HomeMy WebLinkAbout20191932.tiffWATER SUPPLY INFORMATION SUMMARY
Section 30.28.133,(d), C.R.S. requires that the applicant submit to the Caunty,'Adegoate evidence that a water supply 'hat
is sufficient in terms of quantity, quality and dependability will be available to ensure an adequate supply of water.
I. NAME OF DEVELOPMENT AS PROPOSE°
2. LAND USE ACTION
3. NAME OF EXISTING PARCEL AS RECORDED
SUBDIVISION FILING
4. TOTAL ACREAGE
S. NUMBER OF LOTS PROPOSED
BLOCK LOT
PLAT MAP ENCLOSED C YES
a. PARCEL HISTORY • Please attach copies of deeds, plats or other evidence or documentation.
A. Was parcel recorded with county prior to June 1, 1972? .DYES r, NO
3. Has the parcel ever been part of a division of land action since June 1, 1972? C YES 7 NO
if yes. describe the previous action
7. LOCATION OF PARCEL • Include a map deliniating the proEect area and tie to a section corner.
1;4 OF E 34 SECTION 33
XTOWNSHIP �•—r�-.N i:_ S RANGE -� �
PRINCIPAL MERIDIAN: C 9TH O fr.M. ❑ UTE O COSTILLA
3. PLAT - Location of all wells an property must be plotted and permit numbers provided.
Surveyors plat C Yes C No ;f aot. scaJad hand drawn sketch C Yes C No
9. ESTIMATED WATER REQUIREMENTS Ga1om per ney or Acre Ent per Year 10. WATER SUPPLY SOURCE
HOUSEHOLD USE rr /
of units
2U
GPO AF
COMMERCIAL USE ,d of S.F. GPO AF
?RRIGATION 4' of acres GPO ,AF
STOCK WATERING A` of head GPO
OTHER GPO AT
TOTAL GPO AF
EXISTING _C DEVELOPED
WEDS SPRING
WELL PERMIT NUMBERS
NEW WELLS
RA*PO$ED AousERS CErWao OW
WORM = UPPER ARAPAEHOE
!PPR 7ANShc ::OWED ASAPAHOE
= LOWER °AWSOR = ,WARE Fax 41LS
DAM] rA
TE REM
AF O MUNICIPAL
ASSOCIATION
C COMPANY
WWSTRIC T
NAME
LETTER OF COMMITMENT FOR
SERVICE 7 YES C NO
WATER COURT DECREE CASE NO.'S
11. ENGINEER'S WATER SUPPLY REPORT C YES C NO ff YES. PLEASE FORWARD WITH THIS FORM..tho illy ha •i i id Heats Dur'MIA a corrroierea.i
12. TYPE OF SEWAGE DISPOSAL SYSTEM
7,1 SEPTIC TANK/LEACH FIELD C CENTRAL SYSTEM • DISTRICT NAME
LAGOON C VAULT . LOCATION SEWAGE HAULED TO
ENGINEERED SYSTEM ;enact' A copy merneureree deppoj U OTHER
1
W R J•26-72
THIS FORM MUST BE SUBMITTED
WITHIN 60 DAYS OF COMPLETION
OF THE WORK DESCRIBED HERE-
ON. TYPE OR PRINT IN BLACK
INK,
COLORADO DIVISION OF WATER RESOURCES
101 Columbine Bldg., 1$45 Sherman St.
Denver, Colorado 80203
WELL COMPLETION AND PUMP INSTALLATION REPORT
PERMIT NUMBER -53138
WELL OWNER Dale E. Eichxer
Rt. 1, f3ox 20
ADDRESS CoranarcP city, Colo. 8002? T. R f'_ ',f
DATE COMPLETED
M y_,2, 1972
WELL LOG
From
Type and Color of Material
,19
Water
Loc.
1
0
7LN 52
32 33
:3 40
)40
!: 123
123 283
183 1'
191 200
200 213
213 2 2
Sandy clay
Weathered shale
Sandrock
Sandy clay Sandstone
Weathered shale
Sand & Sandotoite
Blue shale
Sand
Shy -1e
Send & Sandy clay
Shale
TOTAL DEPTH
Use additional pages necessary to complete log.
Y. of the SE
'd of Sec.
HOLE DIAMETER
10 J1n_ from 0 to 125 _ft.
7 Z/$n. from to 22 ft.
in. from to ft,
6 P.M
0 15'12
CASING RECORD: Plain Casing ,yta�re st`g�y
STA}c oo
Size & kind steel from 0 to 12'_-,,-____ ft.
