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Home My WebLink About20190700.tiffCOLORADO DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST, RM 821, DENVER, CO 80203 Main: (303) 866-3581 dwrpermFtsonlinefstate.co.us GENERAL PURPOSE Water Well Permit Application Review instructions on reverse side prior to completing form. The form must be computer generated, typed or in black or blue ink. 1. Applicant Information Name of applicant Mailing address k-: City State Zip code Telephone if (area code & number) r E-mail (online riling required) 1t' tsJ .. .. i{�� Yk.+ 4� i \- Office Use Only Form GWS-45 (07/2013) Municipal 6. Use Of Well (check applicable boxes) Attach a detailed description of uses applied for. ❑ ❑ Dewatering System IDGeothermal (production or reinjection ❑ Irrigation - g Other (describe): ) tit , Industrial El f ommerctal c,./ 2. Type Of Application (check applicable boxes) t=1 Construct new well CIUse existing well ❑ Replace existing well CIChange or increase use ElChange source (aquifer) ElReapplication (expired permit) ElCOGCC Well O Other: 3. Refer To (if applicable) Well permit */ Water Court case # Designated Basin Determination # Well name or # 7. Well Data (proposed) Maximum pumping rate gpm Total depth feet Annual amount tote withdrawn Aquifer acre-feet 4. Location Of Proposed Well County , 4,A,/ rf. i ,: 4 - , 1/4 of the k—. 1/4 Section Township N or.S I Range E ar W - Principal Meridian ( 0 Er }+ Distance of well from section lines (section lines are typically not property lines} ,r.>j {'r' Ft. from N ," S �� i , Ft. fromME OW For replacement wells only — distance and direction from old well to new well feet direction Well location address {Include City, State, Zip) ❑ Check if well address is same as in Item 1. Optional: GPS well location information in UTM format You must check GPS unit for required settings as follows: Format must be UTM Zone 12 aril Zone 33 Units must be Meters Datum must be NAD83 Unit must be set to true north Was GPS unit checked for above? ❑ YES 5. Parcel On Which Weil Will Be Located (PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL) A. Legal Description (tray be provided as n a chment): co /I t- 1b EG- $( ,r Easting Northing Remember to set Datum to NAD83 8. Land On Which Ground Water Will Be Used Legal Description of Land (may be vided as an attachmen ):, 5 .s 5/LP c c e i� f ,' (1f used for crop irrigation, attach a scaled map that shows irrigated area,) A. # Acres i B. Owner C. List any other wells or water rights used on this land: B. D. e5 Pro PV # of acres in parcel : C. Owner t' L. '•.., r� Will this be the only well on this parcel? 't9 . :O (it no list other weds) : E. State Parcel ID# {optional): 9. Proposed Well Driller License #(optional): 10. Sign or Entered Name Of Applicant(s) Or Authorized Agent The making of false statements herein constitutes perjury in the second degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S. 24-4-104 (13)(a). I have read the statements herein, know the contents thereof and state that they are true to my knowledge. Sign or enter narne.(s),of person(s) submitting application Date (mm/ddlyyyy) If sigQin t/c li l w g print name and title (1'05�°��. ��l'��5A.r-e,f Office Use Only USGS map name AQUAMAP WE WR CWCB TOPQ MYLAR SB5 DWR map no. Surface elev. Receipt area only DIV WD BA MD COLORADO DIVISION OF WATER RESOURCES GWS-45 GENINST (07/2013) DEPARTMENT OF NATURAL RESOURCES GENERAL PURPOSE WELL PERMIT APPLICATION INSTRUCTIONS Applications must be computer generated on-line, typewritten or printed in BLACK or BLUE INK. ALL ITEMS in the application must be completed. Incomplete applications may be returned to the applicant for more information. Applications are evaluated in chronological order. Please allow approximately six weeks for processing. This form may be reproduced by photocopying or computer generation. Reproductions must retain margins and print quality of the original form. If filing online see online filing instructions! You may also save, print, scan and email the completed form to: dwrpermitsonlinestate.co.us For further information please visit www.water.state.co.us FEES: This application must be submitted with a $100 filing fee. Acceptable forms of payment are check or money order, payable to the Colorado Division of Water Resources. Visa, MasterCard or Discover are accepted by phone through our Records Section at 303.866.3581. Fees are nonrefundable. USES: This form (GWS-45) is to be used to apply for commercial, industrial, municipal, irrigation, feed lot, geothermal (see Geothermal Rules for fee requirements), recovery wells, and other uses not otherwise noted in the following list: RESIDENTIAL use wells — Use of form GWS-44 is required LIVESTOCK watering on a farm, ranch, range or pasture (not feedlots) — Use form GWS-44 MONITORING/OBSERVATION wells — Use form GWS-46 GRAVEL PITS — Use form GWS-27 REGISTRATION of an existing well — Use form GWS-12 (must have been in use prior to May 8, 1972) GEOEXCHANGE SYSTEM LOOP FIELDS — Use form GWS-72 REPLACEMENTS OF WELLS FOR THE ABOVE USES ITEM INSTRUCTIONS: (numbers correspond with those on the front of this form) 1. The applicant is the entity for whom the permit is to be issued. Provide the applicant name and the mailing address where all correspondence will be sent. 2. Check all boxes that apply. 