HomeMy WebLinkAbout20151466.tiff Form No. OFFICE OF THE TATE ENGINEER
GWS-23 COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg.. 1313 Sherman St., Denver, Colorado 80203
(303)866-3581 LIC
WELL PERMIT NUMBER 231.595 - -
DIV. 1 WD 1 DES. BASIN MD
APPLICANT
APPROVED WELL LOCATION
WELD COUNTY
SE 1/4 SE 1/4 Section 13
LESLIE E & JOAN M PETERSON Township 6 N Range 65 W Sixth P.M.
19882 STATE HWY 392 DISTANCES FROM SECTION LINES
GREELEY, CO 80631- 300 Ft. from South Section Line
300 Ft. from East Section Line
(970) 352-2286 UTM COORDINATES
PERMIT TO CONSTRUCT A WELL Northing: Easting:
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 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 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)(I I)(A) as the only well on a tract of land of 73.90 acres described as the S 1/2 of
the SE 1/4, excepting therefrom 6.1 acres, more or less, lying easterly of a line parallel to and 75 feet westerly from the
center line of the right of way of the Union Pacific Railway Co., in Sec. 13, Twp. 6 N, Rng. 65 W, Sixth P.M., Weld County.
4) The use of ground water from this well is limited to fire protection, ordinary household purposes inside not more than
three (3) single family dwellings, the irrigation of not more than one (1) acre of home gardens and lawns, and the watering
of domestic animals.
5) The maximum pumping rate of this well shall not exceed 15 GPM.
6) 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.
7) This well shall be constructed not more than 200 feet from the location specified on this permit,-,* a.,//5�/
APPROVED
JSG M =
Receipt No.0469825 State Engineer DATE ISSUED FEB 1 5 2001 B EXPIRATION DATE FEB 1 5 3
Form ATATE OF COLORADO For Office Use Only
No. '--- OFFICE OF THE STATE ENGINEER
OWS-11 gtg Centennial Bldg., 1313 Sherman St., Denver, CO 80203
06/00 (303) 666-3581 Fax(303) 866-3589 RECEIVED
CHANGE IN OWNERSHIP/ADDRESS
CORRECTION OF THE WELL LOCATION APR 3 0 2002
WATER RESOURCES
Insert the Well Permit Number 2315955 STATE EsOuR R ]�
cOto.� (Oq lJ
Name.address and phone of the person claimino ownership of the well: (/
NAMES) _ Jesus A. Hernandez and Margaret L. C rdenas
Q 1 If your well has an absolute water right,decreed
Mailing Address Ct I o T__—_-- by the court and the well is not registered with the
1 State Engineer,enter the Water Court Case
City, St. Zir're�l�`/r Co• — Number/Civil Action Number and well number
as decreed.
Phone (010 ) Sig f-772k9
This form is filed by the named individual/entity claiming that they are the owner of the well permitted as referenced above.
This filing is made pursuant to C.R.S. 37-90-143. -
WELL LOCATION; County Weld Owner's Well Designation_
(Address) (City) (State) (Zip)
SE 1/4 of the SE 1/4, Sec.l3, Twp. 6 �IE N. or IxnS., Range 65 n E. or x W 6th p.m.
Distance from Section Lines 300 Ft. From ❑ N. or I- S„ 300 Ft. From II E, or ❑W. Line.
Subdivision Name _ Lot�_ Block _ Filing/Unit
The above listed owner(s) say(s)that he, she (they) own the well described herein. The existing record is being
amended for the following reasons: Li Change in name of owner Change in mailing address
❑Correction of location for exempt wells permitted prior to May 8, 1972 and non-exempt wells permitted after
May 17, 1965, Please see the reverse side forfurther information regarding correction of the well location.
I (we) claim and say that I (we) (are) the owner(s) of the well described above and that the commencement of
extraction of ground water from this well, lawfully made under the well permit, occurred on the date indicated, and
that the statements made herein are true to my(our) knowledge.
Please print the Signer's Name&Title Signature(s)of the new owner. Date
Jesus A. Hernandez '.(1-L_ AAiar?
Margaret L. Cardenas ___ __ __ 4I2 -.LI 2 -
It is the responsibility of the new owner of this well to complete and sign the form. Signatures of agents are acceptable if an
original letter of agency signed by the owner is attached to the form upon its receipt.
ACCEPTED AS A CHANGE TN OWNERSHIP For Office Use Only
AND/OR MAILING ADDRESS.
