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HomeMy WebLinkAboutpitkin.eh.264322400010 (2011) (Barns)Permit #: 0028.2011.powt )NSITE WASTEWATER TREA . iENT SYSTEM (OWTS) CONSTRUCTION PERMIT 0405 Castle Creek Road, Suite 10 - Aspen, CO - 81611 Phone: 970.920.5070 Fax: 970.920.5077 Parcel ID #: 2643-224-00-010 Permit Issued: ®NEW ❑REPAIR ❑REMODEL/ADDITION ®TANK ONLY [—]FIELD ONLY ❑AMENDMENT Owner(s): Aspe Property Address: Legal Description: Size of Lot: 40 Size of Building: Kiwi Properties, LLC (BARN 875 Star Mesa Lot 6 Acres Sq. Ft Detached Accessory Unit: Size of Accessory Unit: ®YES ❑NO 2332 Sq. Ft. The system is designed for: Barn — 45 gpd (may include toilet, hand sink, mop sink, and washing machine Table 6.28-2) Designed By: Phone #: Fax #: Mountain Cross Engineering Project #: _ 970-945-5544 Mailing Address: 970-945-5558 Email Address: Perc Rate: 267 Profile Hole Depth Minimum Tank Capacity: 750 gallons 492-015 Dated 826 '/2 Grand Avenue, Glenwood S 5/6/11 CO 81601 8'4" Depth to Groundwater or Bedrock: Greater than 8'4" Minimum Absorption Area: 309 sq ft w/ no reductions Permit Conditions: This OWTS Construction Permit is approved on the condition of compliance with the engineer design as submitted with the application and the specifications cited above. Changes must be approved by this Department and the engineer prior to construction. This system will consist of a minimum 750 gallon, two-compartment tank with an effluent filter on the outlet. The design specifies a 6' x 55' pipe and gravel absorption area with 13" of 1/2" to 2 1/2" gravel. There must be a minimum of 6" of gravel below the perforated distribution pipe. There must be at least 12" of cover over the pipe. The top of the gravel shall be covered with 8 oz. mirafi geotextile fabric. This Permit must be kept on-site during installation. The engineer must do a final inspection of the installation and submit an "as -built" letter to this Department within 30 days of the final inspection, unless a longer period of time has been agreed upon, in writing. This Department must also be called for the final inspection with a minimum of 48 hours notice. Minimum horizontal distances between components of the system and physical features shall conform to the requirements of the Pitkin County OWTS Regulation. This Permit is conditioned upon the property owner(s) providing for regular inspection, cleaning, and maintenance of the system by qualified personnel, in accordance with the manufacturer's recommendations and the requirements of the Pitkin County OWTS Regulation. Issuance of this OWTS Construction Permit does not constitute a guarantee, warranty, or representation by the Department that the system will operate properly or will not fail. THIS PERMIT IS EXPRESSLY CONDITIONED UPON COMPLIANCE WITH ALL REQUIREMENTS OF THE PITKIN COUNTY OWTS REGULATION, INCLUDING BUT NOT LIMITED TO THOSE CONDITIONS SPECIFIED ABOVE. Plans and specifications for the proposed OWTS have been reviewed and are considered satisfactory. Permission is hereby given to the property owner(s) to perform the work indicated in accordance with the Pitkin County OWTS Regulation. This Permit will expire 1 year from the date of issuance unless construction on the system has commenced. An "as -built" drawing must be submitted and approved by EH before final approval of the system will be issued. Issued By: �Ia � (a 0 2 � Date: 3�% ( Expires: L3o/ i oL