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The Citizens' Institute on Rural Design
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Form No.
GWS-25
APPLICANT
OFFICE OF THE STATE ENGINEER
COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303) 866-3581
EKST
WELL PERMIT NUMBER 285756
DIV. 1 WD 2 DES. BASIN MD
J
Lot:
TIFINY & JOSE NEVAREZ
13005 WCR 28
PLATTEVILLE, CO 80651-
(720) 218-5707
CHANGE OF USE OF EXISTING WELL
B Block: Filing: Subdiv: 1211 -29 -3 -RE 2268
APPROVED WELL LOCATION
WELD COUNTY
SW 1/4 SW 114 Section 29
Township 3 N Range 66 W Sixth P.M.
DISTANCES FROM SECTION LINES
150 Ft. from South
150 Ft. from West
Section Line
Section Line
UTM COORDINATES (Meters,Zone;13,NAD83)
Easting: Northing:
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 this permit
does not ensure 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 residential site of 4.876 acres described as Lot B,
Recorded Exemption No. 1211 -29 -3 -RE -2268, Weld County.
4) Approved for the change of use of an existing well constructed under permit no. 212377 (expired).
5) The use of ground water from this well is limited to ordinary household purposes inside one single family dwelling. The
ground water shall not be used for irrigation or other purposes.
6) Production from this well is restricted to the Laramie -Fox Hills aquifer.
7) The 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.
This well shall be located not more than 200 feet from the location specified on this permit.
NOTE: To ensure 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.
es. a* ft
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APPROVED
!DC
Recei.t No. 3648561
Moccaieial.
State Engineer By
DATE ISSUED 05-24-2011 EXPIRATION DATE
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 N. 17th Avenue
Greeley, CO 80631
www.weldhealth.org
Health Administration
Vital Records
Tele: 970 3046410
Fax 970 304 6412
Public Health & Clinical
Services
Tele: 970 304 6420
Fax: 97D 304 6416
Environmental Health
Services
Tele: 970 304 6415
Fax: 970 304 6411
Communication,
Education & Planning
Tele: 970 304 6470
Fax: 970 304 6452
Public Health
Emergency Preparedness
& Response
Tele: 970.304 6420
Fax: 970,304 6.459
Our vision: Together with the communities we serve, we ere working to make Wad Counly The healthiest place to live, learn, work and play
Septic Permit - Final
Application Number:SP-1500438
Owner Name:BARRON JOSE
Site Address: 13005 CR 28
WELD, CO 80651
App Type: HealthlResidential\Repair OWTS\Septic
STEVE DICKINSON
2D ENTERPRISES LLC
PO BOX 504
FORT LUPTON, CO 80621
Parcel #: 121129300050-R7792698
Legal Desc: PT SW4 29-3-66 LOT B REC EXEMPT RE -2268 (.36R)
Work Description: HOUSE
EHS SEPTIC GENERAL:
Associated Disaster Permit No
Location Description 13005 CR 28 PLATTEVILLE
Number of Bedrooms 3
Number of Persons 4
Parcel Acres 4.8
Public Water Supply No
Repair Reason Type Repair for Failure
Waive Fees No
EHS SEPTIC ACTUAL (FINAL):
Septic Tank Size, gallons
Absorption Trench, soft
Design Type
1000
693
Rock and Pipe -Trench
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 25-10-112(1)(b), C.R.S.
This permit is non -transferable and non-refundable. 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 of Public Health and Environment.
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Finated
Application Status:
Finaled
Applied Date:
12/28/2015
Issued Date:
01/04/2016
Finaled Date :
01/29/2016
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Katie Sall January 29, 2016
04- (u(5& 040c311
Environmental Health Specialist Date
Print Date Time: 1/29/2016
1:18:36PM Septic Permit - Final EHS033 Page 1 of 1
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