HomeMy WebLinkAbout20171905.tiffForm No.
GWS•11
08/2016
COLORADO DIVISION OF WATER RESOURCES
DEPARTMENT OF NATURAL RESOURCES
1313 Sherman St., Ste 821, Denver CO 80203
(303) 866-3581
dwrtaerm itsonlineastate.co. us
CHANGE IN OWNER NAME/MAILING ADDRESS
PRIOR TO COMPLETING THIS FORM, SEE INSTRUCTIONS ON REVERSE SIDE
INCOMPLETE, POOR QUALITY, OR ILLEGIBLE FORMS CANNOT BE PROCESSED AND WILL BE RETURNED
(+fame, address and phone number of p rs❑n claiming ownershio 91 the well permit
Name(s): 4( r / "vFcowle / Lye" iets-A,e #10020eir
Mailing Address: ' .401•4 oar.*
City, St, Zip:
dw:.ar.. ; eel sa2
Phone: (A3 ) 6 t'/ - SSW
Email: 44/..44 R P$fe NatrollArd., 4100,
For Office Use Only
RECEIVED
NOV 'il U16
Well Permit Number: f P7 %S Receipt Number: Off,' $9f Case Number (optional).
WELL LOCATION: County: Mrt4, C/
Well Name or # (optional):
Stree ddress at Wall Location City State Zip
irffil Check it well address is same as owner's mailing address
/VC_ 1/4 of the se 1/4, Sec, IV , Township ' ErrorEl S., Range ❑ E. or241., `tt xrn) P.M_
Distance from Section Lines: IwoFt. from Q N. or Line, /3/0 Ft. from r ❑ W. Line.
Subdivision Name (if applicable): ,fretrA.+ )'2'Jas s r.' Lot .2 . Block 2 Filing/Unit
NOTE: If changing/correcting the permitted location of a well, use Form No. GWS-42.
I (we) claim and say that I am (we are) the owner(s) of the well permit described above, know the contents of the statements made herein,
and state that they are true to my (our) knowledge. This filing is made pursuant to C.R.S. 37-90-143.
Signature(s) of the New Owner
e res
see instruL ions.
Please allow 4 to 6 weeks for processing of this form, Thereafter, you can view or print the accepted document at:
http://wmv.dwr.state.co.usiWellPermitSearch
Please print the Signer's Name & Title
Date
///120/
ibility of the new owner of this well permit to complete and sign this form. If an agent is signing or entering information, please
Signature of DWR staff indicates acceptance es a Change in Owner Name and/or Mailing Address.
For Staff Use Only
Staff Signatur- i Date
1/17/2017 State of Colorado Water Resources - View Well Details: Receipt 0376345
1JV1:31'
Colorado's Well Permit Search
THIS PAGE IS NOT THE ACTUAL PERMIT
The informaton contained on this page is a summary of the permit file and may not reflect all dells of the well permit. (Full Disclirpnrl
Well Constructed
Receipt:
Permit #:
Well Name / #:
Designated Basin:
Case Number:
WINED:
0376345
183275- -
Division:
Water District:
County:
Management District:
1
2
WELD
Help Last Refresh: 1/17/2017 12:02:07 AM
[-] Imaged Documents - Permit File
Document Name Date Imaged Annotated
ChanQ6 in Owner Name/AddressiLacation 12/21/2016 No
Original File 12/06/2007 No
[-] Applicant/Contact
Applicant/Contact Name
MORELOCK MIOIEAL & BROOK
Mailing Address
2375 APPALOOSA AVE
City/ State/ Zip
BRIGHTON, CO 80603-
[-] Location Information
Approved Well Location:
Q40 Q160 Section
NE SE 24
Township Range PM Footage from Section Lines
1,0N 66.0W Sixth 2000 S 1300 E
Northing (UTM y): 4431684.6 Easting (UTM x): 523828.5
Location Accuracy: Spotted from section lines
Subdivision Name
NELSON
Filing Block Lot
2 2
Parcel ID:
Acres in Tract:
L-] Permit Details
Date Issued: 11/10/1994 Date Expires: 11/10/1996
Uses (See imaged DoeumerrN for more mf7mation)
General Use(s): DOMESTIC
Special Use:
Area which may be irrigated:
Annual volume of appropriation:
Statute:
Cross Reference Permit(s): Permit Number Receipt
Comments:
Aquifer(s): LARAMIE FOX HILLS
[-] Construction/Usage Details
Well Construction Date: 03/16/1995
Well Plugged:
Elevation Depth
990
Perforated Casing
(Top)
857
Lic # Name
Driller 695 GLOVER, JONATHAN M.
