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WATER SUPPLY INFORMATION SUMMARY
Section 30.28.133,Id1. C.R.S. requires that the applicant submit to the County,"Adequate evidence that a water supply that
is sufficient in terns of quantity, quality and dependability will be available to ensure an adequate supply of water.
1. NAME OF DEVELOPMENT AS PROPOSED
Tee ScLwast-t-kop zsse9 wcie yy Kt-Pay r Co 8-b64y
2. LAND USE ACTION l A>j /MIPS j _}l a/
3. NAME OF EXISTING PARCEL AS RECORDED 105317 OOOo 2S
SUBDIVISION FILING BLOCK LOT B
4. TOTAL ACREAGE a
5. NUMBER OF LOTS PROPOSED I PLAT MAP ENCLOSED ❑ 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? 0 YES ❑ NO
B. Has the parcel ever been part of a division of land action since June 1, 1972? ❑ YES ❑ NO
If yes, describe the previous action
7. LOCATION OF PARCEL - Include a map deliniating the project area and tie to a section corner.
50 1/4 OF SF 1/4 SECTION ) 1 TOWNSHIP u N 0 S RANGE Loy 0 E ffi W
PRINCIPAL MERIDIAN: 0 6TH ❑ fi.M. 0 UTE ❑ COSTILLA
B- PLAT- Location of all wells en property must be plotted and permit numbers provided.
Surveyors plat El Yes 0 No If not, scaled hand drawn sketch 0 Yes 0 No
9. ESTIMATED WATER REQUIREMENTS - Gallons per O.y or Acre Feet per YIN' 10. WATER SUPPLY SOURCE
0 EXISTING 0 DEVELOPED 0 NEW WELLS -
WELLS SPRING PROPOSED AMUFFAe CUED ONO
HOUSEHOLD USE # I of units 3S GPO AF WELL PERMIT NUMBERS o sauna O UPPER ARAPAHOE
o UPPER UNION a LOWER ARAPAHOE
COMMERCIAL USE p of S.F. 66 GPD AF o LOFAER DAWSO. ❑LARAMIE FOX Hach
❑MVO ❑DAKOTA
❑entre
IRRIGATION N ,a of acres GPO AF
STOCK WATERING /I --& of head GPO AF 0 MUNICIPAL
❑ ASSOCIATION WATER COURT DECREE CASE NO.'S
OTHER GPD AF ❑ COMPANY
❑ DISTRICT
TOTAL GPD AF NAME
LETTER OF COMMITMENT FOR
SERVICE ❑ YES 0 NO
11. ENGINEER'S WATER SUPPLY REPORT 0 YES 0 NO IF YES, PLEASE FORWARD WITH THIS FORM. (This my 6.required before our review is compleiwJ
12. TYPE OF SEWAGE DISPOSAL SYSTEM
SEPTIC TANKREACH FIELD 0 CENTRAL SYSTEM - DISTRICT NAME
0 LAGOON 0 VAULT • LOCATION SEWAGE HAULED TO
0 ENGINEERED SYSTEM IAcrech .copy of engineering deeip.l 0 OTHER
FORM NO. . PUMP INSTALLATION AND TEST REPORT For Office Use only
MS-32
i0f84 'STATE OF COLORADO, OFFICE OF THE STATE ENGINEER RECEIVED
1. WELL PERMIT NUMBER 222327 MAR 0 3 2000
2. OWNER NAME(S) Dave & Debbie Munger WATER RESOURCES
Mailing Address 25569 WCR #44 STATE ENGINEER
City, St. Zip Kersey, CO 80644 COLO.
Phone (970 ) 339-5500
3. WELL LOCATION AS DRILLED: SW 1/4 SE 1/4, Sec. 1 7 Twp. 4 N , Range 64 W •
DISTANCES FROM SEC. LINES:
1 Q0 ft. from ciu* outniSec. line, and 31 65 ft. from slictr west?
Sec. line.
SUBDIVISION: LOT_BLOCK FILING(UNIT)
STREET ADDRESS AT WELL LOCATION:
4. PUMP DATA:Type Submersible Installation Completed .7_14_7000
Pump Manufacturer Goulds Pump Model No. 1 7 SR0 741 7 •
Design GPM 1 2 at RPM 3450 , HP 75 , Volts Tin , Full Load Amps
Pump Intake Depth 80` Feet, Drop/Column Pipe Size 1 11 Inches, Kindp v r cch 8 n
with brass i2-4 neowire
ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM:
TURBINE DRIVER TYPE: ❑Electric ❑ Engine ❑Other
Design Head feet, Number of Stages , Shaft size inches.
