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HomeMy WebLinkAboutpitkin.eh.272929203013 (2015)COUN ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) CONSTRUCTION PERMIT 76 Service Center Rd- Aspen, CO - 81611 Phone: 970.920.5070 Fax: 970.920.5374 Permit #: 0043.2015.POWT Parcel ID #: 22729-292-03-013 Permit Issued: ❑NEW®REPAIR ❑REMODEL/ADDITION ®TANK ONLY [-]FIELD ONLY ❑AMENDMENT Owner(s): Federal National Mortgage Association Property Address: 22 Beaver Road Legal Description: Lot A-4. Redstone Ranch Acres Size of Lot: .5 Size of Building: 2700 ft2 Acres Detached Accessory Unit: ❑YES ®NO Sq. Ft. Size of Accessory This system was originally designed to serve 4 bedrooms (permit #01048) Designed By Phone #: _ Fax #: Mountain Works 970-927-0985 Project #: Mailing Address: 1514 Mockin Email Address: Perc Rate: Profile Hole Depth: Minimum Tank Capacity: 1250 gallons Sq. Ft. Dated: 9/12/15 Lane Depth to Groundwater or Minimum Absorption ft2 Permit Conditions: Y 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 permit is to replace the original unlevel tank with a new 1250 gallon 2 compartment concrete septic tank. The original tank will be removed and the new tank will be put in the same location. Tank risers must be accessible from grade, an effluent filter must be installed in the outlet tee. The tank must be at least 50' from any well. 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. 10/20/16 Issued By: Bryan Daugherty, REHS Date: 10/20/15 Expires: Installer. License #: Reactivation Authorized by: Final Ap roy6j;lgsued By Date: i' New Expiration Date: ElFinepaid tomdimercurio From: Gavin Griffiths <griffithsgavin@hotmail.com> Sent: Thursday, October 22, 2015 8.14 PM To: tom.dimercurio@themercurya►liance.com; Bryan Daugherty; Carla Ostberg Subject: 22 Beaver Dr Attachments: IMG 0221JPG; IMG_0222JPG; 22 Beaver Dr.pdf All, Sent you pics of tank, fittings, risers, effluent filter and inlet T. I am also including an as built for you with new 1250 Gallon tank installed in same location as old one. Gavin Griffiths Mountain Works P 0 box 3260 Basalt, CO 81621 970-927-0985 ph 970-927-0985 fax 970-948-4177 cell griffithsgavin@hotmail.com 1 � ��e e� tS ; �;! � Iii !�� rA� Parcel ID# (available from the Pitkin County Assesso,rf's�` Office q _ �T a 1 �''1 _ U ,5 �= 970-920-5160 or at www.pitkinassessor.org): /� � r Y D Purpose of Permit: ❑ NEW EPAIR DUE TO FAILURE ❑ REMODEL/ADDITION 'TANK ONLY ❑ FIELD ONLY Cost of System Rep a �Q r Re odel/Addition (approximate): ``JJQ Cit , tat ip: -/a. l C) . /� /� Property Address:,AZ &, Q ve-r- 4,41 /�Zd s'�C e, Odl ei61 CIO x Cell Phone:� Lot: Block: Filing: S ivision' Fax Number: 0, o H� Property O)wer(s)`: E it Address: / eP �rc��Q% M�-f .0 rl SSa<; 2 C Fa- ,1,e- �ili.Cs.'� Owner's Mailing Address: State,,ZiP, /7 Ldrlh64z-e�, % ri Y� C'/'�i400Y1 li 1�/1S Home Phone: Busine s Phone- - l e e Orn 7p - `Contact information must be provided for the owner signing this application Primary tact Person/Applica t (if not ownec): Company: �2.hG � r Y D L'✓C'c.Lj Contact/Ap licant Mailing Address: - 0, s �d� Su/ Cit , tat ip: -/a. l C) . Cell Phone:� Business Pho 7 Fax Number: 0, o Email Address: -Lo '441 Me a4f,` rw al x1116;C 0221 Building Permit # (if applicable): Lot Size (in acres): Size of Building (square feet): Number of Potential Bedrooms: Detached Accessory Unit? [I YES �-fV0 Size of Accessory Unit (square feet): ` Number of Potential Bedrooms In or Fixture List for the Accessory Unit: Water Source: RNATE WELL ❑ SURFACE WATER ❑ SPRING ❑ COMMUNITY/PUBLIC WATER SYSTEM Name of Community/Public Water System (if applicable): En i ring Firm:. Job. Number: Phone Number: Fax Num r: tv /, tern 10#-Z6 m � - �JC, - X2 7 MMailin Address: 1117 Cit , St Z' by or 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 Sig {Required): _ � Applicant Si�ure: Date: 0 --646 FOR OFFICE USE ONLY Received by EN/HR Staff: Fee & Receipt #: Date: CSO 3 ZCbt7, POJ G:\OWTS March 8, 2008 