Pump
Instaler
695 GLOVER, JONATHAN M.
Pump Installation Date: 03/16/1995
1st Beneficial Use:
Perforated Casing
(Bottom)
990
Address
7261 W.C.R. 31 FT LUPTON, CO 80621
7261 W,C.R. 31 FT LUPTON, CO 80621
Static Water
Level
370
Pump Rate
13
Phone Number
303-857-2041
303-857-2041
1-] Application/Permit History
Ownership Change
Pump Installation Report Received
Well Construction Report Received
Pump Installed
Well Constructed
Permit Issued
12/15/2016
06/14/1995
06/14/1995
03/16/1995
03/16/1995
11/10/1994
http://www.dwr,state.co.us/W el I Perm itSearch/1/iew.aspx?recei pt= 0376345
1/2
1/17/2017
Application Received
State of Colorado Water Resources - View Well Details: Receipt 0376345
10/13/1994
Disclaimer
0,The information contained on this pace is a summary of the permit file and may not reflect ail
details of the well permit. THIS PAGf IS NOT THE ACTUAL PERfitrr.
This a show d not he used as a basis for an le al consideration to determine the allowed uses of
the well to determine construction information, or to determine the terms and conditions under
which the well can operate. The complete well permit life should be viewed to obtain details on the allowed uses
and other relevant information. A complete copy of this file is available in the Imaged Documents' section of this
page, and can be viewed by opening all of the documents listed under that section (documents will open as pdf tiles).
Note that all of the terms and conditions under which a well can operate, particularly for non-exempt wells, may not
be spedfred on the well permit Wells may also be subject to relevant statutes, rules and decrees. To learn more
about well permitting in Colorado, please visit MIT; Well permitting Pane. 1f you have any questions about this well
permit file, please contact the DWR Crouod W.it r information Desk,
http://www.dw r,state.co.usMlel 'Perm itSearchNi ew.aspx?recei pt=0378345 22
Farm No.
GWS-2S
APPLICANT
OFFICE OF THE STATE ENGINEER
COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 84243
(303) see -3581
698
WELL PERMIT NUMBER 1113Z75_
DIV. 1 CNTY. 62 WD 2 DES. BASIN MD
Lot, 2 Block; 2 FilYng:
HARRY T & NANETTA WORKMAN
2885 W 128TH AVE #1333
BROOMFIELD CO 80234
( 303)466-5453
PERMIT TO CONSTRUCT A WELL
Subdiv; NELSON
APPROVED WELL LOCATION
WELD COUNTY
NE 114 SE 1/4 Section 24
Twp 1 N
RANGE 66 W 6th P.M.
QISTANCES_FROM SECTION.LINES
2000- Ft, from South Section Line
1300 Ft:from.. East Section Line
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS 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 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 from seeking relief in a civil court action.
2) The construction of this well shall be in compliance with the Water Well Construction and Pump Installation 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 17.
Approved pursuant to CRS 37-92-602(3)(b)(I) and policy of the State Engineer under the following conditions.
The use of ground water from this well is limited to ordinary household purposes inside two -single family dwellings, --
the watering of not more than four (4) large, non-commercial domestic animals, and the Irrigation of not more than
17,000 square feet of home gardens and lawns.
5) Production from this well is restricted to the Laramie Fox -Hills aquifer which corresponds to the interval between
855 feat and 1155 feet below ground surface. Plain casing shall be installed and sealed to prevent production
from other zones.
6) The maximum pumping rate shall not exceed 15 GPM.
3)
4)
7) The annual amount of ground water to be withdrawn shall not exceed 1.5 acre-feet.
