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Home My WebLink About20173435.tiffF.no v0... 11/90 1I90 For Office Use ony RECEIVED OCT f i ,04 lam Feofr 3'iA trup.:-- F' -C. -- / PUMP INSTALLATION AND TEST REPORT STATE OF COLORADO, OFFICEOF THE STATE ENGINEER 1. WELL PERMIT NUMBER 1 T1S bo 2. OWNER Mailing City, Phone - NAME(S) dco k U; JL{ kl NAN sew Address i 149 WCfZ 34 St. Zip Pit nS-6N C.o gobyZ r ( 303 ) 536-O12-‘0 3. WELL LOCATION AS DRILLED: Ale 1/4 5E 1/4, Sec. 13 Twp. A Al , Range &'S W DISTANCES FROM SEC. LINES: a310 ft. from S Sec. line. and 504 ft. from E Sec. line. wecq BLOCK FILING(UNIT) SUBDIVISION: STREET norm a sous, .sc o ar q Lb <- WC2 LOT ADDRESS AT WELL LOCATION: G Q- Co 4. PUMP DATA: Type SOY installation Completed 5-alo — 94 Pump Design Pump ADDITIONAL Manufacturer 3'Ao.u-zLt Pump Model No. 3o BS 4103!--.5 a. GPM I o at RPM 3I'l 5 O , HP 3 t4P , Votts 0230 , Full Load Amps jb.5 Intake Depth ..8 C2, Feet, Drop/Column Pipe Size I '/'4 Inches, null tc\\.y 0 %O.1v, INFORMATION FOR PUMPS GREATER THAT 50 GPM: TURBINE Design DRIVER TYPE: ❑ Electric I. Engine ❑ Other Head feet, Number of Stages , Shaft size Inches. 5. OTHER EQUIPMENT; ❑ Yes'No, Depth ft. Airline Flow Meter Installed ❑ Yes 2tNo Orifice Depth ft. . Monitor Tube Installed Meter Mfg, Ai/ 4 Meter Serial No. Readout IN Gallons, ❑ Thousand Gallons, ❑ Acre feet, ❑ Beginning Reading 6. TEST Form. DATA: • Check box if Test data is submitted on Supplemental Total Static Date Date .-C'Ja f411, - Well Depth r180 f Time k r , Level —CYO"— 0 Rate (GPM) 6 Measured 5 -d26 -9l Pumping Lvl. K.c'b r 7. DISINFECTION: Type h 7 M 0.41/0r11.4, Amt Used "Cop di Asoltie.d Klan.' • 8. Water Quality analysis available. • Yes 0 No 9. Remarks '0. I have read the statements made herein and know the contents thereof, and that they are true to my knowledg (Pursuant to Section 24-4-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury In the secor degree and is punishable as a class 1 misdemeanor.] CONTRACTOR Spain'..i Se.nvice Inc. Mailing Address 202/ (1O 27 f t. Canton, Name/Title (Please type or print) Torn W. Spain l7neai.dent Phone (211..) 659-1584 Lic. No.7/5 5 Co. 6'0621 firerz Date 104-1 1 rlCruti 1 STATE OF COLORADO, OFFICE OF THE STATE ENG(NE,ER For Office Use only 1. WELL PERMIT NUMBER _."..12.94.D a 3. 4. OWNER NAME(S) scol<t & Vicki Kinnison Mailing Address . 1 1 d 41 wr R 19 City. SL ZIP up rn fl D A 4 9 Phone( lni)- 516--0126 WELL LOCATION AS DRILLED: _ N 1/4 SE DISTANCES FROM SEC. LINES: 2 310 - % from Sec. Ilse. and con northor south) SUBDIVISION: STREET ADDRESS AT WELL LOCATION: GROUND SURFACE ELEVATION DATE COMPLETED 5-19-94 1/4. Sec. 13 Twp. RECEIVED jui 08'94 1t:� N Range 65 ft. from F Sec. line. OR (wt or ws. ) • LOT BLOCK — F!LJNG(UNIT) W ft ORIWNG METHOD Rota y . TOTAL DEPTH 780 ft. DEPTH COMPLETED 780 S. GEOLOGIC LOG: apnt o.aurpon er Q -J0 Material (Type. Slxa. Color. Wear Location) Rrnerr carri Blue s elavers sand 3yti—san Rine shale/layers of coal 5PJ1-7Rn Foxhill sands Water REMARKS: 5% Bentonite, 2% Calcium chlozide added -'to cement 6. HOLE DAM. (in.) From (ft) 6 1/4 20 To (ft) 20 . 