING & DESIGNJSLC
721 4th STREET, , SLATE D, FORT WV I O , Co 80621 • PHONE: (303)-857-9280 ; FAX: (303)-857-9238
May 231 2013
The Sipres Lounge/ Inc.
1490CR27
Brighton, CO 80603
RE: To provide an onsite wastewater system for the existing building at 1490 County Road
27, Weld County, CO
Job # 13-3639
SEPTIC SYSTEM DESIGN DATA:
The purpose of this design is to provide a septic system design for the existing night club
with up to 10 full time employees (FTE) and up to 292 customers per day. The current
water us a is limited b the well emit to 108 600 allons er ear which e uctcs to
about 9 alto ns er day d .
The water usage has been monitored since 2007. The establishment used a total of 66390
gallons for 2012 which averages to 183.5 gpd, with the maximum month in October = 9120
gallons 4 294 gpd.
The club has typically been open Friday, Saturday and Sunday and closed the remainder
of the week.
The percolation test for the site performed by High Plains Engineering & Design had an
average percolation rate of 52.8 minutes per inch (mpi).
Average water usage per day = 298 GPD
x 1.5
TOTAL MAXIMUM FLOW (QmO) = 447 GPD
ABSORPTION AREA - (WELD COUNTYL
Abed - Qrna , t X 1.3 = 1206 SF
3.5
}
Atrench - rrOXN t
3.5
928 SF
(ROck r Pipe) Bed Designs:, One bed is required (24' x 60* OR 0' x 5Q1), with 4 rows OR 5
rows (respectively) of perforated pipe in a "Rock and Pipe" absorption field per bed. The
pipe will be encased in 3/4" to 2-1/2" gravel per governing specifications and backfilled
with in -situ sandy soil as detailed in the cross section.
The 12 -inch layer of aggregate shall consist of clean, washed, graded gravel or rock to
range in size from 3/4 inch to 2-1/2 inches with an average size of 1-1/2 inches. The rock
shall extend from 2 inches above the top of the pipe, level across the bed, to 6 inches
below the bottom of the pipe. The fop of the rock shall be covered with landscape fabric
to prevent the gavel from becoming clogged by earth backlit!.
Shredded tires are an approved alternate for the rock in this type of system.
Contact this firm to discuss suppliers and/or specifications.
A 10 MIL. (min) plastic liner is required around the perimeter of the bed where finished
grades are filled above existing grades (Typical).
COOL SEASON FESCUE GRASS SHOULD BE PLANTED ON THE ENTIRE ABSORPTION FIELD TO
CONTROL EROSION AND AID WITH EVAPOTRANSPIRATION_ THE AREA SHOULD BE FENCED
TO KEEP VEHICULAR TRAFFIC OFF THE FIELD AREA.
NOTE. The Engineer and Health Department will inspect the site when perforated pipe,
rock or shredded tires and septic tank(s) are in place. A final inspection may be made
when the system is completed.
SEPTIC TANK SPECIFICATIONS:
447 GPD x 30124 = 559 gallons
4 Install TWO 1250 -gallon minimum capacity septic tanks with two (2) compartments or units
in series.
**A lift pump may be required due to the elevation at the proposed septic field site
and/or the elevation of the existing plumbing. The pipe must provide 1/8" per foot fall
between the club, septic tank and the distribution system. (See lift pump detail).
installer to provide schedule 40 pipe when trenching below road or driveway. The
absorption "bed" area shall be isolated from oil vehicular travel, parking, grazing and
storage areas.
All construction is to be in accordance with Weld County Colorado Health Departments
Individual Sewage Disposal System Regulations.
Certification:
I hereby certify that the septic system shown on this plan was made by me or under my
direct supervision and is acc �a��;*,the best of my knowledge or belief.
Todd M. Schroeder, PE
Attachments: Profile Hole Log
Figure 1: Rock & Pipe bed section
Figure 2: Lift pump detail
Figure 3: Septic system site plan
Well Permit
Water Usage Summary per owner
Profile Hole Log
ME ere S
lei SIR S
IMP S
0
I
2
3
4
5
6
7
9
A
i
SANDY CLAY (SC)
_ EXISTING
0 GROUND
j 1 - sic -
HIGH PLAINS ENGINEERING & DESIGN LLC
721 4th STREET, SUITE D, FORT LUPTON, CO80621 PHONE - (303) 857-9280 FAX - (303) 857-9238
4" PERFORATED \
PVC PIPE (TYP.)---'-
24'
6' 6'
BACKFILL
6' 3'
4" GRANULAR
FILL
2%
3/4" TO 2-1/2"
GRAVEL (TYP.)
