HomeMy WebLinkAbout20151364.tiff COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-45(07/2013)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST, RM 821, DENVER, CO 80203
Main: (303)866-3581 Fax: (303)866-2223 dwroormitsonline@stEile.co.us
GENERAL PURPOSE
Water Well Permit Application
Review instructions on reverse side prior to completing form.
The form must be computer generated,typed or in black or blue ink.
1. Applicant Information 6. Use Of Well (check applicable boxes)
Name of applicant _______
Attach a detailed description of uses applied for.
Saddle Butte Rockies Midstream, LLC
❑ Industrial ❑ Dewatering System
Mailing address Municipal❑ p illGeothermal(production or reinjection
1900 16th Street, Suite1550
- -Slate Zip code ❑ Irrigation
City ❑ Other(describe):
Denver CO 80202 Commercial
Telephone#(area code 8 number) E-mail(online filing required) 7.Well Data (proposed)
303-446-7532 tmiller@sbpipeline.com Maxi numpumpingrate Annualamounttobewithdrawn
2. Type Of Application (check applicable boxes) 15 gpm .33 acre-feet
❑ Construct new well Li Use existing well Total depth Aquifer
❑ Replace existing well E Change or increase use 580 feet Laramie Fox Hills
❑ Change source(aquifer) ❑ Reapplication(expired permit) 8. Land On Which Ground Water Will Be Used
❑ COGGG Well ❑ Other:
Legal Description of Land(may be provided as an attachment):
3. Refer To (if applicable)
Well permit# Waerboud case# See intormation provided tor#5 of this application.
203955
Designated Basin Determination# Well name or f!
4. Location Of Proposed Well
County (If used for crop irrigation,attach a scaled map that shows irrigated area.)
Weld SW 1/4 of NW 1/4 A. #Acres i B. Owner
Section Township Nor S Range E or W Principal Meridian 32.12 I Saddle Butte Rockies Midstrgm
24 3 RI F I 65 C Ia 6th C. List any other wens or water rights used on this land:
Distance of well from section lines(section lines are typically not property lines) None
1520 Ft.from[%N fl S 250 Ft.from r1 W
-For replacement wells only—distance and direction From old well to new well 9. Proposed Well Driller License#(optional): N/A
feet direction ii.10. Sign or Entered Name Of Applicant(s)Or Authorized Agent
Well location address(Include City,Slate,Zip) ❑Check if well address is same as in Item 1. The making of false statements herein constitutes perjury in the second
degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S.
14668 WCR 47, La Salle, CO 80645 24-4-104(13)(a). I have read the statements herein.know the contents
thereof and state that they are true to my knowledge.
Optional: GPS well location information in UTM format You must check _GPS unit for Sign or enter name(s)of personls)submitting application Date(mm/dd/yyyy)
required settings as follows:
/�J 11
11
Format f : rig prim/ i e
it and tits
Zone must Meters I'j Eastin -'U� 05Bf Zdi
r ust b s 532325
Units Trent Miller, Saddle Butte Environmental Manager
Datum must be NA083 Northing 4451302 Office Use Only
Unit must be set to true nosh USGS map name DWR map no. Surface elev.
Was GPS unit checked for above?O YES Remember to set Datum to NAD83
5. Parcel On Which Well Will Be Located Receipt area only
(PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL)
A. Legal Description(may be provided as an attachment):
PT S2NW4 24-3-65 LOT A REC EXEMPT RE-2045 (.91R1D)
Also, please see attached deed for legal description.
B. #of acres in parcel C. Owner
WE
32.12 Saddle Butte Rockies Midstream
WR
D. Will this be the only well on this parcel? I"❑YES NO(if no list other wells)
CWCB
TOPO
E. Stale Parcel ID#(optional): MYLAR
SB5 DIV WD BA MD
4083479 02/17/2015 07:54 AM
Total Pages: 1 Rec Fee: $11.00 Doc Fee: $53.00
Carly Koppes-Clerk and Recorder,Weld County, CO
Saddle Butte Rockies Midstream,LLC.a Delaware Limited Llabitily Company
14668 County Road 47
La Salle,CO 80645
WARRANTY DEED
THIS DEED,Made on between
David J.Rochelle
of lire County of and Slate ur,grantor(s),and
Saddle Butte Rockies Midstream,LLC
whose regal address is 14660 County Road 47.La Salle,CO80645
of the County of and State of Colorado,grantee(s):
WITNESS.That the grantor(s),for and in consideration of the sum of Five Hundred Thirty Thousand And No/100
DOLLARS($530,000.00),the receipt and sufficiency of which are hereby acknowledged,have granted,bargained
sold and conveyed,and by these presents do grant,bargain,sell,convey and confirm unto the grantee(s),their heirs
and assigns forever,all the real property,together wllh improvements,If any,situate,lying and being in the County of
Weld,Slate of Colorado,described as follows:
Lot A of Recorded Exemption No.1213.24-24-2-RE 2045 recorded March 23,1998 as Reception No,2601118,
being a part of the 51/2 NW 1/4 of Section 29,Township 3 North,Range 65 West of the 6th P.M.,County of Wald,
Slate of Colorado.
as known by street and numbers:14660 County Road 47,Lo Salle,CO 8064$
TOGETHER with all and singular the hereditaments and appurtenances thereunto belonging. or In anywise
appertaining and the reversion and reversions,remainder and remainders,rants,Issues and profits thereof;and all
the estate,right,title,interest,Haim and demand whatsoever of the grantar(s),either In law or equity,of,in and to
the above bargained premises,with the hereditaments and appurtenances.
TO HAVE AND TO HOLD the said premises above bargained and described v4th the appurtenances, unto the
grantee(s), their heirs and assigns forever. And the grantor(s), for themselves, their heirs, and personal
representatives,do covenant,grant,bargain,and agree to and with the grantee(s),their heirs and assigns,that at
the lime of the ensealing and delivery of the presents,they are well seized of the premises above conveyed,had
good,sure,perfect,absolute and indefeasible estate of inheritance,in law,in fee simple and have good right,full
power and lawful authority to grant,bargain,sell and convey the same In manner and form aforesaid,and that the
same are tree and clear from all former and other grants,bargains,sales,liens,taxes,assessments,encumbrances
and restrictions of whatever kind or nature soever,except for,
for general taxes and assessments for the year2015 and subsequent years;and subject to easements,covenants.
reservations,restrictions and rights of way of record.
The grantor(s)shall and will WARRANT AND FOREVER DEFEND the above-bargained premises in the quiet and
peaceable possession of the grantee(s),their heirs and assigns,against all and every person or persons lawfully
claiming the whole of any part thereof. Wherever used herein, the plural references shall be construed to be
singular references and singular references shall be construed to be plural references where the context requires
and all references or gander and person shall be construed to refer to the grantor r grantors identified herein
regardless of the context.
IN WITNESS WHE OF, a ntor(s)have executed this deed an the dale set-forth A ve.
�i.
David J.R chelle
State of (LtLr', o
County of I):'.GY6v
On February 13,2015 before me, the undersigned a Notary Public In and for said County and State,personally
appeared David J.Rochelle personally(mown to me(or proved to me on the basis of satisfactory evidence)to be the
person(s) whose name(s)isfare subscribed to the within instrument and acknowledged to me that he/she/they
executed the same in hlslher/thejr authorized capecity(ies),and that by his/her/their signature(s)on the instrument
the person(s),or Ifl1e entity upon(lehalf of which the person(s)acted,executed the instrument.
WITNESS my ha ,` ntl;offidal sat, \
�Q Lajune Pearson
Signature: rtae cPrw— NOTARY PUBLIC
Notary Pubr STATE OF COLORADO
Notary ID 19974014914
My Commission expiree;V
MY Commission Eryires Septerilber 18,2017
33600.14-Oeb06
COLORADO DIVISION OF WATER RESOURCES Form GWS-57(10/2013)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST.,STE 821,DENVER,CO 80203 Application Receipt No.
main:(303)866-3581 Signiawater.staie COALS
fax:(303)866-3589 Applicant's Name:
COMMERCIAL DRINKING AND SANITARY WELL WORKSHEET
Review instructions on reverse side prior to completing form.The form must be completed in black or blue ink or typed.
