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Home My WebLink About20184135.tiff Form No, OFFICE OF THE STATE ENGINEER GWS=25 COLORADO DIVISION OF WATER RESOURCES ' • 818 Centennial Bldg., 1313 Sherman St.,Denver,Colorado 84203 '(303)866-3581 LIC WELL PERMIT NUMBER 234205 _ APPLICANT DIV. 1 WD 1 DES. BASIN MD APPROVED WELL LOCATION WELD COUNTY SE 1/4 NE 1/4 Section 33 WILLIAM T MATLOCK Township 4 N Range 64 W Sixth P.M, 8601 WCR#8 DISTANCES FROM SECTION LINES BRIGHTON, CO 80603- 1350 Ft. from North Section Line 500 Ft. from East Section Line (303)659-2329 UTM COORDINATES PERMIT TO CONSTRUCT A WELL Northing: Easting: ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CO DITIONS 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 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. 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)(II)(A)as the only well on a tract of land of 61,26 acre(s)described as a portion of the E1/2 of the NE1/4,Section 33,Township 4 North,Range 64 West, 6th P,M„Weld County, more particularly described in attached Exhibit A. 4) The use of ground water from this well is limited to fire protection,ordinary household purposes inside not more than three(3)single family dwellings, the watering of poultry,domestic animals and livestock on a farm or ranch and the Irrigation of not more than one(1)acre of home gardens and lawns. 5) The total depth of the well shall not exceed 410 feet,which corresponds to the base of the Laramie-Fax Hills aquifer. At a minimum,plain casing shall be installed and grouted through all unconsolidated materials and shall extend a minimum of ten feet into the bedrock formation 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 maximum pumping rate of this well shall not exceed 15 GPM. 8) 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. 9) This well shall be constructed not more than 200 feet from the location specified on this permit. NOTE:To insure 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. 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:This permit has been approved for the Laramie-Fox Hills aquifer since an aquifer was not specified. 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.) 0143 3 4Itglo APPROVED JMW 1A40011'` M1 State Engineer BY Receipt No.Q4770336 DATE ISSUED J V N 21 2001 PIRAT Oil DATE J 21 Scanning Cover Sheet for - .. . _ .. - Septic Permits .. . , Permit # SP-0100586 Permit Type: Health/ Residential/New Situs Street Aid ess � 18757 CR 57 Situs City, State, Zip :---WELD CO SO Sec/Town/Range: 33-04N-64W _ Application Status: Finaled Application Date: 11/06/2001 Parcel # (12 digits) 105333000011-80926901 Owner Full Name: SHOCKLEY SHELIA&TRAVIS Owner Address: 16726 WCR 57 KERSEY,CO 80644 Owner Phone #: - Contact Name: COALSON JULIANA Contact Address: 46480 WCR 29 NUNN,CO,80648 Contact Phone# 9708341977 Information above has been Verified in Accela by employee noted below x f • March 04, 2010 Prom v. Date Report ID: EHS00024v003 Page 1 of 1 Print Date-Time:314/2010 4:32:13PM • p . , WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, CO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 ,.analed Permit#: SP-0100586 SectTwn/Rng:33 04 64 Status: ISSUED Owner: <SliHOCKLE ''SHELIA & TRAVIS Applied: 11/06/2001 Applicant: COALSON JULIANA Issued: 01/22/2002 Permit Type: RNEW C=Commercial, R=Residential + NEW, REPair, VauLT Finaled: Parcel#: 1053-33-0-00-011 Location: 18757 CR 55, PT E2 NE4 33-4-64 �� Legal Description: ri 17 Cie' 57 Installer: Cat(6O Description: MODULAR OVER.BASEMENT Commercial: N Residential:Y Acres: 61.02 # of Persons: 5 Basement Plumbing: Y # of Bedrooms: 4 Bathrooms - Full: 2 3/4: 0 1/2: 0 Water Public: N Water Source: Water Private: Y Cistern: N Well: Y Well Permit#: 234205 Percolation Rate: 12.9 Limiting Zone: 8 ft 0 in Description: % Ground Slope: 3 Dir: SW Soil Suitable: (Y/N) Y Engineer Design Required: (YIN) N In 100 Year Flood Plain: (Y/N) N Minimum Installation Chambers Septic Tank: 1250 gallons Absorption Trench: 800 square feet or Absorption Bed: 1084 square feet Actual Installation Septic Tank: ! 