HomeMy WebLinkAbout20142600 EXHIBIT B
WATER SUPPLY INFORMATION
WATER SUPPLY INFORMATION SUMMARY
Section 30.28.133,(d1, 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
AeStittcal-t;e. Ferny 1ivms± W\&n1errfce9op
2. LAND USE ACTION Amended theb o*er'ojRevie�J
3. NAME OF EXISTING PARCEL AS RECORDED Vt.�JN'�2 vS��q vC'� -F F�QgW+ tah pM
SUBDIVISION FILING BLOCK LOT
4. TOTAL ACREAGE be-3 5. NUMBER OF LOTS PROPOSED _4-. PLAT MAP ENCLOSED 0 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?721 YES 0 NO
B. Has the parcel ever been part of a division of land action since June 1, 1972? fit YES 0 NO
If yes, describe the previous action �Xeniytllof1 7YVe 1 ii.932.•
7. LOCATION OF PARCEL • Include a map debriefing the project area and tie to a section corner. ( e,e. usR a j;a,o„ )
N• a 114 OF �J••E. 114 SECTION Z. TOWNSHIP 1- l N ❑ S RANGE (0e ❑ E »W
PRINCIPAL MERIDIAN; j 6TH 0 h,M. 0 UTE 0 COSTILLA
B. PLAT- Location of all wells on property must be plotted and permit numbers provided.
Surveyors plat )-Yes 0 No If not, scaled hand drawn sketch 0 Yes 0 No L`5ee 09R fr c-P,on
9. ESTIMATED WATER REQUIREMENTS - Gallons per Day or Acre Feet per Year 10. WATER SUPPLY SOURCE
IX EXISTING 0 DEVELOPED 4 NEW WELLS -
WELLS SPRING POSED AOUFEIB CHECK ant)
HOUSEHOLD USE N of units GPO AF WELL PERMIT NUMBERS 0 ALLUVIAL 0 UPPER ARAPAHOE
❑UPPED DAMSON ❑LOWEA ARAPAHOE
COMMERCIAL USE g9b00of S.F. GPI) AF 2 82-F 2MONOAWSem NAAAMIt FOX HILLSDaIYFA DAAO{A
o OTHER
IRRIGATION It of acres GPO AF (j€Orojkaging afpl;tion�
STOCK WATERING A of head GPI) AF 0 MUNICIPAL
0 ASSOCIATION WATER COURT DECREE CASE NO.'S
OTHER - GPD AF ❑ COMPANY \t./-42?b-Tr rt.
0 DISTRICT
TOTAL GPD AF NAME
LETTER OF COMMITMENT FOR
SERVICE 0 YES 0 NO
11. ENGINEER'S WATER SUPPLY REPORT 0 YES XNO IF YES, PLEASE FORWARD WITH THIS FORM. (Thu may he required Wore our review es completed)
12. TYPE OF SEWAGE DISPOSAL SYSTEM
SEPTIC TANKILEACH FIELD 0 CENTRAL SYSTEM - DISTRICT NAME
❑ LAGOON 0 VAULT • LOCATION SEWAGE HAULED TO
0 ENGINEERED SYSTEM (With a copy or engineering design) 0 OTHER
•
5-75 •tD OTOS 1l_
COLORADO DIVISION OF WATER RESOURCES 1000201W to Dm
TYPE OR ����`��1S 1Nltgg 818 Centennial Bldg., 1313 Shaman St. 11�BB Olro O
COPItr OP�ccFPtE61 Denver, l:elorodo 87!03 0� �•4o- w
STATEMENT MAILED MAt1R DIVIBIO8
OM REQUEST. STATE OF COLORADO
COUNTY OF �
( 7- MHO
111-504 (8)u CMS
- STATEMENT OF BENEFICIAL USE OF GROUND WATER
AMENDMENT OF EXISTING RECORD
- LATE REGISTRATION
PERMIT NUMBER 24982-f
LOCATION OF WELL
THE AFFIANT(S) Henry J. & D arJorie L. Blakely creme. Weld
whose mailing ) .