NEW REGS O 'ce - Admin Forms OWTS Const Forms OWTS construction permit application.xis Updated: 10/7/08 September 12, 2015 CBO Inc. 33 Four Wheel Drive Road Carbondale, CO 81623 cell) 970-309-5259 office) 970-704-0484 carla.ostbergammail.com Lani Webb Broker Associate, C -REPS Mercury Alliance Mountain Properties lani themercuryalliance.com Onsite Wastewater Treatment System (OWTS) Use Permit Inspection 22 Beaver Drive Pitkin County, Colorado Ms. Webb, As requested, CBO Inc. performed an Onsite Wastewater Treatment System (OWTS) Use Permit inspection at 22 Beaver Lane, Redstone, Colorado on September 11, 2015. The legal description of the 0.5 -acre property is Lot A4, Redstone Ranch Acres. The permit and record drawing was provided by Pitkin County Environmental Health Department (Parcel ID #2729-292-03-013). The subject OWTS consists of one 2000 -gallon, two-compartment concrete septic tank and a 20' x 34' x 12' deep drywell. The OWTS is documented by Pitkin County Individual Sewage Disposal System (ISDS) Permit 01048, which was finalized on October 28, 2002. The septic tank is located in the yard area, to the west of the residence. The lids were not accessible from grade and had to be located and dug up. Both lids are greater than 8 -inches below grade, and both manhole lids are in disrepair. Upon opening lids to the septic tank, the inlet side of the tank appeared to be over -full, with the outlet side holding at normal levels. There was a significant amount of scum accumulation on the outlet side of the septic tank, which is not typical. These observations indicate the septic tank is not level. There are three inlet lines coming into the septic tank. One appears to be a pressure line from an ejector pump, and the other two pipes coming into the septic tank are stacked one on top of the other. There are no tees on the inlet pipes. The outlet pipe does have a tee. The septic tank was pumped by D&D Septic Services at the time of the inspection. The tank appears to be a mid -seam Copeland Concrete septic tank. The drywell does not appear to be accessible from grade. With the location of the drywell unknown, it is not possible at assess the condition of the drywell. We walked the approximate area of the drywell, and there were no signs of surface saturation or failure at the time of the inspection. This OWTS does not meet the minimum criteria to pass the inspection in order to obtain an OWTS Use Permit. Repairs to this OWTS will be necessary; therefore, an OWTS Construction Permit must be obtained. We recommend consulting with a Licensed OWTS Contractor to further evaluate the most cost effective approach to the repair. NECESSARY REPAIRS • The septic tank does not appear to be level. The inlet side of the septic tank must "over -fill" in order to allow effluent to exit the septic tank through the outlet tee. This allows standing water in the pipe which could lead to freezing and/or back-ups. There are likely two resolutions to this issue. 1) The existing septic tank may be leveled. This could prove to be problematic and not cost effective. The tank is a mid -seam, two-compartment, 2000 -gallon septic tank and attempting to level this tank could result in breaking the septic tank. 2) The septic tank may be replaced with a minimum 1250 -gallon, two-compartment septic tank (which will accommodate a 4 -bedroom residence). IMPORTANT CONSIDERATIONS • The sewer line from the house to the septic tank must have a minimum 2% grade into the septic tank. • The sewer line exiting the septic tank must have a minimum 1 % grade into the drywell. • The sewer line must enter the drywell with a minimum of 12 -feet from the inlet pipe to the bottom of the drywell in order to maintain the required square footage of infiltrative area. If this is not possible, Pitkin County Environmental Health Department must be consulted. • Septic tank lids must be brought to grade. • Manhole lids must be in good condition. • Inlet and