1. Name and Type of Business: • • (.1„ t,
2. Is this application for a new well?
❑ Yes
El No If no, is this application for a change of use for an existing well?
J Yes Permit Number of well (if applicable) C),5,1(3:i
❑ No For wells used for drinking and sanitary purposes prior to May 8, 1972, a field inspection of the well to
verify historical uses may be required. See form GWS-12 Registration of Existing Well and
form GWS-12A Statement or Hisioilcai Use for further information.
3. Is the parcel the well is located on(or will be located on)within the boundaries of a water service area(water district,
municipality,water company,etc.)or is water available from another source(such as a well)?
Q Yes If yes, indicate what this other source is -'t; ./ ( . COT O.v-i-y;O
❑ No (name of water district/supplier or well permit number)
4. Proposed type of disposal system to be used:
8 Septic tank/absorption leach field
Central System (district name:)
❑ Vault(location sewage hauled to:)
❑ Other(attach copy of engineering design)
5. Water Demand Calculations(for average factors for water demand see below)
Employees
Number of X Number of Gallons X Number of Days Employee = Gallons per Year
Employees per Employee per Day Works per Year
X J rS X :-)1("Q 5 = '!7 5 7 A
Customers
Number of X Number of Gallons X Number of Days Business = Gallons per Year
Customers per Day per Customer is Open per Year
X X = B
Other Uses (Note: No uses outside of the building would be permitted for this type of well.)
Type of Use X Gallons per Use per Day X Days per Year = Gallons per Year
X X = C
Total amount of water required:
= Gallons per Year
(A+ B+C)
= 7-7, 37,5 -
For wells used for commercial drinking and sanitary purposes on or after May 8, 1972, the total water demand cannot exceed
108,600 gallons (1/3 of an acre-foot)per year.
For wells used for commercial drinking and sanitary purposes prior to May 8, 1972,the total water demand cannot exceed 325,900
gallons(1 acre-foot)per year.
General Guidelines for Water Demand in Gallons per Day
Day Workers at Offices—15 gallons/person/day
Food Service Establishments(with toilet and kitchen wastes)—10 gallons/patron/day
Churches(does not include food service)—5 gallons/seat/day
Overnight Lodging—50 gallons/customer/day
On-Site Proprietor of Overnight Lodging (i.e. on-site owner of a Bed & Breakfast)—80 gallons/person/day
Additional water demand figures may be obtained from a private water consultant or from a technical reference on this subject.
Saddle Butte Rockies Midstream, LLC
Milton Crude Oil Terminal
Evidence of Adequate Sewage Disposal
Temporary sewage disposal, in the form of portable toilets,will be provided during construction and the
initial stages of operation. Immediately after construction is complete, a portable toilet will be provided
for truck drivers and on-site personnel.
After operations have begun, an existing,on-site septic(Weld County Permit#SP-0400192) and leach
field will be utilized and connected to the office building. Within the office building, Saddle Butte
Rockies Midstream, LLC is proposing to build two restrooms utilized by approximately 3 employees and
the occasional truck driver.
•
Scanning Cover Sheet
for
Septic Permits
Permit # SP-0400192
Permit Type: Health/Residential/New
Situs Street Address 14668 CR 47
Situs City, State, Zip
Sec/Town/Range: 24-03N-65W Application Status: Finaled
Application Date: 05/27/2004
Parcel # (12 digits) 121324200026-R7509198
Owner Full Name: ROCHELLE LORRIE & DAVE
Owner Address: PO BOX 101
HUDSON,CO 80642
Owner Phone #: 970.284.5826
Contact Name: COALSON JULIANA
Contact Address: 35735 CR 59
GILL,CO,80624
Contact Phone# 970.454.5556
Information above has been Verified in Accela by employee noted below
X May 09, 2008
Processed by: Date
Report ID: EHS00024v003 Page 1 of 1
Print Date-Time: 5/9/2008 11:04:15AM
•
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE •
GREELEY, CO 80631
• PHONE (970) 304-6415 FAX (970) 304-6411 Finaled
Permit#: SP-0400192 Sec/Twn/Rng: 24-03-65 Status: ISSUED
Owner: ROCHELLE LORRIE & DAVE Applied: 05/27/2004
Applicant: COALSON JULIANA Issued: 06/91/2004`
im
Permit Type: RNEW C=Conercial,R=Residential+NEW, REPair,VauLT Finaled: 7/ 0/07
Parcel #: 1213-24- - - I
Location: 14668 CR 47 .
Legal Description: 6-15151k,
�� � 'I
Installer: �,�y� lu-Ul,uw
Description: MODULAR ON CRAWL
Commercial: N Residential:Y Acres: 35
# 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 #: 203955
Percolation Rate: 31.3 Limiting Zone: 8 ft 0 in Description:
% Ground Slope: 0 • Dir: Soil Suitable: (Y/N) Y
Engineer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N). N
•
Minimum Installation Chambers
Septic Tank: 1000 gallons Absorption Trench: 1035 square feet
or Absorption Bed: 1350 square feet
Actual Installatio
Septic Tank: gallons Absorption Trench: I, square feet )
Absorption Bed: square feet •
Design Type: UU1 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,Title 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 non transferable and non refundable. 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 eld County D rtment of Public Health and Environment.
x q11 1l/-I
Environmental Health Specialist ate
Form:S_FINAL
2l
lu
t3 V_ is-
31( C6- 11 44thc
• • • FOR OFFICE USE ONLY
(� p ISDS APPLICATION FLOW SHEET
Owner Per kP.QQ,/ LOLfiP Dive. Permit#: St'-0 COICP)
Location: 14( o Cg— '1 I Legal Description., a y 3 ��
Date. By Comments
Parcel Number Received telk9 /MS
rm
Infoation Form Complete �
AuthodzadonForm Received •
Map Drawing Received J
Rood Plain? YesR10 N
Site Inspection 0at* ( •1.OL( ,,e4„)
Engineer Design? Yes/No
Date Engineer Design Received
Customer Notified? YesJNo �—
Date Staff Approval Sent
Date Staff Approval Redd
Perc Data Entered in Computer f0'* i
Date of HON Approval •
Eng Approval Latter Sent
. (Loner,Permit,80H Review) •
Date of Final Inspection
Eng Final Inspection Letter Redd
Variances Needed?Yes/No
Sent Variance Slaff Approval
thetd Variance Staff Approval
•
Variance SOH Approval
r
Variance BON Approval Sent
(Variance,SOH Review)
Additional Conanentt
M:WflVlRONM r,,-HEALTH SERVICFSSEAl1OFLOWS)iEr
•
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, COLORADO 80631
PHONE(970) 304-6415 FAX(970) 304-6411
Permit#: SP-0400192 Sec/Twn/Rng: 24-03-65 PERMIT
Owner: ROCHELLE LORRIE & DAVE Applied: 05/27/2004
Applicant: COALSON JULIANA
Permit Type: RNEW C=Commercial,R=Residential + NEW,REPair,VauLT
Parcel#: 1213-24- - -
Location: 14668 CR 47
Legal Desc:
Description: MODULAR ON CRAWL
Commercial: N Residential:Y Acres: 35
# 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 Number: 203955
Percolation Rate 31,3 Limiting Zone>e, ft — in Description —
%Ground Slope Direction C— Soil Suitable(Y/N)
Engineer Design Required(Y/N) 1 In 100 Year Flood Plain(YIN) ki
From the application information supplied and the on-site soli percolation data the following minimum installation specifications are
required:
Chambers
Septic Tank i CY__DrD gallons, Absorption Trench /035 square feet
or
Absorption Bed square feet 4L/
In addition,this permit is subject to the following additional terms and conditions: —c. .- M, -
NOTICE
This permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the Weld County
Department of Public Health and Environment for reasons set forth in the Weld County Individual Sewage Disposal System
Regulations including failure to meet any term or condition imposed thereon during temporary or final approval. The issuance of this
permit does not constitute assumption by the department or its employees of liability for the failure or inadequacy of the sewage
disposal system.
This permit is non transferable and non refundable. Before issuing final approval of this permit 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 is contingent upon the final inspection of the completed system by the Weld County
Department of Public Health and Environment.
