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Home My WebLink About20150102.tiff WRJ-5-Rev. iE7,- - COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denvet,Colorado 60203 • PERMIT APPLICATION FORM - Application be complete w`lE(:EI1IED ( I A PERMIT TO USE GROUND WATER applicable. Type or (X l A PERMIT TO CONSTRUCT A WELL print in BLA T A 51987 FOR: 1x) A PERMIT TO INSTALL A PUMP INK.No overstrikes 10— or erasures unleaTER i I ) REPLACEMENT FOR NO. �$? 2:29 P initialed. 'my-MINED I ) OTHER COW. WATER COURT CASE NO. 032472 66�t01..10' 10I (1) APPLICANT - mailing address FOR OFFICE USE ONLY. X WR'tLE"IN THIS COLUMN QO bbbUUUU UUUUUULLLLLL��,��,CASH 60.00 NAME Michaeleen F. Carlson Receipt No. U -7 9 O DIG / 0.00 STREET 14020 Country Hills Drive Basin DistRTN 1 CL-1 BA 790 CITY Brighton Colo 80601 CONDITIONS OF APPROVAL TELEPHONE NO. 659-3625 654-1168 This well shall be used in such a way as to cause no material injury to existing water rights. The (21 LOCATION OF PROPOSED WELL issuance of the permit does not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested water County Weld right from seeking relief in a civil court action. S.W. '/a of the N.E . V., Section 15 1 APPROVED PURSUANT TO CRS 37-92-602 13) (b) Twp. Nort Ana. 65 We;�t_, 6th. P.M. I AS THE ONLY WELL ON A TRACT OF LAND OF 40 p. tl 9 DESCRIBED AS SW1/4, NE1/4, SEC. 15, T. 1N, (N.$) iE.vn R.65W 6TH P.M. 2)WATER USE AND WELL DATA 2)Tttn PRODUCTION FROM THIS WELL IS RESTRICTED TO LARAMIE-FOX HILLS AQUIFER WHICH CORRESPONDS TO THE INTERVAL BETWEEN 820 FEET AND 1,125 FEET Proposed maximum pumping rate (gpmJ 15 BELOW GROUND SURFACE. PLAIN (NON-PERFORATED) CASING SHALL BE INSTALLED AND SEALED TO PREVENT PRODUCTION FROM OTHER ZONES. Average annual amount of ground water 3 THE USE OF GROUND WATER FROM THIS WELL IS to be appropriated (acre-feet). 2 LIMITED TO FIRE PROTECTION, ORDINARY HOUSEHOLD PURPOSES INSIDE ONE SINGLE FAMILY DWELLING(S) , Number of acres to be irrigated: none TH�IGAARDENS�ANDFLAWNS, THANAANNDTT ONE ATTERING OFF Proposed total depth (feet)* 900 DOMESTIC'ANIMALS. ' 4 THE RETURN FLOW FROM THE USE OF THE WELL MUST BE THROUGH AN INDIVIDUAL WASTE WATER Aquifer ground water is to be obtained from: DISPOSAL SYSTEM OF THE NON-EVAPORATIVE TYPE Fox Hill WHERE THE WATER IS RETURNED TO THE SAME STREAM SYSTEM IN WHICH THE WELL IS LOCATED. Owner's well designation (NOTE: TO INSURE A MAXIMUM PRODUCTIVE LIFE OF IS WELL PERFORATED CASING SHOULD BE SET GROUND WATER TO BE USED FOR: THROUGH THE ENTIRE PRODUCING INTERVAL OF THE APPROVED ZONE OR AQUIFER INDICATED ABOVE. ) ( ) HOUSEHOLD USE ONLY • no irrigation (01 TE1O/25/S7 Ix ) DOMESTIC (1) ( ) INDUSTRIAL (5) ( 1 LIVESTOCK {2) I 1 IRRIGATION i6) ( ) COMMERCIAL (4) I ) MUNICIPAL (8) 1 ) OTHER (9) APPLICATION APPROVED DETAIL THE USE ON BACK IN (11) 149811 PERMIT NUMBER (4) DRILLER 0CT 2 6 1997 DATE ISSUED OCTName —L, eased EXPIRATION DATE OI 261989 Street . City ( TATE EN EER) (state) (Z(p) BY ) n-d Telephone No. Lic. No. I.D. COUNT 6 2, (5) THE LOCATION OF THE PROPOSED WELL and the area on (6) THE WELL MUST BE LOCATED BELOW which the water will be used must be indicated on the diagram below. by distances from section lines. Use the CENTER SECTION (1 section, 640 acres) for the well location. _ N GQTM 0\e 2400 ft. from cwat#.k sec. line + — —h- — ± -- + — + — + — —f- — + — ± Q�V)(ne th) , e .4___1 MILE,5280 FEET—mil - I 2500 50 ft. from m sec. line 7, ;ant or wntQST T + + + + + + + LOT BLOCK FILING w lR� ( SUBDIVISION ''. . a'" + 4 _ NORTH SECTION LINE�_, — y 1 T I rgi I (7) TRACT ON WHICH WELL WILL BE I ,NORTH - + _ - - + — + + LOCATED Owner.�A721 SdAI _ W_ .m z D No. of acres 80 Will this be J N + p I m the only well on this tract? yec f 1 — w 6 (8) PROPOSED CASING PROGRAM th I I- I z se r I Plain Casing Steel + ; ._i_ _ + m + f 1 ' 6 5J$in. from 0 ft. to 40 ft. I I I C-- Rbt I in.from 40' _4,1/.2 ft. to 80.0 ft. + - -I- I � �_ — i Perforated casing Steel SOUTH SECTION LINE I I I I 43 in.from 800 ft. to 900 ft. + -I- + + -I- 4 4 + in. from ft. to ft. 1 I I I I (9) FOR REPLACEMENT WELLS give distance I — and direction from old well and plans for plugging t - -� _ 4_ - + - + - + - + - + it: The scale of the diagram is 2 inches= 1 mile Each small square represents 40 acres. WATER EQUIVALENTS TABLE (Rounded Figures) ' An acre-foot covers 1 acre of land 1 foot deep 1 cubic foot per second (cfs) . . .449 gallons per minute lgpm) A family of 5 will require approximately I acre-foot of water per year. 1 acre-foot . . .43.560 cubic feet . .. 325,900 gallons. 1,000 gpm pumped continuously for one day produces 4.42 acre-feel. (10) LAND ON WHICH GROUND WATER WILL BE USED: Owneris): No. of acres: M Legal description: 111 )� N. £ YII SFO 13 (11) DETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of disposal system to be used. Domestir . Lawn and Garden SEPTA' SYSTFCI (12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers. Type or right Used for(purpose) Description of land on which used Burlington Ditch irrigation (1 THE APPLICTa(NT($) StglE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE, A0 Lh[n) dy S' n SIGNA URECCOF APPL IC NT(S.I S �. �r k)ww ti` Use additional sheets of pager If more space is required. 