outlet tees must be present. We recommend installation of an effluent filter on the outlet tee. If installed, this filter must be cleaned annually, or as needed. This evaluation is not a guarantee of future system performance. This report should be submitted to the Pitkin County Environmental Health Department. The following links are the required OWTS Construction Permit application and application checklist. Application: http://www.pitkincounty.com/DocumentCenter/Home/View/627 Application Checklist: hftp://www.i)itkincounty.com/DocumentCenter/HomeNiew/626 Disclaimer: This inspection is intended only as an evaluation of the present condition of the OWTS based upon what was observed and the Licensed Inspector's expertise in onsite wastewater technology. The inspector has not been retained to warrant or guarantee the property functioning of the system for any period of time in the future. Because of numerous factors which may affect the operation of an OWTS, as well as the inability of the Inspector to supervise or monitor the use or maintenance of this OWTS, this report shall not be construed as a warranty by the Inspector that the system will function property for any particular prospective buyer, and the Inspector disclaims any warranty, either expressed or implied, arising from the inspection of the OWTS or this report. The evaluation does not ascertain the impact the system is having on groundwater. Please call with questions. Sincerely, Carla Ostberg, MPH, REHS NAWT Certified Inspector Certification # 11044 ITC Exp. 2016 Ll View of approx. location of septic tank lids (buried). Alarm does not appear to be associated with any OWTS component outside of the house. 4t 21 Inlet pipe(s) Note 3 pipes coming into tank C M Outlet tee. Note significant amount of scum on outlet side of tank. We believe scum is being pushed to the outlet side because the septic tank is not level. below grade Approximate drywell location in yard area to the west of the septic tank T K I N Onsite Wastewater Treatment Systems (OWTS) Use Permit Inspection Form OU N T_S� Pitkin County Environmental Health Department 76 Service Center Rd, Aspen, CO 81611 Phone: 970-920-5070 Fax: 970-920-5374 Website: www.aspenpitkin.com/ehnr Inspection form for continued use of an existing OWTS Owner's Name: II.I< t r Address: Parcel Number: _ � -1 2 c� _ 21�'I 22n Inspection Date: I Iv1� Inspector's Name: j��, Business Name: PhoneNumber Email:rF Pitkin County Systems Inspector License Number A copy of this inspection repart will be remitted to Pitkin County Environmental Health Department by the Licensed Systems Inspector within 60 days of the inspection regardless of whether the system passes or fails. QUESTIONS FOR PROPERTY OWNER PRIOR TO INSPECTION: Is the home currently occupied? YESNO If NO, how long has the home been vacant? C`i �j rix r How many bedrooms are in the home? If secondary treatment is used, who is the maintenance provider? RECORDS: Were system records available from Pitkin County? NO If YES: Permit number: 0 104 ? Date of Final Approval: 101n # of bedrooms permitted: -�-� Was an as -built drawing available? f Y NO is the as -built drawing accurate? NO If NO: Complete a drawing of the system on last page of this form as accurately as possible. Any question marked FAIL will require correction before an OMITS Use permit is issued. SITE CONDITIONS: Proper grading, no evidence of erosion? CW& FAIL Improper vegetative cover?