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PRINT b.ACK INt;
CCBr OF 4cci t tt
SIATEwiENT MAILED
OA REQUEST t
COLORADO DIVISION OF WATER RESOURCES
RIB Centennial Bldg„ 1313 Sherman St,
Den.ei Colorado 80203
TA 7E Cr CC(
COUNT', Of-
AFFIDAVIT
STATEMENT OF BENEFICIAL USE OF GROUND WATER
AMENDMENT OF EXISTING RECORD
LATE REGISTRATION
PERMIT NUMBER
THE AfANT(S'. - ?i',-7 ' Oho
hose mailing . rPP m/ a s
addiett 13
City
Tip
LOCATION OF WELL
R"9
.
l/r
INCIES
Tr
A 5l
being du 'y swore upon oath, deposes and toys that he (they) is (are) the owner( s) of the well described ha - on, the wall is
located as described above, at distances of 5 d feet from the section line and /,5'CJ _ leer It im the
r..• rk...
day of
rYO•TM 0. .a,...I
section line, water from this well was first applied to a beneficial use for the purpose(itdescribed herein on Ihe.Zi'fr
! 'S 1977 the moximum sustained pumping rote of the well is _I gallons per minute, the pumping
fate claimed hereby is _ 1 gallons per minute, the total depth of the well is r feet, the overage annual amount
of water to be diverted is /_ acre feet, for which claim is hereby made for -___ _ ities/ r_
' purpose(s), the legal description of the lord on which the water from this well is used is
A4/ lx4 ld 1 r( " 7--,.#2 ate} 4 of which
r, acres ore irrigated and which it illustrated on the crap on the re.erse side rat this form; that this ..eII was completed in
compliance with the permit upptoved therefor, this statement el beneficial use of ground water is filed in compliance with law, he
(they) hos (hove) rood the statements mode hereon; knows tie content thereof, and 'after the same are true of his (their) knowledge.
(COMPLETE REVERSE SIDE OF THIS FORM)
5,gnaturel s R
Subscribed and sworn FOR Off ICI lr3E pMEY
to before me on this p _ day of t _ 14
My Commission expires
ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO
PURSUANT TO THE FOLLOWING CONDITIONS
CiWiCou No
P„al
D"
Sec ff
.III Luit r
D ♦r 1 866 n
Da T ---
6
is A
wsn D„
DATE
STATE ENGINEER
r
Well drilled by _,JC .1���C.1'
P/rmCinen1 j � /
Pump r Installed by i5
Meer Ser of No
0.nrr of land on whlLh
oral er is .sedTHE - -
CITYAREALOCATION OF THE WELL MUST BE SHOWN IRRIGATION
ON WINCH THE WATER IS USED MUSTBE SHADED OR CROSS -HATCHED ON THE DIAGRAM BELOW/
L IC No
Lrc No
NOR TN
4
Q-10..1Mir. bath Insrolied
_ Ca ,3 rat
riT
Thls diagram s\y•esents n.ne (9, sect,o-.c Use the CENTER SQUARE
Cone sechcni to Indleose Il.e l caIlan nl •I veil, rl passible
1
4 +
T+# SCALE OF TILE D.AGRAM .57w0 INCHES E
QUAL5 ONE -MIL E
t
r
+--1. IIIile
itATFk EGL)JVALEP TS TALE YQoJr,ad Frquir!'
r• .:lt ILO cc..eI l o.rc al 131] 1 ►uul deep
..L L 14.1 447 9i lu l a per ,I. :l to �yla Y
._I. IL.1 4 50l' '.Vt.