5. OTHER EQUIPMENT:
Airline Installed❑Yes Q No, Orifice Depth ft. . Monitor Tube Installed ❑Yes❑No, Depth ft.
Flow Meter Mfg. none Meter Serial No.
Meter Readout❑Gallons,❑Thousand Gallons,❑Acre feet,❑ Beginning Reading
6. TEST DATA: El Check box if Test data is submitted on Supplemental Form.
Date
Total Well Depth 420 Time
Static Level 20 Rate (GPM) 1 5gpm
Date Measured 2-1 4-2000 Pumping Lvl. 38
7. DISINFECTION: Type H.T.H. Amt. Used 11 ozs.
8. Water Quality analysis available. ®Yes ❑ No
9. Remarks
10. I have read the statements made herein and know the contents thereof, and that they are true to my knowledge.
[Pursuant to Section 244-104 (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 T.ash Drilling. Tnr Phone (9_74;3_844_443.6 Lic. No. 21 D-'
Mailing Address P D Rnx Sh Anil-CO 80610 0055
Name/Title (Please type or print) / Date
Edwin D. Lesh, Pres. �_�!� ~��a��
INSTRUCTIONS FOR PUMP INSTALLATION REPORT
•
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 additions{ 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.
The original and one copy of this form must be submitted to the State Engineer's Office within 60 days after
completing the well or 7 days after the permit expiration date, whichever is earlier. Another copy of the form must
be provided to the well owner.
If this form Is submitted in conjunction with the Well Completion and Test Report, form number GWS-31, ONLY THE
PERMIT NUMBER AND OWNER NAME NEED TO BE COMPLETED in items 1 and 2.
1. Complete the 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. For wells located in subdivisions the lot, block and
subdivision information must also be provided.
4. Indicate the type of pump installed and complete the requested information. When installing pumps greater
than 50 gpm, complete the additional information in this area.
5. Provide the information on other equipment which may be installed in the well.
6. Report test data as required by Rule 14.4. 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.
7. Record the type and the amount of disinfection used, how placed and the length of time left in the hole.
8. Indicate if a water quality analysis was performed and submit a copy of the report if available.
9. Use the remarks area to note any additional information including additional equipment installed, water supply
construction problems.
in Company,Name and Address, of-Contractor -whocinstalled-pumping{-equipment.ThoWepoit-musVbe---
signed by the licensed contractor responsible for the installation of pumping equipment.
mu"No. '/ WELL CONSTRUCTION AND TEST REPORT For Office Use only
GINS-31
a s<r STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
1313 Sherman St.. Rm 818- Denver, CO 80203 RECEIVED
•
1. WELL PERMIT NUMBER 222327 MAR 0 3 2000
2 OWNER NAME(S) pave x pehhi a Miinrjar WATER RESOURCES
Mailing Address 755F9 wrz eSTATE ENGINEER
4 4 COL°
City, St. Zip meraay, CO 84644
Phone ( 970) 339-5500
3. WELL LOCATION AS DRILLED: sw 114 SF, 1/4,Sec. 1 7 Twp. a rs ,Range 64 4Q___.
DISTANCES FROM SEC. LINES:
1 0Q ft. from withrcisournlSec. line, and 31 65 ft. from tigt wasp Sec. fine. OR
SUBDIVISION: LOT_BLOCK FILING(UNIT) .
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION ft DRILLING METHOD Rtd- Rntary .
DATE COMPLETEt2J-1 -00 . TOTAL DEPTH 420 ' ft. DEPTH COMPLETED 420' ft.
5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft)o To (ft)20
Depth Description of Material(Type, Size,Color,Water Location)
8 20 420
0 -2 Topsoil
2 — 8 Brown colored Blow sand 7. PLAIN CASING
OD (in) Kind Wall Size From(ft) To(ft)
8 - i0 weathered shale & Rusty sandstone 6 . 5 steel .250 1 ' shove 20 '
4. 5 PVC . 250 5 100 '
fU - 248 Hard gray shale interveined by 4. 5 PVC . 250 120 240 '
by thin thightly cement sandstone 4 , 5 PVC ,250 260 -LICE
PERF. CASING: Screen Slot Size: . 02
248 - 263 grey sandsone with thin shale 4 . 5 PVC , 250 100 12.0 '
streaks 4 . 5 PVC . 250 240 260 '
4. 5 PVC . 250 3$b 420 `
263 - 420 Tuff sticky shale-some fine
thin sandstone streaks
8. FILTER PACK: 9. PACKER PLACEMENT:
Material gravest Type
Size 125 v 2S0
Interval 22 _ 420 - Depth
10. GROUTING RECORD:
Material Amount Density Interval Placement
REMARKS: rament 5cu.ft 57a1 0 22 ' plw1psd
11. DISINFECTION: Type H.T.H. Amt. Used 11 ozs.
12 WELL TEST DATA: El Check box if Test Data is submitted on Form No. GWS 39 Supplemental Well Test.
TESTING METHOD
Static Level ft. Date/Time measured , Production Rate gpm.