3. Complete all boxes that apply. If the permit is to be issued pursuant to a water court decree or a Designated Basin determination of water right, the case number or determination number must be indicated. If applying to replace or change the use of an existing well, the permit number of the existing well must be indicated. 4. The county, 14 of the section designation, section #, township, range, principal meridian, and distances from section lines for the proposed well must be provided. (An option to providing distances from section lines and the'/. of the Y, section designation is to provide an accurate GPS location in UTM format. The required GPS unit settings must be as indicated on this form.) Colorado contains two (2) UTM zones. Zone 13 covers most of Colorado. The boundary between Zone 12 and Zone 13 is the 108`" Meridian (longitude). West of the 108" Meridian is UTM Zone 12 and east of the 1081h Meridian is UTM Zone 13. The 148"' Meridian is approximately 57 miles east of the Colorado -Utah state line. On most GPS units, the UTM zone is given as part of the Easting measurement, e.g. 1210123456. Check the appropriate box for the zone. Provide the property address of the well location if one exists. If it is the same as the mailing address, check the box next to the well location address. 5. Please attach a current deed for the subject parcel. Complete all boxes and provide a complete legal description of the parcel of land on which the well will be located. If filing online please see online filing instructions for how to submit deed and or legal description attachments. 6. Check ail boxes that apply and attach a detailed description of the uses applied for. 7. Complete all boxes. 8. Complete all boxes and provide a legal description of the land areas on which ground water from the proposed well will be used. If agricultural irrigation is a proposed use, provide a map of the land area with proposed irrigated areas accurately drawn, including section numbers and section lines. A list of all other wells or water rights used on the described land must be provided. 9. The well must be constructed by a Colorado licensed well driller, an authorized individual in accordance with the Water Well Construction Rules, 2 CCR 402-2, or under the "private driller" provision as defined in CRS 37-91-102(12). A listing of licensed well drillers/pump installers is available at: http://water.state.co. us/oroundwaterfBOE/PagesILicensedContractors.aspx 10. The individual signing the application or entering their name and title must be the applicant or an officer of the corporation/company/agency identified as the applicant or their attorney. An authorized agent may also sign the application, if a letter signed by the applicant or their attorney is submitted with the application authorizing that agent to sign or enter their name on the applicant's behalf. If you filled the form out on-line you may save or print, sign, scan and email the form to the Division of Water Resources. Payment must be received via phone, fax or mail prior to processing the application. IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call the Division of Water Resources Ground Water Information Desk (303- 866-3587), or the nearest Division of Water Resources Field Office located in Greeley (970-352-8712), Pueblo (719-542-3368), Alamosa (719-589-6683), Montrose (970-249-6622), Glenwood Springs (970-945-5665), Steamboat Springs (970-879-0272), or Durango (970-247-1845), or refer to our web site at http //www.water.state.co.us for general information, additional forms, and access to state rules or statutes. Purchase Money Transfer Form FmHA 1955-49 <10/28/81) Page 1 of 2 AR2211607 Position 5 UNITED STATES DEPARTMENT OF AGRICULTURE Farmers Home Administration QUITCLAIM DEED State Docu entary Fee Date ..S.. 9.4) $ /2:.1-a. The UNITED STATES OF AMERICA, E iCA, acting through the Administrator of the Farmers `Torre Administration, United States Department of Agriculture, CONVEYS and QUITCLAIMS to GARY W. SMITH and NORMA JEAN SMITH, as joint tenants, of 3960 Piper Street, Hereford, Colorado, 80732, Grantees> for the sum of ONE HUNDRED NINETY—SEVEN THOUSAND AND NO/100 DOLLARS ($197,000.00) al! interest in the foi lowing described rcai estate situated in the County of Welt State or Color do, to wit: Township p 11 North, Rance 6S West of the 6th P.M. Secs on 2: Ai Township 12 