24o gallons Absorption Trench: __S_ t l square feet 2 , Absorption Bed: square feet Design Type: C,A 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 net 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 f Public Health and Environment. • X Envir tune 1 Health Specialist Date Form:S_FIRAL 18 a vi:u '3a O J))1 OP 10 I • I (ci I 1 3 13 v r`� r r., r FOR OFFICE USE ONLY ISOS APPLICATION FLOW SHEET • Owner: [ "ri O Permit#: j 8/67 -Lacation: E Legal Description:. 5 3 7O9- 64,, Date H Comments • Information Form Complete • Q� • Authorization Form Received • Flood Plain? Yes/No Parcel Number Received Map Drawing Received Site inspection Date . Engineer Design? Yes/No - Date Engineer Design Recd , Customer Notified • Date Staff Approval Sent Date Staff Approval Recd .Fgfaled J M Pero Data Ented in Computer �,j , p Date of SOH Approval Eng Approval Letter Sent • (Letter, Permit, SOH Review) Date of Final Inspection - - - Eng Approval Latter Rec'd Variances Needed? / • YesJNa ' Sent Variance Staff Approval Rec'd Variance Staff Approval • Variance BOH Approval Variance ECH Approval Sent (Variance, EOH Review} • -- —--- Additional Comments: • • WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, COLORADO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 Permit#: SP-0100586 Sec/Twn/Rng:33 04 64 1P RilrlIT Owner: SHOCKLEY SHELIA & TRAVIS Applied: 11/06/2001 Applicant: COALSON JULIANA Expires: 11/01/2002 Permit Type: RNEW C=Commercial,R"Residential + NEW,REPair, VauLT Parcel #: 1053-33-0-00-011 Location: 18757 CR 55, PT E2 NE4 33-4-64 Legal Desc: Description; MODULAR OVER BASEMENT Commercial: N Residential:Y Acres: 61.02 # of Persons: 5 Basement Plumbing: Y # of Bedrooms: 4 Bathrooms - Full: 2 314: 0 1/2: 0 Water Public: N Water Source: Water Private: Y Cistern: N Well: Well Permit Number: 234205 Percolation Rate 12-.9 Limiting Zone >4, ft in Description % Ground Slope 2.,6 Direction'l,t) Soil Suitable (Y/N) 4.6 Engineer Design Required (YIN) a In 100 Year Flood Plain ( /N) From the application information supplied and the on-site soil percolation data the following minimum installation specifications are required: Chambers Septic Tank 1 gallons, Absorption Trench g90 square feet 240 or �k Absorption Bed IOW square feet ] In addition, this permit is subject to the following additional terms and conditions: flak ()6t autaibtaim U NOT1C 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 thereon 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. This e3 yak:is_iu. n %e'�.abit. 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. This permit expires oneys_ar from the anitication date. XRUIYI• LIZ2/ZitY-- Form:s P3irrr Environmental Health Specialist Date • • WELD COUNTY DEPATMENT 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 APPLICATION/RECEIPT Initials: SC Per m&Number: lie-J01100586 Receipt Number: HAP-01580 11-06-2001 Amount: $315.00 Payment Method: Check Notation: 2599 Owner Name: SHOCKLEY SIIELIA & TRAVIS Applicant Name: COALSON JULIANA Parcel Number: 1053-33-0-00-011 Site Address: Location: TBD WCR 55 33 04 64 Total Fees: $315.00 Total All Payments: $315.00 This Payment: $315.00 Balance: $0.00 Account Code Description Amount 2560-41400-4221-4203 New Septic Permit $315.00 2560-41400-4221-4203 Repair Septic Permit $0.00 2560-41400-4221-4203 Vault Permit $0.00 2560-41400-4410-4203 Potable Water $0.00 Description: MODULAR OVER BASEMENT Commercial: (YIN) N Residential: (Y/N) Y Acres: 61.02 Number of Persons: 5 Basement Plumbing: (YIN) Y Number of Bedrooms: 3 Bathrooms: Full - 2 3/4: 0 1/2: 0 Water Public: (Y/N) N Water Supply: Water Private: (Y/N) Y Cistern: (YIN) N Well: (Y/N) Y Well Permit Number: 234205 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. 1 further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said applicaion and in legal action of perjury as provided by law. This application, exvires one near —_�ri f f, r `r.!!! � /�' J /�C/G*✓ t! _ f.7 L 3 f-.'.h.