78 7. PLAIN CASING OD (in) K Ind Wall Size From(ft) To(ft) 6 c/9 stcc l `.188 0 20 4—L/-2 .1SR _ 580 PERF. CASING: Screen Slot Size: -A/ 1 A • tomb o is 4 -1/-2 Stool 188 58a 7RO • • -- 8. FILTER PACK: -Material _N/k Size Interval 9. PACKER PLACEMENT: Typelfal iburton basket Placed at Depth 580' 10. GROUTING RECORD: Material rarOQnt Amount Density Interval Placement lAgg.A1 7ga1/ 11-540 Pump - -bag --_-_, 11 DISINFECTION: Type Grant] ] a r rh 1 nr i n o Amt Used Dived in 5 gallons • of water poured throuh drill WELL � DATA: ❑ Check box if Test Data is submitted on Supplemental 'Form. zone ietwied through i. TESTING METHOD A i r • with air. Static Level d 5 n _ ft. Date/Ttme measured 5-19-, 9'1 2.0 0p ra., Production Rate 1 gpm Pumping level :tot t;,,g -it. Date/Time measured , Test length (hrs.)flhra Remarks 43. 1 have read the etatem.nra made herein and know the Dormant* thereof, and that they a'. tru• to my knowledge. (Pursuant to Sedan 24.4-104 (13)(a) c.as.. dui makin at f.lae %taism.n's husks ooradtutaa penury In the second degree and la punishable as a mass t misd.maarwr.) CONTRACTOR John's Drilling Inc. Phone ( 303 423-5246 Uc. No. 827 Mailing Address Rt Name/Title (Please type or print) 1 -Signature Lloyd John Owner/Pr:esident �� 6-2-94 The report must be types ur printed In BLACK INK All changes on 'the form must be initialed and dated. Attach additional sheets if more space is required. Each additional. sheet must be identified at the top by the well owner's name, the permit number, form name/number and a sequential page number. Report depths in feet below ground surface. This form may be reproduced by photocopy methods, or by computer generation with prior approval by the State Engineer. The original and one copy of this form must be submitted to the State Engineer's Office within 60 days after completing the well or 7.days after the permft expiration date, whichever is earlier. Another copy of the form must be provided to:the well owner. 1. Complete the Well Perth Number In full. 2 Fill in Name and Mailing Address of Well Owner where correspondence should be sent. 3. Complete the blocks for the actual location of the well where drilled. If the owner has more than one well serving this property, provide the identification (Owner's Designation) for this well. DO NOT USE THE OWNER SUPPLIED LOCATION unless a survey has been provided. For wells located in subdivisions the,lot,_block, and subdivisiorfinforrration'musf aiso-be provided. 4. Report the ground surface elevation In feet above sea level if available. This value may be obtained from a topographic map. Describe the drilling method used to construct the well and the date completed. Indicate the total depth drilled and the actual completed depth of the well. S. Fully describe the materials encountered in drilling. Do not use formation names unless they are in conjunction with a description of materials. Examples of descriptive terms include: Grain scze—Boulders, gravel, sand, silt, clay. Hardness —Loose, soft, tight, hard, very hard. Color --M materials. Most critical in sedimentary rock. Depth when water is encountered (if it can be determined). 