1 EXEMPT HEEL DATA SHEET - DENVER BASIN, COLORADO APPLICANT: MICHAELEEN CARLSON RECEIPT NO. 280790 LOCATION: SW1/4 OF NEl/4 OF SEC. 15, T.1$., R.65W. (2400 NSL, 2500 ESL) PROPOSED AQUIFER: LARAMIE-FOX HILLS SURFACE ELEVATION: 5040 NUMBER OF ACRES IN TRACT: 80 IS PROPERTY WITHIN SERVICE BOUNDARIES OF MUNICIPALITY 5.8.5 CONSENT MAPS? NO_Sc' YES,___ IF SUBDIVISION IS UNDER AUGMENTATION PLAN, CASE NO. IS , DIV. ____ IF SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY THE WATER MANAGEMENT BRANCH, DATE OF LETTER IS INFORMATION ON SUBDIVISION r OR TRACT OF LAND/SPECIAL RESTRICTIONS: I be—etL -I 0101 ura.W evaluated by JNB on OCTOBER 23, 1987 ELEVATION DEPTH TO ANNUAL NET APPROP STATUS AQUIFER ROT. TOP SAND BOi. TOP A-F UPPER DAWSON LOWER DAWSON ---- --- DENVER UPPER ARAPAHOE 4880 4900 9 160 140 1.088 E NNT LONER ARAPAHOE+LARAMIE-FOX _ 4591 4807 80 449 233 10.880 NNT HILLS -) 3917 4221 145 CID (110r17.280 NT note: E indicates location is at aquifer boundary and values may be ,are approximate. * indicates the proposed aquifer. All values are interpolated fro, the S.B.5 data base assembled in November of 1986. C . go.4 • () woo.- . - Aft-stc ae Lt.. 2) . a) t3era _ REGtIVtu The primed a...t,a.of Ala r,rm r. .,,,<d hl la, ^ 5 '18 Gammas Ant?Au1,ramml.d„tor 7e.c..el OCT1 11 THIS IS A LIG4 INITRGMENI.IF NOT UNDERSTOOD.SEGAL.TAX OR Smil COUNSEL IHOIAD DE(0N5011E0 GENRE SIGNING, WATER MESON= FARM AND RANCH WAIF'ear Best Copy Available CONTRACT TO BUY AND SELL REAL ESTATE Slitil' (Seller's remedy limited to Liquidated Damages) lI PSeptember 28 1,87 er The„nosed a thmr.ny.<Nen.Indm,n.an.remised tram Richard D. Carlson nod Nikki Carlson _ husband and wife tnnlre . , ,.,noel ma A 2,000.00 _Inlh.,.,mar_personal_check - I Iha,em al //// ////- w //-/JJ// Ache held by Richard M._Grnnber /f•/je. e y./t/: re,l.nl. n money and R _ __ Oh'nCr. Ovnrr($)n rots payment far the follow'''. u..erib.0 .ea e•la,e the said cn„do al Wg1,Q__,rol.r,d.,ta wit: The Wi of the NE} and all that adjoining part of the W} of the SEe which lies below or North of the Neres Canal, of Section 15, Township 1 North, Range 65 West of the 6th. P,H. p,` Ih,.e with eN,a .. nddtht of way eel thereto,ell I mvn .Inn and nun,o, el. . ,m . r i Itlyn ILe muebe rer< ,LrnlboliTr r. eidad-In the:pn,ent,nn,li4an.nnnn. nd . rnted.and Arreln,fl. wlnathe PrPnfg. z. .SI.hieet heprnnl.Inn.n,lm,...•nn in.the nn.vm.ned perennial yRi£hgrd D. Carlson and Nikki Carlson_ //// _//(/-_ -__/.//J__.—inn inlet w/st��/„(,�Lomein•ner coded r.I,ehooeA hnehy wen tee. unorIh,eI'r., V an o., , d the under:lnned swamis),hors's.fin•t el non"r.ne.,e,Forme le nil Lh.Property open lh,to rem ann<nn.l gala.,mated he„In, I 1.The m,rcheae prise'hallbeu.S.S 60_t000.o0 .ru chicsFanaw.a 2.000-oa h,r,by,.,.lpl edroe: the balance' of $58,000.00 as herein provided. $28,000.do to be paid in cash or certified funds at the time of closing by purchoser(s), Seller(s) shall carry the balance of $30,000.00 at no interest ox prepayment penalities for a period I o₹ (l2) twelve months after the date of closing or at other terms agreeable to the Purchaser(s) and Seller(si) and reduced to writing. Ii I, 1 Prim to Ind ode the fattening.motsel p.open), none. I I II I 1"h"minrn e.l by Sill of nit at*In t ar[Ineinn in t heta Fe.