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Home My WebLink Aboutpitkin.eh.264511100002 (2012) Fishing Cabin(jTKIN COU N Permit #: 0031.2012.powt O. SITE WASTEWATER TREATML )r SYSTEM (OWTS) CONSTRUCTION PERMIT 76 Service Center Rd- Aspen, CO - 81611 Phone: 970.920.5070 Fax: 970.920.5374 Parcel ID #: 2645-111-00-002 Permit Issued: ®NEW CDU ❑REPAIR ❑REMODEL/ADDITION ❑TANK ONLY ❑FIELD ONLY ❑AMENDMENT Owner(s) Charlie Mountain LLC Property Address: Legal Description: 4100 Snowmass Creek Rd Size of Lot: 33.54 Size of Building: 2600 ft2 Acres Detached Accessory Unit: ❑YES ❑NO Sq. Ft. Size of Accessory Unit: Sq. Ft. The systems are designed for: The 2 bedroom fishing cabin + effluent from the 5 -bedroom main residence. Designed By: Phone #: Fax #: All Service Septic Project #: 970-618-5033 Mailing Address: 303-216-2796 Email Address: Perc Rate: 30 mpi Minimum Tank Capacity 1948 Dated: October 8, 2012 PO Box 2844 Glenwood Springs, CO 81602 cbo261 O@yahoo.com Profile Hole Depth: 8 ft Depth to Groundwater or Bedrock: ➢ 8 ft 563 Gallons Minimum Absorption Area: 1709 ft2 (20% reduction) 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. The system is designed for the 2 -bedroom fishing cabin and the effluent from the 5 -bedroom main house (permit # 0029.2012.powt) and the leachfield is sized for 7 -bedrooms while the tank is sized for 2 -bedrooms. The average daily flow was calculated to be 1300 gallons per day (100 GPD/person/day for the main house and 75 GPD/person/day for the fishing cabin) The system will consist of a 1000 gallon, 2 -compartment septic tank with a biotube pump in the second compartment. The effluent will then be pumped to a distribution box, which is also connected to the main house effluent line, and the effluent from each system is gravity fed to the leachfield. The leachfield is a 33'X 45' sand bed and it will have 6 rows of 12 Eljen modules for a total of 72 modules. Each module row will be separated by 3 feet of space. The minimum setback to the leachfield from any well shall be a minimum of 176' and the minimum setback to the leachfield from the stream shall be a minimum of 126'. 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. Issuance of this permit does not imply compliance with Pitkin County building and/or land use regulations, nor guarantee issuance of building and/or land use permits. 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: �� ._ �-� Q- - Date: 1211/12 Expires: 12/11/13 Installer: License #: Reactivation Authorized by: Final ApprlO��cval Issued By: S` t� N �--3 Date: _ f 7! 4._,_ New Expiration Date: EJ Fee Paid up3j•2o�Z. Pay.�'� Fru ►eta,-Qj sip [6, ((tlCa i o) Cob r,) you -cel � O ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) CONSTRUCTION PERMIT APPLICATION I.II/NR 76 Service Center Rd • Aspen, CO • 81611 Phone: 970.920.5070 Fax: 970.920.5374 Parcel ID# (available from the Pitkin County Assessor's Office _ b 970-920-5160 or at www.pitkinassessor.o�'rq): � 4 5 111 0 Purpose of Permit: L? NEVI ❑ REPAIR DUE TO FAILURE ❑ REMODEL/ADDITION ❑ TANK ONLY ❑ FIELD ONLY CAW of System Repair or Remodel/Additi-)n (approximate): Property Address. 4to'D S(A N"Zi-ss (� Lot: BlockFiling: Subdivision: Property Owner(s)': Email Address: Owner's Mailing Address: City, Slate, Zip: Home Phone. Uusmess Phone: r rarr irtr ,mannas must he nmvrded to • the ovmer signing this application Primary Contact PersolVA !"nt (if not nvnerk I)erlVL Company, \A Contact/Applicant Mailing Address. City, te, Zip: Cell Phone: co � o �4 �b �ko- 5� - Business Phone Fax Number: Email Address: d ' Cie, V- kaAAA k.af Building Permit # (if applicable): , Lot Size (in acres) - 0 3 - cres):03.5 Size of Building (square feet): '2 Number of Potential Bedrooms: L Detached Accessory Unit? E3 -- Size of Accessory Unit (square feet): ❑YIS E3NO Number of Potential Bedrooms In or Fixti re List for the Accessory Unit Water Source: PMATE WELL ❑ SURFACE WATER ❑ SPRING ❑ COMMUNITY/PUBLIC WATER SYSTEM Name of CommunityiPublic Water Systm i (if applicable): Engineering Firtm: Job Number: Phone Number Fax Number: Mailing Addie City. Stat . Zi EL% is 14 Ll to W 00 IF n o _CASE READ BEFORE SIGNING: I certify that the above Information Is complete and accurate and that I [rave provided complete and accurate information in all of the documents included in my application package. t 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): A%.4rri„yq� F�r-Date ��3t�•ZOiz —� CtiC",A(L moa k i, LLC Applicant Signature: n Date: . FOR OFFICE USE ONLY Received by ENJHR Staff. Fee 8 Receipt #. Date: 221 rat)vviStvidicho,iWdNEWltcu�iuui�e ltunn��;1onns��UG�`i;�onnttu�nc.e_rin:>.,n;trucnoopermitapplicaiton.xts U nt :7U d i I MN V11 f CEHONSITE WASTEWATER TREATMENT SYSTEM (OWTS) USE PERMIT APPLICATION CHECKLIST 76 Service Center Rd - Aspen, CO - 81611 Phone: 970.920.5070 Fax: 970.920.5374 A complete application package must be presented at the time of your pre -application conference for acceptance. To schedule a pre -application conference, please call 970-920-5070. PLEASE INITIAL EACH ITEM TO INDICATE COMPLETION Only one copy of each item is necessary. coyt F -C f 7 OWTS Use Permit Application (completed) ,OSite Plan ❑ Please indicate the type of document to be submitted below. ❑ 11" X 17" and/or ❑ Electronic document emailed to ehnr(F2-)co.pitkin.co.us before the date of the pre -application conference ❑ All designs must be 1" to 20' in