FIGURE 1: ROCK & PIPE BED CROSS SECTION
SCALE. 1/4" = 11_011
NOTE: THE EXCAVATION DEPTH MAY BE UP TO 4 FEET DEEP FOR A "REPAIR" INSTALLATION
CHECK WITH THE GOVERNING HEALTH DEPARTMENT / PERMIT PRIOR TO EXCAVATING
EXISTING
GROUND
GEOTE TILE FABRIC
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HIGH PLAINS ENGINEERING & DESIGN, LLC
721 4th STREET, SUITE D, FORT LUPTON, CO 80621 PHONE - (303) 857-9280 FAX - (303) 857-9238
22" LID-----�_��.
LITTLE GIANT 1W frw ALARM & CONNECTION
BOX MOUNTED INHOUSE (OR EQUIVALENT)
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-I I=II 1=1 IE=I 'Ellin.:
11.1
ALLOW SUFFICIENT
CABLE TO
REMOVE PUMP
UN DERGROUND
CABLE
RAM -NECK &
-GROUT
WATER TIGHT
4" PVC
-INLET FROM
SEPTIC TANK
300 GAL.
TANK (MIN)
ELBOW
MAYARA SEALED
AWS-i CONTROL & Th
CONNECTION BOX
2" SCI --I 40 P.V.C.
PIPE (TYP.)
HIGH WATER
ALARM FLOAT -
GOULDS MODEL 3871
(MIN.OR EQUIV.)
SUBMERSIBLE _
PUMP
8" CONC.
BLOCKS
I i •t
i
- CONCRETE BRICK OR
BLOCK RISER 24" CLEAR
AS REQUIRED
_ THREADED UNION FOR
77 PUMP DISCONNECTION
GATE OR GLOBE VALVE
2" SCH 40 P.V.C.
/... PIPE (TYP. )
BUSHING ADAPTER
2" PVC TO
SOLID GROUND
MALE
ADAPTERS
PUMP ON LEVEL
I _ 11
ME
PUMP OFF
LEVEL
MALE
ADAPTER
RAM -NECK &
GROUT BOTH
INLET & OUTLET
\\_ WATERTIGHT
F IG U 2: LIFT PUMP DETAIL (IF NECCESSARY)
SCALE: N.T.S.
DRILL k" HOLE IN
BOTTOM OF PIPE
LEVEL CONTROL
SWITCH
AV SITE MAID
SIPRES LOUNGE
1490 COUNTY ROAD 27
WELD COUNTY, CO
10' UTILITY EASEMENT FOR UNION
IN BGOK 1157, RE. NO. 021001E
TWO 125
SEPTIC
:r
LEGEND
-Percolation Test Hole
X -Percolation Profile Hole
trSo1 Profile Hole
Fence
10' MIN,
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•
1
JOBtk13-3639
DATE 5423-13
Alt locations shown above are based on specific information
furnished by others or estimates made in the field by High
Plains Engineering & Design personnel. The Locations, distances,
directions, etc, are not the result of a property survey but
are approximations and are not warranted to be exact. It is
the owner/builder's responsibility to define property -
boundaries and ensure all onsite improvements are located
within the platted site and out of inappropriate easements.
ALL distances are to be verified prior to excavation.
Form Nov_
OFFICE OF THE STATE ENGINEER
.,COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg 1313 Sherman 51 Denver, Colorado 80203
(303) 566-3581
APPLICANT
MARY SIPRES
1490 WCR 27
BRIGHTONt CO 80601-
(303) 659-8596
PERMIT TO CONSTRUCT A WELL
- �_ ----.. 1229
WELL PERMIT NUMBER 273019 -
DIV. 1 W02 DES. BASIN MD
APPROVED WELL LOCATION
WELD COUNTY
NW 1/4 SW 1/4 Section 29
Township AI N Range 66 W Sixth P.M
DISTANCES FROM SECTION LINES
2370 Ft. from South Section Line
116 Ft. from West Section Line
VTM COORDINATES (Meters ,Zone:13, NAD53-
Easting: Northing:
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS QLAPPR0VAL
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}(t) and the policy of the State Engineer dated 4/23/86 under the following conditions.
