HomeMy WebLinkAbout20191675Form No.`
GWS-25
APPLICANT
OFFICE OF THE STATE ENGINEER
COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg.. 1313 Sherman Si.. Denver, Colorado 80203
(303) 866-3581
KEN WAGERS
BOX 397
DACONO, CO 80514-
(303) 775-3970
PERMIT TO CONSTRUCT A WELL
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF APPROVAL
1)
2)
3)
4)
5)
6)
7)
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9)
10)
LIC
WELL PERMIT NUMBER 4/S/
DIV. 1 WD2
DES. BASIN MD
APPROVED WELL LOCATION
WELD COUNTY
SW 1/4 NW 1/4 Section 33
Township 1 N Range 67 W Sixth P.M
DISTANCES FROM SECTION LINES
2470 Ft. from North
390 Ft. from West
Section Line
Section Line
UTM COORDINATES
Northing:
Easting:
This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of this permit
does not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested
water right from seeking relief in a civil court action.
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.
Approved pursuant to CRS 37-92-602(3)(b)(I) and policy of the State Engineer under the following conditions, for a 3 -acre
parcel known as lot A of Recorded Exemption no. 1469-33-2 RE -3201, more particularly described on the attached Exhibit
A.
The use of ground water from this well is limited to ordinary household purposes inside one (1) single family dwelling
and the irrigation of not more than 14,000 square feet of home gardens and lawns.
Production from this well is restricted to the Laramie -Fox Hills aquifer, which corresponds to the interval between 595 feet
and 900 feet below the ground surface. Plain casing shall be installed and grouted to prevent production from other zones.
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.
The maximum pumping rate of this well shall not exceed 15 GPM.
The annual withdrawal of ground water from this well shall not exceed 1.0 acre-foot.
The return flow from the use of this well must be through an individual waste water disposal system of the type so that not
less than 2% of the total amount of water withdrawn is returned to the same stream system in which the well is located.
This well shall be constructed not more than 200 feet from the location specified on this permit.
NOTE: The ability of this well to withdraw its authorized amount of water from this non-renewable aquifer may be less than
the 100 years upon which the amount of water in the aquifer is allocated, due to anticipated water level declines.
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.
NOTICE: This permit has been approved for 1 acre-foot of Laramie -Fox Hills aquifer water and the uses that amount of
water can support. You are hereby notified that you have the right to appeal the issuance of this permit, by filing a written
request with this office within sixty (60) days of the date of issuance, pursuant to the State Administrative Procedures Act.
(See Section 24-4-104 through 106, C.R.S.)
�. 1. /e/ /o %
APPROVED
MTT
210
State Engineer
Receipt No. 0497451 DATE ISSUED
OCT21 2002
EXPIRATION DATE 1 2
Scanning Cover Sheet
for
Septic Permits
Permit #
Permit Type:
SP -0200412
Health / Residential/New
Situs Street Address 526 CR 17
Situs City, State, Zip
Sec/Town/Range: 33-01 N -67W
Parcel # (12 digits) 146933200024-R1733802
Owner Full Name:
Owner Address:
Contact Name:
Contact Address:
WAGERS KEN
PO BOX 397
DACONO,CO 80514
BUXMAN DON
2478 N 35TH AVE
GREELEY,CO,80631
Application Status: Finaled
Application Date: 09/05/2002
Owner Phone #: 303.280.1853
Contact Phone# 970.356.3710
Information above has been Verified in Accela by employee noted below
X
May 21, 2008
Date
Report ID: EHS00024v003 Page 1 of 1
Print Date -Time: 5/21/2008 10:54:29AM
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE (970) 304-6415 FAX (970) 304-6411
Permit #: SP -0200412 Sec/Twn/Rng: 33-01-67
Owner: WAGERS KEN
Applicant: BUXMAN DON
Permit Type: RNEW C=Commercial, R=Residential + NEW, REPair, VauLT
Parcel #: 146 -33-0-00-008
Location: CR 17 LOT A 33-01-67 5 42 17
Legal Descrip 'on:
Installer: VN. —6u k
Status:
Applied: 0910512002
Issued: 09/ / 1/2p02
02
Finaled: 101
1/41 f 91
Description: MODULAR
Commercial: N
Residential: Y
# of Persons: 4 Basement Plumbing: Y
# of Bedrooms: 5 Bathrooms - Full: 3 3/4: 0 1/2: 0
Water Public: N Water Source:
Water Private: Y Cistern: N Well: Y Well Permit #:
Acres: 3
Percolation Rate: 38.6 Limiting Zone: 8 ft 0 in Description:
% Ground Slope: 0 Dir: Soil Suitable: (YIN) Y
Engineer Design Required: (YIN) N In 100 Year Flood Plain: (Y/N) N
Minimum Installation
Septic Tank: 1500 gallons Absorption Trench: 1420 square feet
or Absorption Bed: 1840 square feet
Actual Installation
Septic Tank: ('O1) gallons
Design Type:
Absorption Trench: ! square feet
Absorption Bed: square feet
Chambers
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 not transferable. 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 oaftblic Health and Environment,
x
Form: S_FINAL
Enyirotunental Health Specialist Date
FOR OFFICE USE ONLY
ISDS APPLICATION FLOW SHEET
Owner: (On Permit ##: O corld a-
Locatian:� $ cibi Legal DescriptionS- 1 ~ c
Date
By
Comments
Parcel Number Received _ l�
Information Form Complete
Authorization Form Received
Map Drawing Received
Flood Plain? Yes/No
Site Inspection Date
ei
-11?›
Engineer Design? Yes/No
;i1,1/0
1'�� f}ta
Date Engineer Design Received
Customer Notified? Yes/No
Date Staff Approval Sent
Date Staff Approval Recd
Perc Data Entered in Computer
9 -{0.