scale. ❑ Site plan must include locations of existing wells, buildings, property lines, ditches, water lines, springs, irrigation lines, drinking water cisterns, drain tiles, water bodies, wetlands, riparian areas, floodplains, dry gulches, and existing OWTSs. rl A �/ �/ Soil Testing Notification & Report (must be provided by a PE) ❑ This Department should be notified when soil tests are conducted. A 2"- 4" perforated PVC pipe should be placed in the soil profile hole for monitoring purposes. ❑ Report must include percolation test results and the soil profile evaluation. e Building Floor Plans ❑ 11" X 17", or submitted electronically to ehnrCcDco.pitkin.co.us before the date of the pre -application conference. e�. e e Land Use Approvals & Other Relevant Permits & Approvals ❑ Recorded Site Plan that designates approved envelope(s) for development. If the property is exempt from this requirement, please have a Community Development Planner email ehnr(a)co.pitkin.co.us with confirmation of the exemption. ❑ 24" X 36" and ❑ 11" X 17", or electronic document emailed to ehnr()co.pitkin.co.us before the date of the pre -application conference ❑ Copies of all land use approvals, as well as all other documentation relevant to the siting of the OWTS(s) and any other development on the property (e.g., Resolutions, Administrative Decisions, recorded easements). Comments from EH/NR regarding Land Use review referrals can be accessed by opening http //www aspenpitkin comlpdfsldeptsl7lianduse. pdf and clicking the blue link in the "Referrals" column. Referral comments more than 2 years old may need to be requested from the County Planning Department. Construction Management Plan ❑ Required & Obtained ❑ Not Required Requirements: ihttp //www aspenpitkin com/pdfs/deptsl7/CMP Manual.pdf Forms: http llwww aspenpitkin com/deptsl7/bldgdiv cfm ✓ ✓ Proof of Adequate Water Supply Legal water supply must be demonstrated in accordance with Colorado water law and meet the requirements of the Pitkin County Land Use Code. ❑ Private systems: Proof generally includes a well driller's report, well permit issued by the Colorado Division of Water Resources, final augmentation plan (if required), and a recent pumping report. Wells must be drilled before an application will be accepted. ❑ Public systems: Proof generally includes a letter from the CWQCD - approved public water system confirming it has sufficient water to supply the development and it has agreed to do so. Initial Site Inspection ❑ All components of the OWTS, as well as the proposed buildings, water source, and other pertinent physical features must be clearly staked and labeled prior to the inspection. Inspection must be scheduled between May 1st and Oct 31st, unless otherwise approved by EH/NR. Applicable Fee ❑ OWTS Construction Permit: $1,023" ❑ Tank Only: $523' `There is an additional Administrative Fee of $175.00 for properties in the Town of Snowmass Village. Please Make Checks Payable To: Pitkin County Environmental Health & Natural Resources Department TO SUBMIT A BUILDING PERMIT APPLICATION PRIOR TO OBTAINING AN OWTS CONSTRUCTION PERMIT THE FAST TRACK WAIVER MUST BE SUBMITTED TO COMMUNITY DEVELOPMENT WITH YOUR BUILDING PERMIT APPLICATION. Please note that this waiver only allows for the submittal of the Building Permit Application. It does not allow for the issuance or approval of the Building Permit without OWTS Construction Permit approval from the EH Department. G:\OWTS March 8, 2008 NEW REGS\Office - Admin\Forms\OWTS Const Forms\OWTS Construction checklist.xls adated:3/20/09 On 33 Four Wheel Drive Rd ALLCarbondale, CO 81623 970.309-5259 11111a �!ZH September 6, 2014 Dennis Derham diderham a gmail.com Onsite Wastewater Treatment System (OWTS) Installation Observations Free Market Single Family House (Parcel A) 130 Charlie Way (formerly 4100 Snowmass Creek Road) Pitkin County, Colorado OWTS Construction Permit Number 0031.2012.powt Dennis, F1 Project No. C1948 ALL SERVICE septic, LLC observed the installation of the onsite wastewater treatment system (OWTS) on July 26, 2013 and August 12, 2014 for the subject property. The OWTS will serve the Free Market Single Family House (aka Fishing Cabin). The main house is served by a tank installed under a separate permit (OWTS Construction Permit Number 0029.2013.powt). Aspen Earthmoving installed the system. The installation included a new 1000 -gallon, two-compartment concrete septic tank with an Orenco® Biotube Pump Vault and pump in the second compartment. The control panel is located inside of the residence. R&A ran start-up on the pump. There is an effluent filter inside the second compartment of the septic tank. This filter must be cleaned annually, or as needed. Effluent is dosed to a distribution box, accessible from grade, and then to six rows of 12 Eljen® A42 Modules placed on 6 -inches of concrete sand. The footprint of the absorption area is 54' x 33'. Initially, a 3 -outlet distribution box was installed. With two pump lines coming into this distribution box, we recommended that a larger box be installed in case the two pumps were to kick on at the same time. The distribution box was replaced (see photos below). The OWTS was generally installed according to specifications. This observation is not a guarantee of workmanship and/or parts and materials. ALL SERVICE septic, LLC should be notified if changes are made to the OWTS in the future. Any