8) The return flow from the use of the 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.
9) This well shall be constructed not more than 200 feet from the location specified on this permit. ?,q,4-
IP
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.
APPROVED
RAN
brio Erplro.r
Receipt No. 0376345
DATE ISSUED NOV 10 1994
EXPIRATION DATE NOV 10 1996
11SP106F' • 4 INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT NO. G-940519
WELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SERVICES
1517 16TH AVENUE COURT, GREELEY, CO S0631
353-0635 EXT.2225
NEW PERMIT
OWNER WORKMAN, HARRY & NANETTA ADDRESS 2885 W 128TH AVE #133}3 PH (303) 466-5453
BROOMFIELD CO 80274
ADDRESS OF PROPOSED SYSTEM 2375 APPALOOSA AVE
BRIGHTON CO S0601
LEGAL DESCRIPTION OF SITE: SE4 SEC 24 TWP 1 RNG 66
SUBDIVISION: NELSON LOT 2 BLOCK 2 FILING 0
USE TYPE: RESIDENTIAL MODULAR HOME
SERVICES: PERSONS 2 BATHROOMS 2.00 LOT SIZE 6.00 ACRES
BEDROOMS 3 BASEMENT PLUMBING NO WATER SUPPLY PWELL
APPLICATION FEE $265.00
REC'D BY CINDY SALAZAR
DATE 10/26/94
SIGNED BY WL MAGRUDER
DATE 10/26/94
PERCOLATION RATE 5.0 MIN PER INCH LIMITING ZONE 0 FEET
SOIL TYPE UNSUITABLE PERCENT GROUND SLOPE O% DIRECTION
REQUIRES ENGINEER DESIGN YES IN 100 YEAR FLOOD PLAIN ZONE NO
FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON -SITE SOIL PERCOLATION DATA
THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED:
SEPTIC TANK 1000 GALLONS. ABSORPTION TRENCH SQ. FT.
OR
ABSORPTION BED 645 SQ. FT.
IN ADDITION, THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND
CONDITIONS:
THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. TI -IS PERMIT
MAY BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT 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 JR FINAL
APPROVAL. THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE
DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE DR INADEQUACY OF THE
SEWAGE DISPOSAL SYSTEM.
0/9-.1'; _id 4
PAM SMITH
11/22/94
ENVIRONMENTAL SPECIALIST DATE
THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS
NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF
THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI-
TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTI VUING BA-
SIS. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE COM-
PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT.
SYSTEM INSTALLER are,
1i FINAL INS DATE DATE Il-
SYSTEM ENGINEER i 'r../APPROVAL 2
`#
TYPE OF SYSTEM INSTALLED '7drkie de_
ENVIRONMENTAL SPECIALIST
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 F'ER'SUANT TO ARTICLE 10, TITLE 25, CRS 1973, AS, AMENDED,
EXCEPT FOR THE PURPOSE OF ESTABLISHING FINAL APPROVAL OF AN INSTALLED ,SYSTEM FOR
ISSUANCE OF A LOCAL OCCUPANCY PERMIT PURSUANT TO CRS 1973 25-10-111 (2).
ORIGINAL -APPLICANT; COPY-WCHD WCHD-EHS MAY, 1984
Application for
Owner -GC^!/� O"•
Direction to site: Hwy
."-ML L �'P J 1,6(A /1 if X42
Lego/ Description: Ptn 6E /V Sec• "IVT_N, RV Subdiv.
permit
l
WELD COUNTY HEALTH DEPARTMENT
1516 Hospitof Road
Greeley, Colorado
Ph. 353-0540
—7W 2c/47
PERMIT NO. p 6/
to Install, Construct, an Individual Sewage Disposal System,
(59~ 639s
0dPhone
, 5 �mi. W mi.
General Information
No. Bedrooms r No. Persons 7'
No• Baths / Basement Plumbing r �
Size of Lot
H2O supply (if yell give depth)
New Home Pr Mobile Home Modular • Add'n
Type of sewage disposal requested: / Septic tank /Privy Other
* = certy ry s„.5 Lis-t
ern i rot
Uri to al_ l_ 400' O+ Pc( 1 C ?Wert
Dept. Use Only
Perc. Rate (Avg. of 31
Soil Type +S
H2O Table Depth -:"` $.