Installer: ,cense #: Reactivation Authorized by: Final App r al Issued By: Date:�Z �aa New Expiration Date: E] Feed C*,v- J � i- �p��S3�VQ REQUEST FOR AN AMENDMENT TO AN 91�1 OWTS CONSTRUCTION PERMIT 76 Service Center Rd • Aspen, CO • 81611 Phone: 970.920.5070 Fax: 970.920.5374 This form should be used for requesting an amendment to on OWTS Construction Permit if there have been significant changes to an 0WTS design that differ from what was approved as part of the OWTS Construction Permit. An hourly fee of $162/hour will be invoiced upon review of the new design and reissuance of the amended permit. The system requirements must conform to the current OWTS Regulation, which can be found at http,//www.aspenpitkin.canr/pdfsjdepts 12jowtsreq,pdf. Permit Number for Which Amendment is Requested: ©d.Z91+12 01 1- flowr Parcel ID# (available from the Pitkin County Assessor's Office =4 �� � ci o 970-920-5160 or at wivvv p_itkinassessor.ore): T r.:�:#mpre: rrrsrrrt-tarn-r. +t-rrnrr Property Address: S-76 si+,Qrfti�a V-088 Lot:6 Block: Filing: Subdivision;6+8rMe4a Building Permit #: 0_ZZ . S0j Z . Me4e— Property Owner(s):A,!�P g,V, �+rC�,n ,.t� / � Email Address: caner' Mai in Address: TT?1 �t�_`"' �, �„' Ci S te, Zip: trrel�vr! 9, t48 �?ugF:,�4uk1a,-r�;'"Iw�artel Home Phone: of ��neis 3 •i 4)ZsQ PririyContact Per on /Applicant (if not owner): Coin ny:�yC Gya rl Wewr Cpp leantMaNiAres epic AvJt- City, Zip - State ip� :epic r CeJJ Pho • q7o •,tot --3c=3 -0) ''i ►fess P ong:Sq� c`�' Fer: 'Num 2 k Email Address: bora r► WMcglim1 PLEASE READ BEFORE SIGNING: I certify that the above Information is complete and accurate. 1 acknowledge that EH/NR may revoke any permit I am issued if my application is found to contain any inaccurate, false, or misleading information. 1 understand that no construction may be undertaken on the OWTS until the OWTS Construction Permit is amended or a new permit is is! Owner/Applicant OFFICE USE ONLY: Recived by: Invoice #: Invoice amount: 10,2.012. Date Date: Date received: OI TE WASTEWATER TREATMENT Sy TEM (OWTS) CONSTRUCTION PERMIT APPLIL.-kTION GH/�R ( (� 0405 Castle Creek Road, Suite 10 •Aspen, Cu •81611 Phone: 970.920.5070 Fax: 970.920.5077 Parcel ID# (available from the Pitkin County Assessor's Office /� �� _ �7 ^l _ ©YU _ Q ( ✓'1 970-920-5160 or at www.pitkinassessor.orq): Purpose of Permit: ' EW F] REPAIR DUE TO FAILURE ❑REMODEL/ADDITION ❑TANK ONLY ❑FIELD ONLY Cost of System Repair or Remodel/Addition (approximate): Property Address: Q7G C� Mia i� CJ Block: Filing: Subdivisionfzw / a Property Owners)*� pt V ( w ( � '� L> E"Cl�lf eC�7 Y'� IgTit%V� Q ko' wai I. c4ow Owner's Mailing Address: �`' City, State, Zip: Rask Grnv ) Lftet 9 t Sf c(�la 10 N&j Zea1aK Hon 1 one:/ _ �1 1 7 C /_ (06) 4sine' ;s phone: *Contact information must be provided for the owner signing this application. Pr i ry Contact Per on/Applicant (if n owner): .'�a v�,v�, _ Dern n Co pany: c��+ Lve Gu K,A rW ATz Contc alicM ' ing Address: CCJJ E71 U't�e�N ity, State, Zip: g ' co t l Ceon 3 (W 7°I -�7? usin ss Phone: 9Zn -'S o Fax um1O` — S� 9 () Eyiail Address: nY�C�u ►r►Yli , CWY� Building Permit # (if applicable): �, 7. I.to k Lot Size (in acres): Size ofBuildin (square feet): Number of Potential Bedrooms: sIfiCD Detached Accessory Unit? ❑YES 01410Size of Accessory Unit (square feet): Number of Potential Bedrooms In or Fixture List for the Accessory Unit: Water Source: jRIVATE WELL ❑ SURFACE