Size 6 2/8& kind ____11 from
Size _ _ & kind from to ft.
Perforated Casing
Size 6 5/8& kin&feel.
Size & kind _
Size & kind _
GROUTING RECORD
Material Cement
116 to `---f' ._� ft.
from la': to 2l-_ ft.
from
from
I ntervaIs
Placement Method R-'ve; se -.dump
GRAVEL PACK: Size
to
to
_ ft.
ft.
Interval
TEST DATA
Date Tested
;may 12, 1972
Static Water Level Prior` to Test
Type of Test Pump _ 1;Jsjer
Length of Test
ft.
Sustained Yield (Metered)
200:.
Final Pumping Water Levi ZBr
NRJ.25.72"
THIS FORi3 MUST BE
Va..56MITTefa PRtOFtTp
THE EXPIRATION OF THE
PERMIT. TYPE OR
PRINT IN BLACK INK.
STATE OF COLORADO
COUNTY OF_ WELD
THE AFFIANT(S)
whose address is
COLORADO DIVISION OF WATER RESOURCES
101 Columbine Bldg., 1845 Sherman St.
Denver, Colorado 80203
A ._STATEMENT OF BENEFICIAL USE OF GROUND WA
__AMENDMENT OF EXISTING RECORD
PERMIT NUMBER 53138
I SS.
DALE S. _ AND JANICE B. EICHNER
Route Nrn her .2, Box 20, Commerce City. Colorado 80022 (At Present)
being duly sworn upon oath, deposes and says that (they)_.ia (are) the owner(s) of the well described hereon; the well is
located in thP6'd9rt. SE 1/4 of the SE V/4 of Section 33 Township 1 North,
(N. or S.
Range 65 West 6th P.M. at distances of 400 feet from the South section line
(E. or W.)
and 350 feet from the East
{East or West)
(North or South)
section line; the total depth of the well is 232 feet; water from this well
was first applied to a beneficial use for the purpose(s) described herein on the ?7th_day of February ,
the maximum sustained pumping rate of the well is___0 ___-gallons per minute, the pumping rate claimed hereby
gallons per minute; the average annual amount of water to be diverted is__.2?L2 acre-feet; for which claim is hereby
made for_
Domestic/Livestock
purpose(s); the legal description of the land on which the water
from this well is to be used is 5 2/2 of SE 1/4 of the 3/E 1/4 of Section 33, Township 1N, Range 65W Qf
6th PM
which totals 20 acres and which is illustrated on the map on the reverse side of this form; that this well was completed
in compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with
law; -he (they) #aa- (have) read the statements made hereon; knows the content thereof; and that the same are true of his
(their) knowledge.
i
Signate�re(s)...—•rrz
Subscribed and sworn to before me on this 23rd day of
February , 19 73
My Commission expires: C)�. . ? ! %
Notary Pnli
IC
ACCEPTED FOR FILING IN THE OFFICE OF THE STATE ENGINEER OF
COLORADO ON THIS DAY OF , 19_ ..
STATE ENGINEER
WHITE COPY FOR DIVISION OF WATER RESOURCES
PINK COPY FOR WELL OWNER
The amount of appreprtatlon to acre feet Is not considered to be nets.
riaf to the terms of this parr it pursuant to Section 148.21-45 CRS.
Prior, Date
Weil Use
FOR OFFICE USE ONLY
, 19
- . ...__I/a. 1/s. Sec. ...�._. ,
T. R.
Yield W.D. M f 1
Co iP ;F. --
Index
COLORADO DIVISION OF WATER RESOURCES
101 Columbine Bldg., 1845 Sherman Street, Denver, Colorado 80203
e0-42
TYPE OR PRINT IN BLACK INK. APPLICATION MUST BE
APPLICATION FOR:
A PE,RM�[T TO USE GROUND WATER
A PERMIT TO CONSTRUCT A WELL
REPLACEMENT FOR NO.
A PERMIT TO INSTALL A PUMP
OTHER
APPLICANT P, %e /'G 4 4i 4 r
Street Address
City & State
p4-/ Box �o
COI ,1 eYe #
Telephone No. „7.--er--
M OF AQJJiFER GROUND :'er.P.TER IS TO BE OBTAINED
FROM:
PROPOSED TOTAL DEPTH OF WELL _
ESTIMATED MAXIMUM PUMPING RATE
AVERAGE ANNUAL AMOUNT OF GROUND WATER TO BE
APPROPRIATED
ANTICIPATED GROUT PROGRAM
Material. C +
Ft.