North. Range 62 West of the 6th P.M. Section 30: Southeast Quarter ownsh i o 12 North, Rance 63 West of the 6th P.M. RECD ms`s MEI VXMOU,M Section 35: South Hal AT THE TIME OF RECORDATION, THrs !',V SZRUMMENT WAS fOUND TO BE INN:P :MI FOR THE sal' PHOPHOTOGRAPHIC REPRCIOJC * t ttON BECAUSE OF Ii•.LEG?Bit.17Y, CARBON. O; PHOTO COPY, Dl$COLORED PAPER, ETC * Together with ail water and water rights, ditches, and ditch rights, used thereon or appurtenant thereto. Subject to exceptions and reservations e vations contained in patents from the United States. Subject to existing easements for roads, highways, ditches, canals, laterals, and power and transmission lines. Subject to the Purchase Money Deed of Trust to be executed simultaneously with the of �de l i very of this deed by the Grantee(s) herein , ofUnited roe -n favor the State America,. acting through the Farmers Home Administration. The Deed of Trust is to secure the $197,000.00 owing on the purchase price of tie land hereby conveyed and the delivery of this Quitclaim Deed is conditioned upon the simultaneous execution and del 'ter� � to the United ,.ed States of said security instrument by the Grantee(s) herein. This teed is executed and deiivered pursuant to the provisions of the accepted aid dated Aprii 24, 1990, and the authority forth set "o- s n. 7 CFR 1900, Subpart A. No member of Congress she i l be admitted to any share or part of this deed or to any benefit that may arise therefrom. Subject to USDA Soil Conservation Service conservation plan dated November 9, 1937, which is on lie in the Weld County Coioradc Soil Conservation Office. B 1264 REC 02214601 05/22/90 10:07 X10.00 1/002 F 1788 MARY ANN FEtrERSTEIN CLERK & RECORDER WELD CO, CO Form ; mHA 1955-49 (10/28/81) Page 2 of 2 Dazed May 8, 1°9O In the presence of: B 1264 REC 02214601 05/22/90 10:07 X10.00 2/002 }`' 1789 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO UNITED STATES OF AMERICA By STATE OF COLORADO } ss: COUNTY OF JEFFERSON *J1lB't' A UAKLIC" State Director Farmers Home Administration United States Department of Agriculture ACKNOWLEDGMENT On this Sts day of May, 1SGO, before me the subscriber, a Notary Public, i ant for the above County and State, appeared Judy A. Jaklich, known to me to be the .`,take Director, Farmers Home Administration, United States Department of Agriculture, and the person wno executed the foregoing instrument, and she aciCno'' Heed to me that she executed the same as the free act and deed of the United States of America, for the uses and purposes herein mentioned. IN WITNESS WHEREOF, : have hereunto set my hand and seal at Lakewood, Colorado, the day and year aforesaid. 4 . 1'• Z \ . vas `,�f ( s E•A:0�3 • ... My corm i=s:.s i on expires: March 2, 1293 Business Address: 855 Parfet Street, Suite E100 :_ake'wood, Colorado 80215 ROBERT C BURROUGHS, P.C. Attorney at Law 115 Second Avenue C:!Yr,7.1.M 80610 C � 12123/2014 0 0.25 0.5 1 Miles I _ " H 11 I N R63W See Map Page 5 COX RANCHES LTD BLACK CIA BILFFYCO BEVERLY A PETERS 313 RANCH INC 'PETERS 313 RANCH flfc PETERS 313 "(RANCH INC ) I6 SMITH j - GARYI* BLACK BEVERLY ANN COX BLACK 1 J -BEVERLY A MEADER RANCHINe- HTW LAND MEADER LLLP RANCH INC .t +fix HTW LAND LLLP (80%) ScI _ HARMER GEOFFREY L CR 128 C Z � C WAHLERT RANCH"LLLP MEADER \ RANCH INC \ MEADER RANCH INC MEADE R RANCH INC aca MEADER RANCH INC AYARS TODD A SMITH GARY W .t DENKAIANBAAL SANCTUARY SMITH GARY I S SMITH GARY W LOYD FARMS } fella Pa e 17 COLORADO STATE OF PFEUFFER INVESTMENT PROPERTIES BURR,qcif SBRBAN ROBERT JOIEIRS OF) COLORADO STATE OF H a - WAOLERTRAN[ 11.1.13f541% INT) PEVLER LARRY W KENy� s NA, Cn CC 0 up i DEADER cs RANCH INC HARPER SUZANNE ROBIN 15 OCT MEADER RANCH INC N AYARS KENYON K AYARS KENYON K 1. CR 130 J BURBAcob rRUST'`tr BURBACH ROBER1 JNEIRS OF) S OASIS RANCH LLC r U MARK LAND CO LLP Bll1&lcu ROBERF J)1ElAS 0r7 OASIS RANCH LLC C 7 pttp� WAHLERT RANCH LLLP -AYARS KENYON K OASIS RANCH LLC OASIS RANCH LLC WAHLERT JEFF WAHLERT (50%10 RANCH LLLP CR 124 HTW LAND , LLLP (80%)( HTW LAND LLLP(80%) IHTW, LAND LLLP HTW LAND LLLP (BO%) CR 24 AVAMS CHARLES ---'y K (6N) 1. HOFF PHYLLIS E AYARS KENYON K r HTW LAND LLLP (80%) /7 f HTW LAND LLLP (8O%) C) H o� ��{� 5 $" t rJ to - 0 HTW LAND LLLP (80%) ,HTW LAND LLLP (80%) az OASIS RANCH' LLC OASIS ( RANCH LLC { // / See Map Page 29 r 6 g MCCOLLI I Y. CINDY I LISA .. x io WERNSMAN ENGINEERING AND LAND DEVELOPMENT llc Eric Wernsman 16493 Essex Rd S Platteville CO 80651 July 28, 2018 Weld County Health Department 1555 N 17th Ave Greeley, CO 80631 RE: Septic System for Expedition Water Solutions EWS #9 Site To whom it may concern, The septic system for Expedition Water Solutions on Parcel #020902000002 will be designed if the USR is approved. If you have any further questions or comments regarding this matter, please contact this office. Sincerely, -q ( Eric Wernsman P.E. Hello