WATER ❑ SPRING ❑ COMMUNITY/PUBLIC WATER SYSTEM Name of Community/Public Water System (if applicable): E Bering Fir Job Numb r: Phone Nu r: Fax tuber: %�KG �4R2-ot5%�a�NO 4S-S'P2R"-S� Mailinq Address: qy, State, Zip: PLEASE READ BEFORE SIGNING: I certify that the above information is complete and accurate and that I have provided complete and accurate information in all of the documents included in my application package. I acknowledge that EH/NR may revoke any permit I am issued if my application is found to contain any inaccurate, false, or misleading information. I understand that no construction may be undertaken on an OWTS until an OWTS Construction Permit is issued. Owner Signature (Required): Date: / i nature: -- Date - App[ 4 1 n�27�i ! �)2,, Ink V QN.j Pitkin County Environmental Health Department - Contact Log Sheet OWTS DESIGN CALCULATIONS - for Pitkin Owner's Name Parcel ID # ; ;< House Size (sq. ft.) � (75 gpd or 100 gpd) 3 7.5 Number of Bedrooms in Main House , Number of Offices, Libraries, Studies, Similar -sized Rooms in Main House +: Number of Bedrooms in Detached Caretaker unit Number of Offices, Studies, Similar -sized Rooms in Caretaker Unit (If the caretaker unit is ATTACHED, treat as if part of main house.) Average Daffy Waste Flow 45 State Review Required? no Perc Rate' (T) Design Flow (Q) = # potential bedrooms X 2 people/bedroom X gpd X 1.5 Q= 67.5 Minimum tank capacity 84 gallons Absorption Area (=Q/5 X SQRT perc rate)(1.4 loading factor) A = 309 sq. ft. of absorption area required Absorption Area (=Q/5 X SQRT perc rate) WITH SECONDARY TREATMENT (no loading factor) A= 221 sq. ft. of absorption area required Abs. Area w/ loading factor (B25) Trench Bed Quick4 Trench Quick4 Bed Pipe and Gravel (-10%) 278 no red. 309 28 31 Dosing (-20%) 247 (-20%) 247 25 25 Chambers (-30%) 216 (-10%) 278 22 28 Max Allowable -50%) 154(-30%) 216 16 22 Secondary Treatment Abs Area w/ out loading factor (B28) Trench Bed Pipe and Gravel (-10%) 199 no red. 221 20 22 Dosing (-20%) 176(-20%) 176 18 18 Chambers (-30%) 154 (-10%) 199 16 20 Max Allowable (-50%) 110 (-30%) 154 11 16 100 SETBACK FROM WELL # of feet = 50 SETBACK FROM POND, STREAM OR IRRIGATION DITCH # of feet = 25 SETBACK FROM DRY GULCH # of feet = Carla Ostberg From: Chris Hale [chris@mountaincross-eng.com] Sent: Wednesday, November 30, 2011 9:48 AM To: Carla Ostberg Cc: janverd@cunniffe.com Subject: RE: Star Mesa Barn ISDS Carla: I figured flows like this: F=ixtures: Toilet: 24.8, Hand sink: 8.4, Kitchen sinks/utility sink (?): 4.4 or 8.4, for a total of (24.8+8.4+8.4) = 41.6 gpd which is less than the item for a Barn (45 gpd) in table 6.28-2. So I used the Barn item of 45 gpd to be conservative. In the Table 6.28-2, it says that the 45gpd for a "Barn" includes a toilet, hand sink, mop sink, and a washing machine. Hope this clarifies. If not, I can revise it however it makes it easiest for you. Let me know and thanks in advance. Sincerely, Mountain Cross Engineering, Inc. Chris Hale, P.E. 826 1/2 Grand Avenue Glenwood Springs, CO 81601 Ph: 970.945.5544 Fx: 970.945.5558 From: Carla Ostberg FinaiIto: Carla. Ostberg(&co.pitkin.co.usl Sent: Tuesday, November 29, 20113:05 PM To: Chris Hale Cc: janverd@cunniffe.com Subject: RE: Star Mesa Barn ISDS Hi Chris, Which fixtures are we throwing into the equation —just for sake of clarification? Toilet 24.8 lavatory 8.4 Utility sink 4.4 or 8.4? Whatever the flows, I'm sure they