address is 2497 I-25 Frontage ROM pp���� . HB k of nap RE M,serum.. 22
City Brie -Colorado 8O%6 Trp. �_A, .Rng.68. iii 'e 6 P.M
Y 1 IMO
IM ON \ 1 �
being duly sworn upon oath, deposes and says that he (they) is (we) the owner(s) of the well described hereon; the well is
located as described above, at distances of 211,0 feet from the tSoutweMl section line and 50 feet from the
Hoot
Ewa section line;water from this well was first applied to a beneficial use far the purposes) described herein on the IL
Dan an nail
day of .Tidy , 1943_; the maximum sustained pumping rate of the well is 159 gallons per minute, the pumping
rate claimed hereby is 359 gallons per minute; the total depth of the well Is 20 ,feet; the average annual amount
of water to be diverted is acre-feet; for aphid!claim is hereby mode for trrisation of 32 A Croon & 36 A
Pasture - purpose(s); the legal description of the land an which the water from this well is used is
tinvoulauental saiuoe aT Water of which
68 acres are irrigated and which Is Illustrated on the map on the reverse side of this form; that this well was completed in
compliance with the permit approved therefor; this stotanont of beneficial use of',mind water is filed in compliance with law;he
(they)has(have) mad the statements made hereon; knows the content thereof; and that the scone are true of his(their)knowledge.
(COMPLETE REVE SE SIDE OP TNIS FORM) EIs
649
Signature(s) N,
Subscribed and sworn FOR OFFICE USE ONLY
to before me an this day , 19_
outlaw.No. W-9220-Irxie,
My Commission expires:
Prior. - W._Door_n.
ACCEPTED FOR FILING BY THE STATE ENGINEER OLORADO
PURSUANT TO THE FOLLOW I f tun '`•— — k• — k. --. s.
f THE 077101 O1/ wan u...____4_ _
TIE STATE MISER
ACCORIMIG TO THE Mai._Sr___ Basin Man.Du.
DRC= GRUM Dim
. OAR NO._lat.gsia .1
WAS DIYISIO$ I Am •
POThlumiT TO BECttoi
37-92-304 !r(B)s ORO
..DATE E t 41s78() , eY a
' 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 dwrpermitsonline(Dlstate.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.
Asphalt Specialties Co., Inc./Stuart Bombel
Industrial ❑ Dewatering System
Mailing address Municipal
10100 Dallas St. p ❑ Geothermal(production or reinjection
Cif State Zip code 0 Irrigation
City ❑ Other(describe):
Henderson CO 80640 RI Commercial
Telephone if(area code&number) E-mail(online filing required) 7, Well Data (proposed)
303 289-8555 robl@asphaltspecialties.com Maximumpumpingrate Annualamounttobewithdrawn
2. Type Of Application (check applicable boxes) 15 gpm 15 acre-feet
0 Construct new well O Use existing well Total depth Aquifer - - -
❑ Replace existing well O Change or increase use 200 feet Laramie-Fox Hillis
❑Change source(aquifer) ❑ Reapplication(expired permit) 8. Land On Which Ground Water Will Be Used
❑ COGCC Well ❑ Other:
Legal Description of Land(may be provided as an attachment):
3. Refer To (if applicable)
Well permit Water Court case# - Part of N1/2 of SE1/4 of Sec. 22, TIN, R68W, 6th PM
Designated Basin Determination# Well name or# Well is for the sole purpose of potable water for a heavy
4. Location Of Proposed Well equipment maintenance shop.
County (If used for crop irrigation,attach a scaled map that shows Irrigated area.)
