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3.0 Correspondence & Conditions
Timeline Waiver Specified in the Unified Land Use Resolution of 2008, as amended And Colorado Revised Statutes Date I George Bagley hereby waive any applicable timelines specified in the Garfield County Unified Land Use Resolution of 2008, as amended and in the Colorado Revised Statutes for scheduling and/or conducting the Director's Decision for the Dutch Major Subdivision Exemption Application administrative review (File No. MAEA-6931) and the Bagley ADU Application administrative review (File No. GAPA-7397). Sincerely, George gley Garfield County Community Development 108 8th Street, Suite 401, Glenwood Springs, CO 81601 Office: 970-945-8212 Fax: 970-384-3470 MEMORANDUM — TRAFFIC FEE STATEMENT REGARDING: Dutch Major Subdivision Exemption Traffic Impact Fee FROM: Garfield County Community Development TO: Kathy Bagley, Owner of Lot 2 Dutch Major Subdivision Exemption DATE: 11/6/13 Please note that in accordance with the conditions of approval for the Dutch Major Subdivision Exemption Traffic Impact Fees are due and payable for Lot 2 at the time of issuance of a building permit. The fee amount is $2131.20 and is due at the time of issuance of your building permit. A separate check for his amount is needed and should be made out to the Garfield County Treasurer. Please contact Glenn Hartmann, Senior Planner or David Bartholomew, Plans Examiner if you have any further questions. QUATTRO FILENAME: FEES-1.WB2 ROAD IMPACT FEE CALCULATION WORK SHEET Project/Applicant Road District Land Use Date Prepared Dutch Major Single Family Dwelling 6 10/31/2013 Base Road Cost $3,410,000 Road Capacity in ADT 16,200 Road Cost per ADT $210.49 ADT per Land Use 9.57 Base Road Impact Fees per Land Use $2,014.43 TAX CREDITS 80% of Annual R & B Property Tax per Land Use $28.42 County Discount Rate 1.06% Road Design Life (Years) 20 Present Worth Factor 17.94 Property Tax Credit $509.77 UNADJUSTED ROAD IMPACT FEE $1,504.66 [Base Road Impact Fee - Property Tax Credit] INFLATION ADJUSTMENT Denver -Boulder CPI Year of Cost Estimate 158.5 Denver -Boulder CPI Year of Impact Fee Calc. 224.5 Inflation Factor 1.4164 [CPI for Collection Year/CPI of Year of Cost Estimate] PRE -CONSTRUCTION INFLATION $2,131.20 ADJUSTED ROAD IMPACT FEE POST -CONSTRUCTION COST ADJUSTMENT County Discount Rate 1.06% Term (Years since Construction 0 Compound Interest Multiplier 1.0000 POST -CONSTRUCTION ADJUSTED ROAD IMPACT FEE #N/A Prepared by the Gadleld County Planning Department WATER WELL SHARING AND MAINTENANCE AGREEMENT THIS AGREEMENT is made and entered into on this day of , 2013, by Charles A. Bagley ("Chuck"). WHEREAS, Chuck owns Lots 3 and 4 of the Dutch Major Subdivision Exemption according to the Dutch Subdivision Exemption Plat recorded on , 2013 as Reception Number in the real estate records of the Garfield County, Colorado Clerk and Recorder's office. Lots 3 and Lot 4 are collectively referred to as the "Lots" and the owners of Lots 3 and 4 are collectively referred to as "parties" or individually as "party." WHEREAS, the current owner of the Lots and his successors in interest are to be the joint owners of a water well constructed under Colorado Division of Water Resources Well Permit No. 75924-F (the "Well") and shall be joint owners of the water well and casing as constructed and installed and of the water to be diverted by said well system for providing domestic use on the respective properties of the parties; and WHEREAS, the Well and casing and pump shall be utilized by said owners as a lawful water right; and WHEREAS, the Well and water system required is drilled and completed and will require continuing maintenance and operation, the costs of which must be borne by the owners and users thereof; and WHEREAS, said owner as party hereto desires to enter into this Agreement for the purpose of clarifying respective rights and duties and establishing recorded non-exclusive easements and procedures for jointly operating the Well and delivering water to the Lots, for providing a method for equitably dividing the water derived from operation of the system, and for equitably allocating the shared payment of costs of operation and maintenance of the water well and its pump and other structures by all of the parties. NOW THEREFORE, in consideration of the mutual obligations, promises, and covenants set forth herein, and the due performance thereof, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, including but not limited to the acceptance of the benefits and detriments deriving herefrom, the above-named party agrees as follows: 1. Each of the respective owners of Lot 