yy 4
�h bro.r rlJta '. J�•I .I�JV ..�1r l„ � Ir J..r r.. 4J4. \1 �. J, ■ left
IJ4 W.w p.w1.■J ..r■ yin AI ..JR •j `JL' J� ■ 1wel
411E AND PINK COPT 10 Pt FII.kV .III 1h! TAB LALAtrtt*
PI.+R COPT WILL Tit RETURNS() 10 0wri1El1
1555 N 17n' AVENUE, GRkrLki, •
W RJ.26.77
THIS FORM MUST ®E SUBMITTED
MTiON ao DAYS OF COMPLETION
OF THEWORK DESCRIBE° F•IERf
ON, TYPE OR PRINT IN BLACK
INK,
COLORADO DIVISION OF WATER RESOURCES
300 Columbine Bldg., 1845 Sherman SI.
Denver, Colorado 80203
WELL COMPLETION AND PUMP INSTALLATION REPORT
PERMIT NUMBER `-221`1
WELL OWNER Robert A. Johnson _
ADDRESS 19567 Weld Co. Rd, 53 Kersey, CO 80644
DATE COMPLETED
From
August 24
WELL LOG
Type and Color of Material
0 13
13 31
31 32
32 38
38 39
39 43
43 44
44 .48
48 55
55 68
68 68
6S 73
73 90
90 120
120 125
125 190
190 195
sand
shale
coal
shale
coal
shale
coal
shale
sandstone
shale
rock
shale
sandstone
shale 8 coal streaks
shale
sandstone
shale
TOTAL DEPTH
Use additional p.F.r. necessary to complete iuy.
195'
NE
T,
00,‘7,
itigt
'J, of the SE y*
415eo-
4 N R.
64 1, b P.M.
19 77 HOLE DIAMETER
Fl in, from __... L to _.121.-L. ft.
1_ �`5. ft.
5 5/8 in. from 126 to
in, from to ft.
DRILLING METHOD R2'tar
CASING RECORD: Plain Casing
6" & kind steel from to 126— ft.
Water
Loc.
x
Size
Size & kind from to ft.
Size & kind _ from to - ft.
Perforated Casing
Size 4" & kind open bolefrom 126 to ft.
Size & kind _ . _ from to ft.
Size & kind from to ft.
GROUTING RECORD
Material Cement
Intervals U - 126 ft.
Placement Method Psesstire
GRAVEL PACK: Size
Interval
TEST DATA
Date Tested
August 24
Static Water Level Prior to Test 100
Type of Test Pump B41.1ec1
Length of Test . 3 hours •
Sustained Yield (Metered)
Final Pumping Water Level
19 21_
ft
_?r"r •7r
PURR 1NS`fi,LLATION REPORT
Pump Makg..; Jacuzzi
Type ., ''bie
Powered by Electric Motor
Pump Serial No.
Motor Serial No.
Date Installed a4ugust_264, 1977
HP 14
Pump Intake Depth 189'
Remarks
WELL TEST DATA WITK PERMANENT PUMP
Date Tested __August 29 s l9_21 _
Static Water Level Prior,to Test
Length of Test Hours
Sustained yield (Metered) 14 GPM
Pumping Water Level 1"2 -Dr
Remarks
CONTRACTORS STATEMENT
The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or
pump installation described hereon; that he has read the statement made hereon; knows the content
thereof, and that the same is true of his own knowledge.
Signature. R 4'WEL PUMP iNC. b License No, 513
State of Colorado, County of _'.___ - SS
Subscribed and sworn to before me this alstday of August , 197 7
MyCommisaiongxPires n 3
Notary Public both FORM TO E MADEcopier must be Q Wed with itPhu State Engineer PINK COPY is FORM for the Owneren ' end YELLOW COPY rs for a ,
sad
�WHIrE AND GREEN cop
_,19 .
COMMERCIAL BUILDING PERMIT APPLICATION
•
wr10144.J.Of, mitre`
1".co"PlOe wrperr•
•0671+t-eb,e };}r ¢r
Print ul Bl AC'K
!' _NuUvervINi.t.s
(It erasures
inrtra)ed
COLORADO DIVISION OF WATER RESOURCES
818 Cantennlal Bldg . 1313 Sherman St , Denver, Colorado 90203
PERMIT APPLICATION FORM
(A, A PE ,114J Tr' ti I I;1(Mlrr)WATE-R
'. A Pi:llt1I1 TO l ON-5TRUCT A WEL I
rr3R i/(I A PEI , IT 1U INSTALL A PLJM'
I I REPLACEMENT I OR NO
OTHER
WATCR COURT CASE NO
IT 1 APPLICANT mailing address
NAME rfJeS hhs,
STREET .' 1('tg1/ 5: q
CI&irr''Staley
flip
TELEPHONE NO . r� •'/O
(2) LOCATION OF PROPOSED WELL
County_
+ 4 of the 'A Section DI,
Twp f. Ai", Rng AY. 6 P.M
..AL"
N Si IE.W.