Weld NE 1/4ofthe SE 1/4 A. #Acres B. Owner
Section Township N or S Range eE�or W Prindpal Meridian
22 1 El ❑I 68 In 0 6TH C. List any other wells or water rights used on this land:
Distance of well from section lines(section lines are typically not property lines) See Section 5 (irrigation well)
2,200 ft. Ft.from❑N❑x S 400 ft. Ft.frorrIJ E�W
For replacement wells only-distance and direction from old well to new well - 9. Proposed Well Driller License#(optional):
feet direction 10. Sign or Entered Name Of Applicant(s)Or Authorized Agent
Well location address(Include City.Stale,Zip) ❑Check if well address is same as in liens 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.
2425 West 1-25 Frontage Rd., Erie, CO 80516 24-4-104(13)(a). I have read the statements herein,know the contents
thereof and state that they are true to my kno w ledge.
Optional: GPS well location information in UTM format You must check GPS unit for Sign or enter name(s)of person(s)submitting application Date tmmmmyyyyl
required settings as follows:
05/16/2014
Format must be UTM
Ilsignmg rint name and title
❑I Zone 12 or la Zone 13 Easting
units must be Meters Rob Laird, Resource Mgr.
Datum must be NADa3 Northing Office Use Only
Unit must be set to true north
USGS map name DWR map no. Surface elev
Was GPS unit checked for above? 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):
Part of N1/2 of SE1/4 of Sec. 22, Ti N, R68W, 6th PM
(see attached verification of ownership/location and authoriza-
tion to apply for permits on this property)
AOUAMAP
B. #of acres in parcel C. Owner
WE
WR
D. Will this be the only well on this parcel? 17 YESE NO(if no list other wells)
CWCB
#24982-F(case#W-9220) TOPO
E. State Parcel ID#(optional): MYLAR
SB5 DIV WD_- BA MD
EXHIBIT C
APPROVALS FOR TWO CONSTRUCTED SEPTIC/LEACH FIELDS
4
•
•
•
HSPI06P INWIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT NO. G-930223
•
WELD COUNTY HEALTH DEPARTMENT EW P c
ENVIRONMENTAL HEALTH SERVICES
1517 16TH AVENUE COURT, GREELEY, CO 80631
353-0635 EXT.2225
OWNER RICKERS, HENRY/MARJORIE ADDRESS 2497 I-25 FRONTAGE RD PH (303) 530-1717
ERIE CO 80516
ADDRESS OF PROPOSED SYSTEM 2425 I-25 FRONTAGE RD
ERIE CO 80516
LEGAL DESCRIPTION OF SITE: 8E4 SEC 22 TWP 1 RNG 68
SUBDIVISION: N/A LOT 0 BLOCK 0 FILING 0
USE TYPE: (DIAL GOLF DRIVING RANGE
SERVICES: PERSONS ISIS BATHROOMS 2.00 LOT SIZE 20.00 ACRES
BEDROOMS 0 BASEMENT PLUMBING HO WATER SUPPLY LFTHD
APPLICATION FEE $150.00
RECD BY JOANNA GALLEGOS SIGNED BY MARJORIE L. RICKERS
DATE 07/01/93 DATE 07/01/93
PERCOLATION RATESlab MIN PER INCH LIMITING ZONE 7L FEET
SOIL TYPE gat PERCENT GROUND SLOPE % DIRECTION
REQUIRES ENGGIItER DESIGN gal_ IN• 100 YEAR FLOOD PLAIN ZONE
FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON-SITE SOIL PERCOLATION DATA
THE FOLLOWING MINIMUM XN TALLATION SPECIFICATIONS ARE REQUIRED:
SEPTIC TANK /SIJs GALLONS, ABSORPTION TRENCH "- SQ. FT.
• OR �,.y�
ABSORPTION BED !1g SQ. FT.
IN ADDITION, IT,rI S�PERMIT I�h 'r8 estiaSUBJECT TO T1 FOLD-.OWI,NIG ADDITIONAL TERMS AND
CONDITIONS: UK:
Nlt,a,"4y'�/'.�'"j5`.'/"Bg�irtri'�"
THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT
MAY BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT 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
AP VAL. THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE
ENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR INADEQUACY OF THE
247,SPOSAL SYSTEM. A 1 _/I �J
__ .-_ _ _ -.. - . -._ _ _ ENVIRONMENTAL GPECIQLIST.. . DATE-
THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS
NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF
THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI-
TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA-
SIS. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL 'INSPECTION OF THE COM-
PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT.