Lot Grade < (3o
Requires Engineer Design YesANo
If yes — reason
Comments:
Septic Tank 7,5,
Installation Instructions: (Minimum Requirements)
Gals.
Other
Special Instructions
Absorption Trenches 33a Sq, Ft.
or
Seepage bed V3O Sq. Ft.
This system will be constructed and installed in accordance with the above specifications and regulations re-
garding individual sewage disposal systems in Weld County, Colorado
This permit shall expire at the same time as the building permit, 'or, if no building permit is issued, the permit
shall expire 120} days after its issuance, if construction has not been commenced_
Date: i 17 I,, 76
Owner:= 'i !�1
Applicant.
The pions and specifications as shown are approved pending payment of permit fee.
Date : /0/7g. 9 74
Sanitarian
The above system inspected and found to comply with plan and description.
Systems Contractor • �� 4-.15 Ca uo i Date : /V -R.
Sanitarian:,
Engineer Review:
(Dole)
Permit Fee: $ j
Received by-'
/
Date :
(5ignclure)
A
i
i
1
1
00
I �
1
r2 l
1
, 'A5-
122
ar
It
36,
r
ALPHA ENGINEER/NC CO.
L AND DEVELOPMENT
617 5TH STREET --- P.O.. BOX 392, FORT LUPTON, COLORADO 80627
FAX & DENVER 573-5186 OR 1-800-767-5186 FT. LUPTON 857-2308
IPL.F7.7_7_7=11.
AN 201995
January 19, 1995
Weld County Health Department
1517 16th Avenue Court
Greeley, CO 80631
RE: Inspection of Septic System on Lot 2, Block 2, Nelson Subdivision, Weld County,
Colorado. (Nan Workman / McGruder)
Dear Sir,
I inspected the above Septic System and found it to be substantially constructed
in accordance with the approved plans for this site. (Alpha Engineering plans file No.
24-1N6-18. The soil removed may be utilized for final backfill.
Sincerely,
;a4k��titllfmitnlrl�� f`••
�� �g•f
ti;?11� :3;..6.6111/41 r'
Bill J. Delap, PE
File # 24-1N6-18L�a 182 •
•a„4•••46„
ale
COLORADO
November 28, 1994
Harry Workman
2885 West 128th Avenue 1333
Broomfield, Colorado 80234
RE: Individual Sewage Disposal System Permit No.: G-940519
Location: Appaloosa Avenue, Hudson, Colorado
Dear Mr. Workman:
DEPARTMENT OF HEALTH
1517 -16 AVENUE COURT
GREELEY, COLORADO 80631
ADMINISTRATION (303)353-0586
HEALTH PROTECTiON (303) 353-0535
COMMUNITY HEALTH (303) 353-0539
FAX (303)356-4968
This is to inform you that your Engineer Designed Septic System has been reviewed
by the Weld County Board of Health and approved.
A copy of the Weld County Board of Health I.S.D.S. Review Form and
your I.S.D.S. Permit are enclosed. PLEASE NOTE THAT THE SYSTEM MUST
BE INSPECTED BY A REPRESENTATIVE OF THIS DEPARTMENT AND BY THE
DESIGNING ENGINEER, BEFORE THE SYSTEM CAN BE APPROVED FOR OPERATION.
THE FNCINFFR MucT CERTIFY TO THIS DEPARTMENT, IN WRITING, .......
, ii. rtL\mil iL�V, ll li1C.
SYSTEM HAS BEEN INSTALLED ACCORDING TO HIS/HER SPECIFICATIONS.
Should you have any questions regarding your septic system, please contact this
office at your earliest convenience at 353-0635.
Sincerely,
Pam Smith
Environmental Protection Specialist
PS/cs-3803
cc: Cecil Crowe, Alpha Engineering
Weld County Department of Planning
..
gsol.ERm
Date: l(1Zt
yr i f O .gDa
RE: Individual Sewage Disposal System Permit No.: G-94 S —
Location:
Dear ALWAII2M„_______:
This is to inform you that your Engineer Designed 5 c System has been reviewed
by the Weld County Board of Health and appro /-------4ignit4 as
submitted.