(3) WATER USE AND WELL DATA
Proposed maximum pumping rate (gpm) /
Average annual amount of ground water
to be appropr+eted (acre•feet). l
Number of acres to be irrigated: e9
Proposed total depth (feet) • HIV, -
Aquifer ground water is to be obtained from
OrReeMire
Owner's well designation
GROUND WATER TO BE USED FOR:
{ ) HOUSEHOLD USE ONLY no irrigation (al
(X) DOMESTIC (1) ( ) INDUSTRIAL (5)
( i LIVESTOCK (2) I I IRRIGATION (61
( ( COMMERCIAL (4) ( )MUNICIPAL (8l
I I OTHER (9)
DETAIL THE USE ON BACK IN (11)
(4) OBIL�LER
` '
Jame _
�
itreet
lei.
;itY sl �rrl tIvS
Lic. No /t
'elephone No.
facoltp
02111
y''wtfl f�
FOR OFFICE USE ONLY DO NOT WlITE 'N THIS COLUMNL-��
,�
Receipt No e a .S 3l
Baser
Ds1
OS14'41C.ONS OF APPROVAL
This ;NO shall be used in such a way as to cause
no material injury to existing water rights. The
issuance of the 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 front seeking relief in a civil court action.
APPROVED PURSUANT TO CIS 1973, 37-92-60E
(3)(b)(II) AS TIE ONLY WELL ON 1 T keT
OP 35 ACRES OR MORE DESIGNATED AS
ACRES IN !t/1''-5' y • T ' -
. 1 ly n7`
,APPLICATION APPROVED 92244
PERMIT NUMBER
DATE ISSUED
kXPIRAT ATE
BY
I.D.
51
(STATE GIN
d f COUNTY
COMMERCIAL BUILDING PERMIT APPLICATION
fFPARTMFNT op at ONNitit= cro+nrcc
( THE LOCATION OF THE PROPOSED WELL and the area on
which the water will be used must be Indicated on the diagram below.
Use the CENTER SECTION Cl section, 640 acres) for the well location.
144-- 1 MILE, 5250 FEET
+
T , --( — NORTH SECTION LINE
I �
NORTH* + +
� I
J
t✓i m
ti�
5
- I
I I
I
1--
i I
I i
— + SOUTH SECTION LINE
+ 1 T
+ 4
I
4
The scale of the diagram is 2 inches = 1 mile
Each small warp represents 40 acres,
+ +
—
WATER EOUIVALENTS TABLE (Rounded Figures}
An acre-foot covers 1 acre of lend 1 foot deep
1 cubic loot per second lclsl . 449 ga.ions per minute- loom)
A famty of S will require apuroe.imletet. I acte•foot of wererper Veer.
I acre -lope . 43,5'50 cubic feat . , 325.900 gallons.
1,000 Barn Dumped cantinuously for one day produces 4.42 acre-Ieet
(6) THE WELL MUST BE OC ATE BELOW
by-----
cEstancPs horn section lines,
sec. line
ft, fromft. faun north OW soNtm
Sec, line
haft or west)
FILING et _1
It
LOT,
SUBDIVISION
BLOCK
(7) TEIAC S N HI 1.1
LOCATED owner
Will this be
No. of acres - f
the only well on this tract?
(8) PROPOSED CASING PR[3 FtAM
Plain Casing
in. from
ft. to
in. from --___ft. to
Perforated casing I,
1J 7fr-- in. from Icl/ e ft. to
/I/0 ft.
ft.
,ed c) ft.
in. from _ ft. to `t
(9) FOR REPLACEMENT WELLS give distance
and direction from old well and plans for plugging
it;
(10) LAND QN WHICH G,f:? N P. WATER WILL BE USi=D.
Owner(sl :
Legal description:
(11( OETAILED DESCRIPTION of the use of ground water:
system to he used. l,S
to
IPE
No, of acres:
Household use and domestic wells must indicate type of disposal
(12) OTHER WATER BIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers,
Type or right Used for (purpose) Description of land on which used
S'& d,.c /d
(13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS
TRUE TO THE BEST OF HIS KNOWLEDGE.
