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Septic Permits -tiA
Permit# G19740421
Permit Type: Health/EHS History/ENS Conversion History
Situs Street Address 1462T CR 22
Situs City, State,Zip
Sec/Town/Range: 09-02N-66W
Application Status: Finaled
Application Data: 03/11/1998
Parcel # (12 Malts) 130909000014-R0042891
Owner Full Name: STEPHENS LARRY
Owner Address: Po BOX 33
FORT LUPTON,CO 80621
Owner Phone*: 303 8574292
Contact Name:
Contact Address:
Contact Phones
Information above has been Verified in Acce/a by employee noted below
Zitf"‘—'9: ` C-*-41 March 02, 2009
Date
Report ID: EHS00024v003
)Tint Date-Time:3/2/2009 12:50:26PM Page 1 of 1
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WC To Planning Department March 26
Dom 1993
From Jeffrey L. Stoll, Supervisor, Environmental Protection Services
comet I.S.D.s. Evaluation far: Stephens, Larry
Number: 012-93/600
OHNER: Ste ens, Lar
PHONE: 857-4292
MAILING ADDRESS: P.O. Box 33
Fort L ton CO 80621
SITE ADDRESS: 14627 Weld Count Road 22 CITY STATE
Fort ton ZIP
LEGAL DESCRIPTION: PT: SW4 80621
PT: 5E4 CITY STATE 2IP
SUBDIVISION: N/A SEC: 09 TiiR; OZ N RNG: 66 M
WATER SUPPLY: Private Nell LOT: 000 SLR: 000
RESIDENTIAL 3 2 000
____ —— TOTAL ACRES:_
Eraer. Thomas — —-- --- — — - - ------ - -- .
PERMIT ON RECORD: Name:
--�_ Permit No.: G-7` 4 8.0.E.: Yes
System Size: Tank: 1000 gallons Trench:
NIA square feet
Percolation Rate: 60.1 Bed: 900 square feet
minutes per inch
Soil Type: Unsuitable
Engineer Design: No/s,o,E, Percent Ground Slope: OX
Direction:
The septic system identified above osufficient-- — -- --- -�` ----
alterations(s) indicated below to the structure(s) se
y this system. Proposed
CURRENT FLOW ADDITIONS
Description: Rouse Rouse to be moved add PROPOSED TOTAL
Persons: ----ii--
eDescription: Mobile Nome
$ Description; Mobile Rome
Bedrooms:
Batbrooms``—� 3 5
Basement Plombin� 1 3
No l
The existing septic system is required to have the following alterationsNo
proposed alterations to the structure(s) served: The fielde made repl to accommodate the
Engineer Designed Repair Permit G-880233. The Repair Permit was issued as apconditon to a Recorded
in
ded
Exemption.
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!either the County of Weld nor any of its agents or employees undertake or assume any liability to
the owner of the above property, to any purchaser of the above property or to any lending agency
faking a loan on the above property or in the report. g y
"his inspection was conducted for the purpose of determining compliance with current regulations
and for detecting health hazards observable at the time of inspection. This does not constitute
warranty that the system is without flaw or that it will continue to function in the future.
nspections requested during periods of snow cover and high soil saturation may be of questionable
slue to potential buyers due to adverse conditions. Evaluations based on Statements of Existing
S.O.E.) relies on information the property owner provides, under oath, indicating current status
f the system and representing to the best of his/her knowledge the system is not failing to
unction properly.
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Film GWS 25 OFFICE OFDNSL0N OF ENGINEER
RESOURCES
.Gvvszs COLORADO
ate semen i We.1313 awrmaa at,D✓wa,Gonda eoem
pxg eas3ssl 489
WELL Pinar NUMBER - - — 1
APPUCANT DN. 1 CNTY. 62 WD 2 DES.51'4111 MD
Lot Wed" Fang Sub6n
APPROVED coat LOCATION
WELD COUNTY
SW 1/4 SE 1/4 Section 9
LARRY R STEPHEN5 Twp Z N RANGE 65W 61h PN.
P OBOX 33
FT i.UfxTON CO 80621 DISTANCES FROM SECTION uHEs
195 Ft from Sash Soodon Lift
( -0242 1925 FL from East Section Line
PERMM-TO USE AN fez ilt&WELL
ISSUANCE OF TH S PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF APPTWAI-
1) This we4 shoe be used n.such a way as to Cause no material njwy to wasting water rights The issuance came
perme does not assure the applicant that no Inlay will scar to another mead water righ or prelude another
owner of a vested water right from seekn8 reed in a oat court action.