6. Provide the diameters of the drilled bore hole. 7. The outside diameter, kind, wall thickness and interval of casing lengths must be indicated. 8. Indicate the type and size of filter (gravel) pack and the interval where placed. 9. Indicate the type and setting depth for any packers installed. 10. The density of t o grout slurry, must be reported and may be indicatedas pounds per gallon, gallons of water per sack, total gallons of water and number of sacks used. etc. Specify the grout placement method, i.e. tremie pipe or positive displacement. The percentage of additives mixed with the grout should be reported under remarks. 11. Record the type and the amount of disinfection used, how placed and the length of time left in the hole. 12.. Report well test data as required by Rule 10.7. Spaces are provided to report all measurements made during the test. The report should show that the test complied with the provisions of the rules. If a test was not performed explain when it will be done.- If available, report clock time when measurements were taken. 13. Fill In Company Name and Address of Contractor who constructed the well. The report must be signed by the licensed contractor responsible for the construction of the well. Form No. GWS-25 • OFFICE OF THE STATE ENGINEER COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St, Denver, Colorado 80203 (303) 866-3581 APPLICANT SCOTT & VICKI KINNISON 11491 WCR 39 HUDSON CO 80642 (303)536-0126 PERMIT TO CONSTRUCT A WELL 827 WELL PERMIT NUMBER 177800 DIV. 1 CNTY. 62 WD 1 DES. BASIN MD Lot Block: Filing: Subdiv: APPROVED WELL LOCATION WELD COUNTY NE 1/4 SE 1/4 Section 13 Twp 2 N RANGE 65 W 6th P.M. DISTANCES FROM SECTION LINES 2310 Ft. from South Section Line 500 Ft. from East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDRIONS 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 light 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. 3) Approved pursuant to CRS 37-92-602(3)(b)(II)(A) as the only well on a tract of land of 35 acres described as part of the NE1/4 of the SE1/4 Section 13, Township 2 North, Range 65 West of the 6th P.M., more particularly described in the attached exhibit A. 4) The use of ground water from this well is limited to ordinary household purposes inside three single family dwellings, fire protection, the watering of poultry, domestic animals, and livestock on farms and ranches, and the irrigation of not over one acre of home gardens and lawns. 5) Production from this well is restricted to the Laramie -Fox Hills aquifer which corresponds to the interval between 540 feet and 835 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. 7) The return flow from the use of the 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. 8) This well shall be constructed not more than 200 feet from the location specified on this permit. 