additional OWTS construction must be according to the county regulations. LIMITS: Observations are limited to components that are visible at the time of the inspection. The installer must have documented and demonstrated knowledge of the requirements and regulations of the county in which they are working. The quality of the installation is dependent of the expertise of the installer, soil type, and weather conditions. Please call with questions. Sincerely, ALL SERVICE septic, LLC r Carla Ostberg, MPH, REHS k T 11 S,l.ts Clean out Reviewed Richard H. 1000 -gallon septic tank Inlet tee Orenco® Biotube pump vault Original small Distribution box HO Replaced with larger box pump line outlet It should be noted that a 4 -inch line coming from the main house tank was originally installed. A pump was later installed, with dosing only through a short length of 2 -inch pipe before it gravity flows to the distribution box. Pump line from septic tank View of septic tank Pump line M Pump line to dobx Eljen bed layout X Fabric cover over Eljen bed Protected by silt fence, vegetation growing over bed. �w 7fiU WVrW 5 F WO rvLQ, alga �%"�IM n0� CR-bi i PITKIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Percolation Test and Soils Data Form - TABLE 2 - PROJECT 1948 4100 Snowmass Creek Road PROFILE PIT #3 Date of Test: 3-14-12 0 - 1' Sand with Cobbles and Gravel, sparse root zone. 1'- 8' Sand, Clayey, Gravelly with Cobble and Boulders. Difficult Excavation, Very Dense, Moist, Red/Brown/Tan No Groundwater or Bedrock was Encountered PVC Installed Hole Hole Interval Measurement at Measurement at Change (in.) Percolation Rate No. Depth (in.) (min.) Start of Interval End of Interval (min./in.) MPI 7.00 in. in. fill 20 4 33 20 3.25 5.00 1.75 20 5.00 6.00 1.00 20 6.00 7.00 1.00 fill 20 1.75 3.25 1.50 20 3.25 5.00 1.75 20 5.00 6.00 1.00 20 5 36 20 4.50 5.75 1.25 20 5.75 7.00 1.25 20 7.00 dry fill 20 3.25 5.00 1.75 20 5.00 5.75 0.75 20 5.75 6.50 0.75 27 6 29 20 3.25 5.25 2.00 20 5.25 6.00 0.75 20 6.00 7.00 1.00 20 7.00 8.25 1.25 20 8.25 9.00 0.75 27 20 9.00 dry ik 0 CD 0 z 0 OD OD CD Q. N CD Cl) Ul 0 0 0 0mmD C = m m 0CD z L --1mO mx� ZO< �„T- 4., Mr- w o N Q n O Q 6 W U) CR CD En CD K 2. AM � L % Passing N W A cT O v 07 co O O O O O O O O O O O O O s I I I I I I I y c 0 O N :m k 'a ;o m k 3 ju ,w N b V, fi l l PO Box 2844 5 Glenwood Springs,181602 SRjla Ph 970-618.5033 Fax 303-216-27% October 8, 2012 Project No. 1948 Glenn Horn C/O Charlie Mountain LLC 215 South Monarch Street, Suite 104 Aspen, CO 81611 Subsurface Investigation and Onsite Wastewater Treatment System (OWTS) Design CDU and Free Market SF House - Parcel A 4100 Snowmass Creek Road Pitkin County, Colorado Glenn, ALL SERVICE septic, LLC performed a subsurface investigation and an onsite wastewater treatment system (OWTS) design for the subject property. A caretaker dwelling unit (CDU) and Free Market Single Family (SF) House are proposed. The property is located outside of Aspen, in an area where OWTS and wells are necessary. SITE CONDITIONS The property is currently developed; however, the existing structures on the property will be demolished prior to construction of the new residences. Water to residences will be provided by a private well. SUBSURFACE CDU: The subsurface was investigated by digging three profile pits and two sets of three percolation holes, as indicated. Profile #1 and the associated percolation holes are closest to the proposed absorption area that will serve the CDU. The materials encountered in the profile pit #1 consisted of 1.0 -foot of a sandy, gravelly root zone, underlain by sandy, clayey, gravelly, very dense, moist red/brown/tan soil to the maximum depth explored of 8 feet. No groundwater or bedrock was encountered, but excavation was difficult. A gradation was performed on profile pit #2 resulting in 14% gravel, 51% sand, and 35% fines. See Tables 1, 2, and gradation analysis for details. Free Market SF House — Parcel A: The subsurface was investigated by digging three profile pits and two sets of three percolation holes, as indicated. Profile #3 and the associated percolation holes are closest to the proposed absorption area that will serve the 2 -bedroom Free Market SF house on Parcel A and the Free Market SF house on Parcel B. The materials encountered in profile pit #3 consisted of 0 0 Page 2 1.0 -foot of sand with cobbles and gravel, underlain by sand, clayey, gravelly, very dense, moist red/brown/tan soil to the maximum depth explored of 8 feet. No groundwater or bedrock was encountered, but excavation was difficult. An average of 30 MPI percolation rate will be used to design the OWTS. See Tables 1, 2, soil log, and gradation analysis for details. DESIGN SPECIFICATIONS CDU: The OWTS serving the CDU will be designed to serve 1 -bedroom. An average daily wastewater flow of 150 GPD will be used. The installation must include a 1000 -gallon, two-compartment septic tank with an effluent filter. Effluent will be gravity fed to two gravelless chamber beds consisting of 2 rows of 8 Quick 4 chambers, for a total of 32 chambers, or one gravelless chamber bed consisting of 3 rows of 9 ARC 36 chambers for a total of 27 chambers. Free Market SF House — Parcel A: A 1000 -gallon, two-compartment septic tank with a Biotube pump vault will serve the Free Market SF House on Parcel A. A P-30 pump and standard control panel are recommended. The absorption area will be sized