2) The construction of this wed shad be in compliance with the Water' II Construction as Purnp trr>steYmion R es
2 OCR 4024 unless approval d a variance has been grated by
the State Board of Examiners of WaterConstruction and Pump installation Contractors In accordance wan Rub 17.
3) Approved pursuers to CAS 3T-92602(3)(b)(1)and the pocky of the Stale Engineer tinder the following carndoions.
4) Appwed tot the use of an edding wed,cartswcted on August 19,1993,to a depth of 560 feet,wider emergency
verbal approval 924E2113,granted August 13,1993.
5) The use of ground water from this wad b linked to ordinal household purposes nee one(1)single family
dwelling.the watering of domestic animals,and the krigabn of not mile than 10,000 square feet of home gardens
and lawns. Said well located on a 32 ate parcel described In attached Edndit A
6) Production horn this wells restricted to the Laranle-Fox Hills aquter which corresponds to the interval between
410 feet and 675 feet below ground surface. Plain casing shy hare been Installed and sealed to prevent
production from other sales.
7) The madman pumping rate shat not exceed 15 GPM
8) The annual)amount of ground waist to be withdrawn Mead not exceed 1 87efoa.
9) The wed constructed under permit no. 153235 must be plugged and abandoned according to the Rules and
Regulations for Water Wed Conant:60n and Pump Installation Contractors within ninety (90) days Mar
construction of the n v well
to)The dalance of this permit hereby cancels pence ro.153236
11)The return flow from the use ol the well must be through an kldvidual waste water disposal system of the type so
that not less than 2%d the total amount of water withdrawn is mburnmd to tie sane stream system In`Mich the
well is located. yi 9 9y
PP'12)Tits wedha slug be constructed not mile than 200 feet from the location
speed on Mb ne mk..J()t-
4 gsM
APPROVED z •
a.
OWR
'RR 13 1981 DTP DATE 13 1996
Receipt No. p36p7B7 DATE ISSUED ect�
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mom. WELL CONSTRUCTION AND TEST REPORT For oact Lim cell
°I4--11 STATE OF COLORADO,OFFICE OF THE STATE ENGINEER % i W`�'
4YY90 •
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1. WELL PERMIT NUMBER /772i7 SO 3°13 I
2 OWNER NAME(S) RR R '1ENSx
Maing Address YD
city, St z fl- L.i..1PVth �L
Phone (3[13) PSI- taka. -
3. WELL LOCATION AS DRL I ED; &1/4 Sge 114.SAc. Q Trip. a S'RarJB �4.�!�—
DISTANCES FROM SEC. UNEB:
JQ5 it. from ll' line. and 1Qa5 tt from EAST Sec. line. OR •
a not FIUNG(UNIT)
SUBDNISION: LOT BLOCK
STREET ADDRESS AT WELL LOCATION:
a. GROUND SURFACE ELEVATION R. DRILLING METHOD n TC�R
,,�D� noa . TOTAL DEPIN �((��K. DEPTH COMPLETED 520 ri. -
DATE COMPLETED Syt[L .
•5. GEOLOGIC LAG: a. HALE DIM& (kn.) Ran (R) lh
0.90 oewisde•a whit Lnwa Ya.crier.wow Lionn to
N-1
L
0').-1- T.PLAIN CASING
L IIrQ (kfl I?) WM S From(!) Tof
I la_ 0 It3Wr4C7 -1" ,
R45 4Lt0 RF. CASING: Screen b(4.
vim-S ) L� -1-. $ISM Utn Sao . _
b if
a MLTER PACK: 9. P R PLACEMENT: '
Mateda% —�_ Type •
Ste Depth (D
Interval _ ___
t0. GROUTING RECORD:
Amount Density Integral
REMARKS: 4
y
Asa Used S . 70
il DISINFECTION: •- a • -
on Supplemental Farah. `
WS n ggr box 1 Test Data o ie submitted on
TESTING METRO >L,[ . • • . PraduClton Rate Pm ;L
P���� It. Date/true measured�j► R. Date/Time measured i1 :`��� .3• ,Test length (his.)_ n
Remarks _ _ _. _ — _. _ — - m yyeg 24-4-M4(171fp G0.9.Si
3. I Move's so saws ors tor.M know M(ens mean end on on..ow ID MY Meal"P�•gn
of IS.alas a1M•aM twig,Mir MOM Mrs eM i Milable a a d..I M mMin r•L
/! -2— Phone ( j 7 Q-Q Lit Na.
CONTRACTOR � ,,.
malting Address --a-- -;111111
� Date ���
N (TRIG (PktBse type a print) S �� ,
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State of Colorado Water Resources - View Well Details: Receip... Page 1 of I
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