9 041 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 Stets Engineer Receipt No. 0366277 DATE ISSUED MAY 10 1994 ' P - • TION DATE MA 0 1996 1rRJ-S.Rer. 76 COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St, Denver, Colorado 80203 Application must be complete where applicable. Type or print in BLACK INK. No overstrikes or erasures unless initialed. PERMIT APPLICATION FORM { ) A PERMIT TO USE GROUND WATER (X) A PERMIT TO CONSTRUCT A WELL FOR: { 1 A PERMIT TO INSTALL A PUMP RECEIVED MAR 03'94 ( 1 REPLACEMENT FOR NO. ( 10THER WATER COURT CASE NO ov (1) APPLICANT - mailing address NAME .SrOff C (/IGK/ STREET //`/9% iUr /2 3�l CITY 1/01c0/1/ CO iiN/V/_s O N Rob‘4z (State, • (2fo) TELEPHONE NO. -303 S36 -oa6 (2) LOCATION OF PROPOSED WELL County hie -442 iVC 'h of the -•..1r✓ ',r;, Section L3 Two._.2._ /V, Rng. 65" k ' IN.SI lE.W1 P.M (3) WATER USE AND WELL DATA Proposed maximum pumping rate (gpm) 9/0/1 Average annual amount of ground water to be appropriated (acre-feet): 1 O Number of acres to be irrigated: • -5- Proposed total depth (feet): 720 Aquifer ground water is to be obtained from: / -- Fvx h, /r-54)1rl s Owner's well designation GROUND WATER TO BE USED FOR: ( I HOUSEHOLD USE ONLY . no irrigation (0) (X) DOMESTIC (1) ( 1 INDUSTRIAL (51 ( } LIVESTOCK (2) ( } IRRIGATION (61 ( 1 COMMERCIAL (4) ( ) MUNICIPAL (8) ( 1 OTHER (9) DETAIL THE USE ON BACK IN (11) (4) DRILLER Name Z/0/11 _ T;,174 Street .P / ,C7OX 6510 City GOLD fAJ CO (State) Telephone No. 5/2-5 ` S,Z'96 Lic. No. A27 FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN Receipt No. 34 4,°Z? 7 Basin Dist. CONDITIONS OF APPROVAL 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. LP.✓ sec 49le 3C1 SEE /,?Zfoy APPLICATION APPROVED PERMIT NUMBER DATE ISSUED EXPIRATION DATE BY _ I.D. (STATE ENGINEER) COUNTY 6 a -- o) (6) THE WELL MUST BE LOCATED B€LOW by distances from section lines. (5) THE LOCATION OF THE PROPOSED WELL ar3 the area on which the water will be used must be indicated on the diagram below. Use the CENTER SECTION (1 section. 64O acres) for the well location. O 2 U W N in w W 1MILE.5280 FEET —_7).1 NORTH SECTION LINE E - + - 1- 1 I - + - i, I - - + - -r l I X - 4- — I rn H i N m _4_ 4 �- + The scale of the diagram is 2 inches 1 mile Each small square represents 40 acres. 2310 SIB ft. from ft. from LOT A-)//:! BLOCK - SUBDIVISION A _souTH (noun or south) sec. line EA ST secline (east or rest) FILING • (7) TRACT ON WHICH WELL WILL BE LOCATED Owner:.SCotf i vim epvaiso'J No. of acres -3S . Will this be the only well on this tract? vrs (8) PROPOSED CASING PROGRAM Plain Casing to S'8 in. from ft. to S4/D ft in. from ft. to Perforated casing 4 -f8 _ in. from .S3%D ft ft. to___O.O ft. in. from ft. to ft. WATER EQUIVALENTS TABLE (Rounded Figures! An acre-foot covers 1 acre of land 1 foot deep 1 cubic foot per second (cfsl ... 449 gallons per minute (gpml A family of S will require approximately 1 acre-foot of water per year. 1 acre-foot ... 43,560 cubic feet ... 325.900 gallons. 1.000 porn pumped continuously for one day produces 4.42 acre-feet. (8) FOR REPLACEMENT WELLS givedistance and direction from old well and plans for plugging it: /yA (10) LAND ON WHICH GROUND WATER WILL BE USED: Owner(s): -S Go TT / !