.SIGMA TURF OF AM. ICANT(S)
I I}c ,1ddltliilldl alluul5 of paper if more Spa4d is required
t
I. ISF':rt ),
sl
INDIVIDUAL SEWAGE DISPOSAL {;YS;TI:i:ri I'I''P:1'141
WET COI 1N41"r'r` iii: AI.. I)I:i:PAN. IMEN I
I:::I41V:I:FC(:11+11'Il :hl i r l I)I:: AT 'T I•T Si E:F?V1::l:;' ;
16tH AVENUE COURT. OF2E::f L..E::'(„ CO E)C)$s::; L
3:5.3—O635 EXT.2225
. 2a';l:':'.i
f:1W1411:::1'; O(:)i-NS:;0)141,. ROBERT ADDRESS 1956 WI Fi ''''
It L: F :S;iI:; Y
ADDRESS OF PROPOSED SYSI ::11 ;r. ',•tifa:' IJI:;h: ::r,'S
KEi RS:;E,: Y
LEGAL, DESCRIPTION or SITE
SUBDIVISION
USE T•YPiii. ^ 1=:E;:T I:I)i:::l'l'T :I: r1I . I.1(:)IJS:;I:i:/S:;(.)F; 939138
SERVICES PERSONS 1':'c,`f ti4NS7 `;, BATHROOMS t.OO LOT T SIZE a':,4O.O!)
BEDROOMS 2 BASEMENT PLUMBING 1410) WATER SUPPLY
r PPI .I:(::.AT:FC)l1 F:I:::EC 'III;:5,.OO
F41::C'I> BY EYII:)l i :1:;af:H"l„I.T:)l l :1:NI:i:
DATE O9/O3,'9::3
CO (:D()4{l
NO. O-93O3I9
REPAIR PERMIT
I::'1•"! (3O::3) 'far-l...fa.•ito?
CO 006e0
GEL,' 29 TWP I''':I IC•)
LOT () BLOCK E) FILING C)
ACRES
F"'WE: I..I...
?I(})1411:4. BY ROBERT A. OC)L IN.iON
DATE O9'O;:3/93
PERCOLATION RATE TE 1O..x:) MIN I"'1:':F': INCH LIMITING II•IG l,:t;iI411::: u FEET
SOIL TYPE SUITABLE r1Ti L PERCENT N T GROUND SLOPE C)% DIRECTION
RI Il(I I:RI:::S:; ENGINEER DESIGN NO TN J 4)') YE::fll'N 1..1•.1(0) PLAIN ZONE NO
FROM TIll APPLICATION I I'II C)RI'Icl a:UNI SUPPLIED r11.II) 1011:' ON -SITE f:iC)1'I... PERCOLATION
THE:: FOLLOWING MINIMUM i INSTALLATION I^sl_.i._ATION SPECIFICATIONS NS AI'1E: Ri:OUIRET);:
SEPTIC TANK 4OO{) (aAl...l._(:)N£z., ABSORPTION TRENCH :'.i::iO SO. » F T' _
ON
ABSORPTION BE: -I) 1:3O) SO. ET.