3 and Lot 4 shall be deemed to own an undivided one-half (1/2) share of the subject well permit, Well, pump, fittings at the well head, meters (whether existing now or to be installed at a later time), pump house, foot valves, and any pipes or pipelines and any other structures which are jointly used. 2. No owner of the Lots are deemed to have any ownership right in and to any pipe, pipeline or other structure used or required solely by the owner of another of the Lots which may utilize any portion of the water flowing from this water well and its structures. This Agreement does not intend to relate to such individually owned or used rights or structures. Nothing in this Agreement shall be construed to give any party any rights to such non -shared property of other parties nor to obligate any party to pay any costs associated with non -shared structures. 3. The owners of Lots 3 and 4 shall cooperate with each other at all times in all matters necessary to promote the proper construction, completion and functioning and use of the water system in such manner as to provide to their respective uses an optimum water supply on demand at all times possible based upon the natural availability of water. The owners of Lots 3 and 4 agree to not waste water and to endeavor to use no more than their respective shares of the available water. Waste or over -use shall be deemed to be a material breach of this Agreement for which the non -defaulting party may seek remedy at law or equity for damages or for injunctive relief, or both. Unless otherwise agreed by each owner, no owner of Lot 3 or Lot 4 shall use more than one-half (1/2) of the water legally allocated to the well. In the event the water physically available from the well is less than the legally available amount, then each owner shall proportionately reduce the consumption of same to one-half (1/2) the amount actually available. In no event shall the well be pumped at a rate exceeding the permitted amount. Any household use of the well water must provide for return flow through an individual sewage disposal system of the non -evaporative type, returning the water to the watershed in which the well is located. 4. The actual and continuing costs of operation, maintenance, extension, upgrading, cleaning, repairing and all other work required on shared components of this water system to cause the water at the Well to become and remain available to deliver water to the owners of Lots 3 and 4 shall be shared by said parties in proportion to their share in the Well. This Agreement shall relate only to costs incurred after the date hereof. Electrical charges for the operation of the Well and any augmentation water, if necessary, shall be shared equally. 5. Subject to the provisions in paragraph 4, above, any party who has been using water from this system and at any time elects not to share in costs, necessary repairs, maintenance, replacement, and similar requirements which are necessary to maintain the water well and deliver the subject water, shall not receive water from the system. At such time as said electing party chooses to resume use of water from the system said party may do so upon reimbursement to the other user the full cost of said party's share of such expenditures with legal interest retroactive to the expenditure date. 6. The owners of Lots 3 and 4 agree to cooperate in the future maintenance, operation, repair, replacement or improvement of all common facilities. In the event said owners are unable to agree on any required maintenance, repair, replacement or improvement, any owner shall be entitled to undertake the minimal maintenance, repair, replacement or improvement necessary and essential for proper functioning of the common facilities. In the event an owner determines to undertake such work unilaterally, such owner shall notify the other owner in writing. The owner undertaking the work shall, upon completion, provide the other owner with a written statement of work performed and the other owner's proportionate share of the cost of same. In the event an owner fails to pay the proportionate share of any amount due within thirty (30) days after presentment, the owner which has paid such cost and expense shall be entitled to pursue any 2 remedy available at law or in equity for a breach. The court, in its discretion, may award to the prevailing party court costs and attorney's fees incurred. 