4) The use of ground water from this well is limited to drinking and sanitary facilities as described in CRS 37-92-602(1)(c), for a commercial
business. Water from this well shall not be used for lawn or landscape irrigation or for any other purpose outside the business building structure.
5) Production from this well is restricted to the Laramie -Fox Hilts aquifer, which corresponds to the interval between 715 feet and 985 feet below
the ground surface. Plain casing shall be installed and grouted to prevent production from other zones.
6) The depth to the top of the Laramie -Fox Hills aquifer is approximate. To ensure the exclusion of poor quality water from zones immediatefy
above the aquifer, plain casing and grout shall extend through the lowermost coal and/or carbonaceous shale that overlies the Laramie sand
portion of the aquifer.
7) The pumping rate of this well shall not exceed 15 GPM.
8) The annual amount of ground water to be withdrawn shall not exceed 0.33 acre-feet (108,600 gallons)_
9) Approved as the only well on a tract of land of 1 acre(s) described as a portion of the I W114 of the SW1/4, Section 29, Township 1 North,
Range 66 West, 6th P.M,, Weld County, reference attached exhibit "Al
10) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions must be
maintained by the well owner (recorded at least annually) and submitted to the Division Engineer upon request.
11) This well shall be constructed not more than 200 feet from the location specified on this permit.
12) 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 The maximum consumptive use of ground water shall not exceed 10
percent.
13) The well constructed under permit no. 240079-A must be plugged in accordance with Rule 10 of the Water Well Construction Rules within
ninety (90) days of completion of the new well. The enclosed Well Abandonment Report form must be submitted to affirm that the old well
was plugged
The issuance of this permit hereby cancels permit no. 240079-A.
NOTE: To ensure 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.
14)
APPROVED
Jrv1W
JReceipt No. 3614448
Stale Engineer
‘4qw 3/24o7
•
DATE ISSUED 03-20-2007 E P I R• I N SATE 03-20-2009
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Analytical
LABORATORIES, INC.
Report To:John Schreckengast
Company: Schrecks Auto
710 N 7th Ave
Brighton CO 80601
Analytical Results
I Domestic Water Quality
TASK NO: 171019006
Bill To:John Schreckengast
Company: Schrecks Auto
710 N 7th Ave
Brighton CO 80601
Task No.: 171019006
Client PO: Paid Ck 5509
Client Project:
Date Received: 10/19/17
Date Reported: 10/26/17
Matrix: Water - Drinking
Customer Sample ID
1 HQ Well
Sample Date/Time: 10/19/17 9:07 AM
Lab No. 171019006-01
'Test (units)
Total Alkalinity (mg/L as CaCO3)
Bicarbonate (mg/L as CaCO3)
Carbonate (mg/L as CaCO3)
Chloride (mg/L)
Iron (mg/L)
Fluoride (mg/L)
Potassium (mg/L)
Nitrate Nitrogen (mg/L)
pH (units)
Calcium (mg/L)
Magnesium (mglL)
Sodium (mg/L)
Sodium Adsorption Ratio (units)
Total Hardness (mg/L as CaCO3)
Sulfate (mg/L)
Total Dissolved Solids (mg/L)
Sample Result J Suggested Maximum
Abbreviations:
mgt = Milligrams Per Liter or PPM
mpn/100 mis = Most Probable Number Index/ 100 mis
524.1
423.9
100.2
38.6
0.050
1.74
1.3
< 0.05
9.20
2.3
11.1
252.6
15.3
51.5
< 0.1
691
Suggested maxlumun levels for Nitrate Nitrogen and Fluoride are
mandatory maximums set by The Colorado Department of Public Health
and Environment
250
250
250
0.3
4
50
10
8.5
200
125
100
4
500
250
500
Comments
High Sodium maybe of concern for health reasons
High Sodium Adsorption Ratio indicates this water will likely
inhibit plant growth (Not suitable for inigation).
High Total Dissolved Solids may affect taste.
240 South Main Street / Brighton, CO 80601-0507 / 303-659-2313
Mailing Address: P.O. Box 507 / Brighton, CO 80601-0507 / Fax: 303-659-2315
171019006
Page 1 of 2
Drinking Water Chain of Custody
Of different from report to) -
rajMt_IoformnNon
State FormContact
Company Name:S [ail
Company
Joky srs e..i't f` t' �k +e
j
Name:Name:
System Name:
Address:
1I 0 I\/. .7*in Avg
Address:
Address:
Cityt3r ;J ictc'3tateccziip 0 ° (.° 1
City S e Zip
City State Zip
Phone:3 03 -52.o-- y IFax: •
Phone: Fax:
County:
Email: Sc11 r e c k by n C co e cc: s t:
Email:
Compli ce Samples: Yes 0 No ■
PO, o.:
Sampler Name: -5+V—V,2—. . I es 4 e_r M.