,/
Form:s_PERMITN Envir nmental Health Specialist Date
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH&ENVIRONMENT
1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE: (970)304-6415 FAX: (970) 304-6411
WEBSITE: WWW.CO.WELD.CO.US
Copy Reprinted on 05-27-2004 at 16:23:38
APPLICATION/RECEIPT
Initials: MS
Permit Number: SP-0400192 Receipt Number: HAP-04193
05-27-2004 Amount: $400.00 Payment Method: Check Notation: 4083
Owner Name: ROCHELLE LORRIE & DAVE •
Applicant Name: COALSON JULIANA
Parcel Number: 121324
Location: 14668 CR 47
Account Code Description Amount
•
2560-41400-4221-4203 • New Septic Permit $400.00
2560-41400-4221-4203 Repair Septic Permit $0.00
2560-41400-4221-4203 Vault Permit $0.00
2560-41400-4221-4203 Variance Request $0.00
•
Description: MODULAR ON CRAWL
Commercial: (Y/N) N Residential: (Y/N) Y Acres: 35
Number of Persons: 2 Basement Plumbing: (Y/N) N
Number of Bedrooms: 3 Bathrooms: Full - 2 3/4: 0 1/2: 0
Water Public: (Y/N) N Water Supply:
Water Private: (Y/N) Y Cistern: (Y/N) N Well: (Y/N) Y Well Permit Number: 203955
• TERMS AND CONDITIONS
A permit fee,as set by separate ordinance 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 aA deemed necessary
to insure compliance with rules and regulations adopted under article 10 title 25,CRS as amended.The applicant certifies 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 res the denial of the application or revocation of any permit granted,and in legal action of perjury as provided by law.
x AIL( aA.Na-h 5-a7- o`{
Own / pplicant Date
Form:RT_ APP
Ili: (T1411/4)t
SEPTIC INFORMATION FORM
' To obtain an I.S.D.S. permit, one must file an"application for Individual Sewage
Disposal System"at the Weld County Environmental Health Services office and
11 O pay the application fee. Aa"repair"fee shall be charged for the expansion,
replacement,or repair of an existing system. The following information must be
COLORADO! provided on the septic information form.
PARCEL NO.: \ 1 3 Q 00 0001 (12 DIGIT NUMBER)
CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT(970)353-3845 EXT 3650
PROPERTY OWNER: L-O VT t Q. C k-YDk x)P P 0ck e Q AR
MAILING ADDRESS: Po p,,,,, lfl l CITY 4ucf 4S1CO ZIP
HOME PHONE: (_____S WORK PHONE ( ) FAX ( )
APPLICANT NAME: ��Lt_AkCti'.tna,Con Z5\--..., )
MAILING ADDRESS: 35-13C- tC.e S9 CITY I ` STC,,O ZIP akin. 'I
HOME PHONE: ( ) WORK PHONE( ) L45y F55( ,FAX ( )
LEGAL DESCRIPTION PTS Va. PT kkASEC Q.y TWN 1\-) RNG( 5(k) ACRES <35
SUBDIVISION RC Qc `i5 LOT A BLOCK FILING
DESCRIPTION OF BUILDING(EX:HOUSE,MOBILE HOME, r ODULA.:,SHOP,OFFICE) Cr‘ 'A a_
7? SITE ADDRESS Tc xc.a 1.oG12 q-7 /4 LL ern \cna ,%9 nn E Sick-Q-
Kli DIRECTIONS TO SITE 1 k-,-(p(De t.c C,2
NEW PERMIT REPAIR PERMIT VAULT PERMIT
00. • $400 $ 150
IF OBTAINING A • ' I' PERMIT, PLEASE LIST PREVIOUS OWNERS OF THE PROPERTY:
FLOOD PLAIN YES NO CENSUS TRACT /8' 00
RESIDENTIAL Y /NO COMMERICAL YES/• O
NUMBER OF PERSONS o) BASEMENT PLUMBING YES/ O
NUMBER OF BEDROOMS 3 BATHROOMS: FULL a Y4 IA
WATER SUPPLY: PUBLIC YES/e NAME 10A PRIVATE ES NO CISTERN YES / O WELL ES /NO WELL PERMIT litatf2R 5S
PERC HOLES MARKED FOR INSPECTION BY SPECIALIST YES
FROM :CORLSON CONSTRUCTION INC FAX NO. :9704545557 May. 26�y 2004 10: 171M P1
J�O 'l0 f
}t� a DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
11(
`E 1555 N. 17t"Avenue
Greeley, o w 80631
WEBSITE: wa��s.co.�celd.cn.us
ADMINISTRATION: (970) 304-6410
C FAX: (970) 304-6412
will PUBLIC HEALTH EDUCATION& NURSING: (970) 304-6420
FAX: (970) 304-6416
O ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415
COLORADO FAX: (970) 304-6411
AUTHORIZATION FORM
RE: PERMIT APPLICATION LS.D.S. EVALUATION
® SALE OF PROPERTY El WATER SAMPLE
L_.s.,3 lA ' /tvt �llrepresent (�O�s t-Ine3\` for the property
located at
(A�e'i lop tiO C. 1 (Owner)
LEGAL DESCRIPTION: SEC a'4 TWN 3 N RNG Co 5
SUBDIVISION NAME: LOT rl BLK
I can be contacted at the following phone 4's: Home
Work all 70 (454( 555(p
Fax #
The property owner can be contacted at the following phone 4's Q �7
Home deg 5E31224°
Work
Fax
•
Correspondence mailed to(only one): ,.Agent/Applicant
/_ El Property Owner
DATE 5— t349 - bq
OWNER'S SIGNATURE i5\--S\ ,
PLEASE DRAW A MAP TO YOUR PROPERTY.
N lJG2- 5ct
I
(NIcbSwce cfl
Er we rtee
0 3-
We12 ,3O or 2
✓.' . •
SOIL ANALYTICS AND FOUNDATION
ENGINEERING, INC.
MICHAEL A.LAIRD,P.E.,PRESIDENT
CONSULTANTS IN CIVIL ENGINEERING
LAKEWOOD,COVIRGINIA
O GRADOo AVENUE
Ye 6- 8 JOB #4246
• 303-988-9229 October 22, 2003
Mr. Dave Rochelle
Post Office Box 101
• Hudson, Colorado 80642 Telephone: (H) 970-284-5826
(C) 970-405-5984 (Lorrie)
Subject: Percolation tests for a proposed residence to be located on'a 35-acre
parcel with the address 14668 WCR 47, Weld County, Colorado.
Legal description: Lot A of Recorded Exemption No. 1213-24-2-
RE2045, a part of the S/2 NW/4 Sec 24, T3N, R65W.
Dear Mr. Rochelle:
This report presents the results of a percolation study which was initiated on
October 7,2003 at the above captioned property.
Percolation tests were performed at the subject site in accordance with the
Public Health Service Publication No. 526, "Manual of Septic Tank Practice"
and Weld County requirements. Refer to Figure 1 for the locations of the test
borings.
This report must be submitted to Weld County and the necessary approval
obtained prior to beginning construction.
The Robert A. Taft Sanitary Engineering Procedure, which is contained in the
"Manual of Septic Tank Practice", was followed for the hole preparation, soil
saturation, rate measurement, and percolation rate calculation.
Site conditions consist of a slightly sloping area with a cover of dry native
grass and weeds. The ground slope in the proposed leaching field area is
about 0.0 to 0.5 percent towards the south-southeast. It is estimated that the
leaching field area is located 0.7 to 1.0 feet below the lowest area of the
homesite.
Mr.Rochelle -2- October 22, 2003
Soil Analytics Job #4246
The results are as follows:
Percolation Test Hole #1 - 38" deep (silty sand)
Percolation rate = 32 minutes per inch
Percolation Test Hole #2 - 33" deep (silty sand)
Percolation rate = 23 minutes per inch
Percolation Test Hole #3 - 42" deep (silty sand)
Percolation rate = 20 minutes per inch
Percolation Test Hole #4 - 30" deep (silty clayey sand)
Percolation rate = 50 minutes per inch
Profile Test Hole
0'-0" - 2'-3" TOPSOIL (SM-SC), firm to very firm, about 1 foot of plant
stabilized wind deposited silty sand over sand-clay with a
hardpan at some locations, brown, moist.