IN r;I)I):r (:1:0)141, !NIS:; PERMIT :t IS Sal.11:;OI:::i::T TO Tl•IF:: FOl..1..ow:ING ADDITIONAL AL.• TERMS r1I'ID
CONDITIONS
DATA
THIS F'l:::i ii:I:1' IS GRANTED TEMPORARILY 'lU Al...l._OW CONSTRUCTION ro Ct)IYIIrlE:NCE.. THIS PERMIT
MAY BE REVOKED OR SUSPENDED BY Till WELD COUNTY HEALTH DEPARTMENT EI:)k ILASiiLNS:; GET
FORNI IN Till WI.I..1) COUNTY :IND.IVIDUAl... SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDING
FAILURE 1O MEET ANY lERM 0)R CONDITION IMPOSED THEREON DURING G TEMPORARY (::II : FINAL
APPROVAL. ,. THE ll::: ISSUANCE OT THIS S PERMIT DOES NICTT CONSTITUTE ASSUMPTION ON BY THE
DEPARTMENT OR ITS I:: PIF I..I:)1'EE::+ OF I IABIL, I TY FOR T 1"u : FAILURE OR ENAD1:;:GIIJrac-Y OF THE
SEWAGE 1):I:YSI T l:::iY1
812''bi
S:;TC)I..L.,, 3I:::F:•F:•
ENVIRONMENTAL SPECIALIST
O9/O3/9
DA•T F
ir'I:I:S3 PERMIT l''I.I. i IS NOT TRANSFERABLE: I:: AND SHALL. I?rl:'..(::l:)rIE:: VOID :I:I} IF SYSTEM CONSTRUCTION HAS
l4NO1 COMMENCED WITHIN 0)441` YEAR OF ITS ISSUANCE. BEFORE E ISSUING FINAL L• APPROVAL. 0)F
THIS PERMIT THE: WELD COUNTY HEALTH DEPARTMENT RESERVES 1 I•IIE: RIGHT T TO :CIYII'''OSli, ADDI-
TIONAL. TERMS AND O11•,1)) C T I:(:)14Lf;; Filii:(:1ij tr:F:::1) 40 MEET OUR REGULATIONS 0)H A L(:TN1 LNt.liN(.I pA •
2ii:l:`T3„ I"1:141(11. PERMIT ('ll"'I''I':C)VI"11., IS 0:(:)1411:1:I'•I(L:?:hII UPON THE FINAL l... :1:14I:i;l I:i.(.:T I:(.1N Of TITLr': C.;UIYI
I'I.. I::: T-I:::I) SYSTEM 1?`r` THE WELD COUNTY Y HEATH I•l DEPARTMENT.
S;1"3'Tr IYI I'N`iTAI. I i::l: - ,fr -X:/10: ...,..
r' iI,CII.L::i'(0TI:M INSTALLED 1j
I :I:l1A1, fI'IS: i I IILA TI
AI::I"'R()VA1.
1;:141V:I:hMIIYIL:i4ir'AL S:1'L(::L AI IS1
! II: P.6S;L1Orl'lf I:: OF 1111.5 I'`1;_ kil•l'I DOES HOT :1:1'11"1, Y COMPLIANCE l:r'shIL:I' WITH cymrk SLOE. ('.l- UN f
I]I: I. III Al PI i.,III ATOP)" 1.11 14IITI. I) lluIth..II.ILF:r: I'll;,J41I'::i„ I• -OF.; I.. I I s(;T f() i:I::I:1 II i IlliAI
11 II :III:,11 r l ' ('=rf lilIL_I l)l'I:I 1V Ihi L,LIII! 'I Li`lIC'I': W.I liI i11'I''E.. LI.rL[:L.Ir Ir1[l I:'L•I11141I'1 rii•1(}
rI1 'rl I•a irdll r=,l I(III` r'tIaIII'II II ['I P. Ir„IiT Ti9 AI 1.II I E: i' ,, 4.1 II. .l:: :. (..Itit:. I`' '.:f l•Ilsl;}
r I f ' I Ir I! ' r 111 11 II.;!'11•..I r'll I ' • I i sl'1 I i sl I 111: t I IE'IAI . i•11 F 1(0111(11,.. I,II' (11',1 I I' I;; r FiL. I. I. is `' L..:
I lit Ai I Il' 1 III ,`til II ! 'I I <I'l C 1 I ( II :S';l.lrlI4l T l () ( .T I ` 4 ".) lo
II 0 (11 11.,, 1 :: ( III " r id( Ili'.