Pumping level ft. Date/Time measured , Test length (hrs.) .
Remarks •
13. I have read the statements made herein and know the contents thereof,and that they are true to my knowledge. [Pursuant to Section 24-4-104 (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 Lesh Drilling, Inc. Phone (970 ) 834-2868 Lic. No. 21 -B •
Mailing Address P.O. Box 56 . Ault- . Cl 80610-005 •
Name/Title (Please type or print) Si -to--.1 Date
Edwin D. Lesh, Pres . ' 5--/--a000
INSTRUCTIONS FOR WELL CONSTRUCTION AND TEST REPORT Rev. 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_sant., _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 wall 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).
5. 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.
w— _ •_. _ .._ vim _ -
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
GVIS-25 COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St.,Denver,Colorado 80203
(303)866-3581 LIC
WELL PERMIT NUMBER 222327
APPLICANT DIV. 1 WD 1 DES. BASIN MD
APPROVED WELL LOCATION
WELD COUNTY
DAVE & DEBBIE MUNGER SW 1/4 SE 1/4 Section 17
3455 W SERVICE RD Township 4 N Range 64 W Sixth P.M.
EVANS, CO 80620-
DISTANCES FROM SECTION LINES
100 Ft. from South Section Line
(970)339-5500 3165 Ft. from West Section Line
PERMIT TO CONSTRUCT A WELL
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF APPROVAL
1) This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of this permit
does not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested
water right from seeking relief in a civil court action.
2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval
of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation
Contractors in accordance with Rule 18.
3) Approved pursuant to CRS 37-92-602(3)(b)(I)and policy of the State Engineer under the following conditions.
4) The use of ground water from this well is limited to ordinary household purposes inside three(3)single family dwellings,
the watering of domestic animals,and the irrigation of not more than 1 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 105 feet
and 390 feet below the ground surface. Plain casing shall be installed and grouted to prevent production from other zones.
6) The maximum pumping rate of this well shall not exceed 15 GPM.
7) The annual withdrawal of ground water from this well shall not exceed 3 acre-feet.
8) The return flow from the use of this well must be through an individual waste water disposal system of the type so that not
less than 4% of the total amount of water withdrawn is returned to the same stream system in which the well is located.
9) This well shall be constructed not more than 200 feet from the location specified on this permit.
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.
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.
3Nia Izd$/ 7
Jp7 A
APPROVED r n O �fLJMW ?1" /CI1
%Receipt No. 0452660 State Engineer DATE ISSUED DEC 1 3 1999 By EXPIRATION DATE DEC 1 3 MR
Pie\i, R2ceIV2C1 RECEI1JEf.'
COLORADO DIVISION OF WATER RESOURCES 10'2 7Cr
DEPARTMENT OF.NATURAL RESOURCES //D J lt(1' NOV 3 0 1999
13'13SIIERMAN ST.,RM.818,DENVER CO 80203 6U✓) O}Lev v Ui��
phone - info: 1303) 866-3587 main: (3031 866.3581 J)ll w,,t,,,lt,,,,,,,,.c,
FILSIDENTIAL *(Note:You may ales use this form to apply for livestock watering) Water Well Permit AAiOltea'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 uaels)for which you may qualify --