•e,I,.n,nune.feet end dr.,ar all r.r""e.I prreru.Incr.li.n.and neeumbr.nree,e,n.pL no other exceptions. fode e•pt.n.re,nnn.I m.uL lien. nnpeneumh.one ,perifedlnr",n.rnnhtl Tha f"Ilnwm ef„tuenni a permanent nature"re excluded train p m h le Male: none. d Pelee toinel,.de thernllnwins oats rights. (1) share of Burlington Ditch Water, and any Nenrylynn water recorded to date of delivery of deed. If. .man is us b•Alm nod h,Purchaser r,n *Void ports.enrages, lip,mpoy.vldl9. w l.ltI"IF far sue hln.n.nn. euta.11 ""ea meet., furnish all ie(rm ,nn and document.r"wwenl.pteu lender,•nn servo pyw"aouan",yr rents old win inr ouch l."a Then II mitts loan nnlnpr, In ,heh,,.nor_applicable.IA__or II an apn,aeed but 1,nut a•,n.ueunm..r closing,this contr.n"h"I'S.null end 'MA end.II,"yesentn and thin["ale.hrt reeei,ed her•Imdv ek.Il he returned in Ibnl..er. 7. Il.note and Les it deed or mortgage h to he...umed,rureh..e,"peer to.pply far•tents a"n mullein ifreeohed and.[rw,to Any III•loan Ire none f,nm In..lrr .I rT not app.i Cable .lid roan Int.rear rm.nnun ere*ea not applicabli ,rannnm.If the lean re hen riled ha: .enl"n•for•share,)equity e .niable leterel rs l",or serum n n [p"Ymns.Chia I. nnditl.ne,lu „1 .rel,a reviewing • .lrn ueh pe..Ig 'rn If the lender's t lb n top, .r i n t,l oir this. b 6 m enn .rind W itl"nad upon 0 .inln"n.eheenrenl i Limpet shame n the tennis and rn.11ttnne of flitch Inn escort re heroin provided. rovided . It a lint.IP In he,wade P.vable to Salle.nl.pnrJd or full pay men(alloy,P,e<ba.pd.4,this contract"hall not be.nituble by Purchaser uhn of ant Feller. 11 b Cn.talany.ppraoil lac loan pi,'purrs In bealdnlnrd slam-this'Isle shallh,pnl.lhy seller(s). in An nb•Ireet of title lathe Property.certified In,lrle.a it current env many"1fur Mile innu"nnn,ewacky In on amount equal to the porch... pries,el roller's option end rapen,e-:onto,.Ineni•nrd in porch"1-r on or before ost.0.ber_9 ,lilpy..libellerMeetsto furnish.old title Mau r.e,ernmmh mea l.Seller.ILI de the titleInane neepolty Co Purchaser after Moslem n.1 pay thepremium thereon II.The Sole of rinsing.hall he the Milt Inr delivery of noun n.Tracked I.parntreph I: The lour end plmee ol<loting.hall Len dalsvint I,yamutual agreement between all__. [ties concerned.