to accommodate flow from both the Free Market SF House on Parcel B (5 bedrooms with living area greater than 6000 square feet) and the Free Market SF House on Parcel A (2 bedrooms). An average daily wastewater flow of 1300 GPD will be used to size the absorption area which will consist of a level 6" deep sand bed, 33 -feet wide by 54 -feet long. 72 Eljen modules will be placed on the bed, 6 rows of 12 modules, with 3 -feet of space between each row. Depth of cover over modules should be between 12" and 24". Construction must be according to Pitkin County OWTS Regulations, the OWTS Construction Permit provided by Pitkin County Environmental Health Department, and this design. OPERATION INFORMATION AND MAINTENANCE The surface of the drain field should be seeded upon completion. Vegetation is an important factor in drain field performance. Erosion control should be practiced prior to and during re -vegetation. No heavy equipment, machinery, or materials should be placed on backfilled drain field. Livestock should not graze on the drain field. Plumbing fixtures should be checked to ensure that no additional water is being discharged to OWTS. For example, a running toilet or leaky faucet can discharge hundreds of gallons of water a day and harm a drain field. The homeowner should pump the septic tank every two years, or as needed gauged by measurement of solids in the tank. The effluent filter should be cleaned annually, or as needed. Garbage disposal use should be minimized, and non -biodegradable materials should not be placed into the OWTS. Grease should not be placed in household drains. Loading from a water softener should not be discharged into the OWTS. No hazardous wastes should be directed into the OWTS. Mechanical room drains should not discharge into the OWTS. The OWTS is engineered for domestic waste only. ADDITIONAL CONSTRUCTION NOTES If design includes a pump, air release valves and weep holes should be installed to allow pump lines to drain to minimize risk of freezing. Excavation equipment must not drive in excavation of drain C 0 Page 3 field due to the potential to compact soil. Extensions should be placed on all septic tank components to allow access to them from existing grade. Precast concrete tanks and distribution boxes should be used, unless plastic or fiberglass is required. Access to all tank compartments and distribution devices is optimal. INSTALLATION OBSERVATIONS ALL SERVICE septic, LLC must view the OWTS during construction. The OWTS observation should be performed before backfill, after placement of OWTS components. Septic tanks, distribution devices, pumps, dosing siphons, and other plumbing, as applicable, must also be observed. ALL SERVICE septic, LLC should be notified 48 hours in advance to observe the installation. LIMITS: The design is based on information submitted. If soil conditions encountered are different from conditions described in report, ALL SERVICE septic, LLC should be notified. All OWTS construction must be according to the county regulations. Requirements not specified in this report must follow applicable county regulations. The installer should have documented and demonstrated knowledge of the requirements and regulations of the county in which they are working. Please call with questions. Sincerely, ALL SERVICE septic, LLC Carla Ostberg, MPH, REHS 3 copies Reviewed 1 Richard H 0. male: V 40'-0" �\' 65 \✓ \�� -_ — �� — �� / / / to I // r// /Z \ p CL R►\ LOPE `1 F\ 1 l._ \ I / l 11 I -i E SE�BAC 1 t j / 1 IN. ELLS TF�HAG14—�`/ / I ( l \ \ / /' I l Q 6 r � 1 / - EDR0C51G1'�— / T IT VE setback w W I'll n d� field �� 7461 P / 2 7459 0 \ \147 =�—=- . � r r :,� � � 1 M . 14 r _ c / 741 / / //// I 1 1 X� \ / / I 475 0 / 14 / W F I // / \ Lj � �/ -=�...�:�:.,: �•�:. / � ...�746III � •qC "- 7477 7479 I I 7419 I I i :Y 1 I I 499 I — ` \ \ / 7479 7.77 ; :r OP ED 7480 E010E7pp _ P.O. Box 2844 Charlie Mountain, LLC. - Parcel A Revision: 10/8/12 Glenwood Springs, Colorado 81602 4104 Snowmass Creek Road nr Phone 970.618.5033 r • 1 ■ O SfHY�� Fax 303.216.2796 Pitkin County, Colorado Designed By: CO ,n, IUILL Proiect Number: 1948 Drawn By: ANG Sheet 1 of 7 i 'ELJE QR782 SF �L LD WITH 6'SAND FI '\ o' 10' 20' \� \ / / / / / ' ' \ LLJ \ \ I ► / / Scale: 1" 20'4' '\ / / / / ' n IX x��l 16 54' 7X. — /X CIO LLJ Q PROFILE #3 PROFILE HOLE 2 PIPE / " DR -'5 SEWCEDR -.7 ^ . O 7461 � / \� �\ \ \ \ \\ 100 G N(,:i�/p COMPAF�TNi N ¢ON(R TE TUBEPUMP VA LT .— .. '; •.. '' ,. ' • • ... _ / M°9 4„ SD - 5 V/ER PIPE D -BOX GAD �_ WITH LEAN�O 2 BED OSTM \RE ARKET CEL A I \ �I 7746 — -- � ....�•:.:��.'.�::".;,,.•:' `�� \ � � II 1462 I I IIII (/ / 3 /1' PROPOSED OWTS I I I I FR MARKETS OUSE - PARCEL A 1' QQ= ' • .. I 1 RLP.O. Box 2844 Charlie Mountain, LLC. - Parcel A Revision: 10/8/12 11 L Glenwood Springs, Colorado 81602 4104 Snowmass Creek Road R septic Phone 970.618.5033 Y Y SERVICE Pitkin County, Colorado Designed By: CO `n,3.O Fax 303.216.2796 Proiect Number: 1948 Drawn By: ANG Sheet 3 of 7 MIN. 12" MAX. 24" OF CLEAN FILL SEED AND LOAM TO PROTECT FROM EROSION n pELJENI DETAIL Y A BOX AND COVER BROUGHT TO GRADE CONCRETE LID FINSHED GRADE 0000 INLET OUTLETS DISTRIBUTION BOX BAFFLE n D -BOX DETAIL � NOT TO SCALE 6" MI AT PERIMETER C±3 C!3 C2M t'3 8 C!3 33' 6 FIELD DETAIL IE FROM EVEL MANIFOLD JLES P.O. Box 2844 Charlie Mountain, LLC. - Parcel A Revision: 10/8112 fl l L Glenwood Springs, Colorado 81602 4104 Snowmass