J 1,ave. +< ebbLe (Y)uni r ❑ A. Ordinary household use in one single-family dwelling
(NO outside use)
owing Address
0 B. Ordinary household use in 1 to 3 single-family
dwellings:
3\-i.S ' L.. . S�.tv I Ct` ?- 11 . Number of dwellings:
cn, sate zip code al Home garden/lawn irrigation, not to exceed 1 acre:
E\i Cif1ScngCLO L area irrigated I 0 sq. ft. ® acre
Tekyhone Number llnclo,e au model
MI Domestic animal watering -- 'non-commercial)
2. TYPE OF APPLICATION (check applicable box(es)) ❑ C. Livestock watering (on farm/ranch/range/pasture)
¢,l Construct new well 0 Use existing well 7. WELL DATA
❑ Replace existing well O Change /Increase Use "aaelm""Mann's rate miss anpwt to be we.m.wn
❑ Change (source) aquifer 0 Rea ppliwtiomavirw wmtkl 5 gpm
acre-feet
❑ Other: ToiS*pth scaler
3. REFER TO lif applicable): ‘°j9O feet Let r grin ie--Po i; fIILLS
Water court case r Permit s 8. TYPE OF RESIDENTIAL SEWAGE SYSTEM
IX Septic tank / absorption leach field
Verbal a Monitoring hole acknowledgment a 0 Central system
-VE- MH- District name:
Well name or f 0 Vault
Location sewage to be hauled to:
4. LOCATION OF WELL 0 Other (attach copy of engineering design)
County Quarter/quarter Quarter 9. PROPOSED WELL DRILLER (optional)
LJeLJ .5 1.-L, V. 5 ii. y. N.me Liravenumber
Section Township Nor& Range E or W Principal Meridian lit e(4 1-5)•-)
I -1 ti in ❑ 671-1 ❑ ta Co '— 10. SIGNATURE of applicant(s) or authorized agent
Distance of well from section lines The making of false statements herein constitutes perjury
1 OCD ft.from ❑N OS 3 165 ft.from 0 BO w in the second degree, which is punishable as a class 1 mis-
Well)station*arum.if different from anthem,addray lit aPPlimbcl demeanor pursuant to C.R.S. 24-4.104(13)(a). I have read
Vctc ct,-,-4. I_.c,n ci — NI. c., Rack r-r—ss the statements herein, know the contents thereof and state
For r.Plaoament wells only-diaanee and difeclien from aid wall to new nil that they are true to my knowledge.
feet direction Miatb.arpetl eignstue
5. TRACT ON WHICH WELL WILL BE LOCATED 1, ),J5-c -riLy n5',C
A. You meet cheek one of the following-see instruction'
Title Date
❑ Subdivision: Name Qc-J41 c_r— lc 80—cicl
Lot no. Block no. Filing/Unit OPTIONAL INFORMATION
YY County exemption (attach copy of county approval&survey) usoemaprene perm ewe me Stefan Sew.
Name/no. 1053` r-i-9 4 r-,9.r-,9.J(o-cTract no. ?7,i4u 1716
❑ Mining claim 'attach copy of deed or survey) Office Use Only Acy_ /Ih-y/ (�Q
Name/no. L4fJ( ;oyi5 11F(�_I✓2n O DIV
ccat ✓ fecktply clef,cor 4.3ocres Set
❑ Other(mach legal description to application) wQ / rat)y540,5V
NO ✓ Co
B. STATE PARCEL N kILAQ
1�7/
ID# (optional): S2/ WD _
C. s eon in vast D. Are you the owner of title property?
1.5 SYES 0 NO lif no- see detailed Inst.) Best Copy Available BA
E. Will this be the only well on this tract?
OYES 0 NO fit other walls are on this tract-see detailed Inst.) -- - USE MD
Form GWS-44(11/95)
COLORADO DIVISION OF WATER RESOURCES GWS-44 FMINST 1121951
DEPARTMENT OF NATURAL RESOURCES
• i
RESIDENTIAL APPLICATIONS - GENERAL INSTRUCTIONS
•
There are variety of uses for ground water in Colorado. This form IGWS-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. DD 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 $60. The filing fees for replacement or deepening well permit applications for most
previously permitted residential and livestock water wells is $20.