2'-3" - 7'-0" SILTY SAND (SP-SM), medium firm, medium to mostly
fine grained sands with a moderate to low silt content,
light yellowish brown, slightly moist.
7°-0°' - 9'-0" CLAY (CL-CH) very stiff, low to medium plasticity, with
medium to coarse sand particles, tan-brown, moist.
9'-0" - 10'-0" CLAYSTONE BEDROCK hard, low to high plasticity,
contains impurities of sandstone and iron and thin lignite
seams, gray-brown, moist.
NOTES: No free groundwater was encountered by or formed in the Profile
Test Hole during the study.
The results given above indicate that a conventional leaching field is
acceptable in the area tested and may be used if it is installed in the
recommended depth zone and if careful attention is given to the
Mr.Rochelle -3- October 22, 2003
Soil Analytics Job #4246
recommendations contained herein. The field must be located exactly over
the test area since different results will be encountered in other areas of the
property. We recommend that the absorption area contain a minimum of
450 square feet of leaching area per bedroom. This recommendation is based
on the following formula:
QN`
A = 1.6
5
Where A = minimum absorption area per bedroom in square
feet
Q = estimated design daily sewage flow per bedroom in
gallons (225)
t = design percolation rate in minutes per inch (39)
1.6 = factor for increase in size due to garbage grinder and
automatic clothes washer
5 = empirical value
In addition, we recommend that the field area contain no less than 1,350
square feet of leaching area, assuming a three bedroom residence.
The sizing requirements and formula used by Weld County may vary from
those given above. Weld County authorities must be properly consulted for
the actual size requirements and authorization to proceed.
The excavation for the leaching field should be made at least 33" deep below
groundlevel in order to assure complete removal of the upper less permeable
topsoils. However, due to layered subsurface conditions, the depth of the
excavation should not exceed a maximum depth of 42" in order to provide
adequate permeable soil cover over underlying less permeable clay materials.
A longer than wide field layout should be used to avoid exceeding the
maximum recommended depth.
After the lower foot of drain gravel containing the distribution laterals is
installed, an overlaying backfill of loamy silty sand materials should be placed
Mr.Rochelle -4- October 22, 2003
Soil Analytics Job ft4246
over the gravel layer for best results. Sufficient backfill materials should be
placed in all areas so that there is a minimum of 30 inches of gravel and soil
over the top of the underlaying distribution laterals in order to establish
adequate insulation against freezing. The top of the field should be mounded
above the adjacent groundlevel in order to shed precipitation and divert
surface runoff away from the site. We are opposed to any system which
inhibits the natural processes of evaporation and plant transpiration of
effluents from occurring over the top of the field.
We do not recommend the use of the non gravel chamber systems which
seem to be popular with some installers. We do not recommend chamber
systems since they are usually downsized in comparison to gravel beds in
order to be economically competitive. We are also opposed to chambers since
it appears to us that they impede the processes of evaporation and
transpiration which serve as a valuable backup to elimination of the effluents
by soil absorption. We believe chambers are popular with some installers
because they require less work to install than conventional gravel systems. If
chambers are used we recommend that they be used in a trench configuration
rather than in a solid bed layout.
It is especially important that the system be not only properly constructed but
also properly monitored. Once properly installed, the soil absorption system
itself does not require much attention as long as the waste water discharged
into it is practically free of settleable solids, greases, fats, and oils. This means
that the septic tank must be regularly checked for sludge and scum
accumulations and that the tank must be periodically pumped before there is
a danger of these materials escaping into the leaching field. All owners of the
dwelling must ultimately be responsible for the operation and maintenance
of the system. The contractor should acquaint the owners with the
importance of this responsibility.
In planning the site development, it is recommended that consideration be
given to allocating a reserve area for the construction of a replacement system
in the event that the initial system should fail. If needed, the second system
would be constructed in a suitable area at the site and would serve for waste
water disposal until the first system was either naturally rehabilitated or
rehabilitated by appropriate efforts of qualified experts in the field.
Subsequently, the rejuvenated system can be used alternately with the second
system to minimize the loading and prolong the life of both fields.
Good surface drainage of moisture away from the field area must be
constructed and maintained to prevent overloading the system. In addition,
Mr.Rochelle -5- October 22, 2003
Soil Analytics job #4246
all roof downspouts must be equipped with discharge extensions which
divert the periodic flows well away from the field area.
This report has addressed pertinent design aspects. If you should have any
questions, or if I can be of further service, please do not hesitate to give me a
call for clarification.
Sincerely yours,
Michael A. La' V.
Consulting E Ab r 10615
l l f 0 -2_Z- 0
encs/
MAL/vjs s 9�s
dN At
SOIL ANALYTICS AND FOUNDATION ENGINEERING, INC.
PERCOLATION TEST READINGS&RESULTS
TABLE I
LOCATTON: 14- b i aA We K 47, Weld Coco-11 , 0o.
CLIENT: Dave. Rochelle.
BEGINNING DATE OF STUDY: Oclobec 7, 2oo3
HOLE NO. TIME INTERVAL WATER DROP PERC RATE
REMARKS
(DEPTH) MINUTES INCHES MIN/INCH
30 1,40
30 I.20
30 1. 10
I
30 LCD +Hz0
(3q") 3c 1.20
30 I. (o
30 ban
?d 646-
30 I. g5
30 1.60
3o ISO 4/4 Le
(3 3') 1.70
30 1.45
30 1.4 f 1♦ o
30 1.40
30 (.30 23
30 2rQ7
30 I, SO
R3 30 1.55 4Nzo
30 1.90
C42') 30 1.5o 44410
30 ►00
30 1.50 20
30 1.25
3o I.oS
P ¢ be,
(30g30 _
30 O.Sa
30 6.75 -} b1,.0
30 :75
30 0.70
36 0.40 56
Average Percolation Rate = 3 7-4-234-240 4 0 _ 32.
mpi
Recommended Design Rate =31 mpi
SOIL ANALYTICS, INC. PERCOLATION REPORT ATTACHMENT
PROFILE HOLE LOG
0 1 P5O'L(5M-5C), flan fo Very -firm,about I -icorof Plan+
sfabiliwed wind deposited sill, sand over sand.Clay
1 with a hardpan at sane locatransr browny mast.
2 '
SILTY SAND (5P SMc, mediurn frrnr rnedlurri to
3 112 mos+ly 47ne grained.. sands with a moderate_ -fo low
1 silt content, fight clellow►sh brown,slighflc Moist.
4 Sample a passing #'200= 33.6
5
6
7
CLAY (CL-C14), very stiff, low to medium_plastici y,
8 with medium to coarse sand particles, fan- brown,
LEIQ / moist.
9
CLAY5ToNE BEDRoCK, hard, low lo high plastiutyx
10 ill" contains Impurities of sandstone and iron and 'Min
1, nice seams , gray-brown, moist.
11
12
13
14
15 r
CLIENT: j)a Ve Rochelle
(35 acre Parcel @ 1440 WC2. 47, Weld Coank, do.)
JOB: 4 146
SOIL ANALYTICS AND FOUNDATION ENGINEERING, INC.
ATTACHMENT TO PERCOLATION INVESTIGATION FOR A PROPOSED SEPTIC
SYSTEM SITE SHOWN ON THE ACCOMPANYING TEST HOLE LOCATION PLAN
Our Client: Dave Roche lle
Beginning Date of Percolation Investigation: October 7, .OO3
GENERAL CONSTRUCTION RECOMMENDATIONS
Tn view of layered sgLsurface cordtttansv the excavation choald have,
a minimum depth of 33 " to remove upper less permeable topsoils with
a clay .centeni 2nd fa eKioose peruea.ble. sands a+ the base, qI the
same -time , Me excavation should n4 exceed a depth of 42`' in order to leave
a reset #hie.Kncss of Sari+( soils in place over low pert rate clay coils
which we. encountered at abod 7 feet,
PLACEMENT OR LOCATION OF THE DISPO A AR A
The cen,,((erline of the disposal area should be placed over a line drawn between F 1
and I%3 . Generally, the disposal area should symmetrically cover the test holes or be
located over or within their perimeter outline. Any exceptions are listed below under
'Additional Notes.'