Creek Road septic Phone 970.618.5033 ' • 4.O SEBYICE Fax 303.216.2796 Pitkin County, Colorado Designed By: CO ,n/ Project Number: 1948 Drawn By: ANG Sheet 4 of 7 ProPak" E ent Pumping System - 2nd Compartment Drawdown -1000-Gallon Septic Tank with the Addition of an Effluent Filter -1000 Gallon, 2 -Comp. 9CRR11"'z' convm Penes Top view Rrsy $Nnpbr Pumping SYslam phwGripeGuk— Canude �l W ,Nth Sbel EOM FdW CONkg. H.MlromFieer FVC RibrWHhGrommet(1) (M id cut to !wired Might) ObcnerBe Amembiy Tap of 4e to b7onN tap a tell INI 1. Mapter (wet or balled) To cu" N. ecNEMumt Dleoharge nlet Tee TenN AaepterBalled)Yodul "F' LevalCantralFbnt hg dcMg* Odfi— Awa , BRAND NAMENOT InletORENCO ENFORCEDOrenw EMuant Pu / �J r Hit. B-i,ppump cult `(Y` afiyEffl V��((( 1000 -gallon, Single Compartment Septic Tank Cmaete IRean ell, We bbt 9 TANK DETAIL ROT rD sGANe d WeeMrye IGWL — IDG WUEW RLlet W Fr TEF &TANK DETAIL ROT B stet P.O. Box 2644 Charlie Mountain, LLC. - Parcel A Revision: 10/8/12 } Glenwood Springs, Colorado 81602 4104 Snowmass Creek Road W6.0 S� tIC Phone 970.618.5033 SfpY��E Fax 303.216.2796 Pitkin County, Colorado Designed By: CO II u Project Number: 1948 ---]Drawn By: ANG Sheet 6 or 7 PROFILE HOLE INFORMATION ALL SERVICE septic, LLC 970-618-5033 PROFILE #1 PROFILE #2 ROOT ZONE, SANDY, ROOT ZONE, SANDY, GRAVELLY GRAVELLY 1 2 BULK SAMPLE FOR 3 GRADATION w4 SAND WITH SAND WITH LL GRAVEL AND GRAVEL AND TCOBBLES, VERY COBBLES, VERY 5 DENSE, MIDST, DENSE, MIDST, RED/BROWN/WHITE. RED/BROWN/WHITE. 6 DIFFICULT DIFFICULT EXCAVATION EXCAVATION 7 8 PROFILE #3 ROOT ZONE, SANDY, GRAVELLY SAND WITH GRAVEL AND COBBLES, VERY DENSE, MIDST, RED/BROWN/WHITE. DIFFICULT EXCAVATION CARETAKER DWELLING UNIT DESIGN 1 -BEDROOM RESIDENCE (75 GAL/PERSON/DAY x 2 PERSONS/BEDROOM x 1 BEDROOM) AVERAGE DAILY FLOW = 150 GALLONS DESIGN FLOW = Q = 1.5 x 150 = 225 GALLONS TANK: 225 x 30 HOUR RETENTION TIME = 281 GALLONS USE 1000 -GALLON, TWO-COMPARTMENT TANK ABSORPTION AREA: PERCOLATION RATE = 30 MPI CALCULATED ABSORPTION AREA = Q/5 x SQRT PERC RATE = 345 SF 10% REDUCTION, CHAMBERS IN A BED TOTAL AREA REQUIRED = 311 SF 2 BEDS, 8 CHAMBERS LONG, 2 CHAMBERS WIDE 32 TOTAL CHAMBERS ('QUICK -4') WIDTH OF TRENCHES = 2 CHAMBERS = 6 FEET WIDE 6' UNDISTURBED SOIL BETWEEN BEDS LENGTH OF TRENCHES = 8 CHAMBERS = 32 FEET LONG TOTAL FOOTPRINT = 18 FEET x 32 FEET REFUSAL REFUSAL 9 WITH WITH RUBBER TIRE RUBBER TIRE 10 BACKHOE BACKHOE FREE MARKET SF HOUSE - PARCEL A DESIGN 1. NO GROUNDWATER OR BEDROCK ENCOUNTERED DURING DIGGING WITH BACKHOE 2. SLOTTED PVC PIPE INSTALLED TO MONITOR WATER CONDITIONS in PROFILE #1 AND #2 2 -BEDROOM FREE MARKET SF HOUSE (75 GAL/PERSON/DAY x 2 PERSONS/BEDROOM x 2 BEDROOM) AVERAGE DAILY FLOW = 300 GALLONS DESIGN FLOW = Q = 1.5 x 300 = 450 GALLONS TOTAL DESIGN FLOW = Q = 1500 + 450 = 1950 GALLONS TANK: 2 -BEDROOM FREE MARKET SF HOUSE 450 x 30 HOUR RETENTION TIME = 563 GALLONS USE 1000 -GALLON, TWO-COMPARTMENT TANK ABSORPTION AREA: Q = 1950 CALCULATED ABSORPTION AREA = Q/5 x SQRT PERC RATE =2136 SF SECINDARY TREATMENT = ELJEN A42 20% REDUCTION, DOSING TOTAL AREA REQUIRED = 1709 SF AVERAGE DAILY FLOW = 1300 GALLONS/ 150 = 8.6 (ROUND TO 9 BEDROOMS FOR SIZING PURPOSES) PERCOLATION RATE = 21-30 MPI = 8 MODULES/ BEDROOM 6 ROWS OF 12 MODULES = 72 MODULES (3 FT BETWEEN MODULES) WIDTH = 4 FT x 8 MODULES + 1 FT SAND = 33 FEET LENGTH = 1709 SF/ 32 FT = 54 FEET FIELD AREA = 54 FT x 33 FT 6 ROWS OF 12 MODULES P.O. Box 2844 Charlie Mountain, LLC. - Parcel A Revision: 10/8/12 fl L LGlenwood Springs, Colorado 81602 4104 Snowmass Creek Road septic Phone 970.618.5033 W7.0 SERVICE Fax 303.216.2796 Pitkin County, Colorado Designed By: CO Project Number: 1948 Drawn By: ANG Sheet 7 of 7 Paul L. Noto* shareholder noto@waterlaw corn reply to Aspen office *bcensea in Ccs W PATRICK l MILLER ( KROPF AttomeysatLaw www wateriaweom Main Office: 730 E. Durant Avenue Suite 200 Aspen, CO 81611 T. 970.920.1028 F. 970.925.6847 Denver Office: 999 18th Street 30th Floor Denver, CO 80202 T. 303.893.9700 F. 303.893.7900 Phoenix Office: 2415 E. Camelback Suite 700 Phoenix, AZ 85016 T. 480.921.4044 F. 480.921.8688 Tulsa Office: 7633 E. 63rd Place Suite 300-18 Tulsa, OK 74133 T. 918.459.4634 F. 970.925.6847 May 24, 2012 Colorado Division of Water Resources Department of Natural Resources 1313 Sherman Street, Ste 821 Denver, CO 80203 dw pgnn tsonlinena,state.co.us Via Fed -Ex RE: Residential Water Well Permit Applications (our file 91058A) To Whom It May Concern: Enclosed please find two residential water well permit applications. 1. Parcel A Well Through this application we wish to use an existing well, old well permit no. 33344 on the new .adjusted Parcel A (see attached Charlie Mountain LLC Subdivision Exemption & Lot Line Adjustment Plat). Well permit no. 32057 also exists on this lot, although the well is not operational. Charlie Mountain, LLC will plug and abandon that well. 2. Parcel B Well: Through this _application we wish to construct .a new well on the new adjusted Parcel B (see attached plat). Also enclosed is check number 2239 for $200 for the filing fees ($100 for each well permit). Any immediate attention you could give to this matter would be greatly appreciated. Please let me know if you need anything else to process these applications. If you have any questions or comments, please feel free to call or email me at your earliest convenience. Thank you for your attention to this matter. Very