✓ 4(i ,c‘'/IVN/.SO/I/ No. of acres: —55— Legal description: Lo7 A RCPOPi)/ J) L-iE /30 7 - (11) DETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of disposal system to be used. DQ(Y2ts: >r• L US/- >t/ON CD m /stele C/A> d1db : fID K •j Y /N4i I,/49e tL ..SF_,0T/C 4Y.51z719 (12) QTHER WATEJR RIGHTS used on this land, including wells_ Give Registration and Water Court Case Numbers. LD>2 h>DU.5 141-c4)4J >G 6i4 1? 7✓ ) L Li s.4L of G4.1.¢ 7 ._ Type or right Used for (purpose) NoA/t Description of land on which used (13) THE APPLICANTS) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO T HE BEST OF HIS KNOWLEDGE. r i ' SIGNATURE OF AbPtf ANTIS) Use additional sheets of paper if more space is required. rvrmte Yell. 11141 CTtPP? - n4NQQP RISTI! NIVI AIIQ ADDT_Trlu4. ern44 & 4Tl'tt V1nyTCn1 DerLTD, In zgg44p 1106?TAH. mvi 11 nP C41/0 AV CPA 11 4 9H D ASH 1911D SS R. SnD 4SLT DDRDRCPn 6nn1PPD• l.lD1MTP_Pn4 ffTTIC C+3AVr,PP P1PV14Tng. Amin iiMMDPD nP RPM TR Tl?ieT7 34 IC OIMOVO4V YI UTV CPDVTre AAfl 1t DTVC nP YU TrTPLI.T?Y c R i MIMI? $ PS9 in 4RS iv muilvTCTny IC llWMD IflfUj9TM D1.1$ P10.V IR IS , 0!?. -- T; •: um,,CTn11 Inc DVrmlWVV1iVy PnD ;DDDAVIi to? +ne IiiTTV xiTlir9M194 RA1krn GATT OF 144461 IS 74"0 . Tny Ar r1VpinTetnu nD ra6rp AP i1RA!^^PrTII. DRe40Tr4Tnys! •vRTD>eted by 1.R on APRII, 29. 1994 ri.aDa4TpY T12P4R 4P annsl. DWI 1.DDR}P S?A?TIS IORTPPD DnV VnD cloy RfT. T1lP i_g : nrrc i►lucf7u TvryVDD iIDD7o IDiPiUnP - - - - ---- Tgii;D IDIDIAAP lean tern A R4 41 R 179 gpT e ti)!4'?-rr? YTllC difiR tint it9 All 444 7 479 IT rn1n• r ,+ hr.nwd;ry ?ftrl v?1ne[ rtPT ha Fntp ?DDroxleate. I ;.a:ne+ar +i.o bmn;;p► III +l.O C Q S A?aA hAgo eegeeT!TAil 1n IlVPphPr of IPA. Map Place Hodder 6/17/2017 State of Colorado Water Resources - View Well Details: Receipt 0366277 J.!. J,! Divi:ii.b1.1 THIS PAGE IS NOT THE ACTUAL PERMIT The information contained on this page is a summary of the permit file and may not reflect all details of the well permit. (Full Disclaimer) Well Constructed Receipt: 0366277 Division: 1 Permit #: 177800- - Water District: 1 Well Name / #: County: WELD Designated Basin: Management District: Case Number: WDID: [-] Imaged Documents - Permit File Document Name Date Imaged Annotated Correspondence, Memos, Findings & Hearings 05/06/2015 No Original File 12/06/2007 No Maps, Deeds & Legal Descriptions 10/04/2007 No [-] Applicant/Contact Applicant/Contact Name KINNISON SCOTT & VICKI Mailing Address 11401 WLP 39 City/State/Zip HUDSON, CO 80542 [-] Location Information Approved Well Location: Q40 Q160 Section Township Range PM Footage from Section Lines NE SE 13 211 65W Sixth 2310 5 500 E Northing (UTM y): 4443078.1 Easting (UTM x): 533676.7 Location Accuracy: Spotted from section lines Subdivision Name Filing Block Lot Parcel ID: Acres in Tract: [-] Permit Details Date Issued: 05/10/1994 Date Expires: 05/10/1996 Uses (See Imaged Documents for more infomation) General Use(s): Domestic Special