DEPTH OF EXCAVATION
t
Minimum recommended depth on low side 331
Maximum recommended depth on high side 4Z/I
List any upper suspected or known poor perc layer which should be completely excavated and
removed from the bottom of the excavation:
Material Topsail
Depth of this material in Profile Hole 2 '-3"
Is the material believed to be deeper at other locations? Cows b e 6't deeper
Maximum anticipated depth of the material 33 '1 P
•
ADDITIONAL NOTES
Location 14668 WCR 417, weld County , Colorado.
N
GR
.,, AVcL
ROAD X
(WCR 47)
FTB N2
X
PROPOSED HOUSE
P-4
•
PTH • • FTB#1
• P-1
•
P-3
X P-2 LX_X -X X X
FENCE CORNER _ FENCE ALONG PRESUMED
(SW PROPERTY _ SOUTH PROPERTY LINE
CORNER?)
14668 WCR 47, WELD COUNTY, COLORADO
LEGAL DESCRIPTION: LOT A OF RECORDED EXEMPTION
'NO. 1213-24-2-RE2045, A PART OF THE S/2 NW/4 SEC 24, T3N, R65W
TEST HOLE LOCATIQN PLAN
1" = 100'-0"
FIGURE 1
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In N M Offal VON 1•13tl.14 CO P 0 0 U
Saddle Butte Rockies Midstream, LLC
Milton Crude Oil Terminal
Evidence of Adequate Water Supply
Bottled water will be provided during construction and during the initial phases of operation of the
Milton Terminal. At some point after the completion of the terminal, an existing domestic water well
located on the property will be utilized for use in the office building only. At that time, the State of
Colorado Division of Water Resources will be consulted to convert the well from domestic to commercial
use for office and sanitary use, for approximately 1/3 to 1/2 an acre foot of water per year(100,000 to
162,500 gals/yr). The existing well is identified with the State as Well Permit# 203955. Receipt#
0415328.
WATER SUPPLY INFORMATION SUMMARY
Section 30.28-133,K C.R.S. requires that the applicant submit to the County,"Adequate evidence that a water supply that
is sufficient in terms of quantity, quality and dependability will he available to ensure an adequate supply of water.
1- NAME OF DEVELOPMENT AS PROPOSED
En
, 'M_InrJ 1,1r
2. LAND USE ACTION _� .�-. 'l t J�l., on ltit v_ 1 .
3. NAME OF EXISTING PARCEL AS RECORDED `�r, ,r , ii I iLEt -,
SUBDIVISION FILING BLOCK LOT
4. TOTAL ACREAGE .h 5. NUMBER OF LOTS PROPOSED 4 PLAT MAP ENCLOSED U YES
6. PARCEL HISTORY • Please attach copies of deeds, plats or other evidence or documentation.
A. Was parcel recorded with county prior to June 1, 1972? U YES L.J NO
B. Has the parcel ever been part of a division of land action since June 1, 1972? U YES J NO
If yes, describe the previous action
7. LOCATION OF PARCEL Include a map deliniating the project area and tie to a section corner.
}A OF ! 1/4 SECTION .71 TOWNSHIP UN US RANGE (,:': DEEW
PRINCIPAL MERIDIAN: El 6TH 0 KM. 0 UTE 0 COSTILLA
8. PLAT - Location of all wells on property must be plotted and permit numbers provided.
Surveyors plat O Yes O No If not, scaled hand drawn sketch 0 Yes 0 No
9. ESTIMATED WATER REQUIREMENTS - Gallon.per Day or Acre het per Year 10. WATER SUPPLY SOURCE
El.EXISTING 0 DEVELOPED o NEW WELLS
•
WELLS SPRING PROPOSED AOUFERS•ICHECX au
HOUSEHOLD USE # of units GPD AF WELL PERMIT NUMBERS 0 MIME a lREn ARAPAHOE
0 UREA OAWSON 0 LOWER AMIAHOE
COMMERCIAL USE # of S.F. GPD )(7 AF 117 0,5 Y LiIUWEII DAWsOH ❑UMMIE FOX HILLS
OMEA ❑UA.OIA
❑OTHIII
IRRIGATION # of acres GPD AF
STOCK WATERING # of head GPO AF O MUNICIPAL
❑ ASSOCIATION WATER COURT DECREE CASE NO.'S
OTHER - GPO Al ❑ ANY
U DISTRICT
TOTAL GPO AF NAME
LETTER OF COMMITMENT FOR
SERVICE 0 YES 0 NO
11. ENGINEER'S WATER SUPPLY REPORT O YES 0 NO IF YES, PLEASE FORWARD WITH THIS FORM. IThe m.y be reeui..d bel.n our review is compleudj
12. TYPE OF SEWAGE DISPOSAL SYSTEM
3.SEPTIC TANK/LEACH FIELD 0 CENTRAL SYSTEM DISTRICT NAME
❑ LAGOON O VAULT LOCATION SEWAGE HAULED TO
❑ ENGINEERED SYSTEM tAtt.rh.copy of engineering deeignl O OTHER
State of Colorado Water Resources - View Well Details: Receipt 0415328 Page 1 of 1
] IAr-),L) Di‘I/ c) u1
Well Constructed Help I last Rebesln 1/14/2D1S Lx 01'3,1 AM
Receipt: 0415328 Division: 1
Permit#: 203955-- Water District: 1
Well Name/ it: County: WELD
Designated Basin: Management District:
Case Number:
WDID:
[-] Applicant/Owners History
Date Range Applicant/Owner Name Address City/State/Zip
Unknarm•Present SARCHtI DLNNY VI&LAVADA M 21581 WCR 30 HUDSON,CO 80642
[-] Location Information
Approved Well Location:
Q90 Q160 Section Township Range PM Footage from Section Lines
SW NW 74 3.ON 65.0W Sixth 1570 N 250 W
Northing(µTM yp 44515/9.7 Fasting(uTM x): 5,7321..
Location Accuracy: Spotted from section lines
Physical Address Subdivision Name
City/State/Zip Filing Block Lot
Parcel ID: Acres in Tract: 35
[-] Permit Details
Date Issued: 0/716/1997 Date Expires: 07/16/1999
Use(s): DOMESI IC Aquifer
Special Use:ISSUED UNDER PRESUMPTION 35-IIA (5):
U3RAMIE FOX HD I S
Area which may be irrigated:
Maximum annual volume of appropriation:
Statute:
Permit Requirements: Totalizing Flow Meter Geophysical Log Abandonment Report
No No No
Cross Reference Permit Number Receipt Description
Permit(s):
Comments:
I1-1 Construction/Usage Details
Well Construction Date: 10/19/1998 Pump Installation Date: 12/07/1998
Well Plugged: 1st Beneficial Use:
Elevation Depth Pei waled Casing(Top) Perforated Casing(Bottom) Static Water Level Pump Rate
580 760 580 262 13
Lic# Name Address Phone Number
Driller 827 'CHIN,II()VD PO BOX 639 HENDERSON,CO 80640 303-655.1759
Pump 715 SPAIN,TOI419. 2011 WELD CO R0 2/Fr LUPTON,C080621 303-659.1584
Installer
I[-] Application/Permit History
Pump Installation Report Received 01/19/1999
Pump Installed 12/07/1998
Well Construction Report Received 11/02/1998
Well Constructed 10/19/1998
Permit Issued 07/16/1997
Application Received 05/06/1997
I[-] Imaged Documents
Document Name Date Imaged Annotated
12/07/2007 No
Copyright CU 2009 Colorado Division of Water Resources.All rights reserved.
Ip,i t!nl tlb !164,1 I '. l I r. 107:LI11:I rl,il: , tosir or,or7 U::iin_I er.s1 II, ,
http://www.dwr.state.co.us/wel 1permitscarch/V iew.aspx?receipt=0415328 1/14/2015
an o! "o• .PUMP INSTALLATION AND TEST REPORT ►a°snit. am
aa•n
lino STATE OF COLORADO, OFFICE OF THE STATE ENGINEER RECEIVED
1. WELL PERMIT NUMBER p 0203 955 JAN 19 1999
2 OWNER NAME(S) D191 1O 11'C-A e- ele.
Malting Address 2 S / " hoc WAtE R RESOURCES
City, St Dp /` � Cpl., STATEENOINEER
�r CALO.