truly yours, PATRICK, MILLER & KROPF, P.C. A Professional Corporation By: Paul L. Noto noto@,waterlaw.com PLN/lar encl. cc; Ben Guill J. Bart Johnson, Esq. a professional corporation 33 Four Wheel Drive Rd ALL Carbondale, CO 81623 pp p 470.309-5259 11111 ! September 6, 2014 Dennis Derham djderham(cgmail.com Onsite Wastewater Treatment System (OWTS) Installation Observations Free Market Single Family House (Parcel B) 130 Charlie Way (formerly 4100 Snowmass Creek Road) Pitkin County, Colorado OWTS Construction Permit Number 0029.2012.powt Dennis, Project No. C1948 ALL SERVICE septic, LLC observed the installation of the onsite wastewater treatment system (OWTS) on July 26, 2013 and August 12, 2014 for the subject property. The septic tanks will serve the Free Market Single Family House (aka Main House). The absorption area was installed under a separate permit (OWTS Construction Permit Number 0031.2013.powt) and is shared with the Free Market Single Family House (aka Fishing Cabin). Aspen Earthmoving installed the system. The installation included a new 1000 -gallon, single -compartment concrete septic tank followed by a new 1000 -gallon, two-compartment concrete septic tank with an Orenco® Biotube Pump Vault and pump in the second compartment. The control panel is located inside of the residence. R&A ran start-up on the pump. There is an effluent filter inside the second compartment of the septic tank. This filter must be cleaned annually, or as needed. At the time of the first inspection in July 2013, the pump had not been installed and a 4 -inch line was installed from the septic tank to the distribution box. After installation of the pump, a 2 -inch line was installed on the discharge assembly and extends out of the riser, transitioning into the 4 -inch line within several feet of the riser. The OWTS was generally installed according to specifications. This observation is not a guarantee of workmanship and/or parts and materials. ALL SERVICE septic, LLC should be notified if changes are made to the OWTS in the future. Any additional OWTS construction must be according to the county regulations. LIMITS: Observations are limited to components that are visible at the time of the inspection. The installer must have documented and demonstrated knowledge of the requirements and regulations of the county in which they are working. The quality of the installation is dependent of the expertise of the installer, soil type, and weather conditions. Please call with questions. Sincerely, ALL SERVICE septic, LLC ew, Ca- 08f Carla Ostberg, MPH, REHS n Reviewed Richard H m Note 2 -inch line out of riser tapped into 4 -inch line 6L Inlet and outlet tees on septic tanks Pump and effluent filter in second compartment second tank Risers were not stacked well q Top riser lip cracking — this was replaced. These items were remedied, including grading around the septic tank, rubber -necking between risers, and replacing cracked risers. 'rG�ll° N o� 15, , Scale: 1" = 30'-0" 33 Four Wheel Drive Road Charlie Mountain, LLC. - Parcel B Revision: 09/06/14 I L Carbondale, CO 81623 130 Charlie Way record 970.309.5259 �y�pr Pitkin County, Colorado Designed By: CO Project Number: 1948 Drawn By: ANG Sheet 1 of 1 j OWTS DESIGN CALCULATIONS - for Pitkin Owner's Name [Charlie -Mountain LLC - Fishings " Parcel ID # House Size (sq. ft.) 1 (75 gpd or 100 gpd) 100 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 Daily Waste Flow 1300 State Review Required? no Perc Rate (1) Design Flow (Q) = # potential bedrooms X 2 people/bedroom X gpd X 1.5 Q= 1950 Minimum tank capacity 2438 gallons Absorption Area (=Q/5 X SQRT perc rate)(1.4 loading factor) A = 2,991 sq. ft. of absorption area required Absorption Area (=Q/5 X SQRT perc rate) WITH SECONDARY TREATMENT (no loading factor) A= 2,136 sq. ft. of absorption area required Abs. Area w/ loading factor (1325) Trench Bed Quick4 Trench Quick4 Bed Pipe and Gravel (-10%) 2692 no red. 2991 273 303 Dosing (-20%) 2392 (-20%) 2392 242 242 Chambers (-30%) 2093 (-10%) 2692 212 273 Max Allowable 00% 1495 (-30%) 2093 151 212 Secondary Treatment Abs Area w/ out loading factor (B28) Trench Bed Pipe and Gravel (-10%) 1923 no red. 2136 195 216 Dosing (-20%) 1709 (-20%) 1709 173 173 Chambers (-30%) 1495 (40%) 1923 151 195 Max Allowable (-50%) 1068 (-30%) 1495 108 151 176 SETBACK FROM WELL # of feet = 126 SETBACK FROM POND, STREAM OR IRRIGATION DITCH # of feet = 101 SETBACK FROM DRY GULCH # of feet = Form No. OFFICE OF THE Sl MTE ENGINEER GWS -25 COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 (303)866-3581 APPLICANT p Pou-c-t l A EXST WELL PERMIT NUMBER 288420 - DIV. 5 WD 38 DES. BASIN MD APPROVED WELL LOCATION PITKIN COUNTY SE 1/4 NE 1/4 Section 11 CHARLIE MOUNTAIN LLC Township 9 S Range 86 W Sixth P.M. C/O PATRICK MILLER & KROPF PC DISTANCES FROM SECTION LINES 730 E DURANT AVE STE 200 2580 Ft. from North Section Line ASPEN, CO 81611- 560 Ft. from East Section Line (970) 920-1028 UTM COORDINATES (Meters,Zone:13,NAD83) C....ti....• Al4kinn .HANGEIEXPANSION OF USE OF AN EXISTING WtLL . 'U' 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)(II)(A), to expand/change the use of an existing well constructed under permit no. 33344, as the only well on a tract of land of 36.36 acres described as that portion of Sections 11 and 12, Twp. 9 S, Rng. 86 W, Sixth P.M., Pitkin County, more particularly described as Parcel A on the attached exhibit A. This well is known as the Parcel A Well. 4) The issuance of this permit hereby cancels permit no. 33344. 