will be minimal and it's just easier to clarify with each fixture —for use by one person. I'm assuming there are no intentions to put in a washing machine? (sorry if you have already answered these questions — they were not on the design and I can't remember anything that happened before I had 3 days off last week!) I'll try to get this permit issued early tomorrow. Thanks! Carla Ostberg, MPH, REHS Environmental Health Manager Pitkin County Environmental Health 970-920-5438 From: Chris Halemailto:chrisC�mountaincross-eng.coml Sent: Tuesday, November 22, 2011 11:08 AM To: Carla Ostberg Cc: janverd@cunniffe.com Subject: Star Mesa Barn ISDS Carla: Attached is the revised barn drawing. . ave incorporated all the comments except ..,e septic tank. I called Copeland Concrete and they make septic tanks as small as 500 gal. but the code requires two compartments the first smallest compartment is 500 gal and the second smallest is 250 gal. so that requires 750 gal. which is what is on the plans. So I changed it to say 750 gal Min. Call with any questions and have a great Thanksgiving. Sincerely, Mountain Cross Engineering, Inc. Chris Hale, P.E. 826 1/2 Grand Avenue Glenwood Springs, CO 81601 Ph: 970.945.5544 Fx: 970.945.5558 Carla Ostberg From: Carla Ostberg Sent: Tuesday, November 29, 2011 3:05 PM To: 'Chris Hale' Cc: janverd@cunniffe.com Subject: RE: Star Mesa Barn ISDS Hi Chris, Which fixtures are we throwing into the equation —just for sake of clarification? Toilet 24.8 lavatory 8.4 Utility sink 4.4 or 8.4? Whatever the flows, I'm sure they will be minimal and it's just easier to clarify with each fixture — for use by one person. I'm assuming there are no intentions to put in a washing machine? (sorry if you have already answered these questions — they were not on the design and I can't remember anything that happened before I had 3 days off last week!) I'll try to get this permit issued early tomorrow. Thanks! Carla Ostberg, MPH, REHS Environmental Health Manager Pitkin County Environmental Health 970-920-5438 From: Chris Hale Fmailto:chris mountaincross-eng.comI Sent: Tuesday, November 22, 2011 11:08 AM To: Carla Ostberg Cc: janverd@cunniffe.com Subject: Star Mesa Barn ISDS Carla Attached is the revised barn drawing. I have incorporated all the comments except the septic tank. I called Copeland Concrete and they make septic tanks as small as 500 gal. but the code requires two compartments the first smallest compartment is 500 gal and the second smallest is 250 gal. so that requires 750 gal. which is what is on the plans. So I changed it to say 750 gal Min. Call with any questions and have a great Thanksgiving. Sincerely, Mountain Cross Engineering, Inc. Chris Hale, P.E. 826 1/2 Grand Avenue Glenwood Springs, CO 81601 Ph: 970.945.5544 Fx: 970.945.5558 Carla Ostberg From: Carla Ostberg Sent: Thursday, November 17, 2011 5:19 PM To: 'Chris Hale' Cc: 'janverd@cunniffe.com' Subject: 875 Star Mesa Hi Chris, I am reviewing the design for this barn and have some questions. I don't quite follow your math. You have 45 gpd design flow. Do you mean average daily flow? With a toilet (24.8 gpd) and sink (8.4) and another sink (8.4 or 4.4, depending on what kind of sink it is) for use by ONE person, if we round up to 45 gpd we still need to add the 1.5 peaking factor to get the DESIGN FLOW. That said, I have cc'd Janver to be sure we have the fixture count right. Also, will there be a washing