-- _ IA Tilde shall Ica erchanlaMe Seller, a"1 s..e, I.In t ht•ca ph and in.,roarHelm IT end II.Snidest toleymn rend . ea4"we presided and eem Miner hr Purelm.er with the ether re m• am? nrv,nan• hector. Soler sell mama and delver a .0.4 awl and uraAmt General ,,,nrr,my need to rnrrha•r.an SC.06gr_i,t`_ In_ .sr.by mutw"i , ,date, g the Property rrv<and ela. u.M-0P tour.e.rent thes.ner.tn:.Mr the seers'sliming,and"e<.et_no other ex_epti.ns free end clear or all hem,In?epeel,IImpry anteiyuned no i he dnlr nr rurch,."r'.signature hereon, hetb.r.a.e.."d. no':Ire"and clear.fall Rr"'"""ane„nhr"lie"‘r'r"M those items recorded to date of delivery of deed. II II esenni.Iha following ee"trialve covenants which do naeont,n n„rht nl re,e.ter none. ii ,„St2 'S-2.111. tcnitIt I ltll111, I0list:l.l.11rtl eslAn.Ilbrm and Ran,AI No P,slim!lld,n-#,"1 to-t sw s aAm Ian,-,..I t toil -'AT, I,.n L'O1!f2JJ .9 DlY1Ji�1] ,L) / Permit Issued: Completion Status Unknown Help Last Refresh:8/2]/201412:01:14 AM Receipt: 0280790 DNsinn: 1 Pere*d: 149811-- Water District: 1 Wel tame/it: County: WELD Designated Basin: Management District: Case Nrnber: WDID: I_[-] Appicant/Owners History Date Range Appicant/Owner Name Address City/State/7y UNalovm-Present CARLSON MICRRE1EEN F. BRIGHTON,CO 80601 I [-] Location Information Approved Wel Location: Q40 Q16O Section Township Range PM Footage from Section Lines SW NE 15 1.0N 65.0W Sixth Northing(UWM y): 4433717.5 Easting(HHM x): 530049.9 Location Accuracy: Spotted from quarters Physical Address Subdivision Name City/State/:ry Rang Block Lot Parcel ID: Acres in Tract: [-7 Pernitoetaks Date Issued: 10/26/1987 Date Spies: Use(s): DOMESTIC Aquifer(s):LARAMIE FOX HILLS Special Use: Area which may be irigated: Maximum annual volume of appropriation: Statute: Pere@ Requiements: Totabig Pew Meter Geophysical Log Abandonment Report No No No Cross Reference Pern*Number Receipt Description Permt(s): Comments: (-1 Construction/Usage Detail Wel Construction Date: Pump Instaiation Date: Well Plugged: 1st Beneficial Use: Elevation Depth Perforated Casing(Top) Perforated Casing(Bottom) Static Water Level Pump Rate [-7 Appication/Pern*History Permit Issued 10/26/1987 Application Received 10/05/1987 [-] Dinged Documents Document Name Date Imaged Annotated Orioinal File 12/05/2007 No Copyright©2009 Colorado Division of Water Resources.All rights reserved. FITS; i lk: I:NDT. LI�UAL SEWAGE DISPOSAL(i ;'A EM PERMIT NO :. WELD COUNTY HEALTP DEPARTMENT NEW PERMIT ENVIRONMENTAL HEALTH SERVICES 1517 18TH AVENUE: CilUR i , I LILI_IiEY, CO 0063T 353-05:;5 E X 1. 2'225 - a i 456 Cite_ m OWNER CARLSON, RICHARD ADDRESS 14026 COUNTRY HILLS DR PH (303) 659--31,2'5 yy 1?RIGHI (]iN CO 80601ADDRESS OF PROPOSED SYSTEM 215%'0 LJCF: 17 BRIGHTON CO 30501 LEGAL DESCRIPTION OF SITE : SW4 NE4 SEC 15 TWP 1 RNCL 65 SUBDIVISION : LOT 0 BLOCK 0 FILING 0 USE TYPE : RESIDENTIAL SERVICES : PERSONS 4 BATHROOMS 5,00 LOT SIZE 01 . 