Phone (303 )/, S'- O/L/
3. WELL LOCATION AS DRILLED 1/4 !1)t.&) 1/4, Sea Twp. Range d,.5 l3
DISTANCES FROM SEC. ONES: Sea Ma
/5:-.70 ft from /1/ Sac Une. and SO R from
SUBDIVISION: °sort a swigt_ BL K FIUNG(UNII)
STREET ADDRESS AT WELL L CATION: 5/i e i.�.V sa/V. C o cep/Un
4. PUMP DATA:TYpe U�, Instillation Completed _L / 1 ) 9
Pump Manufacturer at/, J , Pump Model No. d S 4/./9,7J -Sa
Design GPM /O et RPM ? r6 0 , HP 42 , vans X30 , Full Load Amps /J -z
Pump Intake Depth .So V _Feet, Drop/Column Pips Size /y Inches, lend pa ri/ a n/n-I p.�a
ADDITIONAL INFORMATION FOR PUMP GREATER UT 50 GPM; 7 v
TURBINE DRIVER TYPE O Electric U Engine Other fr/
Design Head feet, Number of Stages , Shaft site itches.
S OTHER EOUIPMENT;
Airline Installed O Yu PING, Ortice Depth ft. . Monitor Tube installed Q Yes[,ZNo, Depth ft.
Flow Meter Mfg. y'9 P�Meter Serial No. /1//A-
Meter Readout Gallons, Q Thousand Gallons, u Acre feet,O Beginning Reading
6. TEST DATA: O Cheek bolt If Test data Is subm Supplemental Form.
Date a 52
Total Wel Depth 5;190 / Time nu« •
Static Level ,-2 ' Rate (GPM) 1,2
Data Measured .2. 4 ! Pumping Lvt 2�(cs'
1. DISINFECTION: TYPeOrtt.r,u r 33 /at j n e Amt Used c s c iccn/ielin ,Sid Wain r
& Water Quality analysis available. 0 Yes [,iiiNo
9. Remarks
0. I have read the statements made herein and know the contents thereof, and that they are true to my knowledg
(Pursuant to Section 24-4.104 (13)(a) C.R.S., the making of false statements herein constitutes perjury in the secor
degree and Is punishable as a class 1 misdemeanor.)
CONTRACTOR Spatn '4�S envies Inc. Phone 003 ) 659-1584 tic. No.715
Malang Address 2021 WO? 27 Ft. Lupton, Co. 8062/
Name/Tlue (Plena type Of print) 5(pnature Date
Torn W. Spaut PneaLdent .,sera cr3; tic96v r+ w l-I f 1 \ q �.
CWS31`°a"t"a / WELL CONSTRUCTION AND TEST REPORT For Office Use only
1094 STATE-OF COLORADO, OFFICE OF THE STATE ENGINEER RECEIVED
1. WELL PERMIT NUMBER ,nletss NOV 0 21998
2. OWNER NAME(S) David Rochelle
Mailing Address 129 S. 11th Ave. WATER RESOURCES
City, St. Zip Brighton, Co. 80601 STn CONOINEER
Phone ( 303 ) 659-0161
a WELL LOCATION AS DRILLED: SW 114 NW 1/4, Sec. 24 Twp. 3 N , Range 65 W
DISTANCES FROM SEC. LINES:
1520 ft. from N Sec. line. and 250 ft. from W Sec. line. OR
(norm or sauml - 'east or west
SUBDIVISION: LOT_BLOCK FILING(UNIT)
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION ft. DRILLING METHOD Rotary .
DATE COMPLETED 10-19-98 . TOTAL DEPTH 580 ft. DEPTH COMPLETED 580 ft
5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft) To (ft)
Depth Description of Material(Type,Sae, Color,Water Location) 8 3/4 0 25
0-10 Brown sand 10 1/4 25 580
10-27 Brown clay
27-80 Brown sandy clay .
80-190 Blue shale/layers of coal 7. PLAIN CASING
190-260 Blue shale/sandstonei ledges OD (in) find Wall Size From(ft) To(ft)
260-580 Fox hill sands Water 6 5/8 Steel .188 +1 25
4 1/2 Steel .188 25 260
PERF. CASING: Screen Slot Size:3/16" torch cuts
4 1/2 Steel .188 260 580
B. FILTER PN/AACK 9. PACKER PLACEMENT:
Material Type cement basket
Size placed at
- - Interval Depth 260'
10. GROUTING RECORD:
Material Amount Density Interval Placement
REMARKS: 5% Bentonite, 2% calcium chloride cement 210gal 7ga1/bag 0-260 pump
added to cement 30 bags
11. DISINFECTION: Type Granular Chlorine
r' Amt. Used
a3�cups
ndissolved innh5 gallons of water
12 WELL TEST DATA: ❑ IRcbOt it T es[uaIili stRi iiRec ortAhMV. aWS 95uigKmetda7 Oa Test
TESTING METHOD Air .
Static Level 262 ft Date/Time measured 10-19-98 10:00am , Production Rate 15 gpm.
Pumping level Jetting ft. Date/Time measured , Test length (hrs.) 6.0hrs
Remarks at 580' .
13. I have read the statements made herein end know the contents thereof,and that they are true to my knowledge. [Pursuant to Section 244104 (13)(a)
C.R.S.,the making of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.]
CONTRACTOR John's Drilling Inc. Phone ( 303 ) 423-5246 Lic. No. 827
Mailing Address 20nn Indiana St resat Trvada, In 20007
Name/Title (Please type or print) Signature Date
Lloyd John Owner/President � 4.."ici-1--- 10-03-98
INSTRUCTIONS FOR WELL CONSTRUCTION AND TEST REPORT 4- Rey. Oct. 94
The report must be typed or printed in BLACK INK All changes on the form must be initialed and dated. Attach
additional sheets if more space is required. Each additional sheet must be identified at the top by the well
owner's name, the permit number, form name/number and a sequential page number. Report depths in feet
below ground surface.
This form may be reproduced by photocopy methods, or by computer generation with prior approval by the
State Engineer. Photocopy reproductions must retain margins and print quality of the original form.
The original form must be submitted to the State Engineers Office within 60 days after completing the well or
7 days after the permit expiration date, whichever is earlier.
A copy of the form must be provided to the well owner. . _
1. Complete the Well Permit Number in full.
2. Fill in Name and Mailing Address of Well Owner where correspondence should be sent.
3. Complete the blocks for the actual location of the well where drilled. If the owner has more than one well
serving this property, provide the identification (Owners Designation) for this well. DO NOT USE THE
OWNER SUPPUED LOCATION unless a survey has been provided. For wells located in subdivisions
the lot, block and subdivision information must also be provided.
4. Report the ground surface elevation in feet above sea level if available. This value may be obtained from
a topographic map. Describe the drilling method used to construct the well and the date completed.
Indicate the total depth drilled and the actual completed depth of the well.
5. Fully describe the materials encountered in drilling. Do not use formation names unless they are in
conjunction with a description of materials.
Examples of descriptive terms include:
Grain size-Boulders, gravel, sand, silt, clay.
Hardness-Loose, soft, tight, hard, very hard.
Color—All materials. Most critical in sedimentary rock.
Depth when water is encountered (if it can be determined).
6. Provide the diameters of the drilled bore hole.
7. The outside diameter, kind, wall thickness and interval of casing lengths.must be indicated.__ _
8. Indicate the type and size of fitter (gravel) pack and the interval where placed.
9. Indicate the type and setting depth for any packers installed.
10. The density of the grout slurry must be reported and may be indicated as pounds per gallon, gallons of
water per sack, total gallons of water and number of sacks used, etc. Specify the grout placement
method, i.e. tremie pipe or positive displacement. The percentage of additives mixed with the grout
should be reported under remarks.
11. Record the type and the amount of disinfection used, how placed and the length of time left in the hole.
12. Report well test data as required by Rule 10.7. Spaces are provided to report all measurements made
during the test. The report should show that the test complied with the provisions of the rules. if a test
was not performed explain when it will be done. If available, report clock time when measurements were
taken.
13. Fill in Company Name and Address of Contractor who constructed the well. The report must be signed
by the licensed contractor responsible for the construction of the well.