Se d Forms to State: Yes • No ❑
•
^1 Colorado
Analytical
LABORATORIES, INC.
Brighton Lab
240 South Main Street
Brighton, CO 80601
Lakewood Lab
12860 W. Cedar Dr, Suite IOOA
Lakewood CO 80228
Phone: 303-659-2313
Fax: 303-659-2315
www.coloradolab.com
v in s ---T 73
CAL Task No.
PHASE I, II, V Drinking Water Analyses (check analysis)
-
Subcontract Ana yses
171019006 r
Is 5au„ pie_
JMK
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V a'.
6'
Total Coliform P/A
504.1 EDB/DBCP
505 Pcsts/PCBs
515.4 Herbicides
524.2 VOCs
525.2 SOCs-Pest
531.1 Carbamates
547 Glyphosate
548.1 Endothall
549.2 Diquat
524.2 TTHMs
552.2 HAA5s
Lead/Copper
Nitrate
_
u
0
Alk./Lang. Index
TOC, DOC (Circle)
SUVA, UV 254 (Click)
Gross Alpha/Beta
Radium 226
Radium 228
I Radon
Uranium
Date
Time .
Client Sampie ID / EP Code
z
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I%9Itcleel
{ Na W--1)
l
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Instructions:
f01.4 `k Z3 C LC--uC *-5-Sticl
C/S Info:
Delivered Via:
CJS Charge 0
Seals Present Yes I No ❑ Headspace Yes No
Temp. 161e °C/Ice Id Sample Pres. Yes, No
D
■
Relinquished By:
iJG, —o�14,%r
b..4,-
Date/Time: 9 6Received
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By:
-rte-
Date/Time:
19
ji In
Relinquished By:
Date/Time:
Received By:
Date/Time:
f:\s. Colorado
• Analytical
LABORATORIES, INC.
Report To:John Schreckengast
Company: Schrecks Auto
710 N 7th Ave
Brighton CO 80601
Analytical Results'
TASK NO: 171019006
Bill To:John Schreckengast
Company: Schrecks Auto
710 N 7th Ave
Brighton CO 80601
Task No.: 171019006
Client PO: Paid Ck 5509
Client Project:
Date Received: 10/19/17
Date Reported: 10/26/17
Matrix: Water - Drinking
Lab Number !Customer Sample ID
171019006-02 Schreck 2
Sample. DateRime
Test
10/19/17 9:07 AM Total Coliform
E -Coll
Abbreviations/ References:
Absent = Coliform Not Detected
Present= Coliform Detected -Chlorination Recommended
Date Analyzed= Date Test Completed
SM = Standard Methods for the Examination of Water and Wastewater APHA; 19th Edition; 1995
Result
Absent
Absent
Method
SM 9223
SM 9223
DATA APPROVED FOR RELEASE BY
240 South Main Street / Brighton, CO 80601-0507 / 303-659-2313
Mailing Address: P.O. Box 507 / Brighton, CO 80601-0507 / Fax: 303-659-2315
Page 1 of 2
Date Analyzed
10/20/17
10/20/17
171019006
111
Drinking Water Chain of Custody
". Report'rn Infnrmatlnn'.
-Rill Tn Information (Ifdifferent from report to)- ' •
StateForm/ Project Information • = -
Company Name:5 tihlI r e C 1<-.S1<-.S//y -4)
Company Name:
VS/SID:
1
Name: Jo rs n.S � r t3 C k en 9 0.t
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ontact Name:
System Name:
Address:
11 a N. •71-x, A Ne_
Address:
Address:
City,-.; `'st tateCCZip R O c' O1
City S e Zip
City State Zip
Phone:3 03 -52.0" ti II?.
Phone: Fax:
Coun :
Email:SC.hrec kMgn @corwct.s.it,
Email:
Com.li- ce Samples: Yes No■
PO, o.:
Sampler Name: Steno_ ) e54 e-rM
Se d Forms to State: Yes ■ No ■
^ Colorado
• :Analytical
LABORATORIES, INC.
Brighton Lab
240 South Main Street
Brighton, CO 80601
Lakewood Lab
12860 W. Cedar Dr, Suite 100A
Lakewood CO 80228
Phone: 303-659-2313
Fax: 303-659-2315
www.coloradolab.com
ft_.)/5"11.
