HomeMy WebLinkAbout20151757.tiff LIEN R VI YN IRRIGATION DISTRICT
617 Birch St.; PO Box 85
Hudson, Colorado 80642 •303.536.4702
Water Supply
Name of Development as Proposed:
Henrylyn Irrigation District Maintenance/Office site
Location of Parcel:
Part of the NW 1/4 of Section 1, Township 1 North, Range 64 West
An application is pending with the Office of the State Engineer
Colorado Division of Water Resources.
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112
COLORADO DIVISION OF WATER RESOURCES Office Use On), For.-745 FIC1ZF VED
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST,RM 821,DENVER,CO 80203
Main:((3 031 866-3581 Fex:(303)866-2213 dwTpennitsanlineaslale.coyg F 6 0 5 ZOi5
GENERAL PURPOSE
Water Well Permit Application wArER souRCE
Review Instructions on reverse aide prior to completing form. STATE tIs NEERS
The form must be computer generated,typed or In black or blue ink. C0LCC
1.Applicant Information 6.Use Of Well(check applicable boxes)
Horne d eyysA
Attach a detailed description of uses applied for.
Henrylyn Irrigation District El Industrial ❑ Denelerllg System
''sing e555w ❑Municipal 0 Geothermal(plpdutllon or reinjection
P,O.Box 05 ❑Irrigation
rap I woe by,..e ❑ Other(describe):
Hudson COl 80642 ®Commercial
te.wmi a Ian..d.P.nice.) —_.,mi,,,..,r9r,e.,or 7.Well Data(proposed)
(303)536.4702 caw...nm.d in A,w-,.,ar;.u<areweenn gran
--
2.Type Of Application(check applicable boxes) 15.0 TED by DWR acre-feet
IIII]Canslrud new well O Use existing well Tee°w rIxc""
0 Replace existing well 0 Change or increase use Aoorox 300 feel (Lost Creek Groundwater Basin
❑Change source(aquifer) 0 Reapplication(expired pramil) 8.Land On Which Ground Water Will Be Used
o 000Cri well [] Omer_._ --- Legal Oescnpeon of Land(nay boa prowled es Altdnrg.
3.Refer To(if applicable)
We,w,r„a 7 wen co,,,.,aa Lot B in Sec 1,T 1N,R 64 W;please see attached Plat map
O,FNneeamsnpamnva,me wet names
4.Location Of Pro osed Well
Coon mu:.e.0 for crop mgro.'an:ch A,Cal map Lvutvmemateda¢si__
Weld NE wwae NW w A no. a osss
Sod. Ten,ra tin S neat Fora PM1cgeee'.)A.
1 I rl 0 64 ❑ ID 6th C. °Gaily Osa eeasnar nits wed wet lard
os.w,cr.e pan uao..oes ins,inn.. as.., -cal
215 rum.,tx.N MS•2,400 FLeml[ME IEW
ft,rpousy„„s„drip-...y oande.. ,,n„—;e,,,,e„.., 9.Proposed Well Driller License a(optional):
feel direction 10.Sign or Entered Name Of Applicant's)Or Authorized Agent
car mcedd,.aae..p•d.r.z.,.sre'.Do Q a+„d+e Ache.,,,a,na,„mm, The mating of false slale'nents herein constihlteSpeOury Ins the SecoM
degree,vd,ich is pledslabie as a dens 1 musdemeano pursuant to C.R.S.
Located:Lot Bin recorded exemption no,1475-01-2 RE-4903 23.4.104(13Ha). I hm read the statements herein.know the contents
thereat a lethal lh{y sreIue Iomyk ,sledge
optional:DES waMbeator information MUTM formal You((,tint shedOPs Lets for S7,y Om IrM„y Kc4oc ns _i O..isnw'lry�y;
Iequlled manias as follows: fj
a.�F' er ' J.,24 V.W.wa1—
Cmrmmune tire
❑Iune 11,10 Zone 13 Easing
�/
unu maee Male, ca ea 41e'�, .yin d r A,....,Gr"--
MALT mat ea RAW Nauwy Office Use Only
UU
e'r'""•rom+ on.‘,..) aum n.+
WnGP5 oil.11•0.4lwawwyOYES Remember to epee Paean to NAM
5.Parcel On Which Well Will Be Located Receipt area only
_(BLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL)
A. Legal Description Um,eepwted as an anatomy
Lot B in Sec 1,T 1N,R 64 W;please see attached Plat map
H. Iaaanepa,e C direrAowauP
5.0 t/- IdirerBoyd Arnold we
We
O. WI inks be the e+..e,uw n,pnv I=rear)no re ix)in.w..w, crack
'CPO
E. sedc oars lm ow-nor 14YIAR
see ON We_ aA_MO_
Transaction#. 3628262
Date: 24512016 10:30:46 AM
transaction TOhal' $100.00
CREDIT CARD $100.'00
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HENRYLY N IIt1:IGIATION DISTRICT
617 Birch St; PO Box 85
Hudson, Colorado 80642 •303.536.4702
Sewage Disposal Plan
Name of Development as Proposed:
Henrylyn Irrigation District Maintenance/Office site
Location of Parcel:
Part of the NW %of Section 1, Township 1 North, Range 64 West
Portable toilets will be onsite during the construction phase. Once
construction is completed,portable toilets will no longer be needed.A septic
system /leach field will be on site thereafter. A septic permit will be applied
for prior to construction.