t
Date of BCH Approval
Eng Approval Letter Sent
(Letter, Permit, BOH Review)
Date of Final Inspection
j 0_ipz,
D
Eng Final Inspection Letter Rec'd
Variances Needed? Yes/No
Sent Variance Staff Approval
Recd Variance Staff Approval
Variance BOH Approval
Variance BOH Approval Sen
(Variance, BOH Review /
Additional Corn ts:
-
Y_�
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411
WEBSITE: WWW.CO.WELD.CO.US
Permit Number: SP -0200412
09-05-2002 Amount: $315.00
Payment Method: Check
Owner Name: WAGERS KEN
Applicant Name: BUXMAN DON
Parcel Number: 146933000008
Site Address:
Location: TBD CR 2 & CR 17 LOT A
APPLICATION / RECEIPT
Expires: 09/05/2003
Initials: DYC
Receipt Number: HAP -02409
Notation: 2765
Total Fees:
This Payment:
$315.00
$315.00
Total All Payments: $315.00
Balance: $0.00
Account Code
2560-414004221-4203
2560-41400-4221-4203
2560-41400-4221-4203
2560-41400-4410-4203
Description
New Septic Permit
Repair Septic Permit
Vault Permit
Potable Water
Description: MODULAR
Commercial: (YIN) N Residential: (Y/N) Y Acres: 0
Number of Persons: 4
Basement Plumbing: (YIN) Y
Number of Bedrooms: 4 Bathrooms: Full - 2 3/4: 0 1/2: 0
Amount
$315.00
$0.00
$0.00
$0.00
Water Public: (YIN) N Water Supply:
Water Private: (YIN) Y. Cistern: (YIN) N Well: (YIN) Y Well Permit Number:
NOTICE
Applicant acknowledges receipt of the individual sewage disposal system guide and that 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 to be made and furnished by the applicant or by the Weld County Department of Public Health and
Environment for purposes of the evaluation of the application; and 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 certifies theat the proposed system will not be located within 400 feet of a community sewage system. The undersigned
hereby certifies that all statements made, information and reports submitted herewith and required to be submitted by the applicant
are, or will be, represented to be true and correct to the best of my knowledge and belief, and are designed to be relied on by the
Weld County Department of Public Health and Environment in evaluating the same for purposes of issuing the permit applied for
herein. I further understand that any falsification or misrepresentation may result in the denial of the application or revocation of
any permit granted based upon said application and in legal action of perjury as provided by law. This application expires one
X
Q Te "Applicant
Form: RT_HAPP
Date
AUTHORIZATION FORM
RE: ® PERMIT APPLICATION I.S.D.S. EVALUATION
n SALE OF PROPERTY [1 WATER SAMPLE
I_ 0
(Agent/Applicant)
located at ZS..- ,a- \
LEGAL DESCRIPTION: SEC S 3 TWN I RNG • 14 -2 -
represent
SUBDIVISION NAME:
Le- Jfc e
(owner)
for the property
LOT BLK
I can be contacted at the following phone #'s: Home _'7d - 3 S'6 37/Q
Work 9?0 —39/ -/4/”
Fax # 9 ?
The property owner can be contacted at the following phone #'s
Home 303-40
Work 303— i/h — 3 V fo f
Fax # -X61'731 3
Correspondence mailed to (only one): I \' Agent/Applicant
0 Property Owner
DATE 3-- Ca.
OWNER'S SIGNAT
e i
Weld County Health Department
Percolation Test and Soils Data
High Plains Engineering
735 Denver Avenue • Fort Lupton CO 80821
Phone 303-357-9280 a Fax 303-857-9238
8/13/02
�• FILE NO.
a1 Z 2497 I _ —
propertr Address
S 1/2 of the NW 1/4 of Section 33 TIN, R67W of the 6th PM
Legal Description
Property Owner Info
Name
Street
City, State, Zip
Phone
J and S Site Development, 1NC.
PO Box 397 _
Dacano. CO 80514
303-775-3970 Jim
Saturation
and Swelling
•Groundwater.
Smeared Surfaces
Removed:
YES
Encountered at GREATER T 8 t• -1
r
im. -' 'ep o m'
seasonal water table if not
encountered in •rofile:
Sand or Gravel Added:
NO
Date and Time
Presoak Water Added:
8/7/02
date
, : r i
ime_
Amount of Presoak
Water Added:
15
gallons
Is area believed to be subject 10
seasonal fluctuations which could
result in a seasonal water table within
.8' of surface?
Date and Time
Percolation Test
Started:
8/8/02
10:00
date
time
_- -
. t Slap e_ Determination lit Absorption
Area .
Did Water Remain in Hole
Swelling Period?
After the Overnight
1.5
-
to the] Nort st
direction
Hole 1
NO
Hole 2:
NO
I .. . Bedrock- 1, V. r I,
Hole 3
NO
Encountered as (GREATER THAN 8 Ifaet -
Hole 4
NO
_,,.-.f
Hole 5
NO
Estimated depth if not encountered in
rofile:
Hole
NO
percolation Nate
, Measurement
'
Deep -(In)
Percolation-
Rate (minlin)
Hole 1
38
41.67
of Bedrock:
f
Hole 2
42
_31.25
_ __Type
-
Hole 3
38
35.71
—
Hole 4
40
50.00
Is bedrock fractured or weathered?
Hole S
_ 36
41.67
_
Hole 6
35
5
Is bedrock believed to be permeable
Average
38.6
, (perc rate a 60 min/in)?
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