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 after 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 lyourl 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 tract 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
planed 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 (303-866-3587), or the nearest Division of Water Resources Field Office located in Greeley
1970-352-8712), Pueblo (719-542-3368), 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-see-3587 (Information), 303.8893521 (Main), 303-see-3447 (Welt &Watar Rights Recordel, 303.880-3558(Fax)
•
• EXEMPT WELL DATA SHEET - DENVER BASIN, COLORAD
APPLICANT: MUNGER RECEIPT NO . 452680
LOCATION: SW1/4 OF SE1/4 OF SEC. 17 , T. 4N. , R. 64W. (100 SSL, 2115 ESL)
PROPOSED AQUIFER: LARAMIE-FOX HILLS
SURFACE ELEVATION: 4720 NUMBER OF ACRES IN TRACT: 15
IS PROPERTY WITHIN SERVICE BOUNDARIES OF MUNICIPALITY S .B. 5 CONSENT MAPS? N
IF SUBDIVISION IS UNDER AUGMENTATION PLAN, CASE NO. IS
IF SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY THE WATER MANAGEMENT BRANCH,
INFORMATION ON SUBDIVISION OR TRACT OF LAND/SPECIAL RESTRICTIONS :
eva
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 4331 4617 185 389 103 4 . 163 M NNT
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
10/18/80 NON 11:45 FAX 87O 338 8545 LTG-GREELEY 1 001
RECEIVED
Filed for record the dry of ,A.D. 19 o; o'clockN. w RECORDER. OCT Reception act. By DEOV1y. 2 8 1999
WARRANTY DEED WATERRESWR
STATEE I CE.9
'MISDEED, made on talc day of October U.1999 COLD A'EER
between 3OHN M.TOMES
3
of the Coney of WELD and State of Colorado , of the Grantor(a), and
DAVID A.HUNGER AND DEBORAH C.MUNGER
whose legal M etrese to : 5001£.96 DRIVE,THORNTON,CO 40219
of the Canty of end State of Colorado , of the grantee(:):
WITNESS, met the Grentor(U, for end in conelderatlen of VW oz.of ( 315,090,00 )
'es Sweaty rive Thovw.C end 00/100 ref DOLLARS
the receipt and guff felony of Mich Is hereby acknowldgd, has granted, bargained, sold awl conveyed, and by These
precente dots grant, bargain, melt, convey and confirm unto the Orantee/s), their heirs end ...tan. forever,
not fn tanency in careen but in joint tenancy, ell the rest property, together with IMrovements, If eny, altwte,
tying end Oting In the cTa ty of WELD end Stet.of Colorado, described es follow:
LOT B 0P RECORDED EXEMPTION NO]OD-17+RESa00 RECORDED MAY 15,1999 UNDER RECEPTION NO.2695795,
BEING PART OF THE.SOUTH HALF OF THE SOUTHEAST QUARTER OF SECTION IT.TOWNSHIP 4 NORTH.RANGE 64
WEST OP THE 6TH P.M..COUNTY OP WELD.STATE OP COLORADO.
AND 31CtAiDD G ALL OIL AND MINERAL RIC,ffTS 1O BE HEREBY =RAYED TO
GRANTalso�sssstreet number TED,VACANT LAND.MERSEY,CO 80644
TOGETHER with all and',Inquiet and hereditemento end appurtenances thereto balMsiny, or in anywise appertaining
and the reversion and reversions, remainder end rescinders, rents, Issues end profits thereof; and all the estate, right
tilt. interest, etatn end demand whatsoever of the Grantor(:), either in law or equity, ef, in and to the above bargained
premises, with the Cereal tents end appurtenances;
TO LAVE AND TO HOLD the said breasttea above bargained end described 111th appuranu)c.s, unto toe Peugeots),
their heirs and assigns forever. The Grntor(s, for hioself, hi°heirs and personal representetiwa, does covenant, grant
bargain, and agree to and with the Grntee(o), their hairs and anions, that et the sine of the asealing arid del ivory
of these presents, he is welt seised of the premises above Corveyd, Me good, sure, perfect. absolute and ind.faesible
estate of idnritence, in lee, in foe .imple, and has good right, full power and lawful authority to grant, bargain,
Sell and convey the Farm In tamer end lore as aforesaid, and that the sane aro free oral clear from all former sit other
grants, bingeing, sales, liens, tam, aeeeeeaents, encmbrances and restrictions of whatever kind or nature server,
EXCEPT GENERAL TAXES AND ASSESSMENTS FOR TT(E YEAR 1999 AND SUBSEQUENT YEARS.AND SUBJECT TO THOSE
EXCEPTIONS REFERRED TO IN T[IIE INSURANCE COMMITMENT NO. PC197610 ISSUED BY LAND TITLE OUARAt•7Fll
COMPANY.
The grantor(*) "hall end Will WARRANt N40 f9REVER DEFEND the atone bargained premises In the quiet end pe.c.eeu
poaaue ion of the Grenteee., his heirs Crud acetone, against all and every person or persona lawfully Cl staking the whole
or any pert thereof. The circular number shall include the plural, and the plural the singular, and the use of ony gender
shall be applicable To all seders.
IN WITNESS WHEREOF the orantorls) has executed this dead an the date cat forth above.
101Q4 M.'CO�N��.4
STATE OF Ccaoredo ) V
)50,
Canty of WELD
The foregoing instrument woe acknowledged before ae on this day of October 1).1999 i f.s:.!1,'(11C,
by JOHN M.TOMES _ -:Ii4Od :
Hy cowl al on exp.ran MY Commission _
wetness ay nand and off'ttIiYT: r"u•"`ei.
• )dam Ceamdgslon
&Mins:Vie/toot Note ry Public
• Nan and Address of hereon Creating Miwly Crested legal Description 5 36-35 Oa.5, D.R.s.)