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 must be located not more than 200 feet from the location specified on this permit. 9) The old well constructed under permit no. 32057 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. NOTE: Expired permit no. 33344-A was previously issued for this lot.j APPROVED JSG State Engineer No.3655439B DATEISSUED By EXPIRATION DATE COLORADO DIVISION OF WATER RE50URcts DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST., Ste 821, DENVER, CO 80203 Main: (303) 866-3581 Fax (303) 866-2223 dwnnermttsonlinelatstate.co.us RESIDENTIAL Note: Also use this form to apply for livestock watering Water Well Permit Application Review form instructions prior to compteting form. Hand completed forms must be completed in black or blue ink or typed 1. ADDlicant Information Charlie Mountain LLC, c/o Patrick, Miller & Kropf, P.C. 33344 Dosigrialed Basin DelerminaNan # Well name or # Parcel A Well 4. Location Of Pro sed Well (Importantl See Instructions) County Pitkin SE lraorMle )NF ra Section Township N or S Range E or W Nrcipal Meriden 11 9 C " 86 ❑ C 6th Distance of well from section lines (section Anes are typically not property lines) 2580 Ft from N F S 560 Ft from IF E n W c.v .w�� hn mW — distance and direction from old well to row well feet Direction Well location address (Include City. State, Zip) Chetln if well address is same as in Item 1. 4100 Snowmass Creek Rd, Snowmass CO Optional: GPS well location information it UTM fomtat. GPS unit settings are as follows: Format must be UTM 1..�.,1 zone 12 or zona 13 Etirtg: 331257 Units must be Motors 4350205 Datum must be MAD03 Northing_ Lind must be set to true north Was GPS unit &-ded for above? []YES Remernbw to Set Datum to NAD83 S. Parcel On Which Well Will Be Located (You must attach a current deed for the subject arced A. You must check and complete one of the following: ❑ Subdivision: Name Lot Block Fifing/Und ❑ County exemption (attach copy of county approval & survey) Nance Lot # ❑ Parcel less than 35 acres, not in a subdivision attach a deed with metes & bounds description recorded prior to June 1, 1972, and current deed ❑ Miring claim (attach copy of deed or survey) Name/#: ❑ Square 40 acre parcel as described in Item 4 Parcel of 35 or more acres (attach metes & bounds description or survey) ❑ Other: (attach metes & bounds description or survey) B. # of aeras in parcel C. Are you the owner of this parcel? 36.365 19YEs 0 No D. Will this be the only well on this parcel? EYES ❑ NO (d no — list other wells) 264511100001 and 264511100002 Office Use Only (1112011) MAY 2 9 2012 6. Use Of Well (check applicable boxes) See instructions to determine use(s) for which you may qualify ❑ A. Ordinary household use in one single -faintly dwelling (no outside use) 0 B. Ordinary household use in 1 to 3 single-family dwellings: Number of dwellings: 3 Home garden/lam irrigation, not to exceed one acre: area irrigated 1 I3 sq. ft. El acre Domestic animal watering - (non-cDarmercial) ❑ C. Livestock watering (on farm/ranch/range/pasture) 7. Well Data (proposed) Maiamum pumping rate Annual amount to be withdrown acre-feet 15 gpm 3 Total depth Aquter 95 feet alluvium 8. Water Supplier Is this parcel within boundaries of a water service area? ❑YES 19 NO If yes, provide name of supplier: 9. Type Of Sewage System ■ Septic tank / absorption leach field ❑ Central system: District name: ❑ Vault: Location sewage to be Hauled to: ❑ Other (explain) 10. Proposed Well Driller License #(optional): 11. Sign or Enter Name of Applicant(s) or Authorized Agent 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. 24-4-104 (13)(a). I have read the statements herein, know the contents thereof and state that they are true to my knowledge. Sion or eAter name(s) of persons) submitting application 1 Date (mmrddtyyy W---►-4111ii r.e Use Only map name DM map no. 730 E. Durant Ave. suite ZUU I city Aspen slow ZIP CO 181611 . A Telephone# (970) 920-1028 E mal(orinefiIngitisrequis" noto wateriaw.com 2. Type Of Application (check applicable boxes) ❑ Construct new well ❑ Charge source (aquifer) ❑ Replace existing well ❑ Reapplication (expired permit) Use existing well ❑ Rooftop precip. collection ❑ Change or increase use Other AouAMAP— (aqp' 3. Refer To (if applicable) 33344 Dosigrialed Basin DelerminaNan # Well name or # Parcel A Well 4. Location Of Pro sed Well (Importantl See Instructions) County Pitkin SE lraorMle )NF ra Section Township N or S Range E or W Nrcipal Meriden 11 9 C " 86 ❑ C 6th Distance of well from section lines (section Anes are typically not property lines) 2580 Ft from N F S 560 Ft from IF E n W c.v .w�� hn mW — distance and direction from old well to row well feet Direction Well location address (Include City. State, Zip) Chetln if well address is same as in Item 1. 4100 Snowmass Creek Rd, Snowmass CO Optional: GPS well location information it UTM fomtat. GPS unit settings are as follows: Format must be UTM 1..