5
CAL Task No.
PHASE I, II, V Drinking Water. Analyses (check analysis)
- -
Subcontract Anayses
171019006 r
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JMK
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Total Coli form P/A
504.! EDB/DBCP
505 Pests/PCBs
515.4 Herbicides
524.2 VOCs
525.2 SOCs-Pest
531.1 Carbamates
547 Glyphosale
—
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m
m
co
549.2 Diquat
=
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552.2 HAA5s
Lead/Copper
Nitrate
i
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o
Alk./Lang. Index
TOG DOC (Circle)
SUVA, UV 254 (Circle)
L7
_
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Gross Alpha/Beta
Radium 226
Radium 228
Radon
E
2
Date °
Time -
Client Sample ID / EP Code
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Instructions:
t al 1 Z2> C Ls _cI¢_ ssa l
C/S Info:
Delivered Via:
C/S Charge ■
Seals Present Yes ■ No ❑ Headspace Yes • No ❑
Temp.11°rl° °Circe ti Sample Pres. Yes,Z9No IN
Relinquished By:
.rAZc:
DateITime:
OP l 9 6
1014
Received By:
c≥ -
Date/Time:
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ill
Relinquished By:
Date/Time:
Received By:
Date/Time:
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COLORADO
Division of Water Resources
7 enar:ment of Nah„al Resources
WELL PERMIT NUMBER 273019 -
RECEIPT NUMBER 3614448
ORIGINAL PERMIT APPLICANT(S)
MARY SIPRES
APPROVED WELL LOCATION
Water Division: 1 Water District: 2
Designated Basin: N/A
Management District: WA
County: WELD
Parcel Name: N/A
Physical Address: N/A
NW 1/4 SW 1/4 Section 29 Township 1.0 N Range 66.0 W Sixth P.M.
UTM COORDINATES (Meters_Zone:13, NAD831
Easting: 516210.5 Northing: 4430158.0
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 CR5 37-92-602(3)(b)(I) and the policy of the State Engineer dated 4/23/86 under the following conditions.
4) The use of ground water from this well is limited to drinking and sanitary facilities as described in CR5 37-92.602(1)(c), for a
commercial business. Water from this well shall not be used for lawn or landscape irrigation or for any other purpose outside
the business building structure.
5) Production from this well is restricted to the Laramie -Fox Hills aquifer, which corresponds to the interval between 715 feet and
985 feet below the ground surface. Plain casing shall be installed and grouted to prevent production from other zones.
6) The depth to the top of the Laramie -Fox Hills aquifer is approximate. To ensure the exclusion of poor quality water from zones
immediately above the aquifer, plain casing and grout shall extend through the lowermost coal and/or carbonaceous shale that
overlies the Laramie sand portion of the aquifer.
7) The pumping rate of this well shall not exceed 15 GPM.
8) The annual amount of ground water to be withdrawn shall not exceed 0.33 acre-feet (108,600 gallons).
9) Approved as the only well on a tract of land of 1 acre(s) described as a portion of the N W1 /4 of the SW1 /4, Section 29, Township
1 North, Range 66 West, 6th P.M., Weld County, reference attached exhibit "A".
10) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions
must be maintained by the well owner (recorded at least annually) and submitted to the Division Engineer upon request.
11) This well shall be constructed not more than 200 feet from the location specified on this permit.
12) 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. The maximum consumptive use of ground
water shall not exceed 10 percent.
13) The well constructed under permit no. 240079-A must be plugged in accordance with Rule 16 of the Water Well Construction
Rules within ninety (90) days of completion of the new well. The enclosed Well Abandonment Report form must be submitted to
affirm that the old well was plugged.
14) The issuance of this permit hereby cancels permit no. 240079-A.
NOTE: To ensure 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.
Printed 01-29-2018
For questions about this permit call 303.866.3581 or go to www.water.state.co.us Page 1 of 2
WELL PERMIT NUMBER 273019 -
RECEIPT NUMBER 3614448
Issued By
Date Issued: 3/20/2007
Expiration Date: 3/20/2009
PERMIT HISTORY
01-29-2018 CHANGE IN OWNER NAME/MAILING ADDRESS. CHANGED TO JOHN SCHRECKENGAST
Printed 01-292018
For questions about this permit call 303.866.3581 or go to www.water.state.co.us Page 2 of 2
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