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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 eh 6PSiO biLP Leo e1/249# ee,el egir r.- BelyQ 0.6 cnii viva -60Y= gel setts rJrb Pate 4v !L%rM- PrbpQSJL.t-e, rei soe 35eds "otne", Alden& vt Xatetait,a)aea, salt a r pcitacteac leo* Ae aqi 4teit = itNO taae &p/1: Fig hfrdir Farr` teedl1/4.7ta 1467LetSt /wee! 9o'jzA0 Jic iit2e, ;,7-fi- eis-c4y 5) 1_3,3 i If apir 7/eht-re( 464,4miitte ills, 40(e, 1 3 fir Re d'r1 ,c_ / Ar(e fr-_ >Atpelt-Agee 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 Jthsib LeDLIKITYi btPRIZIMerit I i E I me - Inman 1 3 I 1 a I eib he al i PiStatBOTiOC P f • N Box Pirrt COI" PLeartirD se- 1 a 12 sufr 13 .b the gESS ratio cR 07Bet 4, tiro Ai Co le 6O5 IA/c4LLU- 6.4i14) e 11303) - 5 5Rqs- ;,2 x &a r Rocs Et L i1O Q , F"+. ci gag' ' - ---T --- --. ---.�Or...— — If.. . 15' w a C JWco r& fiLagt.ivk }49O cets rvI F 4 1matt K 1-1"513k. 35 I 4C de fiaPfer. Oil A hi a etilrfr I er #Idcp-rt I Wan ain rigs' R-\.< I Ai GI Lot W“L A-3 A C b A % E Cteat3I+`Llt so. Ica I " C tie A—ic 9' - Pre L" cam-ibz l q" x y y r•- 38 J `;,17.,;t • Ls • ti F M t ,114 a • er _• Tkist?“-iticor42 ?tees ,1 (&4) L i*e ri t Lid4fs 14 EkEsa rei) rye ?,?E iz" OP :AI/450E ke (2 ) Pfrovitroe Cmpanto entir0 C f4t? ft- .`i Ed -Aft c o11Z e' ar44 KS (±!) 3° RvaS 0-0 Li CL&L-b $ EfcS'1 7z.LP. PJ r&4 A M R41 t. t4 L Ate -.1 At. A IL east Paz - littstyr AT 111 CPAk pa l &_Lars (fSIDt -44k 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 r4a) i"f:10R [1- tter-C15 rs-a iirkt %.*- /10 PZtLL 1 7/30 G 0 4PQ ��?5° c;,O7O r3/Y 7e:r) C� L.fy ?c' L fj A tirsi ■ O io radicak. (tee 4tee Pk zey enfiree. ed„cr_ SQ/i ds. Opc? c• tokocaE, 5tArevoiwy Sri AL2Kne -c` --C-Po- cc;,wc„? coat r nriAltAL-0( u G f 1/11\62--L r -N4 5 r 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 st-lo • as J i • t4ri tacn4 Dls+Ancec a Pow r- pelt 3 s • I 47 1/2, 42.' 3 (0 Veil 3(0' 62: e b'I . , corner r 9 r rek isl$1 Scene 3 M am1�1mp7 woo I Uid` TsAe testis Aes id /., trio' w shpt eiCsi (€PsCrht1tta 02.0 °zit ("Po rt geos 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 sioDn. 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. a i I. r' NAME - t. INVOICE 4 PIPELINE DRAIN CLEANING 4487 E 93rd Ave., Thornton, CO 80229 • (303) 287-3699 DOMESTIC, MUNICIPAL & INDUSTRIAL ae 20 ' 7 TERMS: N T CASH f � ■ 1 letr4 I 'a ADDRESS Item DATE 27 • JOB ■ R3OTS CAUSE OF STOPPAGE GREASE CLEAN -0(11j _ NUMBER OF Ft CLEANED SCALE SIZE OF CABLE -USED KNIVES USED .r *a& hi.......?,.�- O.3 r Oct--= '_ REMARKS: i ,7\1...� . ff - GDC:..--4;:::(,___ - - __ I4 4 l r - / t Ali ecerti-lin... a:7Y IL J/r rl i r = 1 I. r-^ f ' f i .