Escrad GR197610 iAn Recorded Return to: DAVID A. WAGER LID DE8DUR C, ANGER
'flied FC197610
5001 E. 96 Delve
some mg, 911e aw 4.94. WARRANTY'DEED Ito Joint Tenants) T CO SOD29
Best Copy Available
•
NOV 3 0 1999
wA.,
STATE ENGiNEEF
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Scanning Cover Sheet
for
Septic Permits
Permit # SP-9900632
Permit Type: Health/Residential/New
Situs Street Address 25775 CR 44
Situs City, State, Zip
Sec/Town/Range: 17-04N-67W Application Status: Finaled
Application Date: 12/13/1999
Parcel # (12 digits) 105317000021-R0231693
Owner Full Name: MUNGER DAVE AND DEBBIE
Owner Address: 5001 EAST 96TH DRIVE#191
DENVER,CO 80229
Owner Phone #: 303-252-9350
Contact Name: HOJIO MIKE
Contact Address: P.O. BOX 5331
GREELEY,CO,80631
Contact Phone# 970-352-2661
Information above has been Verified in Accela by employee noted below
X June 11, 2008
Processed by: Date
Report ID: EHS00024v003 Page 1 of 1
Print Date-Time: 6/11/2008 1:28:31 PM
•
•
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE (970) 304-6415 FAX(970) 304-6411 _
Permit#: SP-9900632 Sec/Twn/Rng: Status: LSS`tLEW'
Owner: MUNGER DAVE AND DEBBIE • Applied: 12/13/1999
Applicant: HOBO MIKE Issued: 12/29/1999
Permit Type: RNEW C=Commercial,R=Residential+NEW,REPair,VauLT Finaled: W-0160#:
Location: PENDING ADDRESS HWY 34 AND 49 17-4-64
Legal Description: S gg Lice
Installer: f
Description: HOUSE
Commercial: N Residential:Y Acres: 0
#of Persons: 2 Basement Plumbing:
# of Bedrooms: 4 Bathrooms - Full: 2 3/4: 0 1/2: 1
Water Public: N Water Source:
Water Private: Y Cistern: N Well: Y Well Permit#:
Percolation Rate:7.1 Limiting Zone: 6 ft 0 in Description CLAY
% 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: 1250 gallons Absorption Trench: 868 square feet
or .Absorption Bed: 1172 square feet
Actual Installation
Septic Tank: 1?co gallons Absorption Trench: sR I square feet
Absorption Bed: square feet
Design Type: C->„/A,
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 not transferable. The Weld County Department of Public Health and Environment reserves the right to impose
additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval was contingent upon the
final.inspection of the completed system by the Weld County Department of Public Health and Environment.
X � D4,r Z--(�tY.
Envir enta ealth Specialist Date
Penn:S FINAL
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R , 3
3
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•
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-9900632 Sec/Twn/Rng: (`--t4-1++ PERMIT
Owner: MUNGER DAVE AND DEBBIE Applied:
12/13/1999
Applicant: HOJIO MIKE Expires:
12/07/2000
Permit Type: RNEW C=Commercial,R=Residential + NEW,REPair, VauLT
Parcel #: Ic93k*o0e 3Ei ea oif Fop fl, 45ils;
Location: PENDING ADDRESS HWY 34 AND 49 17-4-64
Legal Desc:
Description: HOUSE
Commercial: N Residential:Y Acres: 0 iU cei
# of Persons: 2 Basement Plumbing:
# of Bedrooms: Bathrooms - Full: 2 3/4: 0 1/2: 1
Water Public: N Water Source:
Water Private: Y Cistern: N Well: Y Well Permit Number: •
Percolation Rate \-ACI Limiting Zone (I) in Description Cl1,9,
% Ground Slope Direction Soil Suitable (Y/N) a
Engineer Design Required (Y/N) NVD In 100 Year Flood Plain( /N) YLD
From the application information supplied and the on-site soil percolation data the following minimum installation specifications are
required:
Chambers
Septic Tank 1 gallons, Absorption Trench 191 square feet 24(
or
Absorption Bed t11-2_ square feet SE
In addition, this permit is subject to th ollowing additional terms and conditions:
61A.�1�, tsLeA diat�,to h,..V aCP boti4(S " eQQ a 1lk2 vc au. 2 fr€ rt,Viti `�ll�oOs
U (So u
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 not transferable. 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 continuging basis.