GPM
Acre-feet
Intervals -� - Q O
/
Placement Method / If- /// '6 i K'747)
PROPOSED NG:
5
Plain t yin. from I) ft. to 7=-.061t. Other water rights on this land
Perf. fir_ in. fromft.
�� �- O� ft. to �v'�� ft.
/in, from t. to ft.
Driller '1 n } L T r
"L No, ID
COMPLETED BEFORE ACCEPTANCE,
GROUND WATER TO BE USED FOR:
X DOMESTIC (1) COMMERCIAL (4)
LIVESTOCK (2) INDUSTRIAL (5)
MUNICIPAL (8) IRRIGATION (6)
OTHER
WELL LOCATION
COUNTY
_ 1off'
4/1
the 4 of Section cli
T. /
0(Q P $- -IN ADDITION TO THE ABOVE, THE WELL MUSMUS BE
LOCATED WITH REFERENCE TO GOVERNMENT SURVEY
CORNERS, MONUMENTS OR SECTION LINES BY DISTANCE
AND BEARING (DOMESTIC WELTS MAY BE LOCATED BY
LOT, BLOCK, & SUBDIVISION.)
ft. from section line
(North or South)
ft. from section line
(East or West)
in. from ft. to
LOT BLOCK FILING
SUBDIVISION
Ground Water Basin „ yam L/- ,'
Water Mgmnt. Dist.
Anticipated drilling date d
Owner of land on which well
is located:
gxe)
Addrestll*Q ? IIu((M PPl t Di III ez h ! 1? tf X , Signature
of Applicant
IF WELL IS USED FOR IRRIGATION, BACK SIDE OF THIS APPLICATION MUST BE COMPLETED. L/ -Y-/
CONDITIONS OF APPROVAL
FOR OFFICE USE ONLY
APPLICATION APPROVED: VALID FOR ONE (1) YEAR
AFTER DATE ISSUED UNLESS EX'2ENDRD FOR GOOD
CAUSE SHOWN TO THE ISSUING AGENCY.
PERMIT NO.
DATE ISSUED
53138
MAR 1 51272
STATE ENGI ' FAR
BY
R. Y[J a So P.M.
Diana Aungst
Subject: Portable Toilets
From: Kevin <kevind195@hotmail.com>
Sent: Wednesday, January 16, 2019 2:14 PM
To: Diana Aungst <daungst@weldgov.com>
Subject: Re: USR
Caution: This email originated from outside of Weld County Government. Do not click links or open attachments unless you recognize the
sender and know the content is safe.
Portable toilet to be used
1
Scanning Cover Sheet
for
Septic Permits
Permit #
G19732386
Permit Type: Heafth / EHS History / EHS Conversion History
Situs Street Address
Situs City, State, Zip
20995 CR 2
Sec/Town/Range: 33 -01N -65W
Parcel # (12 digits)
Owner Full Name:
Owner Address:
Contact Name:
Contact Address:
147333000057-86479386
EICHNER DALE
RT
BRIGHTON,CO 80601
Application Status: Finaied
Application Date: 03/11/1996
Owner Phone #: 303 6593704
Contact Phone#
Information above has been Verified in Accela by employee noted below
x
Processed by.
Report ID. EHS00024vQ03
Print Date -Time, 3/26/2009 10.50.23AM
March 26. 2009
Date
Page 1 of 4
Application
Owner
WELD COUNTY HEALTH DEPARTMEN 52 3
` 2 `�
1555 17th Ave. T' �� `�
Greeley, Colorado
Ph. 353-0540 M.H. No._ _
for Permit to Install, Construct, Alter or Repair Individual Sewage Disposal System.
Add
Legal Descriptio
Direction
General Information
1. Living Units
2. No. of Bedrooms
3. No. of Baths
4. Basement Drain _
5. Automatic Dishwasher
6. Garbage Disposal
7. Automatic Latin-
8. Size of Lot
5
9. Type of Soil - _
10. Percolation Test r? .vv. /0
1L Water Supply.
12. Lot Grade
13. Water Table Depth
14. Other
7rhtrl
1. Liquid Capacity
2. Dimensions
3. Material
4. Type Inlet
Type Outlet
B.P. No.