Use: Area which may be irrigated: Annual volume of appropriation: Statute: Cross Reference Permit(s): Permit Number Receipt 137304-- 0248593 Comments: Aquifer(s): LARAMIE FOX HILLS [-] Construction/Usage Details Well Construction Date: 05/19/1994 Well Plugged: Elevation Depth 780 Driller Pump Installer Perforated Casing (Top) 580 Pump Installation Date: 05/26/1994 1st Beneficial Use: Perforated Casing (Bottom) 780 Lic # Name Address 827 IOHN, LLOYD PO BOX 639 HENDERSON, CO 80643 715 SPAIN, TOM W. 2021 WELD CO RD 27 FORT LUPTON, CO 8C621 Static Water Level Help Last Refresh: Pump Rate Phone Number 3036551759 3036591584 [-] Application/Permit History Pump Installed 05/26/1994 Well Constructed 05/19/1994 Permit Issued 05/10/1994 Application Received 03/03/1994 http:l/www.dwr.state.co.us/W el I Permi tSearchM ew. aspx?recei pt=0366277 1/2 6/17/2017 State of Colorado Water Resources - View Well Details: Receipt 0366277 Disclaimer *The information contained on this page is a summary of the permit file and may not reflect all details of the well permit. THIS PAGE IS NOT THE ACTUAL PERMIT. This page should not be used as a basis for any legal 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 file 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 files). Note that all of the terms and conditions under which a well can operate, particularly for non-exempt wells, may not be specified 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 DWR's Well Permitting Page. If you have any questions about this well permit file, please contact the DWR Ground Water Information Desk. Copyright © 2016 Colorado Division of Water Resources. All rights reserved. http://www.dwr.state.co.us/WellPermitSearchMew.aspx?receipt= 0366277 2/2 4••ISF•':1.4) }I'' INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WELD COUNTY i HEALTH DEPARTMENT ENVIRONMENTAL NTAL.. HEALTH ;:SF.::RJ:4:(.;C::.:+ 1512 16TH i-I AVENUE COURT, (:31. 4:::1-.I...i:::Y , CO 8063:1. 35;:1-063:: EX'T . 2.:2.;;1 NO. G-940270 NEW F:'F::FiF*i:1:T OWNER 1;3 u :i:SCiN V7:(14C:1: & SCOTT ADDRESS 9f1•ty)5 WC:R 49 € H dos' 4.cg y9 HUDSON SON CO 80642 ADDRESS Q;;: PROPOSED S c Y HUDSON CO c3(:6{I2 IE:. 4 SEC .I.3 T W1•' 2 RN(3 65 LAYT () BL..00: K 0 FILING 0 LEGAL DESCRIPTION (7f SITE: SUBDIVISION: _USE TYPE: RESIDENTIAL I••I(:lLi::Sl::: SERVICES: PERSONS rl BATHROOMS IR(:3f:iiY4`cS 2.25 LOT c:S:r:PI:.: ;:'s;`.i„0C7 ACRES BEDROOMS r BASEMENT PLUMBING NO WATER SUPPLY PW4:::I...I..- APPLICATION l i FEE $265.00 RE::C; ' D BY CINDY ::SALA '.Pd DATE 06/02/94 SIGNED BY VICKI K.I:h-4€' :r:soN DATE 06/02/94 (3)3) 1y36••-0126 PERCOLATION N RATE 2.6 MIN PER INCH LIMITING 1t:ll•11:::. f'a FELT SOI€... TYPE UNSUITABLE PERCENT GROUND S1..UF'E: 0'% I)•:€:I Efi.;'TI(:JN F;.:(;11j:1:R1:::;:S ENGINEER i:NIliE:€i DESIGN Y1:::{:5 3:41 100 YEAR F i_(:lOD_ !''L,.f 7:Ikl ZONE l'1Ci FROM i••ll::. A€''€''I...:ic;rcT:l:(:}N INFORMATION SUPPLIED AND "f't-ili:: ON —SITE sac:1:1... PERCOLATION DATA .1-l.•Hl:. FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARI. l';i:.t:Ti.i.l.l'a1::.I?.: SEPTIC TANK 1250 (3Al...l--.