_ YES Evidence of compaction such as heavy machinery or livestock? NO YES Improper discharges such as straight pipes?P FAIL Evidence of high ground water? YES Snow cover present? YES 2 M 4 $; Page 1 TANK: Tank 1 N67- OIf Tank 2 PASS Tank 3 Does the pump/wiring/dosing siphon appear to be in good condition? Tank capacity FAIL gallons PASS gallons SECONDARY TREATMENT: gallons Tank material, Is a secondary treatment unit present? YES NO UNKNOWN If YES, does the unit appear to be in good working condition? YES NO inc��h--e��s.. # of compartments NO UNKNOWN Maintenance Provider: Phone: YES i NO Is it level and in good condition? Date of last pumping ( FAIL Lids/risers in good condition PASS FAIL PASS FAIL PASS FAIL Risers to grade YES < NO YES NO YES NO Riser height Riser condition/watertightness Inlet sanitary T/raffle PASS I< PASS FAIL PASS FAIL Outlet sanitary T/baffle , LAS FAIL PASS FAIL PASS FAIL Effluent filter (if part of design) PASS CFAVL /A PASS FAIL N/A PASS FAIL N/A Condition of tank material PASS° FAIL PASS FAIL PASS FAIL Tank was pumped for inspection Y NO YES NO YES NO If YES, list the pumping company If NO, when was the last pumping Scum level (1st compartment) inches inches inches Sludge level (1st compartment) inches inches inches Scum level (2nd compartment) inches inches inches Sludge level (2nd compartment) inches inches inches Backflow (if pumped) P FAIL PASS FAIL PASS FAIL Midtank bafflep.. FAIL N/A PASS FAIL N/A PASS FAIL N/A Watertightness ;...,_ FAIL PASS FAIL PASS FAIL PUMPS/DOSING SIPHONS: Is a pump or dosing siphon present? YES N67- OIf IfYES, is the pump/dosing siphon functioning properly? PASS FAIL Does the pump/wiring/dosing siphon appear to be in good condition? PASS FAIL is the high water alarm working, both visible and audible? PASS FAIL SECONDARY TREATMENT: Ports Probing Is a secondary treatment unit present? YES NO UNKNOWN If YES, does the unit appear to be in good working condition? YES NO inc��h--e��s.. Does the owner have a current maintenance contract for the unit? YES NO UNKNOWN Maintenance Provider: Phone: YES i NO If there is no maintenance contract, a contract must be in place prior to occupancy of the home. A copy of the contract must be submitted to Pitkin County Environmental Health Department. ABSORSTION AREA: Effluent surfacing? —PASS FAIL Evidence of past surfacing? NO- YES Surface dampness? NO YES Excessive odors? NO- YES Field location verified by observation ports or probing: Ports Probing Liquid in observation port? NO YES If YES, record depth: inc��h--e��s.. Distribution Box or ADV part of original design? YES (fit If YES, is it accessible from grade? YES i NO Is it level and in good condition? PASS ( FAIL �.�' �• � gat;` . Page 2 UNKNOWN 4 0 Any problems with the system that were not addressed in the inspection checklist? Please list any recommendations for the continued use of the system: Were any repairs done as a result of this inspection? NO YES �'�eai ' ",JO,-� irate# If YES, please describe the repairs. C nrok 1 To the best of my knowledge and training, the information collected in this inspection is accurate as of .20 Licensed Systems Inspector Signature:;{= Additional Notes: Clearly label any ioiictures and attach them to this form. Pitkin County Environmental Health Department Permit for an Individual Sewage Disposal System 0405 Castle Ck Rd, Aspen, Colorado 81611 Phone 970-920-5070 / FAX 970-920-5077 Permit # 01048 Parcel ID # 2729-292-03-013 Type of permit New( j Repair( } Addition to House{ X j Name of Owner Ronald Purcio Street Address 22 Beaver Lane, Redstone Property legal description Lot A-4 Size of lot .5 Total square footage of the house 2,700 sq ft Water source Private Well # of bedrooms in house 3 # of offices, lofts & similar sized rooms in house Offict J uture ADU Caretaker unit Total square footage of the caretaker unit # of bedrooms in caretaker unit # of offices, lofts _& similar sized rooms in caretaker unit _ _,Dc;5iy8ed fCji Mthat #roomg(itst� . _ ... {4��t�1� 3, bedraorrrY . U Permit information Designed by Gamba & Associates Mailing Address 113 Ninth St, Ste 214, PO Box 1458, Glenwood Springs, CO 81602 Perc rate 47 Profile hole depth 16 ft Depth to groundwater or bedrock + 16th Septic tank capacity 1750 minimum Absorption area 1979 sq ft r> Comments Septic permit approved per compliance with the engineer design and specifications stamped 7117101. Any changes must be approved by this department and the design engineer prior to