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■■ DEVELOPERS OF AGRICULTURE
Water Statement
Prepared for Box M Ranch, LLC
This Use by Special Review application is intended to be processed in conjunction with
an Amended Recorded Exemption application and a 2 -Lot Recorded Exemption
application. The Amended Recorded Exemption will enlarge Lot A of Recorded
Exemption RE -1462 to include the entire boundary of AmUSR-991. The 2 -Lot Recorded
Exemption will create two (2) lots from Lot B of Recorded Exemption RE -1462. The
Recorded Exemption is intended to split off the proposed USR site from the larger
agricultural parcel. The existing well, whose permit is included with this application, will
remain with proposed Lot B. No new wells or taps are proposed for Lot A. Bottled water
will be provided to supply the USR site on proposed Lot A with drinking water.
ENGINEERING, PLANNING, CONSULTING & REAL ESTATE
3050 67th Avenue • Greeley, CO 80634
970.535.9318 /office ■ 970.535.9854 / fax • www.agpros.com
W RJ 25 72
mils Rir OrifiST BE
1J8MlT['EO PRIOR TO
THE EXPIRATION OF THE
PERMIT. TYPE OR
PRINT IN/qLACK JNIC.
STATE OF COLORADO
COUNTY OF
THE AFFIANT(S)
COLORADO DIVISION OF WATER RESOURCES
101 Columbine Bldg., 1845 Sherman St.
Denver, Colorado 80203
X STATEMENT OF BENEFICIAL USE OF GROUND WATER
AMENDMENT OF EXISTING RECORD
�. r1. ester ReisstiAAF O./
PERMIT NUMBER. 73845
SS,
L
whose address is 49.0.‘4,-1- 1, o x 0 4 , !6 r+P e . c /9 /iz v4 do _ea '
being duly sworn upon oath, deposes and says that he (they) is (are) the owner(s) of the we1J described hereon; the well is
located in the Ar ( 14 of the__________x/4 of Section 1 I , Township 4t
(N or $.)
Range 6 Lt.) La P.M, at distances of /9'80 feet from the es.1 Lt,-,FA' section line
(E. or W.)
(North or South)
and /d ?.O feet from the_ GJe_Sf- section line; the total depth of the yvelf is._ ..91!_ _feet; water from this well
(East or West) f' J f 0 Ala - 5 eCAL
was first applied to a beneficial use for the purpose(s) described herein on the !�{ day of_ , t9;
the maximum sustained pumping rate of the well is /5 gallons per minute, the pumping rate claimed hereby is-- _
gallons per minute; the average annual amount of water to be diverted is , acre-feet; for which claim is hereby
made for ,__..Do /'YI S -1 C•-- .- - purpose(s); the legal description of the land on which the water
from this well is to be used is_ W 4 .f r'`r __.J1'1c6- 6 9` to) ra
which totals /60 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) has (have) read the statements made hereon; knows the content thereof; and that the same are true of his
-(their) knowledge. 5 pp
v Signatures) 272;���
Subscribed and sworn -to before me on this.___ v day of
err
My Corrimisstori expires;.__ ,2 — ,/ — 7
.cSai1I)•
Notary Public
ACCEPTED FOR FILING IN THE OFFICE OF THE STATE ENGINEER OF
COLORADO/ON Ti• 4S.___OAY OF.
WHITE COPY FOR DIVISION OF WA
PINK COPY FOP WELL OWNER
FOR OFFICE USE ONLY
Prior. Date --
Well Use Z
1/4,
T. , R.
1/4, Sec.
Yield .W. D.
Index
AGPROfessionals
M= DEVELOPERS OF AGRICULTURE
Sewage Disposal Statement
Prepared for Box M Ranch, LLC
This Use by Special Review application is intended to be processed in conjunction with
an Amended Recorded Exemption and a 2 -Lot Recorded Exemption application. The
Amended Recorded Exemption will enlarge Lot A of Recorded Exemption RE -1462 to
include the entire boundary of AmUSR-991. The Recorded Exemption will create two
(2) lots from Lot B of Recorded Exemption RE -1462. The 2 -Lot Recorded Exemption is
intended to split off the proposed USR site from the larger agricultural parcel. The
existing septic systems, whose permits are included with this application, will remain
with proposed Lot B. No new septic systems are proposed for Lot A. The USR site on
proposed Lot A will use portable toilets for sewage disposal.
ENGINEERING, PLANNING, CONSULTING & REAL ESTATE
3050 67th Avenue • Greeley, CO 80634
970.535.9318 / office • 970.535.9854 / fax • www.a2pros.com
Scanning Cover Sheet
for
Septic Permits
Permit #
Permit Type:
SP -0900168
i
Health / Residential / New
Situs Street Address 26663 CR 40
Situs City, State, Zip
Sec/Town/Range: 28 -04N -64W Application Status: Finaled
Application Date: 10/26/2009
Parcel # (12 digits) 105328400021-R2788204
Owner Full Name:
Owner Address:
GUTTERSEN ART CO CONSERVATOR
ESTATE OF MYRTLE THOMPSON 17506 COUNTY RD 57
KERSEY,CO 80644
Owner Phone #: 970-3967777
Contact Name: FRONT RANGE STRUCTURES LLC
Contact Address: 3816 CR 5
LOVELAND, CO,80537
Contact Phone# 970-669-1413
Information above has been Verifies! in Accela l v employee noted below
x
Processed by:
April 07, 2011
Date
Report ID: EHS00024v003 Page 1 of 1
Print Date -Time: 4/712011 11:02:12AM
-Scanning Cover Sheet
for
Septic Permits
Permit #
Permit Type:
G19780181
Health / EHS History / EHS Conversion History
Situs Street Address 26667 CR 40
Situs City, State, Zip
Sec/Town/Range: 28 -04N -64W _ Application Status: Finaled
Application Date: 03/11/1996
Parcel # (12 digits)
105328400024-R2788204
Owner Full Name: THOMPSON MYRTLE AVIS
Owner Address: 26663 WCR 40
KERSEY,CO 80644
Contact Name:
Contact Address:
Owner Phone #: 303 2846625
Contact Phone#
Information above has been Verified in Accela b Ir employee noted below
X February 02, 2009
Processed by:
Date
Report HI EHS00024v003 Page 1 of 1
Print Date -Time: 2/2/2009 2:40:31 PM
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