di AA N1I2002
State Engineer B Date
. , 9FCEIVED // RECEIVED f
COLORADO DIVISION OF WATER RESOURCES NOV 2 9 2000
DEPARTMENT OF NATURAL RESOURCES FEB 0 2 2001
1313 SHERMAN ST.,RM. 818,DENVER CO 80203
WA I C M holetS WA L EH HL SrCAAIGES
phone-info:(303)866-3587 main:(303)866-3581 sip/Ic.t NEER STATE E COLO oNcEH
RESIDENTIAL *Mae:You may alto use nit fens to apply for Iwnock wee/owl Water WeII Permit Application
Review instructions prior to completinq form Must be completed in black ink or typed
1. APPLICANT INFORMATION 6. USE OF WELL (check appropriate entry or entries)
tine w aesaaam See'neructtone to determine male)for which you may qualify—
Leslie E. Peterson and 0 A. Ordinary household use in one single-family dwelling
Joan M. Peterson (HD ourside use)
Malay m e. ® B. Ordinary household use in 1 to 3 single-family
19882 State Hwy. 392 dwellings:
Number of dwellings: 2
Orr Sale be Cell. 00 Home garden/lawn irrigation, net to exceed 1 sae:
Greeley, CO 80631 area irrigated 1 __ _ ❑ sq.ft. al eat
teligenna umaer maw*taw wet) 0 Domestic animal watering — (non-commercial)
(970) 352-2286
2. TYPE OF APPLICATION (check applicable box(esil 0 C. Livestock watering Ion farm/ranch/range/pasture)
g1 Construct new well ❑ Use existing well 7. WELL DATA
❑ Replace existing well 0 Change /Increase Use .auanun P altpnd rat .rein nose to a..mr«:. ---
❑ Change (source) aquifer O Reappiicationtiam.dFem'u 15 G.P.M. gpm 2 acre-feet
❑ Other: Tani desk /avatar
3. REFER TO lif applicable)0 feet
water coin cases Permit a 8. TYPE OF RESIDENTIAL SEWAGE SYSTEM
® Septic tank / absorption leach field
verbal r Monitoring hole acknowledgment e 0 Central system
-VE• MH- District name:
eel name era 0 Vault
Location sewage to be hauled to:
4. LOCATION OF WELL 0 Other(attach copy of engineering design)
County Qusrtarlquarter Quince 9. PROPOSED WELL DRILLER (optional)
Weld SE y. SE V. Nn Liens„`"'.
Section Township N or S Range E or W Primeva aaawian
13 6 63 o 65 o 96th
R 10. SIGNATURE of applicant(s) or authorized agent
D' ance of well bons section lines , 30O .g-✓ The making of false statements herein constitutes perjury
300 tt.from❑ti I&' s -2848— K run, CR E 0 w in the second degree, which is punishable as a class 1 mis-
Wel besti.a Wares,n amain tram eaPw.rm stare.lil oteleaeMu demeanor pursuant to C.R.S. 24-4-104(13)la). I have read
the statements herein, know the contents thereof and state
ea moves tie era Only•dirt...AIt direction from au wet to maw wall that they me true to m knowledge.
- -- feet direction ''''rr ?;y Ic� n.� —
5. TRACT ON WHICH WELL WILL BE LOCATED os— h'1 r-1 ---'
A. You must cheek one of the following-see ineuetiore Tie Lime
❑ Subdivision: Name Owner (1-‘,/7- 0o
Lot no. Block no._ Filing/Unit OPTIONAL INFORMATION
❑ County exemption (attach copy of county approval & survey) USGS nap atria ta+m mapcal.Name/no.
Sulam VW.
Tract no. a3-A
•
❑ Mining claim 'attach copy of deed or sunray) /ffice Use Only
Name/no. ,i t.- 5E(S e/ DIV
® Other lettach legal description to application) $r0\SE-✓
CO
B. STATE PARCEL Two—"a 'tit"'cini t
KV lovean.n: 080313000020 aW voice q 49825 WD
' 5y aRsGy , ,, ken /29/08 -- 2.27:84 PM
• C. a acne in tract D. Are you the owner of this properly?
/ ;_ rt vLi Cashier180
688 BA ID: 81
4773,y.� 90 EWES 0 NO (if no- see instmctionsl
E. Will this be the only well on this tract? Check Purchase- 03
Ak
®YES 0 NO (if other wells are on this tract-see instructions) 75.9 A.-:._-013455 USE MD
Form GWS-44(11/95)
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE (970) 304-6415 FAX (970) 304-6411 Vj 81a
Permit#: SP-0200217 Sec/Twn/Rng:13-06-65 Status: ISSUED
Owner: CARDENAS MARGARET & HERNANDEZ JESUS Applied: 05/17/2002
Applicant: COALSON JULIANA Issued: 07/23/2002
Permit T R=Residential + NEW, REPair, VauLT Finaled: $i 2n .( „
arcel #: 0803-13-0-00-045
Location: 33057 CR 49 13-06-65
Legal Description:
Installer: (n W ECC.
Description: MODULAR
Commercial: N Residential:Y Acres: 3.5
# of Persons: 2 Basement Plumbing: N
# of Bedrooms: 3 Bathrooms - Full: 2 3/4: 0 1/2: 0
Water Public: N Water Source:
Water Private: Y Cistern: N Well: Y Well Permit #: 231595
Percolation Rate: 25 Limiting Zone: 3 ft 0 in Description: GROUNDWATER
% Ground Slope: 0 Dir: Soil Suitable: (Y/N) N
Engineer Design Required: (Y/N) Y In 100 Year Flood Plain: (Y/N) N
Minimum Installation Chambers
Septic Tank: 1000 gallons Absorption Trench: 0 square feet
or Absorption Bed: , , 909 square feet:. .
Actual lnstallatio h�
Septic Tank: �WU gallons Absorption Trench: square feet
y� ',� ,,,_n Absorption Bed: (1O6i square feet
%l Design Type: U1 i M(I
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, Tide 25, CRS as amended, except for the purpose of establishing final approval of installed system for
issuance of a local occupancy permit persuant to CRS 1973 25-10-111 (2).
This permit is not transferable. 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 Qepartment oHealth and Environment.
x � ghttitA IBC(
Environmental Health Specialist Date
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