The engineer des i tem was denied based u
Approved: A copy of the Weld County Board of Health I.S.D.S. Review
Form and your I.S.D.S. Permit are enclosed. PLEASE DOTE THAT THE
SYSTEM MUST BE INSPECTED BY A REPRESENTATIVE OF THIS DEPARTMENT AND
BY THE DESIGNING ENGINEER. BEFORE THE SYSTEM CAN BE APPROVED FOR
OPERATION. THE ENGINEER MUST CERTIFY TO THIS DEPARTMENT IN
WRITING, THAT THE SYSTEM HAS BEEN INSTALLED ACCORDING TO HIS/HER
SPECIFICATIONS.
ur info ion is equired
ease ontact
c
Should you have any questions regarding your.septic system, please contact this
office at your earliest convenience at 353-0635.
Sincerely,
Jeffrey L. Stoll, M.P.H.
Director
Environmental Protection Services
JLS/cs-
cC: Engineer
Weld County Department of Planning
WELD COUNTY BOARD OF HEALTH
ENGINEER DESIGNED SYSTEM REVIEW
APPLICANT: Harry Workman PERMIT NO.: G-940519 (New)
LEGAL DESCRIPTION: PT: SE4 SECTION: 24 TOWNSHIP: 1 RANGE: 66
SUBDIVISION: Nelson LOT: 02 BLOCK: 02 FILING: 00
SITE ADDRESS: Pending Appaloosa Ave., Hudson, CO.
FACILITY: Residential 3 bedroom home
PERC RATE: <5.0 SOIL: Unsuitable
LIMITING ZONE: At grade -sand
Yes ENGINEER DESIGN (3.5)
ENGINEER: Cecil Crowe, Alpha Engineering
ADDRESS: P.O. Box 392, Ft. Lupton, CO 80621
ESTIMATED FLOW: 675 G.P.D.
PRIMARY TREATMENT: Standard tank
DISPOSAL METHOD: Absorption bed
REQUEST FOR VARIANCE: nla
WATER SUPPLY: Well
ACRES: 6.0
No EXPERIMENTAL DESIGN (3.14)
CAPACITY: 1000 gallons
SIZE: 645. Square feet
STAFF COMMENTS: The unsuitable layer will be removed and replaced with soil having a
percolation rate of 10.0 mpi. The system is adequately sized for the
proposed load.
STAFF RECOMMENDATION: Approval
ENVIRONMENTAL PROTECTION SPECIALIST: Pam Smith
REVIEWED BY BOARD: November 22,1994
B.O.H. DECISION: APPROvID: DENIED:
1)(14)
t.1,N m . T=.1,1^r,
,l^r w''.w1 ^.:•0;�^
,
Weld County Board of Heth
TABLED:
DEPARTMENT OF HEALTH
Wale
COLORADO.
November 10, 1994
1517 - 16 AVENUE COURT
GREELEY, COLORADO 80631
ADMINISTRATION (303) 353-0586
HEALTH PROTECTION (303) 353-0635
COMMUNITY HEALTH (303)353-0639
FAX (303) 356-4966
To: Applicant for Weld County Individual Sewage Disposal System
Applicant: Workman, Harry Application No.: G-940519
Address of Proposed System: Appaloosa Avenue, Hudson, Colorado
Legal Description of Site: PT: SE4 SEC: 24 TWN: 01 RNG: 66
Subdivision: Nelson Lot: 002 Block: 002 Filing: 000
Date of Site Evaluation: November 1, 1994 By: Pam Smith
Dear Applicant:
Please be advised that the proposed j.:xdivi.lual Sewage Disposal System for the
above site must be designed by a Colorado Registered Professional Engineer as per
Weld County I.S.D.S. Regulations 3.5 and/or 4.6, as follows in part:
3.5 ....Except as provided in 25-10-107, CRS 1973, no permits shall be issued
for the following systems unless they are designed by a Registered
Professional Engineer and after they have been received and approved by
the Board of Health.
