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Home My WebLink About20151557.tiff FORAM NO. STAR OF .. .4UO .—. For Office Use only 0wsIl • OFFICE OF THE STATE ENGINEER 07/93 OFFICE CenlemrW Bldg..1313 Shemin Ell.Denver.Colorado 60203 (303)0089061 PRIOR TO COMPLETING FORM,SEE INSTRUCTIONS ON REVERSE SIDE '*!Fr..FlVFr CHANGE IN OWNERSHIP/ADDRESS / LOCATION WELL PERMIT, UVESTOCK TANK OR EROSION CONTROL DAM Alt 1 2 291.0 1. NEW OWNER LL /y1 ///'''�1 . •µ:: ms NAME(S).......(:,4,/[!&al /i J • ,I/�[.r 1 ilea-) j��{ Mailing Address ../q�.A [O PLAT:(1(,) ^'-f City, St. ZIP .1,04g1non.LCD 8.Q.504 Phone (4.43) lc.7R 6J94� • 2 THIS CHANGE IS FOR ONE OF THE FOLLOWING: ® WELL PERMIT NUMBER._ O LIVESTOCK WATER TANK NUMBER ❑ EROSION CONTROL DAM NUMBER......................................._........... o r (1-0-a1 3. WELL LOCATION: COUNTY '(/V f 4 OWNER'S WELL DESIGNATION ,.,._,..___,,,_......_E_ .55.523 (-( � 5..2 Keeera3esbors CQ 704940 Cr' (Address)./ ION. (City) ,�S (6�) ) Enw S i" 1/4 a the S W 1/4, Sec ar/ Twp � IAI N.or❑S., Range & ❑E. or ©W. 13 P.M. Distances from Section Lines / 1 Ft. from❑N.or SS. Line, 11090 FL from❑E.or®W.Une. Subdivision Lot..._. Block.. . Filing (Unit) 4. LIVESTOCK TANK OR EROSION CONTROL DAM LOCATION: COUNTY 1/4, Sec.............. Twp ❑N. or❑S., Range ❑E. or❑W. P.M. 5. The above listed owner(s) say(s)that he (they) own the structure described herein. The existing record is being amended for the following reason(s): ® Change In name of owner. O Change In mailing address, O Correction of location. 6. I (we) have read the statements made herein,know the contents thereof, and stale that they are true • to my (our) knowledge. (Pursuant to Section 24-4-104 (13)(a) C.R.S.,the making of false statements herein constitutes per(uly in the second degree and Is punishable as a class 1 misdemeanor.) Name/ ale (Please type or print) Signature Date LoI/+al m . m i sreo : A. /2 - Y-ad/q FOR OFFICE USE ONLY CURD AS A CHAINS WOWNERSHIP ANDIOR mamma ANIMUS • , / 01 rag II-CD;41 slate Engineer By Dale Court Case No. DN. Co. WD Basin MD Use Form No. • OFFICE OF THE STATE ENGINEER Gw'S-25 COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg.,1313 Sherman St.,Denver,Colorado 80203 (303)8S&35S1 LR WELL PERMIT NUMBER 249889 - • APPLICANT DIV. 8 WD 1 DES. BASIN 5 MD 9 APPROVED WELL LOCATION WELD COUNTY SE 1/4 SW 1/4 Section 3 ROBERT GRAUBURGER Township 1 N Range 63 W Sixth P.M. 33323 HWY 52 DISTANCES FROM SECTION LINES KEENESBURG,CO 80643- 71 Ft.from South Section Line 1690 Ft.from West Section Line (303)732-0220 UTM COORDINATES REGISTRATION OF EXISTING WELL Northing: Easting: CONDITIONS OF APPR,QV11L 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 predude another owner of a vested water right from seeking relief in a civil court action. 2) Construction details for this existing well have not been provided to this office:therefore,it is not known if the construction of this well is in compliance with the Water Well Construction Rules,2 OCR 402-2. The issuance of this permit does not relieve the well owner of responsibility or liability in the event contamination of the groundwater source results from the construction or use of this well,nor does the State Engineer assume any responsibility or'labifity should contamination occur. 3) This well is recorded and permit approved pursuant to CRS 37-90-105(4)(a). The use of this well is limited to the historical use as recorded with this office and by the terms of CRS 37-90-105,being a well used for domestic purposes inside 3 single family dwelling(s),the irrigation of not more then 1 acre of lawn and garden,and the watering of the owner's own large non-commercial domestic animals with a maximum pumping rate of 15 GPM. The total depth of the well is estimated at 140 feet. 4) The date of first beneficial use,as claimed by the applicant,is December 31,1919. NOTICE:This permit has been approved with a change to the permit application form from that applied for by the applicant. You are hereby notified that you have the right to appeal the issuance of this permit,by filing a written request with this office within sixty(60)days of the date of issuance,pursuant to the State Administrative Procedures Act.(See Section 24.4-104 through 106,C.R.S.) APPROVED Id T , SMJ pt,/�(,� d,i i(�JA►�� State Engineer BY 44! Receipt No.0507228 DATE ISSUED 05-01-2003 EXPIRATION D E Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970)304-6411 www.co.weld.co.us Septic Permit Application Application Number: SP-1100167 App Type: HealthlResidential\Repair1Septic Applicant Name: JIM MILLER 33323 HWY 52 KEENESBURG, CO 80643 Owner Name: MILLER LOLITA M Parcel it: 147703000081-R1026002 Legal Desc: PT E2SW4 3-1-63 LOT A REC EXEMPT RE-958(.31R) Site Address: 33291 HWY 52 KEENESBURG, CO 80643 App Specific Info: 1/2 Bathrooms 0 3/4 Bathrooms 0 Basement Plumbing Yes Full Bathrooms 3 Location Description 33291 HWY 52, KEENESBURG Number of Bedrooms 4 Number of Persons 4 Parcel Acres 3.535 Private Water Supply Well Public Water Supply No TERMS AND CONDITIONS A permit fee,as set by separate ordiance of the Board of Weld County Commissioners,shall be required of applicants for new individual sewage disposal systems(ISDS),payable at time of application.Permit fees are non-refundable;permit applications are non-transferable. If both a building permit and an ISDS are issued for the same property and construction is not commenced prior to the expiration date of the building permit,the ISDS permit shall expire at the same time as the building permit. If an ISDS permit is issued for a property that does not require a building permit,the ISDS permit shall expire one year after its issuance if construction on the septic system has not commenced.Any change In plans or specifications after the permit has been issued invalidates the permit unless approval is secured from the Health Officer or his/her designated agent. Expired permits can be renewed by payment of the permit fee only if: A.There has been no change in the plans and specifications of the proposed system as set out in the original application or such change is reviewed and approved by a Division Representative. B.The surrounding land,its use or zoning has not changed so-as-to cause the original application not to be acceptable under these regulations NOTICE The completeness of this application is conditional upon further mandatory and additional tests and reports as may be required by the Weld County Department of Public Health and Environment(WCDPHE).The issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under article 10 title 25.CRS as amended.The applicant certfies that the proposed system will not be located within 400 feet of a community sewage system.The undersigned certifies that all statements made,information and reports submitted herewith are,or will be, represented to be true and correct to the best of his/her knowledge and are designed to be relied on by the WCDPHE for evaluation for purposes of issuing the permit applied for herein.Applicant further understands that falsification or misrepresentation may result in the denial of the application or revocation of any permit granted,and in legal action or perjury as provided by law. 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