4t.,S""`Gs-
Phone
Septic Tank
./ S O
i ' L
Gallons
D
Secondary Treatment
Cl/fig -1c-
Field 2)°1 9 Bed
1. No. of distributionA4nes
2. Trench: Width 411 Length
3. Type Filler Material
4. Depth of Filler Material
5. Gravel Size
6. Type Tile
7. Depth of Cover
8. Other
6OAa/iFd (:7i', cJtL-
- j/s/
w
The Per_uiL is to remain in full force and effect for six (6) months from date, until revoked for non-compliance.
This system will be constructed- in accordance with the above specifications and regulations governing non -
municipal sewage disposal systems, in accordance with Regulation No. 1 of the Weld County Health De-
partmcnt. Owner cannot: transfer permit.
Owner:
Date: 1 , Applicant
The plans and sp•c fications as shown are approved, pending payment f-'p-ermitlfee'
A,1?7,
Sanitarian:
Date:
The above system an
ins inspected d -to comply found p with the plan and description.
��
Date'
Installed by -.
PERMIT FEE
Received by.
Ff
Sanitarian:
Please use reverse side for Plot Plan or use separate sheet of paper.
Date
WELD 'COUNTY HEALTH oEL'ARTMELIT
RN7IRONMENTAL PROTECTION SERVICES ./4 SCE 9 _
I.17 16th Avenue Court UMV4
Greeley, Colorado 80631 _.�itc'tt.�ur LSDS s
(343)3S3-033S+23dCounty Health Department REPAIR
STATEMENT OF EXISTING FOR SEPTIC SYSTE.Wr'
Pa7.2 1 9X997
(PLEASE FILL OUT IN BLACK INK ONLY)
OWNER OF RECORD: t -
MAILLNG ADDRESS: c)67 9 r WC l(. , v. Z 44_,,,,61/
C ty State Zip
SITE ADDRESS: O 19 , - G -U. �, Ly1_ e t ia.-yC_ L .e. re, D/
PHONE: 3a. -' - 7G47
C. y State Zip
LEGAL DESCRIPTION: PT: SE/3/ PT:�� SECTION:W-3 1. TOWNSHIP: //Y RANGE: (0 S'(..J
LOT: BLOCK: FILING:
SUBDIVISION:
NUMBER OF PEOPLE: 1 BATHROOMS:
RESIDENTIAL. or COMMERCIAL
LOT SIZE: 7A -
BASEMENT PLUMBING: Yes
No
BEDROOMS: �.
WATER SUPPLY: _ L L
SYSTEM SIZE: Tank is constructed of C. -Cm C r-e� c and has tag -e9 gallons capacity
(material)
FIELD: Bed �'/ CU sq. ft. or Trench sq. ft. DATE SYSTEM INSTALLED: ma.e /q 73
You are required to draw a diagram of the system on the reverse side of this form in
black ink only and indicate location, length, width. and distance from the dwelling.
The undersigned property owner hereby certifies that the above described septic system
is in fact installed, as described, and exists at this time on the parcel of ground
identified by the above legal description and further states that the system is in good
working order and to the best of his/her knowledge is not failing to function properly.
I further understand that any falsification or misrepresentation may result in revocation
of any permit granted based upon this information hereby submitted and in legal action
i,--,a1jry co pr=74dtd by
Date
JA/Ca,-,,,eA. _-
Owner
Subscribed and sworn to before me this � 7 day of J4/'G % 19972
by e-
/71:1.