7. The owners of the Lots hereby grant and dedicate across that portion of Lot 3, Dutch Major Subdivision Exemption, designated on the final exemption plat thereof, as necessary and sufficient for this Agreement to be performed for the benefit of the respective owners of Lots 3 and 4, as users of the shared well, pump, and common pipeline and treatment system, and also grant a non-exclusive easement for non -shared or individual pipelines conveying water to the respective Lot over and across the easement. Said Easement shall be twenty (20) feet in diameter, the center of said Easement being the Well as constructed and existing on the date hereof. The owners of the Lots shall not install any improvements in the easement area that may affect the use and operation of the well and pipelines including but not limited to structures of any kind, trees or other landscaping other than grass or easily removable and replaceable landscaping. 8. Each owner of Lot 3 and 4 agrees to not interfere at any time with the proper use by any other party of its interest in any water structure and shall indemnify and hold harmless all other parties and users from any loss or damage or injury caused by the acts of said indemnifying party. 9. This Agreement shall be binding upon and inure to the benefit of the parties, their heirs, devisees, executors, administrators, assignees, transferees, and successors in interest, and the easements and covenants granted or agreed to herein shall be deemed to run with the land and shall encumber the land of each party for the benefit of the properties of the parties as described herein. Upon execution by the parties, this Agreement shall be recorded in the records of the Garfield County Clerk and Recorder's Office, and shall run with the lands identified herein. 10. This Agreement embodies the entire and complete agreement of the parties on the subject matter herein. No promise or undertaking has been made by any party, and no understanding exists with respect to the transaction contemplated, except as expressly set forth herein. All prior and contemporaneous negotiations and understandings between the parties are integrated and merged into this Agreement. 11. This Agreement may be amended from time to time by a written instrument executed by the owners of the Lots. 12. The laws of the State of Colorado shall govern the validity, effect and construction of this Agreement. IN WITNESS WHEREOF, the parties have signed this Agreement on the date stated above. Charles A. Bagley 3 STATE OF ) ss. COUNTY OF The foregoing instrument was acknowledged before me on this day of 2013, by Charles A. Bagley. Witness my hand and official seal. My commission expires: 4 Notary Public LEGAL AND ADEQUATE DOMESTIC WATER — WELL PERMIT SUMMARY BAGLEY ACCESSORY DWELLING UNIT AND DUTCH MAJOR SUBDIVISION EXEMPTION LOT 1 • Includes two existing dwelling units. • One unit is proposed to be approved as an Accessory Dwelling Unit pursuant to the Bagley ADU Application. This lot is served by an existing shared well approved by Well Permit #76688-F. This new well permit cancelled/replaced Well Permit # 47466 and authorized the well to serve two dwelling units. The new permit is subject to a contract with the West Divide Water Conservancy District. Status of Previous Testing ➢ While the Applicant has provided information indicating that this well has historically provided a consistent and quality water source for the existing units, no previous testing for this well has been provided. Remaining Steps to Meet Code/Conditions 1. The Applicant needs to provide a 4 hour pump test in compliance with the provisions of Section 4- 203(M)(2)(f) confirming that the well is adequate to serve two single family dwelling units. 2. A water quality test needs to be completed meeting the revised requirements (consistent with the CDPHE Deluxe Colorado Package plus the Alpha — Beta radioactivity screen). A detailed listing of the requirements is attached below. LOT 2 • This lot is currently vacant. • It is proposed for development with one new single family residence. This lot is served by an existing domestic well, Well Permit #1172 - A. It also has an existing stock watering well, Well Permit #30778. Status of Previous Testing ➢ This Well was pump tested 4/22/12 by Ray's Well Done Pump Service LLC and the test/report meets the 4 hour test requirement. ➢ The report's conclusion indicated that it is adequate for a single family dwelling with Cistern Storage. ➢ A water quality test was completed on 4/23/12 but did not include testing for all required parameters. Remaining Steps to Meet Code/Conditions 1. The water pump test report needs to be updated to include a cistern size recommendation. The Applicant needs to provide confirmation that cistern storage consistent with the size recommendation will be installed for the well at the time of building permit application. 