Final permit approval is contingent upon the final inspection of the completed system by the Weld County Department of Public
Health and Environment. This permit expires one year from the application date.
e
x ti➢VN,o1 �. apet h'l
J
"TvHORIZON icc71
- CONSTRUCTION 0 „�{1„
_- SERVICES, L.L.C. P , ''�
. 1 sir `))/
•
1 _ I ENVIRONMENTAL - GEOTECHNICAL - MATERIALS TESTING /,
• I ` /
sic-
December 2, 1999 /
Mr. Jeff Stoll
Director Environmental Protection Services
Weld County Health Department
1517 16th Avenue Court
Greeley, CO. 80631
Re: I.S.D.S. Percolation Tests
Dave& Debbie Munger
S1/2 of the SE1/4 of Section 17,
T4N, R64W of the 6i°PM
Weld County, CO
Parcel #: 105317000021
Dear Jeff:
Please find enclosed the data pertaining to the percolation test performed for an Individual
Sewage Disposal System (I.S.D.S.) for the above referenced site. The percolation test was
performed by Horizon Construction Services, LLC (Horizon) on November 29, 1999. The
average percolation rate was found to be 17.1 minutes per inch and is summarized on Table No.
1.
The average percolation rate met the County regulation rates for a standard system. A limiting
zone of a gray silty clay was encountered at the site at a depth of six feet (6'-0"). See attached
Soil Profile. It is our recommendation that a standard I.S.D.S. be allowed for the above
referenced site since the limiting zone is greater than the minimum depth required by regulation.
The bottom of the infiltrators should be placed no more than two feet (2'—0") below existing
grade.
The Weld County Health Department retains the final approval authority for all I.S.D.S.
evaluations. Your permit should be reviewed entirely prior to any construction of the I.S.D.S.
Please contact me if you have any questions concerning this matter.
Sincerely,
HORIZON CONSTRUCTION SERVICES, LLC
Reviewed by: \`` OQp...,... ... ..ud,J"b O. ..,__
Shawn Stille, EIT Thomas Copr.'e;-eE 24 9 ":
`s+' // y 99 Qs
3310 STATE STtf .E4 S CbLdqp 0 80620
(970) 330.37Vf,t9 plm➢.1i2}81,a FAX
".',i l
0NAlC-\wog`.
HCS Job #99151
•
•
TABLE NO. 1
PERCOLATION DATA SUMMARY
FOR
PROPOSED MUNGER RESIDENCE
Percolation Percolation
Bore Rate
No. (mpi)
1 16.0
2 20.0
3 20.0
4 20.0
5 13.3
6 13.3
Average 17.1
HORIZON CONSTRUCTION SERVICES, LLC
K 1
SOIL PROFILE
Percolation Test
S1/2 of the SEl/4 of Section 17,
pus T4N.R64W of the 6th PM
n•
v.r.r
- Alfalfa and Silty Sandy Topsoil
— Brown Damp Silty Sand with
_ Some Clay
s
Gray Damp Silty Clay with
7,7 Some Calcareous Deposits
A Brown Damp Silty Clay
to' with Little Oxidation
16'
No water was detected in the
bore hole to a depth of 8 feet
HORIZON CONSTRUCTION SERVICES,LLC.
1
•
•
Munger Residence
t
NORTH
Dave&Debbie Munger
Proposed Residence
S1/2 of the SE 1/4/4 of Section 17,
T4N,R64W of the 6th PM
Weld County,CO
Proposed Leach Field
oo « 300'
4 t 6
120'
iiii/viiira'iiaswiiiu.a^ 'i,,,tr asuri,.Sisa riiia;.:h:. r•a ",,,,,.93 ilee./0 iuc;::xrs:.^,:0:44iireuu.4t0W4 zicr in.(,..WAW is rinic1274=.;uir
r
Entrance to Property
Approximately 0.3 miles to WCR 53 Mag 18.00
Thu Dec 02 11:16 1999
from Entrance to Property ~
Scale 1:1,758(at center)
200 Feel
50 Meters
— Local Road
US Highway
River/Canal
Horizon Construction Services,LLC
0 1998 DeLonne. Sine Attu USA
' WELD COUNTY DEPARTMENT OF PUBLIC HEALTH& ENVIRONMENT
1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE: (970) 304-6410 FAX: (970) 304-6411
APPLICATION/RECEIPT
Initials: RB
Permit Number: SP-9900632 Receipt Number: HAP000019
12-13-1999 Amount: $315.00 Payment Method: Check Notation:
Owner Name: MUNGER DAVE AND DEBBIE
Applicant Name: HOJIO MIKE
Parcel Number: ??