Form No. • OFFICE OF THE STATE ENGINEER
GWS-25, COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St,Denver, Colorado 80203
(303) 866-3581
LIC
WELL PERMIT NUMBER 203955
APPLICANT DIV. 1 CNTY. 62 WD 1 DES. BASIN MD
Lot: Block: Filing: Subdlv:
APPROVED WELL LOCATION
WELD COUNTY
DENNY W & LAVADA M SARCHET SW 1/4 NW 1/4 Section 24
21581 WCR 30 Twp 3 N RANGE 65 W 6th P.M.
HUDSON CO 80642-
DISTANCES FROM SECTION LINES
(303)536-4613 1520 Ft. from North Section Line
250 Ft. from West Section Line
PERMIT TO CONSTRUCT A WELL
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 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 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)(II)(A) as the only well on a tract of land of 35 acres described as the
SW1/4 of the NW1/4 Section 24,Township 3 North, Range 65 West, Sixth Principal Meridian.
4) The use of ground water from this well is limited to ordinary household purposes inside not more than three single
family dwellings, fire protection, the watering of poultry, domestic animals, and livestock on farms and ranches,
and the irrigation of not over one acre of home gardens and lawns.
5) Production from this well is restricted to the Laramie Fox-Hills aquifer which corresponds to the interval between
255 feet and 580 feet below ground surface. Plain casing shall be installed and grouted to prevent production
from other zones.
6) The maximum pumping rate shall not exceed 15 GPM.
7) The return flow from the use of the 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.
8) This well shall be constructed not more than 200 feet from the location specified on this permit.
Note: To insure a maximum productive life of this well,perforated casing should be set through the entire
producing interval of the approved zone or aquifer indicated above.
Note: The ability of this well to withdraw its authorized amount of water from this non-renewable aquifer
may be less than the 100 years upon which the amount of water in the aquifer is allocated, due
to anticipated water level declines.nprtM
•
APPROVED �
RAN 7,lQ/ •
Stele Engineer gy r y�l C�
Receipt No. 0415328 DATE ISSUED JUL 16 1997 EXPIRATION DATE JUL 16 1999
, ...r •- - O - r T
COLORADO DIVISION OF WATER RESOURCES RECEIVED
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST., RM. 818, DENVER CO 80203 JUN 1 91997
phone - info: (303) 866-3587 main: (303) 866-3581
RESIDENTIAL *(Nate:You may also use this foes,to apply for livestock watering) Water Well Permit Arip " tion
Review instructions prior to completing form Must be completed in black ink or typed
1. APPLICANT INFORMATION 6. USE OF WELL (check appropriate entry or entries)
Name of applicant See instructions to determine use(s)for which you may quality --
Denny W. & Lavada M. Sarchet ❑'A. Ordinary household use in one single-family dwelling
(NO outside use)
Mailing Address
21581 WCR 30 WKS. Ordinary household use in 1 to 3 single-family
dwellings:
Number of dwellings: r,,,p
City State Zip code a Home garden/lawn irrigation, not to exceed 1 acre:
Hudson Colorado 80642 area irrigated
Tdmhonc Number(include area code( gu2(. 9 1 +— O sq. ft.1�acre
303-536-4613 p,e VeAN/thUS)flRk Ei Domestic animal watering -- (non-commercial)
a,3 6.29—ogit-
2. TYPE OF APPLICATION (check applicable box(es)) O C. Livestock watering (on farm/ranch/range/pasture) _
2 Construct new well 0 Use existing well 7. WELL DATA
❑ Replace existing well ❑ Change/ Increase Use M.ximn pw,pina roc. r Annual unonnr roa withdrawn
v
❑ Change (source)aquifer O Reapplicationletrpind permit) 15 gpm 3 +— acre-feet
❑ Other: Tow depth /LOW
3. REFER TO (if applicable): from 250 — 580 feet Laramie Fox—Hills
Water court case a Pemlfit a 8. TYPE OF RESIDENTIAL SEWAGE SYSTEM
g1 Septic tank / absorption leach field
Verbal R Monitoring hole acknowledgment A O Central system (None existing at present
-VE- MH- District name: will be built to Weld Co.
Well name or 7 ❑ Vault Standards)
Location sewage to be hauled to:
4. LOCATION OF WELL O Other (attach copy of engineering design)
County Quarter/quarter Quarter 9. PROPOSED WELL DRILLER (optional)
WELD SW % NW y, Name License number
Section Township N or S Range E or W Principal Meridian to be determined
24 3 tfy C1 65 0 pq 6 th PM 10. SIGNATURE of applicantls) or authorized agent
Distance of well from section lines The making of false statements herein constitutes perjury
1520 ft. frornfN ❑ s 250 ft.from O E 2 W in the second degree, which is punishable as a class 1 mis-
Wel location address,it diiaent from applicant address lir applicable) demeanor pursuant to C.R.S. 24-4-104(13)(a). I have read
unnumbered Vacant Land the statements herein, know the contents thereof and state
For replacement wells only-durance and direction from old well to new We that they are true to my knowledge.
feet direction ;pow- 2 pQ
5. TRACT ON WHICH WELL WILL BE LOCATED fJ� -4./ ��/1/
A. You must check one of the following -see instructions Tills Date
❑ Subdivision: Name Owner 6-17-97
Lot no. Block no. Filing/Unit OPTIONAL INFORMATION
❑ County exemption (attach copy of county approval & survey) USGS moo name Owls map no. Surface taus
Name/no. Tract no.
❑ Mining claim (attach copy of deed or survey) Office Use Only 4l SS�
Name/no. U DIV
I3( Other(attach legal description to application)
Part SW4NW4, Sec. 24, T3N, R65W 1/4,f sSs-s S0 CO _
R. STATE PARCEL
ID# (optional): 1213 24 000 025 WD 1
C. #acres in tract D. Are you the owner of this property?
35 M/L P`or
laYES O NO (if no- see detailed inst.) My+AL BA
E. Will this be the only well on this tract? 4°eK
JAS
J(TYES ❑ NO lit other wells are on this tract •see detailed inst.) c'a4 USE MD
Form GWS-44 (11/95)
COLORADO DIVISION OF WATER RESOURCES GWS-44 FMINST (121951
DEPARTMENT OF NATURAL RESOURCES
RESIDENTIAL APPLICATIONS - GENERAL INSTRUCTIONS
There are a variety of uses for ground water in Colorado. This form (GWS-44) can be used when applying for a permit for
a new well or replacement of an existing well for the following types of uses:
ORDINARY HOUSEHOLD USE inside one single family residence (NO outside water use allowed)
OTHER RESIDENTIAL USE (sometimes referred to as "domestic" use) which may include use in up to three single
family residences, watering of up to one acre of home gardens and lawns, and watering of domestic animals
LIVESTOCK WATERING on a farm, ranch, range, or pasture
If you are applying for a NEW household use only well, or for a NEW 35+ acre residential well outside the Denver Basin or
Designated Basins of eastern Colorado, please use simplified forms GWS-49 or GWS-50. DO NOT use this form for
registration of an existing unpermitted well (Use Form GWS-12), monitoring/observation wells (Use Form GWS-46), gravel
pit wells (Use Form GWS-27), or for other uses not listed above,including -commercial, industrial, crop irrigation, municipal,
etcetera (Use GENERAL PURPOSE Form GWS-45).
FEES Applications must be submitted with the appropriate required non-refundable filing fees. The required filing fee for
most well permit applications is S60. The filing fees for replacement or deepening well permit applications for most
previously permitted residential and livestock water wells is S20.
Checks should be payable to the COLORADO DIVISION OF WATER RESOURCES.
Applications are evaluated in chronological order. Please allow approximately six weeks for processing.
APPLICATIONS must be completed clearly, and legibly in BLACK INK or typed. ALL ITEMS in the application must be
completed. Incomplete applications may be returned to the applicant for more information. Do not change or alter the
application in any way.
THE LOCATION of the well in item 4 must be correctly and accurately described. The county, quarter/quarter, section,
township, range, principal meridian, and distance from section lines must be provided.
NOTE: Distances are not necessarily the same distances as the distances from (your) property lines.
For additional assistance in describing the location of your well, review the publication entitled "How to Determine
Well Location" which was provided with your packet, or can be requested from any Colorado Division of Water
Resource office.