�.,1 zone 12 or zona 13 Etirtg: 331257 Units must be Motors 4350205 Datum must be MAD03 Northing_ Lind must be set to true north Was GPS unit &-ded for above? []YES Remernbw to Set Datum to NAD83 S. Parcel On Which Well Will Be Located (You must attach a current deed for the subject arced A. You must check and complete one of the following: ❑ Subdivision: Name Lot Block Fifing/Und ❑ County exemption (attach copy of county approval & survey) Nance Lot # ❑ Parcel less than 35 acres, not in a subdivision attach a deed with metes & bounds description recorded prior to June 1, 1972, and current deed ❑ Miring claim (attach copy of deed or survey) Name/#: ❑ Square 40 acre parcel as described in Item 4 Parcel of 35 or more acres (attach metes & bounds description or survey) ❑ Other: (attach metes & bounds description or survey) B. # of aeras in parcel C. Are you the owner of this parcel? 36.365 19YEs 0 No D. Will this be the only well on this parcel? EYES ❑ NO (d no — list other wells) 264511100001 and 264511100002 Office Use Only (1112011) MAY 2 9 2012 6. Use Of Well (check applicable boxes) See instructions to determine use(s) for which you may qualify ❑ A. Ordinary household use in one single -faintly dwelling (no outside use) 0 B. Ordinary household use in 1 to 3 single-family dwellings: Number of dwellings: 3 Home garden/lam irrigation, not to exceed one acre: area irrigated 1 I3 sq. ft. El acre Domestic animal watering - (non-cDarmercial) ❑ C. Livestock watering (on farm/ranch/range/pasture) 7. Well Data (proposed) Maiamum pumping rate Annual amount to be withdrown acre-feet 15 gpm 3 Total depth Aquter 95 feet alluvium 8. Water Supplier Is this parcel within boundaries of a water service area? ❑YES 19 NO If yes, provide name of supplier: 9. Type Of Sewage System ■ Septic tank / absorption leach field ❑ Central system: District name: ❑ Vault: Location sewage to be Hauled to: ❑ Other (explain) 10. Proposed Well Driller License #(optional): 11. Sign or Enter Name of Applicant(s) or Authorized Agent 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. 24-4-104 (13)(a). I have read the statements herein, know the contents thereof and state that they are true to my knowledge. Sion or eAter name(s) of persons) submitting application 1 Date (mmrddtyyy W---►-4111ii r.e Use Only map name DM map no. Receipt area only - 019" A tom► of 3reS . A tGr.r,,,_ ret t�lra.sd AouAMAP— (aqp' Dade; 512WW12 7:55:28 AM r 3 3'l`i�A Transactloti Tote!° M.00 CH ECK #2239 $200.00 WR ( {YQh-t) X AA( N•K : ?Grp -jiff -- v4 Pt' ...;t- cwce COPD=f%uj 11Gt 3�os�7 MYLAR w �� SB5 DIVWD- SA! MD ler Cpv. s iR>< Pss� ss� —x� 'fir e��aks -+,-a COL,5 Sor, r -e'', lafw f k r.e� o+n ?Ct r e e / S = '7 3. It, are--" STATE or COWRA1Y D a✓ ?A -4SS DIVISION OF WATER RESOURCE OFFICE OF THE STATE ENGINEEV _�W28ft Index No. IDWD UseMAP AND STATEMENT FOR WATER WELL FILING - Registered PERMIT NUMBER _,,�� A A Know all men by there presents.- That the undersigned...1- 7L tn g- claimant(;), whose address ,City the %j4W jocatedige shown on the -map below; the d from this well is work states: Claimant(py is. � �rWbf well 0._ .& total number of acres of land owned by him (them) -to beAftiple was commenced on this well by act construction .1 1 Q, day.of.. T9]�f, the of said well fo�r which claim is here' gade for_ tested capacity (gpm) WIM, purposes; that the aver.age,.,apnual amount of water to be diverted is acre -ft.; and that the aforementioned statemeftpgTq,made'aind this map. and statementare filed in compliance with the law. State of Colorado County of ) Claimant(s) Subscribed and sworn before me this day of 19 My Commission expires: Notaiy Public THE WELL SHALL BE .LOCATED WITH REFERENCE;TO GOVERNMENT SURVEY CORNERS OR MONUMENTS, OR SECT. -ION LINES BY DISTANCE AND BEARING. -fe& from Nofth or South) section line -16et from (East or West) section line IF WELL IS FOR MRj"T3014, THE AREA TO -BE MWGATED MUST BE SHADED OR CROSS- HATCHED. The square below will, be u to indicate the location of the well and the irrigated land. r T r T T _4 t 1---r-- - L'11 ACCEPTED FOR FILING,1N, THE DAY OF WELLLOCATION County '5" 1/4 1/4, see. m P. MI Oa Zkound Water Basin �.Water Management. District Domestic wells may be located by the mi. following: LOT BLOCK SUBDIVISION OFFICE OF.THESTATE ENGINEER OF COLORADO ON THIS . 19- , State Engineer LOG AND HISTORY WELL LOG Ground Elevation Type Drilling From To Type of kkterial Water r Loc. _ Perf.' O P-5. (S. WELL DATA Date Started_ Date Completed— Hole ompleted Hole Diameter: in. from 1ft. to --iF.S.-- ft. fn. from ft. to ft. in. from ft. to ft. CASING WCORD CementVd, from PIR!g Casing. Size -4, kind rom 0 ft. to ft. Sizeadr kind a from Aft. to_;L"C ft. Size, , kind—from—ft. to ft. Perforated Cas*n Size kind from ft. to...Y_-V-- ft. Size—, kind from ft, to ft. Size—, kind—from—ft. to ft. TEST DATA Date Tested Type of Length of Test Constant Yield Drawdown PUMP DATA (To be filled in . Type of Pump— Outlet ump Outlet Size Driven by Horsepower— Use orsepower Use additional paper if necessary'to complete DIM log andNa�tach. •+■ ` WELL DRILLERS STATEMENT ,I, DXpM State of•,Golorado ) ss County of ) ,being #uly sworn, deposes and says: he is the driller of the above described well; he has read the above map and statement; knows the content thereof, and the same is true of his own knowledge. License No.- Subscribed o. Subscribed and sworn to before me this day of My Commission expires , 19_. Notary Public , 19—. FORM TO BE MADE OUT IN QUADRUPLICATE: Original WHITE (both sides) S Triplicate GREEN Copy must be filed with the State Engineer within 30 -days after well is completed. Duplicate PINK copy is for the Owner S YELLOW copy for the Driller. WHITE FORM MUST BE AN ORIGINAL COPY ON BOTH SIDES AND SIGNED.