machine? Sometimes those pop into barns at the last minute and it's easier to size the system accordingly ahead of time. It would not add much to the size. You have spec'd a 750 gallon tank, but I'm not sure they even make them anymore. I think the smallest is 1000 gallons. Oh, and you have a min of 10" of cover on the gravel bed — it has to be 12". Shoot me an email or give me a call tomorrow. Thanks! Carla Ostberg, MPH, REHS Environmental Health Manager Pitkin County Environmental Health 970-920-5438 Chris Hale From: Bryan Daugherty [Bryan.Daugherty@co.pitkin.co.us] Sent: Monday, July 02, 2012 3:09 PM To: Chris Hale Subject: RE: Message from "RNPOO267345D9C9" That's fine. There is no amendment or any notes about the change. I did receive a call about a month or 2 ago to issue a permit for the barn from Margot I believe with the general contract firm but I told her there was already a permit in place and I sent a copy of the existing to her. She didn't mention she was calling for an amendment to the system. Was the system supposed to change size based on the 2nd barn's use or will the system that was installed suffice? If it can work I can amend the permit to show that it can handle the flows of the 2nd barn. Bryan Daugherty, REHS Environmental Health Specialist Pitkin County Environmental Health (970) 920-5076 -----Original Message ----- From: Chris Hale [mailto:chris@mountaincross-eng.com] Sent: Monday, July 02, 2012 2:36 PM To: Bryan Daugherty Subject: RE: Message from "RNP00267345D9C9" Bryan: Some history first then a question... About a year ago 875 Star Mesa had me do a design for the ISDS of a barn. Since then, they have decided to add another, a second barn. I redesigned the ISDS for two barns and I sent the design drawing to Charles Cunniffe Architects to revise/amend the barn ISDS permit. Now that I look at the permit I notice that it has the flows as 45 gpd for one barn. To complicate it more, I also know that Carla has left since then, too. Now the question... Is there another permit for the combined barns or is there an amendment to this permit? Sorry to be difficult. Thanks in advance. Call or email any questions. Sincerely, Mountain Cross Engineering, Inc. Chris Hale, P.E. 826 1/2 Grand Avenue Glenwood Springs, CO 81601 Ph: 970.945.5544 Fx: 970.945.5558 -----Original Message ----- From: Bryan Daugherty [mailto:Bryan.Daugherty@co.pitkin.co.us] Sent: Monday, July 02, 2012 2:18 PM To: Chris Hale Subject: FW: Message from "RNP00267345D9C9" Here is a copy of the signed permit. Bryan Daugherty, REHS Environmental Health Specialist Pitkin County Environmental Health (970) 920-5076 1 -----Original Message ----- From: pitkinworks@co.pitkin.co.us [mailto:pitkinworks@co.pitkin.co.us] Sent: Monday, July 02, 2012 1:50 PM To: Bryan Daugherty Subject: Message from "RNP00267345D9C9" This E-mail was sent from "RNP00267345D9C9" (Aficio MP C4502). Scan Date: 07.02.2012 13:50:22 (-0600) Queries to: pitkinworks@co.pitkin.co.us Email secured by Check Point 6 Mountain Cross Engineering, Inc. Civil and Environmental Consulting and Design 826 1/2 Grand Avenue, Glenwood Springs, CO 81601 Ph: 970.945.5544, Fax: 970.945.5558 LETTER OF TRANSMISSION DATE: 07-27-12 TO: Bryan Daugherty, PitCoEHD 76 Service Center Rd Aspen CO, 81611 FROM: RE: 875 Star Mesa Road, OWTS for Two Barns Bryan: Attached for your use are: - Completed "Request for Amendment to an OWTS Construction Permit". - Copy of Finalized