�Jpb ?Jslt a e Fors SEPTIC INFORMATION FORM _'. f ,„. To obtain an I.S,D.S. permit, one must file art"Application for Individual- 11 g,',:x;'.{ . Sewage Disposal System" at the Weld County Environmental Protection • � � s _ Services office, and pay the application fee. A•"repair" fee shall be charged COL --+,- for the expansion, replacement, or repair of an existing system. The • following information must be provided on the septic information form: PARCEL NC ;!k ; ; ,3-300001 t _THIS CAN BE OBTAINED FROM THE ASSESS.:;A.'S OFFICE AT (970) 3534845 EXT 3650 PROPERTY ,-fi '6 E!� � -7-,1k°R,a_ Ar k{ - MAILING AIaDREs. ._ ':D171 _6v. — C #r5 TY}' ,e ST ,ZIP `tL) HOME PHOJ.,Z { . WORK PHONE i' i FA.3__j(__)._____ ) - - Cka -9 a. ,— Act-Plz..LCAMT.M.e11.1n_ k.L. ik..CL, MAILING ADDRESS la0 It_a CITY 10 U ne) SiCio ZIPgbLoq HOME PHONE fORRK PHONE 1 FAX LEGAL DESCRIPTION.PT a PT _ SEC -5'5 TWN4 IQ RNGIP'1 ACRES. &I, a SUBI]IVI 13 LOT �U BLOCK FILING DESCRIPTION OF BUILDING (ex: House, Mobile Home, oduia Shop, Office). JI SITE/LOCATION ADDRESS 'IM R,.. T C tAD __ DIRECTIONS TO SITE mot- c 4C 4- . �._ _ Cje 55 0 - d r'l v-e ct1 11 . NEW PERMIT_ REP IR PERMIT VAULT PERMIT $3 - $315 $150 IF OBTAINING A REPAIR PERMIT, PLEASE LIST PREVIOUS OWNERS OF THIS PROPERTY FLOOD C I. wi Y t J'.0 ,_ CENSUS TRACT r . RESIDENTIAL '/ NO COMMERCIAL YES NO NUMBER OF PER, OI s S BASEMENT PLUMBING et /)s10 NUMBER OF BEDROOMS 3 - BATHROOMS: FULL 3/4 .1/2 WATER SUPPLY: PUBLIC YES/ O NAME - PRIVATE_( �;� YES-l(-.-E WELL YES NO WELL PERMIT# r9t 4'905 If Z591 • r • •f •I . • PLEASE DRAW A NAP TO YOUR 1 0PERTY ' • N . S • N 6 Weld County Health Department- 10/23/01 Percolation Test and Soils Data is Plains Engineering . 'S 'r'r ,t 735 Denver Avenue # Fort Lupton CO 80621 Phone 303-857-9280 • Fax 303-857-9238 L. TWIT01-1516 J —, Propertx mes Legal Description The E 1/2 of the NE 1/4 of Sec 33, T4N, R84W,6th PM, Weld County, CO Property Owner Info Marne COAL.SON CONSTRUCTION 1 t' ,,,r,46480 WCR 29 3z;Lc,;2 R NUNN, CO 80648 P none l 970-834-1977 Groundwater • S "�s;: Encountered at- GREATER THAN 8 feet Remy -: YES Sand or Grav Rdded:,i NO —Esti i tea depth to maximum seasonal water table if not Date and Time 10/4/01 date encounte -{ in .rofile: • Pry: c Water Added: : 'i ime Amount of Pro cak: Is area believed to be subject to Water Added: 15. •ailons seasonal fluctuations which could Date and'time result in a seasonal water table within Percolation Test 10/5/01 date 8'of surface? Started: 4:45 time '��$f � ,.Detarr i�la#Iorti: h Ablko'-, oif Are '•' Did Wafer Re-Hein in Hole After the Overnight 2.5 % Swelling Period to the SOUTHWEST direction Hole 1 NO Hole 2 NO Hots 3 _ NO Encountered� GREATER THAN 8 feet - Hole 41 NO Hole u NO - Estimated depth if not encountered inl — ---Ao1e NO profile; 'erco, a kohl • a: F :w:��s: '' Deep.(la). lliat 4mlrrlll>I),l Hale 1 36 _ 11.90 Type of Bedrock: Hole 2] 38 13.89 - - Hole 39 13.89 ! 37 13.89 . Is bedrock fractured or weathered? Hole 51 36 11.90, dole 6 38, 11.90 Is bedrock believed to be perrneable Ate�ngj 12.9 tc rate< 60 rnfrJirr ? RECEIVED NOV 0 6 2001 ENYIHRBIfAL IBL>3 SERYI Weld County Health Department 10/18/01 Percolation Test and Soils Data profile Hole Information cont. Note: Soils must be classified usin. unified = - em ASTM D2487 :DIcir9 C,Iic op - - — --— - - — - • • 2 I e : ; SANDY SILT(SM) 5 j 6 0 ,10 CorrliAuz-dldn . 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. tO ti11�t* sc ,' o High Plains Engineering S' �:atarre r $4 • 4 735 Denver Avenue Ft:Lupton, CO 80621 23 G f} �o° ° 303$57-92$Ll Date 'I l.),,,,,,.- r .:.,,;.;l+t•5 '�;• • 7j k ..:1 :t..,.! -4 l' • TM 6 'h. i 3 s v.( p..N: i-1-r . i['r.Tre)r-E ?•i. r-(i'+, ZLult,i) vie, 0 lele) '/ 1 j , ea r. T. _r„) ,.. , ..T.,,, ,,h ,,, _ .___„ _..„ ... . . _ __. ..______________ __...__.... .....,...__,.. e_R.44 .� .- y . ....- - I .• fififi 1 � x I G\ . € ' 0 , iiil o 4 f 4 ,i I', 1j` rso- LEGEND ' I -Zia' i o - Percolation doles _ . __._? �....._..., ., 46,4 IA.,e..44- 6uerss X - Percolation Profile Hole Q-Soil Profile Hole Hello