Site Address:
Location: PENDING ADDRESS HWY 34 AND 49 17-4-64
•
Total Fees: $315.00 Total All Payments: 315.00
This Payment: $315.00 Balance: $0.00
Account Code Description Amount
256041400-4221-400 New Septic Permit $315.00
256041400-4221-400 Repair Septic Permit $0.00
256041400-4221-400 Vault Permit $0.00
256041400-4730-400 Potable Water $0.00
Description: HOUSE
Commercial: (Y/N) N Residential: (Y/N) Y Acres: 0
Number of Persons: 2 Basement Plumbing: (Y/N)
Number of Bedrooms: 4 Bathrooms: Full - 2 3/4: 0 1/2: 1
Water Public: (Y/N) N Water Source:
Water Private: (Y/N) Y Cistern: (Y/N)N Well: (Y/N) Y Well Permit Number:
NOTICE
Applicant acknowledges receipt of the individual sewage disposal system guide and that 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 to be made and furnished by the applicant or by the Weld County Department of Public Health and
Environment for purposes of the evaluation of the application;and 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 certifies theat 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 reports 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 designed to be relied on by the Weld
County Department of Public Health and Environment in evaluating the same for purposes of issuing the permit applied for herein. 1
further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit
granted based upon said applicaion and in legal action of perjury as provided by law. This application expires one year from the
signature date.
X %72✓LA
`7 /J-/3 — qq
Owner/Applicant Date
Form:RT_HAPP
SEPTIC INFORMATION FORM
y/r�vr. To obtain an I.S.D.S. permit, one must file an "Application for Individual Sewage
I I� Disposal System" at the Weld County Environmental Protection Services office, and
Wile. pay the application fee. A "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. /0s.31 70 00 402 I THIS CAN BE OBTAINED FROM THE
ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650
PROPERTY OWNER AA✓4-. e- Aebbj'e irUNje
MAILING ADDRESS .Sbo I C %411 [Jr #qirry 1 Aorr 4b— ST Cb ZIP RC1o7 `j
HOME PHONE O3 ? -9350 WORK PHONE /VP 3S/- /371 FAX (979. 339- SSo
APPLICANT NAME Lill l k( Th\ii 0
MAILING ADDRESS CITY ST_ ZIP
HOME PHONE ( 1 WORK PHONE ( ) FAX(_ )
DESCRIPTION OF BUILDING (Ex.: House, Mobile Home, Modular, Shop, Office) !r/dceDdRY
SITE/LOCATION ADDRESS CITY
DIRECTIONS TO SITrl 9 aloe- k Rs vi 5a„-th 7/0 led LP-1,
Psi-- sift — behveet.. S-/4 S3 .
LEGAL DESCRIPTION PT Sir,* PT-5-6 ' /SEC 1 7 TWN iiill__ RNG g y M ACRES 15's 8y4c(o s
SUBDIVISION LOT BLOCK , FILING
NEW PERMIT Y REPAIR PERMIT
$315 $315
IF OBTAINING A REPAIR PERMIT, PLEASE LIST PREVIOUS OWNERS OF THIS PROPERTY
CENSUS TRACT
RESIDENTIAI(W)/NO COMMERCIAL YES MCP
NUMBER OF PERSONS � BASEMENT PLUMBING YES /6
NUMBER OF BEDROOMS `I BATHROOMS: FULL a 3/4 1/2 /
WATER SUPPLY: PUBLIC YES 9J UTILITY NAME
PRIVATE/0n_• CISTERN YES / -.O WELL 6§) WELL PERMIT #"TBA
- APR-15-1998 1622 WELD GOUNTY HEALTH DEPT 19703564966 P.01
6atitillH6‘111:
DEPARTMENT OF HEALTH
I 151716TH AVENUE COURT
GREELEY, CO 80631 .
. : : ADMINISTRATION(970)353-0586
• • HEALTH PROTECTION (970)353-0835
COLO DO 0MMUNITY HEALTH (970) 353-0639
FAX (970)358-4966
AUTHORIZATI: N FORM
RE: ?a PERMIT APPLICATION o I.S .S. o WATER SAMPLE •
•
n PERC TEST ONLY ' o S E OF PROPERTY
- p
I InT+ke �i b repro t L\AVG &b6i e / ( e_r
• for the property located at •
LEGAL DESCRIPTION: SEC I IWN 1".n RRNG r'/ W, ' 6
411
SUBDIVISION NAME: • LOT BLIP_ •
I can be contacted at the following phone Ws Home
Work.
• • Other
•
Fax#
• The'property owner can be contacted at the;f flowing phone#'s
Home 3O 3 353 93 Ta
Work 7010 35/ ' / 3 rill •
. Other
Fax It 77° 337-SS°/
OWNER'S SIGNATU
DA /0 2Wi9
Th u
TOTAL P.01
Hello