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DEPARTMENT AOFvenue
PUBLIC HEALTH AND ENVIRONMENT
IA. .= 1555 N. 17th Avenue
1 1 7 r t r \ Greeley, CO 80631
' .1 9
www.weldhealth.org C Pub&icHeal h
k
,C Ib methClearer0000x00.7 ankhEmeEmergencyy Pawn..
Hamm
Pampas rvn Punk Yrvbe Maim SEUW•Plen all A faamen
Tele 970]1148410 Tele MO]M F)0 Tem 970/046415 Teta 970 SG 0410 Tel 570 304142a
Faa 970 304 5412 far 570301541E rat 470304.6411 i15 0705046452 fun:920 3040454
.,40..40.nwrlRe Nn"¢mm✓b00,0 s m.m•gyp b mw MW 70015 tee hsse550 awe to Wry to.man and pry.
Septic Permit Application
Application Number SP-1500062
App Type: Health\Commercial\New OWTS1Sepiic
ROD BAUMQARTNER
HENRYLYN IRRIGATION DISTRICT
607 BIRCH ST
HUDSON,CO 80642
Owner Name: ARNOLD BOYD A
Parcel#: 147501200059-R6786698
Legal Deec: PT NW4 1-1-64 LOT B REC EXEMPT REC-4903
Work Description: SHOP AND OFFICE
Site Address: TBD CR 14
App Specific Info:
Location Description SHOP AND OFFICE
Number of Persons 4
Parcel Acres 5
Public Water Supply No
TERMS AND CONDITIONS
Patina Me as elblnearest wam¢ce M Ito sown OI NNW Osage m M plead of n0yecanle Peron..vu x}Mewryn a,
m treatment Matern
Parable el 1e N epolcal n Permit Ins ere 40nAYnaage:perm applc.no nee�m4n.Yreble It Pout a Wionp permit Ina.v,OWIS are uol for Me
sane oromay and co„alrucuu,55 0041[.m1,n w pap to the e.,nmwa,Dap:d Imo dep.ne pane,ere owls Pam,WI cape N Md saea lung to Inc blMnp
papa II em oWrs!mina nape,tor n properly Intl dOee 004 aquae 4 dnanw paint mn OW15 pemm Mae natere ate Year efa„ie 015,0004,10Cnew4vn M
mo eeplte Warm.has roe mmmm.ed Any Manila in wms a ipmencanats Mar me permit hal been issued,nv04a,ne Ole prmn mane app'ovaI In aoCo,EN 0154,
,rya Hews,0neor w nLntt deemnateu apml EMI'S Parr...M rtl,ws by ppyneml M the penal lee mM
A Thole ho'Mart no Cantle n NO plane aid.oecaubone of Me proposed ryele.,p MI Out em Is,°aria dplionlo,or each Nenpe Is retreated and
approved by n rAwnu:n Ngaesmilo0M
G Tne wnaewina lam,Ss use MZPnets IIem 0401 aaralg.d!!sate 744400 tae capital application not e,be apsptano.sote Mese'chastens
NOTICE
The Cwnplalunnn.olID'S nppremartn r0r0evnl,pon wnaN narnamory pMMdibomn mue told reports as may be rebated by the area Carat Oapalm,emw
pudic HOLO1 a,4 Enww,mmIINCDPHFI Then,sane at one maw le wblect Is such terms and[ixttons an doomed necessary to cm1bm00 mm mac
and ryululvw0 adopted mars Edo',10 tea 25.CRS at amended The epp'cdm Melees Illy Ind W,posed.y%en wma M be IC ales]40,1111,,400 r.q d a eemmat.}
sewage intent The undo...red µ4715S Thal o9'Menem male tam nalan aid tempos wbn4l,4 berera,at Cl pet M,reprewa,led tube bun nod eyed to
Me Mel04Mather kn 0042dge n,4 so 110091.44 to be tetrad M bf sly l0CIX+H[Ia Maaar°,Iw!,4!040.al 0040,7!Ina Vaal aPas04 Ca here.ApplGnl father
Ie4enlsl.lam Waikato,,a mwevroMnLaten Iny(nut n,the clonal N the p,Wcoin Of re ud%Ion of any Porno y0nlad,rho n 104.1 algrt 0,!01,15 000
owed ad by less
X
Owner Applicant Date
Print Date Time: 3/6/2015 11:18:51AM Report ID: EHS00056v004 Page 1 of 1
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IIEN RYLYN IRRIGATION DISTRICT
617 Birch St; PO Box 85
Hudson, Colorado 80642 9303.536.4702
Water Supply
Name of Development as Proposed:
Henrylyn Irrigation District Maintenance/Office site
Location of Parcel:
Part of the NW 1/4 of Section 1, Township 1 North, Range 64 West
An application is pending with the Office of the State Engineer
Colorado Division of Water Resources.
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