D. Absorption fields for which th-a location cannot meet
c114+1'1'5 c a
i1 --
...+� or .a ..l war �. qillltil[iCIILS.
4.6 A suitable soil shall meet the following criteria:
A. A minimum depth of four (4) feet between the bottom of the proposed
absorption field and any limiting zone(s). (Depth to limiting zone
at above site:' at grade -sand).
B. Has the capacity to adequately disperse the designed effluent
loading as determined by a field percolation rate of between five
(5) minutes per inch and ':0 minutes per inch or by other approved
soil tests (Percolation r4..3 at above site; [5.:s minutes pia. inch) .
Harry Workman
November 10, 1994
Page 2
C.. Acts as an effective filter within its depth for the removal of
pathogenic organisms.
The engineer design must be approved by the Weld County Board of Health before
a permit can be issued. The Board of Health meets on the fourth Tuesday of each
month: therefore, two (2) engineer designs must be submitted to this office ten
(10 days) prior to the meeting. Should you have any questions concerning this
matter, please contact this office.
Sincerely,
QM S'
Pam Smith
Environmental Protection Specialist
PS13712
HST -1061
INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT NO. 0-940519
WELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SERVICES
_1517 16TH AVENUE COURT.-GREELEY., C •£JO631
353-0635 EXT. 225
NEW PERMIT
OWNER WORKMAN„ HARRY & NANETTA ADDRESS 2885 W 128TH AVE #1333 a PH (303) 466-5453
BROOMFIELD CO 00234
ADDRESS OF PROPOSED SYSTEM APPALOOSA AVE
HUDSON CO 80642
LEGAL DESCRIPTION OF S:ETE a 3SE4 SEC 24 TWP 1 RNG 66
SUBDIVISION; NELSON LOT 2 BLOCK 2 FILING 0
USE TYPE: RESIDENTIAL MODULAR HOME.
SERVICES: PERSONS 2 BATHROOMS 2.00 LOT SIZE .6.00 ACRES
BEDROOMS 3 BASEMENT PLUMBING NO WATER SUP'P'LY F'WELL
APPLICATION FEE 26 5 . Q0
REC'1) BY CINDY SALAZAR
DATE :10/26/94
SIGNED BY WL MAGRUDER
DATE 1.0/26/94
F'EFtiC0 ATIEJ �I RAE -1. * f�ll:l�I PER INCH LIMITING ZONE () FEET
SOIL TYPE .... PERCENT GROUND SLOPE -„ DIRECTION ___
RrEOU I:RES ENGINEER DESIGN IN 100 YEAFti'nFLOOD PLAIN ZONE
FROM THE APPLICATION INFop' MAT:CON SUPPLIED AND THE , ON -SITE SOIL PE=RCOLATION DATA
THE FOLLOWING MINIMUM IN' L.LATION SPECIFICATIONS ARE REQUIRED:
SEPTIC TANK JA-; GALLONS, ABSORPTION TRENCH ,P-7 • SQ.
OR
ABSORPTION BED L f'J SO. F T .
IN ADDITION f EIII .CS S eLT :CT yT THE FCILLC)ldTl�lr` X?D :rIoNA!' T T'!'i�i A
CONDITIONS: {�t,�k..,..,,r'`,.
�4Q.tifae..
FT.
THIS PERMIT It' . Ral•T'ED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT
MAY BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SET
FORTH TN 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 SY THE
DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOP HF F3:LURE; OR INADEQUACY or THE
SEWAGE DISPOSAL SYSTEM.
ENVI:RONMENTf`L SPECIALIST D ray
TH:fS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS
NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE. ISSUING FINAL APPROVAL OF
THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI--
TIONAL. TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA-
SIS. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL.. INSPECTION OF THE COM-
PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT.