(:]N,:=, ABSORPTION TRENCH i•-1 t{: ,. [•"..i"., OR ABSORPTION BED f:360 SQ. FT. IN ADDITION, THIS PERMIT :1:c, `::S1.JBJE:f:'..I. TO THE FOLLOWING ADDITIONAL TERM:' AND CONDITIONS: THIS PERMIT IS GRANTED TEMPORARILY "i'(:1 €'i!_.1...t:1W CONSTRUCTION TO COMMENCE. 1117:1:1 PERMIT MAY BE REVOKED DR us1::1::NDED BY T1••ii::: WELD COUNTY HEALTH I)I:;:PAR'TPI1:::NT FOR REASONS SET FORTH i:;: TI-•i :r1 i T4•'ll::: WELD COUNTY Y :ri'iD):1:'J:f.DUA1... :SI:WAGES. DISPOSAL SYSTEM REGULATIONS INCLUDING FAILURE .•1-(:J MEET ANY TERM OR CONDITION IMPOSED :iSE::I) THEREON DURING TEMPORARY OR FINAL APPROVAL. OVAL.. -r•4-41::: ISSUANCE €F T1-i:I:::Y PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE DEPARTMENT i ME::I T (:71": :l:'•1';:S EMPLOYEES DE LIABILITY FOR THE FAILURE 4...CjI E: OR INADEQUACY OF THE. SEWAGE DISPOSAL SYSTEM. PAM 1311:r ri--€ ENVIRONMENTAL SPECIALIST 06/22/94 DATE THIS PERMIT I:.3 MCII. TRANSFERABLE AND SHALL BECOME VC):1.D :4:4: SYSTEM CONSTRUCTION HAS NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE::.. BEFORE ISSUING FINAL A€'PROVAI... OF THIS I:: E;:R€ril 1 1I -I4::: WI:::I,..D COUNTY Y HEALTH H DEPARTMENT iF._:1••I'T RESERVES Vl;:: S T1•-41::: RIGHT F TO .:',MPOSE ADDI- TIONAL TERMS AND CONDITIONS ONf:S REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA- SIS, FINAL PERMIT A1=PROVAl.. IS CONTINGENT UPON THE FINAL INSPECTION O1= THE COM- PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT. SYSTEM E11 INSTALLER AL.l_.ER _Owner FINAL ....,...,..._........... APPROVAL I €" i SYSTEM 1:.4'1 ENGINEER TYPE l- OF SYSTEM I::-MYi INSTALLED ::1 1 ..1R IiY4E::l;I'T-r11.. `.•'3F• i:::::i:AI...:C#:ST THE ISSUANCE:: OF. THIS PERMIT T DOES NOT IMPLY COMPLIANCE WITH OTHER STATE, (:;c)I.iN•T•Y OR LOCAL REGULATORY OR BUILDING REQUIREMENTS. NOR `i1-•ir''r1...L. IT Al:; T TO CERTIFY THAT THE Ii_. t:}F JI:c,.TEI.: T SYSTEM W:l:LI... OPERATE A Ti::: IN COMPLIANCE WITH APPLICABLE STATE, a COUNTY T'' AND 4...C3(:,A1... REGULATIONS AlFlJi11::S ADOPTED I I":IR::;SUr}NT .T-(.1 ARTICLE :I.(?„ TITLE `2_::1.. (:;R3 1973, AS AMi:::Ni)4:::I) EXCEPT FOR II:k THE PURPOSE OF ESTABLISHING AT 1...7:::SH'17:4`If::T FINAL APPROVAL OF AN INSTALLED SYSTEM :M FOR :i::i`.3!Sf1NE.:t-. LA. A I.-.i:2€:.i F?... i3f.;C:l.3{'' (=1T1i:.Y t"'El`tI•i:l:'r' I"•U1':ti,,11A#-f'Y' TO i:'.F=:£:r OR7(: I I AL-•_Al'!='I_.:I:C;r'a1-•I.1' R (`(:Ji::'Y—-W(::1—II) Wf:::i-•I:i) ...1=' I••tS MAY, [I.9E:z; i Nom & o03 lB N4- I•le:3P:l.06P :1:lkl()IV]:D(.JI'1L.. SEWAGE DISPOSAL S3Y`,-s''r'I_l'! PERMIT RM:I:T WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL J:E:RONiiYu:::NrrAE... HEALTH SERVICES 1517 16TH AVENUE COURT,, Gfil::.EL...EY CO E:3S) }„�,1. .:k'�. 4:}....1 6 5 EXT.2225 OWNER i{:I:i4lt-1:1:4:3(Jt•1., VICKI & SCOTT ADDRESS 77405 4. t: R 4 HUDSON ADDRESS OF PROPOSED SYSTEM W(R r.T{F BEFORE WC;E: 22 LEGAL DESCRIPTION OF SITE:: 4:3i.JIDIV:1:s:33:(:1h1;: USE:.: T'I:::: RE:4:31:I)E::I•!'r':I:AE.,. HOUSE ;:'i:Fiv:I:C:E Sa PERSONS 0 BATHROOMS 2.25 LOT SIZE 35.00 BEDROOMS rt BASEMENT PLUMBING NO WATER SUPPLY CO S0602 APPLICATION FEE $265 .00 !