kitness my, hand and official seal. My carrnission expires:
977
Date
STATEMENT OF EXISTING REVIEWED BY:
Notary Public
Environmental Protection Specialist
_„,,\
(441,,:irsq)
COLORADO
SEPTIC LOAN APPROVAL
CLOSING DATE: 04-25-02
New Loan
DEPARTMENT OF PUBLIC HEALTH & RN4 ONMENT
1555 N. 17Th AVENUE
(. REELFIY CU1.ORADO 80631
WW W.CO.WELD.CO.US
ADMINISTRATION (970) 304-6410
PURLIC HEALTH EDUCATION & NURSING (970) 304.6420
PAX (970) 394-6416
ENVIRONMENTAL HEALTH S1.RVICE;S (970) 304-6415
FAX (970) 394 -Gal 1
REQUEST NO.: 02.011
DATE RECEIVED:03/18/2002
FEE: $ 110.00
TO WHOM IT MAY CONCERN: Review and inspection report regarding water and the sewage
disposal system for an existing dwelling:
Mail To: DONALD WILLIAMS
Fax To:
Pick Jn:
20995 WCR 2
BRIGHTON CO 80603
INFORMATION:
Legal: PT:
Subdivision:
Owner No.: 303-655-7975
Owner No.:
Realtor No.:
Fax No.:
Address: 20995 WCR 2 BRIGHTON Age of Septic: 1973
PT: SEC: 33 TWN: 01 N RNG: 65 W
Property Owner: WILLIAMS, DONALD
Tank Pumped on: 3-13-02 By: SOCK IT JP
LOT: ELK: FIG:
Original Owner: EICHNER, DALE
Licensed: yes
PERMIT ON RECORD: Name: EICHNER, DALE Permit No.: 619732386 S.O.S.: NO
Bathrooms: 2 Eedro7ms 2 Tttal Acres: 7 Date of Final Inspection: 05/08/73
Water Supply: WELL Well Permit No.:
Tank Capacity: 1000 gallons Leachfield Size: 810 Square Feet
INSPECTION FINDINGS: Date of Inspection: 03/20/2002
SOIL CONDITIONS: Dry XX Saturated Snow-covered
RESIDENCE; Occupied XX Vacant
SEWAGE DISPOSAL SYSTEM: Satisfactory XX Other
BACTERIOLOGICAL WATER TEST: Acceptable XX Other
DATE:
SIGNATURE:
Environmental Health Specialist
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 in connection with either its
examination of the property or in the report.
This inspection was conducted solely for the purpose of detecting health hazards
observable at the time of inspection, and does not constitute a warranty that the system
is without flaw or that it will continue to function in the future. Inspections requested
during periods of snow cover and high soil saturation may be of questionable value to
potential buyers due to adverse conditions. Water sample reports reflect the
bacteriological quality of the water supply at the tame the sample was taken. 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 representing to the best
of his/her knowledge the system is not failing to function properly.
illiDe.
COLORADO
SEPTIC LOAN APPROVAL
CLOSING DATE: 5-15-2OOO REQUEST N0:OO-O29
NEW LOAN DATE RECEIVED: 5-9-2O0O
FEE $90.00: 5-9-2OOO _
TO WHOM IT MAY CONCERN: Review and inspection report regarding water and the sewage
ai:3posaw system for an oxisti: g dwelling:
PICY UP: P_hylliSweet
OWNER NO.: 3O3 -659-190O
FAX NO_: 3O3 -659-889O
'INFORMATION: Address: 20995 Weld County Road 2, Brighton Age of Septic: 1973
Legal: PT: PT: SEC: 33 TWN: 01 N RNG: 65 W
Subdivision:_ — —_-- _ LOT: _ BLK: FLG:
Property Owner: Gilmer I.isolotte Original Owrier: Same
Tank Pumped on: 5-4-20OO By: Art's Sanitation Service
Licensed.: Yes
PF..'RNIT ON RECORD: Name; Gilmer, iisol_otte Permit No: G19732386 S.O.E-; No
Bathrooms:_2_ Eedroom:3; 3 Total Acres; 6.444 Date of Final Inspection; N/A
Water Supply: P=ivateWell Well Permit No.:
Tank Capacity:4l_250_- gallons Field Size: 810 Square feet
TgPECT
. _... Iti:;IpYc;;: Da�4,i of .-nspe`tian: 5-12-2000
:osidonce: C..conaleu ewae l;_ spcsal S,. ;t. e: Satwsfact ory XX_
+aoteriologi_ca2 Water Test: Acceptable_ Other See Comments
CeM
DATE: 5 _ 1 ,, t - r ,
SIGNATURE:
-nvironmental Protection Specialist
Nether the County of Wald, nor any cf its agents or employees undertake or assume any
liability to the owner of the a'oove property, to any purchaser of the above property or to
any lending agency :nailing a loan on the above property in connection with either its
exajninaticn of the property or in the report.
This inspection was conducted solely for the purpose of detecting health hazards
observable at the time of -inspection, and does not constitute a warranty that the system
is withit flaw or that it will continue to function in the future. Inspections requested
du--iug period of sr,os' coves' and high soil saturation an may be of questionable value to
potential buyers ._._e to adverse conditions. Water sample reports reflect the
hafteriolcgical quality of the water supply at the time the sample was taken. Evaluations
cased on Statements of Existing {S-O,E-) relies on information the property owner
provides, under oath, indicating current status of the system and representing to the beet
of his/her knowledge the system is not failing to function properly.
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