2. An updated water quality test needs to be completed meeting the revised requirements (consistent with the CDPHE Deluxe Colorado Package plus the Alpha — Beta radioactivity screen). The testing can add to the previous parameters tested for if that is determined by the Applicant to be the most efficient way to move forward. LOTS 3 & 4 • Lot 3 is currently vacant and Lot 4 has an existing single family dwelling. The lots are served by an existing domestic well located on proposed Lot 3 approved by Well Permit #75924 — F. This new permit replaced previous Well Permit #75024 — F and approved the well to serve two dwelling units. It is subject to a contract with the West Divide Water Conservancy District. Easements and shared well agreements are required. Status of Previous Testing > This Well was pump tested on 12/6/11 by Ray's Well Done Pump Service LLC and the test/report meets the 4 hour test requirement. ➢ The report's conclusion represents that it is more than adequate for a single family dwelling. ➢ A water quality test was completed on 12/6/11 but did not include testing for all required parameters. Remaining Steps to Meet Code/Conditions 1. The Report needs to be updated as this is a shared well between Lots 3 and 4. It needs to include a revised determination that the well is adequate to serve two single family dwellings. 2. An updated water quality test needs to be completed meeting the revised requirements (consistent with the CDPHE Deluxe Colorado Package plus the Alpha — Beta radioactivity screen). The testing can add to the previous parameters tested for if that is determined by the Applicant to be the most efficient way to move forward. 3. The shared well agreement needs to be finalized, reviewed by the County Attorney, and executed. It will also need to be recorded concurrently with the Subdivision Exemption Plat. WATER QUALITY TESTING REQUIREMENTS "Water quality shall be tested by an independent testing laboratory for the following contaminants: alkalinity, arsenic, cadmium, calcium, coliform bacteria, chloride, conductivity, copper, corrosivity, fluoride, hardness, iron, lead, magnesium, manganese, nitrate/nitrite, pH, sodium, sodium adsorption ratio, sulfate, total dissolved solids, uranium, zinc and alpha/beta radioactivity. Additional testing may be required for other contaminants that occur within the County. The results shall show that the Maximum Contaminants Levels (MCLS), as set forth by the CDPHE within the Colorado Primary Drinking Water Standards, are not exceeded, or the Applicant has otherwise identified a treatment system that will bring the water within acceptable MCLs. Annual testing, testing for other contaminants, and testing for secondary drinking standards including taste, odor, color, staining, scaling, and corrosion is also recommended." This Summary was prepared by the Garfield County Community Development Department Glenn Hartmann, Senior Planner March 27, 2013 Northwest Comer Section 5 Brass Cop Witness Comer in Place Bears 500'51'47E 25.8' (from point for corner) IL 589•41'$i• W 1,,___ 1 396002' 25' Witness Corse Ann EJohnson 5905 02 233 324 CO 81652 Harold GJr. A Lon A Bmnler 6025 CR 293 5111, CO 81652 County Road No. 233 Gaslirm Make I Gas Apeb e Fence 26.4' " 15.0'Easemen1for Highway Gas6ne Marba'Geay Book 26, Page 514 ..__ I ❑ Pe82N.y4970 ' jt ‘1,1466 DUTCJW MAJOR Do. Cop 1S �fNa 10871 Lisa tang 6 Courtney WM 6091 CR233 594 CO 81652 I 'Reber 4 Cop. LS Na. 13501 8 R Enggid s ;661919 1 CR 233 584 CO 8164 _ 1 �r r>. L• 5 00'48'12' E 30.0' Antlers Orchard Dc°elopvwd RO W (Scene form Pert Reception Na 037488) D0D ti9909 1 4e 9° Dorothy Hooky 1211 CR229 5512, CO 81642 P.0.3 Lott • Center North 1/16 Comer Section5 3-1/ 4' Aluminum Cop L5 No. 16397 014 T°�7• �o 6 941 1o¢� 55 m a 8.° [9 Rebm 3 Cop LS No. 36572 `Tie N 893548' E ]2349 Center NorthNorm 1/16 GonCap LS No. 5 3-1/4. Aluminum COPLSNa 16397 lhodSnoo 1 Ragsdale S Darlene E Davis 655 OR 216 Rifle. CO 81650 -r 4.52 j4. 45833 30.0'ANlers Orchard D2.,dnpenvuR4IV (Soule Joon PIG, Reception No. 037488) e Proposed Well to Peine No. No. 9o. 9.6034 P.O.B. Lot3 Exemption Lot 1 20.510 3 Acres 37.23' . Permit No. 3078 -28.7 I'; Power Pole w/E1ee Meter \\• Location of \ \ Leach field \\\ \\waterlineAe ns 6. \\ M i" \ •.". rice Easenat 0.3658 Acres �a \ u£\\ \\\sr-. 