k(',, 11A
Pp4 tr i L - 6iL1t
01)
Cfeittak
f " wEL.0 COUNTY RLkLTN DEPARTMENT
ENVIRONMENTAL PROTECTION SERVICES
1.517 16th Avenue Court
Greeley, Colorado 80631
(303)353-0635 Weld County Beath Deparrrxnt
ILAN MI:
I.5D5 I:
REPAXR 0:
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
(PLEASE FILL OUT IN BLACK In ONLY)
OWNER OF RECORD: /-\'/-,1-1,4 ,04., f jr;:, YMfri it
PHONE:
MAILING ADDRESS: (9 4 ,r } e r
City State Zip
SITE ADDRESS: f 7
City State Zip
LEGAL DESCRIPTION: PT: A/6- PT:S F SECTION: .2..? TOWNSHIP: ®tf N RANGE: 6 if W
SUBDIVISION:
LOT:AA t BLOCK: ,V 4- FILING: IV It
NUMBER OF PEOPLE:) BEDROOMS: r. BATHROOMS:
RESIDENTIAL / COMMERCIAL BASEMENT PLUMBING: Y
SYSTEM SIZE: Tank is constructed of c',2_,trn a4-,-4-
(material) 1
FIELD: Bed /0 JA or S o p or Trench J / square feet. DATESYSTEM INSTALLED: ` -44".°)
Tan are required to draw a diagram of the system on the reverse side of this form in
black ink curly 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
for perjury as provided by law.
Date Owner
WATER SUPPLY: L,J1f. /j
LOT SIZE: 4 kit) acres
Subscribed and sworn to before me this
by
Witness .t[ry hand and official seal.
Date
STATEMENT OF EXISTING REVIEWED BY:
My C
and has /nn f,
day of
ission expires:
gallons capacity
3
4_ 199)/.
tiotar"'ublic
, V
Environmental Protection Specialist
So
/k
BLACK INK ONLY!
5
P1L!U X,154LI
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 N 17tfi Aver -up
Greeley CO 80651
wr.ti4 we ,!,pall!! olq
',WI' Ir Arr•.l•nlallal •r
1. Ili' kn., in
Application Number:SP 1-00089
Owner Name:JOHNSON BRENDA
Site Address: 19545 CR 53
KERSEY CO 80644
rrdan ' rani, A I Irnu a'
Snr, r ea
r'„'rrr lima, Staln. I r a+,,
r•r.•r, ea rn,�r at", , A r�anr,��lq
Septic Permit - Final
App Type: Heal thlResidential,New ONTS\Septic
DON BUXMAN
BUXMAN EXCAVATING
32186 CR 29
GREELEY CO 80631
Parcel #: 105329200010-R8944923
Legal Desc: S2NE4/NVV4 29-4-64
Work Description: HOUSE
EHS SEPTIC GENERAL
Associated Disaster Permit No
Number of Bedrooms 2
Parcel Acres 237 86
Private Water Supply Permit Reference 92244
Public Water Supply No
Waive Fees No
EHS SEPTIC ACTUAL (FINAL)
Septic Tank Size gallons 1000
Absorption Bed. soft 480
Chamber Model Quick4 Standard or High Capacity
Number of Chambers Installed 40
Design Type Chambers -Bed
Lift Station Yes
Lift Station Size 600
Comments
Pump verified by installer Buxman Exc for lift to DBOX
public Health
r mnrgarlcy prrparran.•s
& Fnapr,r.aa'
Finafed
Application Status
Finated
Applied Date:
031291201 7
Issued Date:
G4/05,2017
Finaled Date :
04/13/2017
NOTICE
The issuance of this p -r ii et does 1101 imply cuiriplldnt:r .' i', arl,i r ;I ,il ,oul,ty or local regulatory of but ouiq pequuenrcrlts nut shall it at,t to cel illy that the
subfecl System will operate ,n contpirance Wntlr dtr(,d,c.iulr: slag I_ul,llly and local reyuiatlons adopted pelsuai it to Artroe IC) hilt 25 CRS as an,unrjed
excel lot the purpose of estabushulg Ilr,al approval ov tlsnlaiteu systu111 fur issuance of a local occupancy perms per suarit to 25i° 1 121 I lib} t: Rs
This perrnit rs non -transferable and able I fr �taeiu r .Missy l iekartinetn ut f'ul llr, r ieaith and E twn ol,ii,erlt leSet ve: y the plot IL, appose
additional !lms and t:urldi uic Ir (ti,trl'_ri to meet our regulations on a cornuruing bass Final permit approval was t:ontirlyenl upon the hrlal Inspeclioi, of the
completed system by the Weld County Dep tli eilt of Piibtlo Health add f-rawrionment
Alex Comments
April 13 2017
Environmental Health Specialist Date
f':1 lrY 'r ,•r
EXISTING m
BUILDING
SCALE 1' = 50'
PRIPERTY LINE
¶31 TE _LOCATION
FLAN
1954.5 WON 1 Y ROAD 53
EXISTING
YELL.