100 ACRES. BEDROOMS 5 BASEMENT PLUMBING NO WATER SUPPLY EWI=!_L. APPLICATION FEE $150, 00 REC ' D BY CINDY SALIA .:AF: SIGNED BY RICHARD D. CARLSON DATE i /04/87 DATE 11 /06/87 PERCOLATION RATE 45, 9 MIN PER INCH LIMITING ZONE:: 7 FEET SOIL_ TYPE SUITABLE PERCENT GROUND SLOPE 32: DIRECTION S- N! REQUIRES ENGINEER DESIGN NO FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON-SITE SOIL PERCOLATION DATA THE FOLLOWING MINIMUM INSTALLATION SPFCTFICAT-TONS ARE EQ!.IIRE:D : SEPTIC TANK 15u0 ' GALLONS', ABSCRPI ION TRENCH 5-T0 SO. FT . - •.:p:;•.� OR ABSORPTION BED 1985 SQ. FT, IN ADDITION, THIS PERMIT IS SUBJE=CT TO THE FOI..I._OIJINL ADDITIONAL TERMS AiNT) CONDITIONS THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COIMMENCE, THIS PERMIT MAY BE REVOKED OF, SUSPENDED BY TI-IE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SET TORCH IN THE WELD COUNTY IND.I:VLDUAI_. SEWAGE DISPOSAL SYSTEM RES:GUI.,ATCON , INCLUDING FAILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DARING TEMPORARY OR FINAL APPROVAL.. THE: ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION E'Y THE DEPARTMENT OF: ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR INADEQUACY OF THE SEWAGE DIS'1'•OSAI.. SYSTEM. STOLL, JEFF t /8-7 1-C1 u "' nJ 6 8//"qa aS ENVIRONMENTAL SPECIALIST DATE az*,,,P THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL or THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT Al TMEN RESERVES THE: RIGHT TO IMPOSE ADDI - TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING OA- SIS, FINAL PERMIT APPROVAL IS CONTINGENT AEON THE FINAL. INSF'E:C:TION! OF THE: COM SYSTEM ED SYSTEM BY THE WELT) COUNTY HEALTH DEPARTMENT. I SYSTEM INSTALLER .. ...__ _.... FINAL INSPECTION DATE 1/4. SYSTEM ENGINEER ._ _ .. .. Al I Lt1U'rdl._ y1,EU'0k . — . . _._-... ._...... _ -.._ .... TYPE OF SYSTEM INSTALLED A. ENVIRONIif.NTAL SPECIALIST I:ST THE ISSUANCE OF THIS PERMIT DOES NOT IMPLY COMPLIANCE WITH OIlIER; STATE, COUNTY OR LOCAL REGULATORY OR BUILDING REQUIREMENTS, I'Iii SHA11..L. TT ACT TO CERTIFY THAT THE SUBJECT' SYSTEM WILL OPERATE IN COMPLIANCE WITH APPLICABLE STATE . COUNTY AND LOCAL REGULATIONS ULATIONS ADOPTED F'FRSUAiNT TO ARTICLE 10 , TITLE >, CRS 1973,-73, AS AMENDED, EXCEPT FOR THE: PURPOSE OF ESTABLISHING FINAL APPROVAL, OF AN INSTALLED SYSTEM FOR ISSUANCE O; A LOCAL. OCCUPANCY PERMIT PURSUANT ILl CRS 19'15 25- 10-111 (2) .. ORIGINAL-APPLICANT ; CPPY- LJCHI7 WI:':NU -EMS MAY , 1904 s'y • etc 0/ 0 I / 1 Tp� J 1 1 N , � 1 w. 1- 5- I 1. . P � 1 ' p 91' oOH"') To -bA li tei 11 ,4I4 s) 5 +t .ks . �lae�,ll y °t, �p pppp � O Ir1�, yttkm�v1 C,ct64 I- SI' i 6r1 