ORIGINAL -APPLICANT: COPY•-WCHD WCHD--EI"I5 MAY, 1.984
HSF' 1.Os5P
APPLICATION FOR INDIVIDUAL SEWAGE I)ISF'OSAL. SYSTEM NO. G•-940519
WELD COUNTY HEALTH DEPARTMENT NEW APPLICATION
ENV T RONMENTAL HEALTH SERVICES
. _..151' 1.6114 AVENUE COURT I •f3RE Et--i_Y -CO— - 80631-
353-0635 E:XT..22r 5
OWNER WORKMAN, HARRY & NANETTA ADDRESS 3060 E BRIDGE ST#410 PH (303) 654-0575
BRIGHTON CO 50601
ADDRESS OF PROPOSED SYSTEM APPALOOSA AVE
HUDSON CO 50642
LEGAL DESCRIPTION OF SITE: 6E4 SEC 24 TWP 1 RHO 66
SUBDIVISION: NELSON LOT 2 BLOCK 2 FILING 0
USE TYPE: RES:EDEN-TIAL.. MODULAR HOME
SERVICES: PERSONS 2 BATHROOMS 2.00 LOT SIZE 6.00 ACRES
BEDROOMS 3 BASEMENT PLUMBING NO WATER SUPPLY F'WE:LL
APPLICANT ACKNOWLEDGES THAT THE COMF'L.-ETENESS OF THIS APPLICATION IS CONDITIONAL
UPON FURTHER MANDATORY AND ADDITIONAL TESTS AND REPORTS AS MAY BE REQUIRED BY THE
WELD COUNTY HEALTH DEPARTMENT TO BE MADE AND FURNISHED BY THE APPLICAI"1 OR BY THE
WELD COUNTY HEALTH DEPARTMENT 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
1.0;, TITLE 25;, CRS 1973n AS AMENDED. THE APPLICANT CERTIFIES THAT THE PROPOSED
SYSTEM WILL NOT BE LOCATED WITHIN 400 FEET OF A COMIIUNITY SEWAGE SYSTEM. THE
UNDERSIGNED HEREBY CERTIFIES THAT ALL. STATEMENTS MADE, INFORMATION AND REPORTS
SUBMITTED HE:REW:[TH AND REQUIRED TO BE SUBMITTED BY THE APPLICANT AREA, OR WILL BE,
REPRESENTED •ro BE TRUE AND CORRECTTO THE BEST OF I''IY KNOWLEDGE AND BELIEF, AND
ARE DESIGNED TO BE RLEL:[ED ON BY THE:'. WEL.D COUNTY HEALTH DEPARTMENT TN EVALUATING
THE SAME FOR PURPOSES OF ISSUING THE PERMIT' APPLIED FOR HEREIN. X FURTHER UNDER-
STAND 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 FOR PERJURY AS PROVIDED BY LAW,
1:'.c.l YnhY 7Akl 1-c'm' (k"jL IC ^^
RECD ,BY CINDY SALAZAR
DATE 10/26/94 OWNER/
li irl /ti (Y L'..Id t7iy-C.
'. 0/26/94
rT URE DATE
ORXGINAL-APPLICANT;, COPY--WCHD WCHD•-EH s MAY, 1984
h • 3038333054 ZADEL REALTY
-.00T-117-1994 12110PM FROM SAFEWA`r' 41145
566 PO1 OCT 20 '94 09:25
TO Vexr , 0
0
DEPAMAgRIT OF NeALTH
i09: ecriuw
psocommaiwa
$C," Ba CSMIRF ftwicoamoMtgl.Ti;
SDlagnNT aathmTgat Harry T, ar�d Nanette L. Workman
i ..raw---T-T ..cum.■.rrJ�-•^�-�^c.:..F.
%O$Ibtalla m aegetis took ps as. Tyr of Via Phi
rey
r _ '
Atol Let 2, Block 2,:'Nelson Subdivision, County of Weld
00 mitO psi is' TBD Appelooaa Ave.
pms
Pato 10-19-94
PoSiBit No.
Eugene J. DQPinto
Mary Ann D4lilinta
t ' w* ISEE $ is )
rss -,oce t
TOTAL P,01
1
WELD COUNTY'HEALTH DEPARTMENT ENVIRONMENTAL PROTECTION SERVICES
SITT, EV. ATION OWNER: + W1 -.