~ i 1 ff 1 Tjs'i I de. 4-r I,r-,f,r t _or {J es%.1.. I/ V f + "___,__ ii PLEASE PAT FROM pus INVOICE • STATEMENT FURBISHED OW UPON REQUEST 53( I . 1 OPERATOR s- . �. y,. CASH GREG 2:11 CHARGE 7 DATE TO SE PAID . at • a. t: 1 1 • 4 I, • .1 • I seit A • am • .- J I LA• • I• ' • . + • ag d -a — 11' r t: Dee :-,1.•�(1 : 9 5:41! - ' i= G 1 C C t r ti 1• f' rk I •1. 1 I t 1. • T. r • 1'l+ j• fir`. 'l 17 *I c VI - tilt, r'?1r •' 40. 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N.0.4 6. 'If�, ' Ye; eV I ' ' • I I r • b _ • • • • � :it: , ••• I• . • abi. . I• is / iitdx.11• II� L. •� �• 1 r' , rT ), r i�` � .,enalif , f lie e Ls f mt.., .L' , I , • 7, ' •i ,� r I r acts *Ling of sYst4e r Crvtcc Sale • . '•r•.. t'• I 4 r r Matt 'mane . Real •1r ?II4 r �* t r • 13e. proms ' • a •• •. • 4 �' , , r•t'r i• , �4, _ N • ' Tn • Gilleal 1 • 4 . . . -• ••r . ▪ ' L • es .1 ' "1Y I' • I • • •J I. { I w ti 1 L. • • r J I - I•' I • 4 r • T • :• ••• • q.• -- it•la Aijkl I • ashi , **FOIStat1 ) Mrn , rr : • 5 ii �•• • ` 11Vai• Jr r J J r• 1' I.• 5. • 0 J ta • I i • I • • ' I• • • Aftil 5 177ge es. 7111. id. I) 110 i r 1 I r' i • • • • F r f. • Ti • 3- • • • • • • • I • • 4 • la 1 • I • • • • • 1 { I- rr I • WEST 1/4 CORNER. SECTION 29. (FOUND PK NAIL) • l DETAR. SCALE: s 40' e 1 1 EXCEPTED PARCEL O BY ED OCT. 22. 1946 IN BOOK 1190 AT PACE 330. CONTAINS: 0.011 AC. till 3 �J •• .. rW# r...r7r Ur s • ��# Al.WIPED l i St t 7. } 3 _4e, OM. M 1 r I U, 0 z t I S he 41? x 24' STAGE SHED I So* f IL? is � L .Cete gk' toL tee 1 II acts gcr ge 0 Q �T C� C.) Ci C.� • • .� 154.42 10' t T1UTY EASEMENT FOR UNION RURAL ELECTS ASSOC. IN BOOK 1157, REC NO 02100165, MAY 19, 1987, a a lacallafralll a FENCE (TYP) its ‘Ta 0 Isom tei 0 I 1• 1/ S P-' • Nro ..: —--'-ice .. .R MI • e u.iccE ta'''t ccel-T''r la a WEST 1/4 CORNER SECTION 29. ' (FOUND PK NAIL) DETAL'. SCALE: 1" = 40' 1 r. EXCEPT PARCEL CONVEYED BY DEED RECORDED OCT. 22, 1948 IN BOOK tmo AT PAGE 330. CONTAINS: 0.011 AC. +/.- 'iii *.resesest w r. �w LI j 'r,.4.6 eti7 C+ i f r • rit 4 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. r 1 r tJ. .,,'W,_. ` eso ''1 1 v f -d raid ace " i.16464' r I''1 IP 4 . I t • a cfs f se, + + "Sr ti rot w K Y • r -TS Cies ,.•.. r t, gat a ,t a e at ft k 11 4 ex ry. _ J Y 4 e: r -, is ' 's -"T irr • ars C as x .0ei i • f• ' e .! K •f• aft as • • ti if ipt gels a a air sib M1' _a e 4 a el 3 a ig„ a� e i a • e e e a w f �k f res a a 8 ,r mirs o.• . I If allb aS 1 f a 6 a r a. asa 5* a i am r r at a gets;__ t i 141. •. 