INDIVIDUAL SEWAGE D SPOSAI. SYSTEM PERMIT NO, G-670239 WELD COUN1A HEALiEl DEPARTMENT- NEW PERMIT -EiNVIRONiMENTAL HEALTH -SERVICE'S 1516 HOSPITAL ROAD, GREL.LEY, CO 8663.1 353- 0635 EXT. :1.? _`> OWNER CARLSON, RICHARD ADDRESS 1µO20 'COUNTRY HILLS DR PH (303) 659-3625 BRIGHTON CO 80601 ADDRESS OF PROPOSED SYSTEM AEPROX : 21450 WCP 10 BRIGHTON . -- CO 80601 LEGAL DESCRIPTION OF SITE : . ,SW4 NE4 SEC 15 TWP I ' RING 65 SUBDIVISION : LOT 0 BLOCK 0 FILING 0 USE TYPE: RESIDENTIAL SERVICES : PERSONS A :BATHROOMS 5,00 - LOT SIZE 81 .00 NACRES BEDROOMS 5 BASEMENT PLUMBING NO WATER SUPPLY E'WELL APPLICATION FEE. $150.00 RI_C 'D BY RECEPTIONIST AID SIGNED BY RICHARD D. CARLSON DATE: 11 /06/87 CC DATE. 11 /06/97 RATE F.. ,9 PERCOLATION MIN FE:R -INCH LIMITING ZONE 7i5FEET SOIL TYPE -B ACc6e-r Lt PERCENT •GROUND SLOPE I 3 " DIRECTION 5?� REQUIRES ENGINEER DESIGN 1J0_.- FROM THE APPLICATION INFORMATION SIJPPLIL:D AND THE ON-SITE SOIL PERCOLATION DATA T'I-IL" FOL.l_.LIWING MSiNl:ML)M ' :ILISTAI.:.I_.ATION SPECIFICATIONS ARE REQUIRED : SEPTIC TANI< [51Q°.._ GALLONS, ADSURITICIN TRENCH/37V0. ,SG,'. FT., f_i F: • iFSORFTIOiN LIED MS-SQ., FT. IN ADDITION THIS PERMIT I.S -SUB HT TO THE FOIIOWING ADI)JTTONAL.. :TERMS AND CONDITIONS: •tXt"mC•lyyvrurrrrl. diret-Oln ,,,•Ga _..._ THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT MAY DE REVOKED OR SUSPENDED BY THE WEI..D ,COUNTY HEALTH DEPARTMENT FOR. REASONS SETT FORTH IN THE. WELD COUNTY INDIVIDUAL S'E'WAGE DISPOSAL. .S'YST'EM RC:GULATI:(NS :INCLUDING FAILURE TO MEET ANY TERM OR CONDITION 1:MPCi;"ED THEREON DUE NO TEMPORARY OR FINAL APPROVAL. THE ISSUANCE 01= THIS FERMI. DOES NOT CONSTITUIE ASSUMPTION BY THE DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR IF. FAILURE OR INADE:QUAC:i OF THE SEWAGE DISPOSAL SYSTEM, - \y -BO E I:.. .. JMI::. TAI. SPI .CLAI. .S F DO !/ all THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME: VOID - IF 'SYSIE_M CONSTRUC ION HA NOT .r_r:1MMENCED WITHIN ONE ,YEAR OF ]:T S ISSUANCE., BEFORE ISSUING FINAL APP'ROV'AL 01 THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RI-GMT TO LMI'UsE:: ADDI- TIONAL TERMS AND COND]: I IONS' REQUIRED JO MEET OUR REGULATIONS ON A CONTINUING BA- SIS ; FINAL PERMIT APPROVAL_ :[,S CONTINGENT UPON THE FINAL INSPECTION OF THE:: COM- PLETED SYSTEM BY THE WELD C0UNTY 'HEALTH DEPARTMENT. / .,i 0l(d 2- iuDe�02.Pl (r ed lx reQev� - Pa4v 571611 /a-zl-9 la �c arbina JGINAL-A PL_ICANT, COPY- LI0F10 - WCHD-f-HS MAY,- 1904' • , WELD COUNTY )IEALTII DEPARTMENT p ENVIRONMENTAL HEALTH SERVICES SI• TE EVALUATION ounerffl,4<5OA/, K /G//41D Application No 2�]Sioe 2n. /C-,S () G✓Cee/o PTNeil SILT,/ R- Oate /1/a,Q7 Sub Lot _Block Filing PERCOLATION TEST DATA:' Start Time// 3f) Hole Hole HZo ( min. No. Depth Remain inch • min. min. min. min. min. min. min. min. min. -CA 4 5-19'L 6-2z /4S-gib 5oz - (�}jg O !J (oa$ 0, _ VIZ- 5 ° 2 9l . th y 'in . 