-4I::.(.. ' I) BY CINDY S: sFll...t,.Al'k DATE 06/02/94 HUDSON CO 80642 SE::4 SEC :1. 3 TW ' `3 !':HO 65 LOT () BLOCK NO. G-940270 NEW PERMIT PH • .: 03 ) :':,,.,6---0.1.26 0 1 ' :l: L..:I l41G : 0 ACRES PWELL SIGNED BY VICKI EC:i:Ni'i:csoi i DATE l:: 06/02/94 PERCOLATION RATE 2.6 MIN N PER ::Fti INCH I LIMITING l£:1NI::: (} FEET :'r - SOIL.. TYPE. UNSUITABLE PERCENT T GROUND SLOPE 0% DIRECTION REQUIRES ENGINEER DESIGN t YES IN :I.C:} ) YEAR FLOOD PLAIN ZONE NO FROM THE APPLICATION INFORMATION SUPPLIED ni ID 'r'E-•ir ON -SITE {:>t:J:CI... PERCOLATION DATA TTF••fl. FOLLOWING l,J:I:Nt MINIMUM INS:5'r'G5l...I...A-r:l:£:5t•I SPECIFICATIONS ARE REQUIRED: SEPTIC TANK 1250 GALLONS, ABSORPTION TRENCH SQ. I'' -r'.. OR ABSORPTION BE!) 860 SO. F r' . IN ADDITION, THIS PERMIT IS sl.Er•;ji:;:c'r' TO THE FOLLOWING ADDIT:I:ONAL... TERMS AND CONDITIONS: THIS PERMIT T IS GRANTED TI:::lrll''£:)I::AI::IL..Y 'r'Ci AL..I...(:3W CONSTRUCTION TO ct)ITIEYII:::NcE:::..i THIS PERMIT NAY :t- REVOKED (:1!'4 SUSPENDED BY THE WELD C{:1'.Ii-TY HEALTH DEPARTMENT FOR REASONS SE FORTH I_! IN THE WE:::L..X) COUNTY :1:N1()T,V:I:'.{)(.JAI._ SEWAGE DISPOSAL SYSTEM REGULA1'T:I:£:1NI{3 INCLUDING FAILURE IL..I.JF:E:: TO l"II:::E':T ANY .T.1:I:..ii OR £::ONIX):r'r'I(:)N IMPOSED THEREON DURING TEMPORARY OR i':FI-•If11.-. APPROVAL. „ Till ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE DEPARTMENT T ME: NT OR :!:'T'::3 EMPLOYEES OF LIABILITY FOR 'i'I-.i1. FAILURE 1-.-! fRI::: OR INADEQUACY OF THE SEWAGE X):1:4:5E:''CI3Al... SYSTEM. PAM SMITH Etta/;'t;≥/9 4 ENVIRONMENTAL SPECIALIST d...:l::3TT DATE THIS PE::Ri'1:l:'r' IS NOT TRANSFERABLE 1hFD SHAE..,L.. BECOME VOID IF SY13'T'E:EYM CONSTRUCTION HAS NOT COMMENCED W:1:'Tl"1111 ONE YEAR O1:' :1:Tr•S ISSUANCE:.. BEFORE ISSUING FINAL'APPROVAL OF THIS !"'ERN:1:T T'Hi::: WEI...0 COUNTY HEALTH DEPARTMENT RESERVES S THE RIGHT To IMPOSE ADDI— TIONAL "11:E:4119 AND CONDITIONS REQUIRED 'Ill MEET OUR REGULATIONS ON A CONTINUING BA— SIS. I::':l:h!At.. PERMIT nI:.:'E'.£:1VAl... IS CONTINGENT UPON THE FINAL INSPECTION OF 'r.l•.HE::: COM— PLETED SYSTEM BY THE WE:::I.-.X) COUNTY HEALTH DEPARTMENT. SYSTEM M INSTALLER __FINAL :I: EL1:3E SYSTEM ENGINEER Lt.. -._. �elf—Wita +l -F RUVA1... TYPE (:11' SYSTEM :i:NSTAI...1_-ED _ +.aC' ENV 1: W ISSUANCE T X)t:.ii: tI(:,"I i:iir'L..' (:'£:ll°Il''1,..:I:'Sl�4E;1::: UJ:E::T:i••I cirE•II:::I:: STATE, COUNTY rE��IE::: I.:+.:s(,J�'il�Ei:`E:: (:)f:- THIS PERMIT ` � '` } . £:JI:R: LOCAL REGULATORY Y OR X:s(.JIL,.73:E:hi(:! I.'E:(:II.J:i:4:R.IEMYII:::I'-lrc:s„ !kl(:)l:t 4:3E-'I'1l...L„ IT ACT TO CERTIFY THAT THE:: SUBJECT SYS'r'EIY! WILL OPERATE 7:N COMPLIANCE WITH APPLICABLE STATE,. COUNTY AND E...C1CA1... REGULATIONS ADOPTED !:'ITR9UAE-•IT ''I'£:1 ARTICLE 10, TI.Ti._E 2.5;, CRS :1.9-73;, AS AMENDED, L:'Js-`F i T FOR THE PURPOSE I: OF E::4:3'r'At:BE...7:si?i-'!:IN(:'! FINAL APPROVAL OF AN INSTALLED SYSTEM FOR ISSUANCE (7I::' A I._OCAi.., OC£:;UI:'ANCY PERMIT PURSUANT TO CRS :E.973 21-10-111 k 1 .. ORIGINAL -APPLICANT; COPY .._WC::1••!X) Wcl••!:D....E!-IS NAY, :L904 Hello