A LEGAL DESCRIPTION of your lot or parcel of land is required in item 5._ For tracts of less than 35 acres-approval may
depend upon whether The was created by a division of land after June 1, 1972. If your lot is less than 35 acres in size,
it would be prudent to have a deed or legal description that shows your tract was divided from a larger tract prior to June
1, 1972. This may be accomplished by obtaining a copy of a deed for the tract issued prior to June 1, 1972.
An ORIGINAL signature must be on each application. The applicant's authorized agent may sign the application, if a letter
signed by the applicant is submitted with the application authorizing them to act as agent for the purpose of obtaining a well
permit.
IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call the Division of Water Resources
Ground Water Information Desk (303-866-35871, or the nearest Division of Water Resources Field Office located in Greeley
(970-352-8712), Pueblo 1719-542.3368), Alamosa (719-589-6683), Montrose (970.249-6622), Glenwood Springs (970-
945-5665), Steamboat Springs (970-879-0272), or Durango (970-247-1845).
DETAILED INSTRUCTIONS ARE AVAILABLE UPON REQUEST
COLORADO DIVISION OF WATER RESOURCES, 1313 SHERMAN STREET, ROOM 821, DENVER, CO 80203
PHONE 303-866.3587 (Information), 303-866-3581 (Main), 303-866-3447 (Well &Water Rights Records), 303-866-3589 (Fax)
-
I
EXEMPT WELL DATA SHEET - DENVER BASIN, COLORAD
APPLICANT: SARCHET DENNY & LAVADA RECEIPT NO. 415328
LOCATION: SW1/4 OF NW1/4 OF SEC. 24 , T. 3N. , R. 65W. (1520 NSL, 250 WSL)
PROPOSED AQUIFER:
SURFACE ELEVATION: 4850 NUMBER OF ACRES IN TRACT: 40
IS PROPERTY WITHIN SERVICE BOUNDARIES OF MUNICIPALITY S . B. 5 CONSENT MAPS? N
IF SUBDIVISION IS UNDER AUGMENTATION PLAN, CASE NO. IS _ l
IF SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY THE WATER MANAGEMENT BRANCH,
INFORMATION ON SUBDIVISION OR TRACT OF LAND/SPECIAL RESTRICTIONS:
ELEVATION DEPTH TO ANNUAL
NET APPROP STAT
AQUIFER BOT. TOP SAND BOT. TOP A-F
UPPER DAWSON ---- ---- ---- ---- ---_
LOWER DAWSON ---- ---- --_- ---_ ---_
DENVER ----
---- ---- ---- ---- ----
UPPER ARAPAHOE ---- ---- -___ -_-- -___ ____ ---
LOWER ARAPAHOE ---- _-_- _ ____ ____ ____ __
LARAMIE-FOX HILLS 4271 4596 179 579 254 10.740 NT
note: E indicates location is at aquifer boundary and values may be m
* indicates the proposed aquifer.
All values are interpolated from the S.B. 5 data base assembled in Nove
IMPROVEMENT LOCATION CERTIFICATE
Lot A of Recorded Exemption No. 1213-24-24-2-RE 2045
Part of the South Half of the Northwest Quarter of Section 24,
TIN.R65W of the 6th P.M.,
County of Weld_State of Colorado
I
Ahem.C,rit x
r1s r:74; 0 P. 0 0 - _ x . --
PhtSCap N 89'33'14-E 1111.89' 7-1.'10 ---_—
PLS 123-4
Pipeline Easement 18'Barbed Wire Fence
Rec.No.2444876
/ °Unspecified Width) /0)
Approximate , r
0 \ - Buried Gas Pipeline Flowline V'
Production Facility I Concrete
d l/�' (Meter/Separator) I 20'Access Easement / Wing Walls
x i—Combustor --2-Track Rec.No.2395080 V
I----- --- - --L- -- /
d p i Cattle Guard Noble I ISR
LINE BEARING DISTANCE r 60'CMP
�" L1 N 27°4751"E 129 4T 1 "L Epstein 5-24
'''\ L2 N 06°17'18"E 45.45' Caswell
L3 N 12'51'19'W 57.13'
/ I L4 N 19°03'20"W 350.30'
I Tank \. ,_
L5 N 24°40'49'•W 236 40' l�
2' h Battery --i I L6 N 20°58'45"W 134.39'
to L7 N 08"46'30"W 142.46' \
Corrals I x LB N 40.15'23"E 71.78'
tot -' L9 N22°00'01"E 247.59'
G 410 N12°12'01"E '1901' _I 3
03 30'Road E.QW
Rk.86 P .273 I. o`�030 RFpe/p ', ._ — Gate Valve
Lot A RE-2O4_ °o
w'
_Barbed I I cob:�•GRABQy�4 14 \
N Wire Fence I s-�'� 11/3/14 *"'•ti
art. L �, 14668 WCI247 097
�I =
I Current Access Road '
9- a/kla GR 478 -' ,-48.6'x60.2' (! - — Az
267' Woad Barn "io.,451.415:1%oop`°��
yn10eurtlunllos \A
/{,pry\ Gale 2-Truk 7.9'x 26 7'Covered Patio t
-i { / on Concrete Foundation
Overhead ,/y ,r
A.( 26.T x 56.2'1 Story House on /
Single Phase, / YJJ•� Concrete Foundation w/Basement w
Pnwerline N
North �/I' Barbed Wire Fence J
--• -330 .�— -_-Propane Tank
Storm Cellar
--n Access G `- Approximate
1 Leach Field n 7
Alum rapt\ 5 89'27'51"W 1199.03'
Pt S 2211011
Pipeline Easement
Rec. No.2444876 East Neres Canal---____
0 200 400
_ I
Graphic Solo in Foot
t"=200'
PROPERTY DESCRIPTION. L E C E IN O
Lot A of Recorded Exemption No 121324 24.2 RE 2045 recorded March 23.1990 as Reception Na 2401119.
being a pan ci loo South Halt of the Northwest Quarter of Section 24. 0 Section Corner
T3N_ROW:of the 6th P AI Courtly of Weld,State o1 Colorado.
(a) Found Monument as Noted
NOTES: 5,5 Utility Pole
I GEOSURV Inc relied en Nurlli Aruanuri ntw insurance Company Caremndnew order Nu 33800 1.1 05008.
Elmcnue Carter 21.2014 for the preparation o1 this Improvement Location Candicare Plotlame Lccepllmrs per
Smedu!e a of said one cornmdrnenl are shorn heron Cuy Wire
9 Electric Meter
2 Utility connections may be located urger and through each residence and lot shown Screen for serve to adjacent
residences and lots Only those unties vism!e al the lime of Ibis survey are shown Thedomtion orandergronnd .. Telephone Pedestal
connections are unknown
O, Water Well
SURVFVOR'S STATFMFNT.
I hereby ceclry that bis Improvement Location Certificate was prepared tot Saddle Butte Rockies Midstream LLC a . Water Hydrant
Colorado Limited Liabrnty Company.that it as rot a Land Survey Plat or Irnprouernrm Survey Plat and mat it is rot he Oco Clean Out
relied upon for toe eslabl.shrnent of fence.bridling.orother lul ore rrrlprovemenl tires This wnitca!e's valet only for
use by Saddle Butte Rockies Midstream LLC a Colorado Limned Liabiky Company and describes the percers
15< Gas Valve
appearance on°Caber 19.2014
r
1r 1_ er tlyIli h.it hi t hthe"abe' b cr dial
eof are ncroah 9. 1.except Iihtynt connections
- improvements of h parcel. ill 1 M1 s r 1 deocnbed1,Iv
preMiSeS by iMprOvernenIS On any adjOirongp ses.e pt aS indicated.andha there 5no appaoartevdecce or AillY+'q cfRA
sign of any easemerh crossing or burdening anypar.&said p 1,excepta ed.
LAND SURVEYING AND MAPPING
owG GGEosuavrwemm<nresaadweene f.r.Eine l envoener.e Parrnn1ccei teen') LAFAYETTE-WINTER PARK
osnr NI n Nov onn.m .1 03.2011
us,IV naFGEs Ph 303 668 0379 Fx 303 665 6320
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