62? (0,?fif) (O 2.Y) A'' _ 5-7 rcc. 56 ssi ,Fig 3? • co.y41 ro, Z yg f.of X062 < 3O ` 4/a S74z', TO S 4 rb,Y7) o.39) T 3�� 5 3 1 4,2_ Y6 4yg ' t 1,x/7) iGin, 3 11� 5-4,1 se,z . 5 70 a r r1`p�( CYy '7 3 CO.47, Mara) oa7. All measurements in .m@ unless otherwise indicated. Total x751 * - Add H2O Environmental Health Specialist_ .1.,f40...7-67Average Rate _ i PLOT PLAN f . SOIL PROFILE • 3% S> ) I 0"--4.s n. ,• `1.4444 o-uc we g 0 2Y'`-2V.,, 6 G sa-J --------\ . -VP ` v foGdif7 . d' or, lo, FhS'106P APPLICATION FUR INDIVIDUAL SEWAGE. DISPOSAL SYSTEM NO. G-870239 WELD COUNTY HEALTH DEPARTMENT NEW APPLICATION ENVIRONMENTAL HEALTH SERVICES 1516 HOSPITAL_ ROAD, GREELEY; CO 80631 353L0635 EXT.2225 OWNER CARLSON, RICHARD ADDRESS 140'20 COUNTRY HILLS DR PH (303) 659-3625 BRIGHTON • CO 00601 ADDRESS OF PROPOSED:.SYSTEM FENDING . BRIGHTON CO 80601 • . LEGAL DESCRIPTION OF SITE : ≥'W.4 NE4 SEC 15 TWP I RNG 65 SUBDIVISION : LOT 0 BLOCK 0 FILING 0 USE TYPE : RESIDENTIAL_,' SERVICES : PERSONS . 4" BATHROOMS 5.00 LOT SIZE 9]1 ,00 ACRES BEDROOMS. 5 .BASEMENT PLUMBING NO WATER SUPPLY I''WEI_L_ APPLICANT ACKNOWLEDGES THAT THE COMPLETENESS OF. THIS APPLICATION IS CONDITIONAL UPON FURTHER MANDATORY AND ADDITIONAL TESTS AND REPORTS *AS- MAY BE REQUIRED BY 'THE WELD COUNTY HEALTH DEPARTMENT TO BE. MADE AND FURNISHED BY THE AFT LI:CA?1T 'OR BY THE WELD COUNTY HEALTH DEPARTMENT FOR PURPOSES OF THE EVALUATION OF THE APPLICATION; AND THE ISSUANCE- OF THE: PERMIT IS SUBJECT TO SUCH TIiERME AND CONDITIONS AS DEEMED NECESSARY TO INSURE CCIMPLIANCE WITH. RULES AND REGULATIONS ADOPTED UNDER ART'iJI..[:[ 10, TITLE. 25, CRS 1973,. AS_ AMENDE:D,. THE APPLICANT CERTIFIES THAT THE PROPOSED SYSTEM WILL NOT BE LOCATED.WITHIN 400 FEET OF A COMMUNITY SEWAGE SYSTEM. THE UNDERSIGNED HEREBY CERTIFIES THAT ALL STATEMENTS MADE, INFORMATION- AND RiF1IIIS SUBMITTED HEREWITH AND. REQUIRED TO . BE SUBMITTED BY THE APPLICANT ARE, OR WILL BE, REPRESENTED TO BE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE: AND BELIEF, AND ARE.'BESIGNED TO BE RELIED ON BY THE WELD COUNTY.,HEALTH DEPARTMENT IN EVALUATING THE: SAME FOR PURPOSES OF ISSUING THE Fl RM1 r OF I Li ED FOR HEREIN. I FURTHER UNDER- STAND THAT ANY FALSIFICATION OR MISREPRESENTATION MAY RESULTI - IN THE: DENIAL OF THE APPLICATION OR REVOCATION OF. ANY. PERMIT. GRANTED BASED UPON SAID APPLICATION AND IN LEGAL ACTION FOR PERJURY 4-,S PROVIDED- BY-'.LAW-. _ . AP'P'LICATION FE I i 0.00 It I IH'• ` ,r S REC ' U BYDUF EEP! .S( O11 �y L.ff/`!L£ 4i /06/67 DATE i /06/87 -LiWNE R/AGE NT SIGNATURE ATE Hello