Permit to be changed. - Check for $162.00 - Design for Two Barns on 11"x17" plan - As -Built for Two Barns on 11 "x 17" plan - Hard copy of email correspondence A few weeks ago we discussed that the OWTS for the barns at 875 Star Mesa was to have been amended from one barn to include the expansion for a second barn. The General Contractor was to have coordinated this but it seems to have gotten confused. Since then the OWTS was constructed to the Two Barn design and the As -built submitted. But the Construction Permit was finalized with the information for a single barn. Please amend the permit to incorporate the second barn. You may submit the revised Construction Permit to the information at the top of the page or by email to chris@mountaincross-eng.com. Thanks in advance. Feel free to call if you have any questions or comments. GRAEME & ROBYN HART 743 Riddell Road, Glendowie, Auckland, New Zealand Phone: 64-9 3666 259 Fax: 64-9 3666 263 RECEPTION#: 584016,11/01/2011 at 21 October 2011 01:46:29 PM, 1 of 1, R $11.00 Doc Code NOTICE Janice K. Vos Caudill, Pitkin County, CO Cindy Houben Director Pitkin County County Community Development Director 130 Galena Street Aspen, Colorado 81611 USA Re: Site Plan Review for a Barn 875 Star Mesa Road, Pitkin County, Colorado Dear Ms. Houben 1 -am the Owner of Aspen Kiwi Properties, LLC, which has applied for and received approval of the Site Plan Review for a Barn at the above address. I hereby authorize Charles Cunniffe to sign the required Final Plat Mylar on my behalf. Thank you in advance for your cooperation. Best regards, Graeme Hart Aspen Kiwi Properties, LLC I I 0) m t0 r c CY) CY) Cl) 0 ..w m 0 C) C) 0 04,000 C-0COO cli CN CL 0 0) LO Ln 6 — CD 0 0 4) CD 0 0 4) a CL Lo q cn a Z Go cy) 00 : > Mto 00 c 4) Ln LO Lo W 4) v Cl) LO c > CY) U') 04 c 4) cy) 00 cl) oa > r (Y) (D 1 U-) Lo Ln o C) 0 Coon co m m (D C> C) c) C:) o III CO m (Y) az CD m CD Cl) C) Cf) C) 0 C:) Uj C, Cl 1p (D C) (Y) (Y) coC) O m LO U*) LO co ui c) Ll 101 1 1 U') LO Ln CN 0 3: I L I ,p 4 c ro 0 ..w m 0 C) C) 0 04,000 0 0) cl) M 6 — CD 0 0 4) 0- a dM Lo q (0 co CO 4) v Cl) LO > CY) U') 04 W oa 1 a 0 o o C) 0 Coon co m m (D C:) o III C, C, C, CD m CD Cl) C) Cf) LQCN C'! LP Uj 04 CIJ m CN LO C-4 Cq co c) Ll 101 1 1 L I I- (.0 QO CU Lo C14 11 co N ,p 4 c ro 0 ..w m 0 C) C) 0 04,000 0 0) cl) M 6 — CD 0 0 4) 0- a dM Lo q (0 co CO 4) v Cl) LO > CY) U') 04 W oa 1 a 0 o o C) 0 Coon co m m (D C:) o C:) C, C, C, CD m CD Cl) C) Cf) LQCN C'! LP Uj 04 CIJ m CN LO C-4 Cq co c) Ll 101 1 1 I- (.0 QO CU Lo C14 11 co N Form No. STATE OF COLORADO, OFFICE OF THE STATE ENGINEER For Office Use Only GWS -09 821 Centennial Bldg., 1313 Sherman St, Denver, CO 80203 6/2006 (303) 8136-3581 Fax (303) 866-3589 httpJ/www.water.state.00.us WELL ABANDONMENT REPORT Use to report plugging and sealing of permitted wells, monitoring and other holes. Type or print in black or blue ink. Instructions and plugging standards are on reverse side of form. Well Permit Number of the well being plugged 1 3 4 5 0 9 or MH File Number MH- Hole ID #/Name individual/Company responsible for plugging and sealing the well: NAME(S) Sh 1 ton Drilling, rcarp Mailing Address _A c) T%nsr j ()59 City, St., zip Basalt, Co 81621 i Phone ( 970 ) . 