Wdiu-ENS MAYS 1984
ORIGINAL-APPLICANT; COPY-WCHD
-
HSP106Rr APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM NO. G-930223
WELD COUNTY HEALTH DEPARTMENT NEW APPLICATION
ENVIROPHIENTAL HEALTH SERVICES
• 1517 16TH AVENUE COURT, GREELEY, CO 80631
353-0635 EXT.2225
OWNER RICKERS, HENRY/MARJORIE ADDRESS 2497 I-25 FRONTAGE RD PH (303) 530-1717
ERIE CO 80516 •
ADDRESS OF PROPOSED SYSTEM 2425 I-25 FRONTAGE RD
ERIE CO 60516
I FRAI DESCRIPTION OF SITE: SE4 SEC 22 TWP 1 RNG 68
SUBDIVISION: N/A LOT 0 BLOCK 0 FILING 0
USE TYPE: COMMERCIAL GOLF DRIVING RANGE-
SERVICES: PERSONS 1 BATHROOMS 2.00 LOT SIZE 20.00 ACRES
BEDROOMS 0 BASEMENT PLUMBING NO WATER SUPPLY LFTHD
APPLICANT ACKNOWLEDGES THAT THE COMPLETENESS OF THIS APPLICATION IS CONDITIONAL
UPON FURTHER MANDATORY AND ADDITIONAL TESTS AND REPORTS AS MAY BE REQUIRED BY THE
WELD COUNTY HEALTH DEPARTMENT TO BE MADE AND FURNISHED BY THE APPLICANT OR BY THE
WELD COUNTY HEALTH DEPARTMENT FOR PURPOSES OF THE EVALUATION OF THE APPLICATION;
AND THE ISSUANCE OF THE PERMIT IS SUBJECT TO SUCH TERMS AND CONDITIONS AS DEEMED
NECESSARY TO INSURE COMPLIANCE WITH RULES AND REGULATIONS ADOPTED UNDER ARTICLE
10, TITLE 25, CRS 1973, AS AMENDED. THE APPLICANT CERTIFIES THAT THE PROPOSED
SYSTEM WILL NOT BE LOCATED WITHIN 400 FEET OF A COMMUNITY SEWAGE SYSTEM. THE
UNDERSIGNED HEREBY CERTIFIES THAT ALL STATEMENTS MADE, INFORMATION AND 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 HEALTH DEPARTMENT IN EVALUATING
THE SAME FOR PURPOSES OF ISSUING THE PERMIT APPLIED FOR HEREIN. I FURTHER UNDER-
STAND THAT ANY FALSIFICATION OR MISREPRESENTATION MAY RESULT IN THE DENIAL OF THE
APPLICATION OR REVOCATION OF ANY PERMIT GRANTED BASED UPON SAID APPLICATION AND
IN LEGAL ACTION FOR PERJURY AS PROVIDED BY LAW.
APPLICATION FEE *150.00 MARJORIE L. RICKERS
•
•
REC'D BY JOANNA GALLEGOS id .re A4.11 / -As. 07/01/93
DATE 07/01/93 OWNER/AGENT SIGN DATE
ORIGINAL-APPLICANT; COPY-WCHD WCHD-E}IS MAY. 1984
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Project Description: Owner:
FFOP S(LrZ 122112 R IV.inr
21 1 SS`h N A-C V3
106..5 606216
Upcoming
--1 Completed (15)
Pending SI I E EVAI(1e\I ION (Pi ii(;)(21.000) View Details
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Result es/ s neee/gned or TBD an TOO
Pending Piss Standards('06100) View Detail>
https://accela-aca.co.weld.co.us/citizenaccess/ 5/7/2014
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