them being made. Minimum horizontal distances between components of the system and physical features shall conform to the Pitkin County ISDS regulations. Engineer design is for a 2,000 -gallon two-compartment concrete septic tank. Pitkin County regulations require an effluent filter on the outlet. A drywell is designed to be 20 ft X 34 ft X 12 ft deep. Old tank and field are to be properly abandoned. This department does not endorse any brand of products. The engineer must do a final inspection of the installation and submit an as -built letter to this department. This department must also be called for an inspection with a minimum of 48 hours advanced notice. Permit approved by Date: Ff Plans and specifications of the sed individual sewage disposal system have been reviewed and are considered satisfactory. Permission is hereby granted to the owner or the agent to perform the work indicated in accordance with the Pitkin County ISDS Regulation in effect at the time of issue. Tins permit becomes invalid 0 months from the data that the Permit wag issued unless system construction has commenced or an extension has been approved in writing by the Department. As -built drawings must be included with this permit before the final approval will be issued. t d� ��iv� I�� ��� \ �- t 1 t f rt \ 1 r I + 1 r I t I I w y ��iv� I�� ��� F�71id1 si-_I• �-^r-r. -T �- 85! m � w \ g xag::� r cn � r +Z y�i' rA OjH N 2 39^ State of Colorado Water Resources - View Well Details: Receip... http://www.dwr.state.co.us/Wel[PermitSearch/View.aspx?re... Colorado Department of Natural Resources 06lar)A'a Y)IUI�]all .al Colorado's Well Permit Search Well Constructed Receipt: 0082479 Division: 5 Permit #: 92008-- Water District: 38 Well Name / #: County: PITIQN Designated Basin: Management District: Case Number: WDID: Help Last Refresh: 8/18/2015 1: [-] Applicant/Owners History Date Range Applicant/Owner Name Address City/State/Zip Unknown - Present BROWN JOE PO BOX 634 RANGLEY, CO 81648 [-] Location Information Approved Well Location: Q40 Q160 Section Township Range PM Footage from Section Lines SE NW 29 10.0S 88.OW Sixth 1730 N 1588 W Northing (UTM y): 4337461.5 Easting (UTM x): 306029.4 Location Accuracy: Spotted from section lines Physical Address City/State/Zip Parcel ID: Subdivision Name REDSTONE RANCH ACRES Filing Block Lot A-4 Acres in Tract: 1 [-] Permit Details Date Issued: 07/29/1977 Date Expires: Use(s): HOUSEHOLD USE ONLY Special Use: Area which may be irrigated: Maximum annual volume of appropriation: Statute: Aquifer(s): ALL UNNAMED AQUIFERS Permit Requirements: Totalizing Flow Meter Geophysical Log Abandonment Report No No No Cross Reference Permit Number Receipt Description Permit(s): Comments: As a well on >1 acre. Limit use to HUO, being 1 SFD & no outside uses. dmw 6/30/06 1 of 2 8/18/2015 8:50 AM State of Colorado Water Resources - View Well Details: Receip... http://www.dwr.state.co.us/Wel[PermitSearch/View.aspx?re... [-] Construction/ Usage Details Well Construction Date: 12/04/1978 Pump Installation Date: Well Plugged: 1st Beneficial Use: Elevation Depth Perforated Casing (Top) Perforated Casing (Bottom) Static Water Level Pump Rate 48 38 48 21 15 Lic # Name Address Phone Number Driller 634 COLLINS, F. E. "BODIE" 0525 COUNTY RD 109 GLENWOOD SPRINGS, CO 81601 970-928-9902 [-] Application/ Permit History Well Construction Report Received 12/28/1978 Well Constructed 12/04/1978 Permit Issued 07/29/1977 Application Received 06/27/1977 [-] Imaged Documents Document Name Date Imaged Annotated Original File 12/05/2007 No Copyright © 2009 Colorado Division of Water Resources. All rights reserved. Home I Contact Us I Help I Water Links I Colorado.gov I DNR I Privacy Policy I Transparency Online Project C 2 of 2 8/18/2015 8:50 AM Wv. N-ev.76 Application must be complete where applicable. Type or print in ;BLACK INK. No o'erstrikes or erasu unless initialed. COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 PERMIT APPLICATION FORM ( ! A PERMIT TO USE GROUND WATER?