1 r 43/40 Fan cn Ca s NI chi 1 to: 0 )Lsi ,4 kt% Cl� o: pa)6\1 � I aite : Roy 17, /973 Owners: A/vfri B. f/ermsen & Be My L. Herrrisen Ste 2 ego/ 179 fort to1/1,75/ C�/orodc W ;, s r ire 6.47-CV4vteet 141 . let 5; fli € "ee 6 5 77.44.4 tiAdtit p�47 } }i743.(7,c- sae. mat ' PcitifilseeaeWe feet K t4) o L or LOT'B" e40. 5.30/ :ACRES8 el -O W time 9/. 5 x8'35'00"W 8.4/.9ln' . SW Corner coIJAJYPsys SeC3Z8e 7 Rent of South Line, SW�', Sec3t8-&7 Beg/an/rig &v,: l"=/504' A L 'F, I DISCUSSION NOTES: St -0"-k c near' _ c- erIS C8>As 1 ti41 C Lia4444(7 Sin& telf- "eltj244 fti D SEE ADDIT[D1vAC. NOTE SHEET (ATTACHED) Ph -at rs. \I 6. • cti n,c_,.,ti-.7, tJn i JE-Nee-f—sts'ar 0,4A- 1-7-SAAZ- Cmity% _fry— Lam. [- k C.rt 1- 2r, et, st. G.,EFP 0 kr-flora-Ls V 4F (A oot c I, +-ttrkt C`+Y �t.� . ' "mss .P *►� - a fl �.. . w s . - �_ a. - a. a __ �.! .� f rink 11.1 i 1+� eyL 1 # X � 1 • � .ire. L� _� .J . ■ i t . � S _ _ , r. _ 0 11&rvcn& LA/ 1 r 1. L Nr I C les • touce ?ky gel 11.€4 C �'►�t5 Lc`1 rrJVe�I. � t. L.yaz-.. (.tts,�f.£� , 1�u.'�"` l�kt:vl'�Icr h.P. �i� �. aU'�i� � f� . Gc�.�.'i-��qf car +'t.G G'ficV[ FIT) c-4_,91( c-cTyc.-k r- is ke-c� , 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 Ir • a r 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) -11 r 111= I-I,I-;LI; •III�i!I-I! I-1 I HI I- II= . r-1 i i-= l.. -.L: I--I-I-Ill-lll� ---1I.-111 -'10I;7II..�.i,-- -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, J• t` • 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 t4 L I I d a • • • • frZrLL Yfr�R Aid L2-..1,0 ft77-,-7R, 713a r se; ?ea. eg#:)_ (":".O • ! f 1^5 r ; r.i• 'as...) f / l l! 1 J7 J f s _,:.. I' • r a A ,;:;2 2 7 C Sv4t4fZ/ r f re; c i (17 t' '}7 f Y •f asee r*7 Ca) l f at are '761, dr.\:\ Colorado 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 r c i= > 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 1 E I%9Itcleel { Na W--1) l X11. x 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 ii 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 ii 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 .11 Scan it. JMK r •�_ g c, v @ r L 2. ^. :. Ti. • 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 — z o c m m co 549.2 Diquat = N 552.2 HAA5s Lead/Copper Nitrate i o v_ S u c o Alk./Lang. Index TOG DOC (Circle) SUVA, UV 254 (Circle) L7 _ '''uV r. C v \ Gross Alpha/Beta Radium 226 Radium 228 Radon E 2 Date ° Time - Client Sample ID / EP Code o ¢ ' ii:4111Cv:01 { Now/./_(1 t . X toJ4trio of:U7 S {�r� Ic Z i - . /'-. - 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: l0j Ill ill Relinquished By: Date/Time: Received By: Date/Time: 0 N m en m 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 Hello