993-41 97 Well (Hole) Owner: NAMES) Aspen Kiwi Properties LLC Phone ( ) Mailing Address, City, St, Zip % P.O. BOX 4759 ASAen , Co 81 612 ACTUAL WELL LOCATION: County P i t k i n Property Address, City, St Zip 875 Star Mesa Road Aspen, Co x_1/4 of the SW 1/4, Sec. 23 , Twp. 9 � N. or®S., Range 85_ O E. or[] W., 6_ P.M. Distance from Section Lines 974 Ft From [] N. orK] S., 151 Ft From ❑ E. or ® W. Line. Subdivision Name- S ar Mesa Lot H . Block . Filing/Unit Optional: GPS well location information in UTM format You must check GPS unit for required settings as follows: Format must be UTM. zone 12 0 or zone 13 Q ; Units must be meters; Datum must be NAD83; Unit must be set to true north. Easting 3 3 9 6 0 3 Northing 4346245_ 1(we) report the existing well (hole) was plugged and sealed on the date of _ 11/10/11 for the following reason(s): ❑ The well was plugged and sealed as required under Well Permit Number ❑ The well was not in use and was plugged and sealed - El Other (please explain) The well was plugged with the following materials placed at the indicated intervals: Amount and Type of Material Method of Placement Interval Sand & Gravel 3.8 yards gravity _y from 10 feet to 790 feet Bentonite Chips 4 bags gravity from 2_feet to 245 feet 485 NP -at ment 9 hags gravity from 0 feet to 10 feet Intervals of casing removed/ripped in feet from feet to feet Report must be signed by person who perfonned the well plugging worts or by the well owner if this person is unknown or not reachable. I (we) have read the statements made herein, know the contents thereof, and that they are love to my (our) knowledge_ Signa! _ _ _._ .-_ .--_— print the Signer's Name & Title Data ----� Wayne Shelton President I 11/11/11 It Is the responsibility of the well owner to have the welVhole properly plugged and sealed. The Well Construction Contractor is responsible for notifying the owner of this requirement Form No. GWS -25 APPLICANT OFFICE OF THE STATE ENGINEER COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St„ Denver, Colorado 80203 (303) 866-3581 EXST WELL PERMIT NUMBER 287052 - DIV. 5 WD 38 DES. BASIN MD Lot: H Block: Filing: Subdiv: STAR MESA APPROVED WELL LOCATION PITKIN COUNTY SW 1/4 SW 1/4 Section 23 ASPEN KIWI PROPERTIES LLC Township 9 S Range 85 W Sixth P.M. CIO OKGKM DISTANCES FROM SECTION LINES 533 EAST HOPKINS AVE 3RD FLOOR 942 Ft, from South Section Line ASPEN, CO 81611- 158 Ft. from West Section Line (970) 920-1700 UTM COORDINATES (Meters, Zone: 13,NAD831 r_, 6, n• Alnrfhinn- 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 ensure 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)(I1)(A) as the only well on a tract of land of 40.25 acres described as lot H, Star Mesa division of land, Pilkin County. Further identified as 875 Star Mesa Road, Aspen, CO 81611. Any and all other existing wells located on this parcel, specifically permit no. 134509, must be plugged in accordance with Rule 16 of the Water Well Construction Rules within ninety (90) days of completion of the new well. The enclosed Well Abandonment Report form must be completed and submitted to affirm that the old well was plugged. 4) Approved for the installation of a pump in, and the use of, an existing well, constructed on September 7, 2011, to a depth of 837 feet under permit no. 286554 (canceled). Issuance of this permit hereby cancels permit nos. 134509, 134509-A and 286554. 5) The use of ground water from this well is limited to fire protection, ordinary household purposes inside not more than three (3) single family dwellings, the watering of poultry, domestic animals and livestock on a farm or ranch and the irrigation of not more than one (1) acre of home gardens and lawns. 