�{ (%A A PERMIT TO CONSTRUCT A WELL 77 g p1) FOR: r) A PERMIT TO INSTALL A PUMP ( ► REPLACEMENT FOR NO. ( )OTHER WATER COURT CASE N0. (1) APPLICANT - mailing address Nb K FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN Mr. and Mrs. Joe Brown ; . Receipt No. Z c/—/ STREET P.0. Box 634 CITY Rangl6y. Colorado 81648 (state) (Zip) TELEPHONE NO. 675— 22.57 (2) LOCATION OF PROPOSED WELL County Pitkin SE '/n of the FEW %, Section 29 Twp. 10 —E, Rng, _$�_ _X_I 6rh P.M. ft S) (E,w) (3) WATER USE AND WELL DATA Proposed maximum pumping rate (gpm) 15 GPM Average annual amount of ground water V1 acre feet to be appropriated (acre-feet): Number of acres to be irrigated: None Proposed total depth (feet): Estimated 45 Aquifer ground water is to be obtained from: Owner's well designation Brown Well No. i GROUND WATER TO BE USED FOR: - (xX HOUSEHOLD USE ONLY - no irrigation (0) ( ) DOMESTIC (1) ( ) INDUSTRIAL (5) ( ) LIVESTOCK (2) ( ) IRRIGATION (8) ( ) COMMERCIAL (4) ( ) MUNICIPAL (8) ) OTHER (9) DETAIL THE USE ON BACK IN 01) (4) DRILL -In. Collins Name Street 0589 Thomas Road City Ca 1,ondala, Colorado 81623 (state) (zip) Telephone No. Lic. No. �J Basin Dist. CONDITIONS OF APPROVAL This well shall be used in such a way as to cause no materia) injury to existing water rights. The issuance of the permit does not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested water right from seeking relief in a civil court action. APPROVED FOR HOUSEHOLD USE ONLY, FOR ONE (1) SINGLE FAMILY DWELLING AND NOT TO BE USED FOR IRRIGATION. THE RETURN FLOW FROM } ' H E,. USE OF THIS WELL: MUST BE RETURNED TO THE SAME STREW SYSTEM IN WHICH iiHE WELL' IS LOCATED. TO ASSURE THAT THE RETURN FLOW IS TO BE RETURNED TO THE SAME STREAM SYSTEM, AN INDIVIDUAL -WASTE -WATER D(SPOSAL:SYSTEM, WHEN USED .MUST 4BE � THE ,AIO �N-EIf�BAi1 T,. :;Ps APPLICATION APPROVED PERMIT NUMBER 92 008 DATE ISSUED JU1 29 1977 EXPIRATI TEy V L 44 4A4c, 4�-* M BY t��:'/1•'� / COUNTY L, (5)°:THi-LOCATION OF THE PROPOSED WELL and the area on Whit th6,uvOter will be used must be indicated on the diagram below. Use the CENTER SECTION 0 section, 640 acres) for the well location. f �.. - fi -- + - + -+-- I !4- --1 MILE, 5280 FEET) NORTH SECTION LINE l 4 -NORTH 4 -NO+ w z I z 0 +- + 2 w �- 4— i s IA I M + J" Baa `e I + s + ( t I i _t f M + J" + ; + y m I -4- -- + 0 + — -+ -- -#- z Ir m + �- I The scale of the diagram is 2 inches = 1 mile Each small square represents 40 acres. WATER EQUIVALENTS TABLE (Rounded Figures) An acre-foot covers 1 acre of land 1 foot deep 1 cubic foot per second (cfs) ... 449 gallons per minute (gpm) A family of 5 will require approximately 1 acre-foot of water per year. I acre-foot ... 43,560 cubic feet ... 325,900 galions, 1,000 gpm pumped continuously for one day produces 4.42 acre-feet. (6) THE WELL MUST BE LOCATEQ by distances from section lines. 1730 ft. from North sec. line (north or South) 1588 ft. from West sec, line (east or west) LOT A-4 BLOCK FILING rr SUBDIVISION Redstone Ranch Acres (7) TRACT ON WHICH WELL WILL LOCATED Owner No. of acres ag(4 -uUtd•s Will this be the only well on this tract? V8) PROPOSED CASING PROGRAM Plain Casing l.f� in, from J_ ft. to ft. in. from ft. to ft. Perforated casing ��=, in. from 20 ft. to , 6` ft. in. from ft. to °t. (S) FOR REPLACEMENT WELLS give distance and direction from old well and plans for plugging it: (10) LAND ON WHICH GROUND WATER WILL BE USED, Owner(s): Joe and Beatrice Brown _ No. of acres: 0.56 Legal description: 7r*' A—A RPr1ct•nnA_ Rant -b AcpY quI-% 4-%x-lcin„ V'(11) DETA LED DESCRIPTION of the use ground water: Household use and domestic wells must indicate type of disposal system to be used. r (12) OIHES WMER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers. Type or right Used for (purpose) Description of land on which used (13) THEAPPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS T O THE BEST OF HW KNOWLEDGE. OF APPLICANT(S) Use additional sheets of paper if more space is required. SOUTH SECTION LINE + ; + -i' -� 4 4- -t- 4-- —= -% t — + + — -+ -- -#- — 4-- — - The scale of the diagram is 2 inches = 1 mile Each small square represents 40 acres. WATER EQUIVALENTS TABLE (Rounded Figures) An acre-foot covers 1 acre of land 1 foot deep 1 cubic foot per second (cfs) ... 