APPLICATION NO.:114OS1(1, SITED `./PO% O ) 1:7 !• PT$ 4 S TJ H 1p (Q
DATE: y SUBDIVISION: LT- BLK FLG
Si : s =--=-se=a======_
PERCOLATION TEST DATA: Start Time:
Hole
No.
Hole
Depth
H2O
Remain
min.
min.
min.
min. ;
min.
min,
min.
min.
min.5
min. 1
1
2
3
4
5
6
All measurements in .mm unless otherwise indicated.
* - Add H2O
Total
Environmental Specialist '.i N.1."
Average Rate
PLOT PLAN
rui,..g°W� Y� e^ $41,44ASOIL PROFILE
C
"'10 y,'� t 6cb
RI d� ' i� i � v put, •1c..
al d I o
a A
I
'41-81'
6
U vr_ 4 .C V%OW . n
diLt kAILA, u44,1 kills
-loo, 6,1 t.41 -u 4
Nil Bi AaN
PNOPoOED
WATER WELL
SITE PLAN
4• L"
L. I•
1 1 .
PVC PYC LYE(VP)
a 0'
r_.
BED CROSS SECTION
APPALOOSA AVENUE
3/4' •D E-:/2
111AVLL
SM
OESION DATA:
PURPOSE OF THIS DESIGN IS TO PROVIDE A SEPTIC SYSTEM FOR A THREE
BEDROOM SINGLE FAMILY HOME
AVERAGE PERCOLATION RATE AS ESTABLISHED 6Y PERCOLATION TEST
PERFORMED BY WELD COUNTY HEALTH DEPARTMENT IS LESS THAN E MINUTES
PER INCH, A CLAY LATER APPRDNIMATELY 1 FOOT THICK MUST BE REMOVED
AND THE EXISTING SOIL 4 FEET ['NEAGH SIDE AND BELOW TOE BED REMOVED
AND THIS AREA REFILLED WITH to MINUTE PER INCH PERCOLATON RATE SAND
5FFnC T>1Nx TFCC:F=[ATIQ:.i;
'000 GM CM,CI TT, Wlnl 5 -NO I II COMLAII MTHOE OR V YI rE FV
A GENES
ANSDR4'LON AREA MAR
' II;iFOETYU SOIL NENCG_AT1ON TATE S TO IC MINUTE EFR 'NEIL
YI9 SRU.+R1 FEET PER BEDROOM X 3 BEOIDDMS - IRA !WARE FEET.
SCE A 1e FEET X SS FEET ABSORPTION EEO.
NOTES:
1- PROVIDE A MINIMUM OP ROE 151 FEET BETWEEN THE DISTRIBUTION 5011
AND SEPTIC TANK.
1. PROVIDE A MINIMUM DR FIVE TBl FEET OF SOLID PIP! SEIWWEN THE
cIFIDE SOY AND BRIE LATERALS P500151 A MINIMUM CF FIVE 16I FEET
BETWEEN THE SEPTIC TANK AND ANT EUILOINDS
3. ALL CONSTRUCTION III TO BE IN ACCORDANCE WITH WELD COUNTY.
COLORADO HEALTH DEPARTMENTS INDUSTRIAL SEWAGE DISPOSAL SYSTEM
REO UIR EMENTS.
T EPSIFRCATECH
I HERESY CERTIFY THAT THE IFPT10 SYSTEM SHOWN OM THIS PLAN WAS
DONE SY ME OR UNDER MV DIRECT SUPERVISION AND IS ACCURATE TO THE
SOOT or 1.14 ANOVnEOGE OII 11.!11
E PE RJROW[ P[ 615 I•!]9�"-0• -.
•
4iU.iO
SLPT'C SYSTEM DESIGN FOR
LOT 2, OLOCK 2, (NELSON SLBO!VSION
WELD COUNTY, COLORADO
ALPHA ENGINEERING CO_
517 5TH STREE- - '101 XVI- ^.V• .N•11.. .-1i �•
FAX A 10401? an -1156 •19 •
-, _••- - ^. r NAN WORKMAN
n REVIS:CVB aT I DATE DWG BY: 0 -Ill ,0011.0! AS VOTED
-R4 CATO NOV R. IUS4
IP11 IFLE HD -'14-•
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