Ur- \
igelf
5 WIN
p ip M i
KAMAN EXCAVATING, LLC
32186 CR 29
GREEL E Y, CO 80631
RUG h+ U.,1 CT 0156798
pRaPERT`I LINE
ROCK`r MOuNTA��
GROUP
j{ t�
1 ;,° 1;1
C. •
Li:JOON+no 4 ci Jt�
.61
i I 1 i 41 k 1 11„ it 11 ({
I, 4 1 k l l i y i! I I f f 1 f
I 1 I I 1 1 4 1 1 1 1' 1) f 1 1 1, 1 1 1'
1` .„i1 , " I 1
L R• j 1 r't1.
rk.i �+r
OOO • cf,',Q\ T �►.a w�
� + r
} '1.
COLORADO
Division of Water Resources
Deaa-trnent of Natj at?esources
February 6, 2017
Ryder Reddick
Weld County Department of Building and Planning Services
Transmitted via email:
rreddick@co.weld.co.us
RE: Brenda Johnson Recorded Exemption
Case no. RECX17-OO18
Sec. 29, T4N, R64W, 6th P.M.
Water Division 1, Water District 1
Dear Mr. Reddick,
John W. Hickenlooper
Governor
Robert Randall
Executive Director
Dick Wolfe, P.E.
Director/State Engineer
This referral does not appear to qualify as a "subdivision" as defined in Section 30-28-101(10)(a),
C.R.S. Therefore, pursuant to the State Engineer's March 4, 2005 and March 11, 2011
memorandums to county planning directors, this office will only perform a cursory review of the
referral information and provide informal comments. The comments do not address the adequacy
of the water supply plan for this project or the ability of the water supply plan to satisfy any
County regulations or requirements. In addition, the comments provided herein cannot be used to
guarantee a viable water supply plan or infrastructure, the issuance of a well permit, or physical
availability of water.
According to the additional information submitted on February 2, 2017, the above referenced
proposal is to create by exemption three lots of approximately 4.84 acres (Lot A), 10.85 acres (Lot
B) and 142 acres (Lot C). The proposed water supply for Lot A and Lot C is proposed wells. The
proposed water supply for Lot B is an existing well operating under well permit no. 92244. The
revised information clarified that well 251898 will not serve any of the proposed lots. Sewage
disposal for Lots A, B and C will be septic systems.
Permit no. 92244 was issued on August 5, 1977 for domestic use as the only well on a tract of 40
acres described as the NE1 /4 of the SE1 /4, Section 29, Township 4 North, Range 64 West, 6th P.M.
Use from this well cannot exceed 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. The well is
not located on the property that is the subject of this proposal and based on Weld County records is
not located on property owned by the Applicant. Since the property on which the well is located is
not being divided, this proposal does not affect the legal operation of the well. However, since the
well is issued as the only well within the NE1 /4 of the SE1 /4, Section 29, Township 4 North, Range
64 West, 6th P.M. the owner of that property could not obtain an exempt well on that claimed land
unless the well is re -permitted. In addition, since well 92244 is not located on proposed Lot B the
ability of Lot B to use the well could be restricted by the well owner and by any legal agreements
between the owner of Lot B and the owner of the land on which well 92244 is located.
Office of the State Engineer
1313 Sherman Street, Room 821, Denver, CO 80203 P 303.866.3581
www.wate r.state. co. us
Brenda Johnson Recorded Exemption
February 6, 2017
Page 2 of 2
The ability of the Applicant to obtain a well permit on proposed Lots A, B and C, or the ability to
re -permit well 92244, will be determined at the time that well permit applications are submitted to
this office. If you, or the applicant, have any questions please contact me at 303-866-3581 x8265.
Sincerely,
7/
Jaann Williams, P.E.
Water Resource Engineer
Cc: File for permit nos. 251898 and 92244
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