449 gallons per minute (gpm) A family of 5 will require approximately 1 acre-foot of water per year. I acre-foot ... 43,560 cubic feet ... 325,900 galions, 1,000 gpm pumped continuously for one day produces 4.42 acre-feet. (6) THE WELL MUST BE LOCATEQ by distances from section lines. 1730 ft. from North sec. line (north or South) 1588 ft. from West sec, line (east or west) LOT A-4 BLOCK FILING rr SUBDIVISION Redstone Ranch Acres (7) TRACT ON WHICH WELL WILL LOCATED Owner No. of acres ag(4 -uUtd•s Will this be the only well on this tract? V8) PROPOSED CASING PROGRAM Plain Casing l.f� in, from J_ ft. to ft. in. from ft. to ft. Perforated casing ��=, in. from 20 ft. to , 6` ft. in. from ft. to °t. (S) FOR REPLACEMENT WELLS give distance and direction from old well and plans for plugging it: (10) LAND ON WHICH GROUND WATER WILL BE USED, Owner(s): Joe and Beatrice Brown _ No. of acres: 0.56 Legal description: 7r*' A—A RPr1ct•nnA_ Rant -b AcpY quI-% 4-%x-lcin„ V'(11) DETA LED DESCRIPTION of the use ground water: Household use and domestic wells must indicate type of disposal system to be used. r (12) OIHES WMER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers. Type or right Used for (purpose) Description of land on which used (13) THEAPPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS T O THE BEST OF HW KNOWLEDGE. OF APPLICANT(S) Use additional sheets of paper if more space is required. PUMPkNSLLATION REPORT Pump INlacieS •~ `�^.� roan '/.af7 Type Powered by HP Pump Serial•�No. Motor Serial No. Date Installed Pump Intake Depth Remarks M'! �-WA -1 •. i. �M I �:• > i ___---- ___ Hie _� WELL TEST DATA WITH PERMANENT PUMP Date Tested Static Water Level Prior to Test Length of Test Hours Sustained yield (Metered) GPM Pumping Water Level Remarks WATER TABLE /C014 E OF DEPRESSION CONTRACTORSSTATEMENT The undersigned, being duly sworn upon oath.,, deposes' and says that he is the contractor of the well or pump installation described hereon; that he has read the statement made hereon; knows the content thereof, and that th' same is true of is own. nowledge. 4�� i• Signature r License No. „ State of Colorado,Cdunty of:: "_ SS Subscribed and sworn to bsl'thls cry of A, 19 ,My:Commission a pires: + - n Notary Public z _ .. FORM TO 8E MADE OUT IN OUADOUPLICATEWHITE FORM must be an original copy on both sides and signed. WHITE AND GREEN copies must be filed with the State Engineer. PINK COPY is for the Owner and YELLOW COPY is fo► the Driller. VW RJ -26-72 THI'9 ORM MUST BE SUBMITTED WITHIN BD DAYS -OF COMPLETION OF THE WQRK DESCRIBED HERE- ON. TYPE OR PRINT IN BLACK INK. COLORADO DIVISION OF 300 Columbine Bldg., Denver, Color WELL COMPLETION AND PUMP PERMIT NUMBER tom': NATER RESOURf�F;S� �.+`'� �� ;�'': ;.:' : ' 845 Sherman St. io 80203 ---._.- ---._..- INSTALLATION REPORT # P/1 _ el.- --- .....-..-.- - . RFCOVED DEC 2 81378 . Jmft fou am.4lift WELL, OWNER�".� of the %. of Sec. ADDRESS "-7"-G�— R• -d GI—��_.. P.M. DATE COMPLETED`: — , 19 HOLE DIAMETER WE". -LOG Water From To Type and Color of Material Loc. (� k=J� TOTAL DEPTH Use additional pages necessary to complete log. in, from to ft. iri. film to ... ft } _ in. fromm o ft. ; DRILLING METHOD CASING REC RD: Plain Casing Size kind from to _-dr— ft. Size & kind from to ft. Size & kind from to - ft. Perforated Casing. Size kind 00'from to Size & kind from to ft. Size & kind from,_.tct,_,_.�ft. GROUTING RECORD, Material c� Intervals Placement Methodn!2Z.4 f GRAVEL PACK: Size Interval `#Est DATA4. .•Date'['e�ad.i`�.Ti3- ` �^Z� , 18�� y�StatiEY1Fs' a, brae��riorto.Test — ft. Ast �rstaiq�dtiY11:611F�txedl®