6) The pumping rate of this well shall not exceed 15 GPM. 7) The return flow from the use of this 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 located not more than 200 feet from the location specified on this permit. NOTE: This well was decreed as Rondelay Well H in Division 5 Water Court case nos_ 81CW0492, 88CW0070, 94CW0047, 11CW0140 (pending). NOTE: A move of greater than 200 feet from the decreed location is considered a change of water right. Application should bo made to the Division 5 Water Court for this change of water right. NOTE: Permit nos. 134509 (abandonment required), 134509-A (canceled) a 286554 (canceled) were previously issued for this well. NOTE: Parcel identification Number (PIN): 49-2643-224-00-010 NOTE: Assessor Tax Schedule Number: R012280 APPROVED DMW `✓ Stale By Receipt No, 9503507 DATE ISSUED 11-15-2011 EXPIRATION DATE WELL CONSTRUCTION AND TEST REPORT FOR OFFICE USE ONLY STATE OF COLORADO, OFFICE OF THE STATE ENGINEER I. WELL PERMIT NUMBER 286554 Owner Name(s): Aspen Kiwi Properties LLC 2 Mailing Address: % Oats, Knezevich Law 533 E. Hopkins Ave. City, State, Zip: Aspen, Co 81611 Phone # APPROVAL # GWS31-91-03 3' WELL LOCATION AS DRILLED SW 1/4 SW 1/4 Sec: 23 Twp: 9 S Range: 85 W 6th PM DISTANCES FROM SEC. LINES ft. from Sec. line and ft. from Sec. line OR Easting: 3 39 605 Northing: 43 46 235 SUBDIVISION: Star Mesa LOT: H BLOCK: FILING (UNIT): STREET ADDRESS AT LOCATION GROUND SURFACE ELEVATION ft. DRILLING METHOD Air Rotary 4. DATE COMPLETED: 9/7/2011 TOTAL DEPTH: 837 DEPTH COMPLETION: 830 5. GEOLOGIC LOG 6. HOLE DIAMETER (in) FROM (ft) TO (ft) Depth Type of Material (Size, Color, and Type) 9.0 0 96 000-012 Dirt 6.5 96 837 012-086 Boulders, Cobbles, Clay 086-775 Mancos Shale 7. PLAIN CASING 775-830 Lower Mancos Sandstone OD (in) Kind Wall Size From (ft) To (ft) 830-837 Manocs Shale 7.0 Steel 0.240 -1 96 5.5 PVC 0.250 0 770 PERF. CASING: Screen Slot Size 5.5 PVC 0.250 770 830 8. Filter Pack 9. Packer Placement Water Located: 775+ Material Type Size : Depth Remarks Interval 10. GROUTING RECORD Material Amount Density J Interval Placement Cement 7 sks 6 gal/sk 10-40 poured 11. DISINFECTION Type : HTH Amt. Used: 15 oz. 12. WELL TEST DATA : () Check Box If Test Data Is Submitted On Supplemental TESTING METHOD: Air Compressor Static Level : 482 ft. Date/Time Measured 9/7/2011 Production Rate 15' gpm Pumping Level : Total ft. Date/Time Measured 9/7/2011 Test Length : 2 hours Test 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 244-14 (13)(a) CRS, the making of false statements constitutes perjury in the second degree and is punishable as a class I misdemeanor.) CONTRACTOR : Shelton Drilling Corp. Phone: (970) 927-4182 Mailing Address: P.O. Box 1059 Bas t, 621 Lic. No. 1095 Name / Title (Please Type or Print) Signa e _ _ ., ...._.._. _..:.._,� Date 9/8/2011 Wayne Shelton / President ` ORIGINAL �rog on l,'Sgi'i=B?::° Pe�`+o p.p,�i YN-c 'osz�,cm.�e mo.n�wN S 7' zO 33 <� k,3' S'L'a R�^ugms�8oy $AS`s off$~�ag'a3o gmR z� �; a' o' i yii u Zm O?3f4�ogmoa, �Q°% vmmF3&S�'`° aN ��Ti 22°g. 8-mpDa3 .. $SS=d$35°O�_ D m �m o S Sul � > S S'O Ilz P�i=F=� g �is':�Fi - �g�s6g�• ��_ ;E u� ozU� o IIS ga gR" '2g m; f 11 o ' u zs o O3Fvogv°,c S'g' °3 0° °a�', �"=.".'x_�a'+''�e yiO B`x �.ga !m �?' nx''oo 3m '3�-a3m S°.. 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