10.0' sV 10.0'" �\\ ^ . os.. oo\\ \•\\ IS:Wdnea \$70.44•£; r� t] • 20.0'0rrl9aer , Easoned 0.180 SAwas 60.0' loo.o'91t Pump Conal • -Rightof-WlVdodEusarienf '. Book389, Page 276 Rebar 6: Cop JS No. 36572 5U m� Atm (HJp./ N° J' Exemption Lot 3 12.723 3 Acres 5 89'35'48' W 668.24' Marion B 0 a A Gilmore PO BOX 56 New Castle, CO 81647 Fence o6t"�ntaE\I>, c° u5\IS°t.5 —�Ca1mMe 10.0' N 82'49'26' B 286.60' Rebar 6 Cop 150'1 15 No. 36 Pole Som Hower Pole Exemption Lot 4 13.963 ±Acres ids 0.0 Propane 15 -(ran mt.,. Napa., *26, Hage 514 30.0'A^"" d 06asemer0 45oca 8 88'35'48 E I. 658.63' No. SR<bar 6.3 S 89'35'48" W 658.49' Ent Charles* Dlaryma Bona 963 CR 229 912, CO 81652 I .4 1,0 _lo lrn a to _J East!Comer SP1b.n 5 3"Brstip LS'No. 14060' 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 GEORGE E BAGLEY 6044 COUNTY ROAD 233 SILT, CO 81652- (970) 309-8349 CHANGE/EXPANSION OF USE OF AN EXISTING WELL Easting: Northing: EXST WELL PERMIT NUMBER 76688 -F DIV. 5 WD 39 DES. BASIN MD Lot: 1 Block Filing Subdiv: DUTCH MAJOR EXEMPTION APPROVED WELL LOCATION GARFIELD COUNTY NE 1/4 NE 1/4 Section 5 Township 6 S Range 92 W Sixth P.M. DISTANCES FROM SECTION LINES 123 Ft. from North 900 Ft. from East Section Line Section Line UTM COORDINATES (Meters,Zone:13,NAD83) 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 37-90-137(2), on the condition that this well is operated in accordance with the West Divide Water Conservancy District Augmentation Plan approved by the Division 5 Water Court in case no. 02CW0123. If this well is not operated in accordance with the terms of said decree, it will be subject to administration including orders to cease diverting water. WDWCD contract #120816GB(a). 4) Approved for an expansion of use of, an existing well, constructed on July 21, 1972 to a depth of 62 feet, and with a pump being installed July 21, 1972, at under permit no. 47466 (canceled). Issuance of this permit hereby cancels permit no. 47466. 5) The use of ground water from this well is limited to ordinary household purposes inside two (2) single family dwellings, the irrigation of not more than 12,000 square feet of gardens and lawns, and the watering of five (5) domestic animals. This well is known as GE Bagley Well (aka Lot no. 1, Domestic Well). 6) The pumping rate of this well shall not exceed 15 GPM. 7) The average annual amount of ground water to be appropriated shall not exceed 1.49 acre-foot (485,516 gallons). 8) The owner shall mark the well in a conspicuous place with the well permit number and name of aquifer as appropriate, and shall take necessary means and precautions to preserve these markings. 9) This well shall be located not more than 200 feet from the location specified on this permit. 10) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions must be maintained by the well owner (recorded at least annually) and submitted to the Division Engineer upon request. NOTE: This well is to be located on a residential site of 20.51 acre(s) described as lot 1, Dutch Major Exemption, Garfield County. NOTE: Section 5 is an irregular "Tall" section, approximately 5700 feet North/South. NOTE: Parcel Identification Number (PIN): 23-2179-051-00-040 ' 7►._ i_— NOTE: Assessor Tax Schedule Number: R200338 (totaling 52.0 acres) °T/ . / Zz'/ 2 APPROVED DMW State Engineer \Receipt No. 9503616 DATE ISSUED 09-11-2012 By EXPIRATION DATE Aug 16 13 05:14p Rocky Mountain Drilling 004CY MOUNr4, 4t)R,L U N G S. P u'MP —Services, LLC. — Licensed# 1372 970-434-4171 p.1 GerrcJe E. Bagley Well C 6044 233 Road Slit Colo. Permit # 76688-F After well test this well would be more than sufficient tosupply water for two or three homes. Indoor residential demand is 1/3 acre-foot per year or 300 gallons per day. it would take 50-75 gallons per day per person. The ability of this well will meet the two home requirements. WATER WELLS 26- 1. James M. Logue CWD/PI LIC # 1372 MINERAL EXPLORATION TEST HOLES P.O. Box 4006'1 Grand Junction, Colorado 61504 United States (970) 434-8554 FORM NO_ GWS -39 11190 SUPPLEMENTAL TEST REPORT STATE OF COLORADO, OFFICE OF THE STATE ENGINEER For Office use only 1. WELL PERMIT NUMBER 7 6 6 8 8- F a OWNER Mailing City, Phone NAME(S) George E. Bagley Address 6044 233 Road St. Zp Silt, Colo. 81652 ( 208 ) 409-0610 3. WELL LOCATION AS DRILLED: NE 1/4 NE 1/4, Sec. 5 Twp.6 0 S Range 92.0 W 6th DISTANCES FROM SEC. LINES: 123 ft. from North Sec. line. and 900 ft from East Sec. line FlLING(UNIT) XX SUBDIVISION: STREET (north or south) (east or was» None LOTXX BLOCK XX ADDRESS AT WELL LOCATION: 6044 233 Road Silt . Col o _ 4. STATIC WATER LEVEL: 6.0 ft, Date 05/2 8 / 2 013 , Time 0830 - Measurement Method: sounder , Length of airline (d used) ft. 5. PUMP: Type Submersible , Horsepower .5 , Setting 50.0 feet Power Source 230 Volt 2/W , Discharge pipe 1 0" in., Discharge Pressure 39 P s i psi 6. FLOW , Type ME i tH: 'Manufacturer Diameter inches, Average pumping rate , Volume pumped during test 7. TEST Time 0830 DATA: Date of Test 05./28/2013 Recovery Data — — Time Water Level (feet) Pumping Level Drawdown Pumping rate Pumping Pressure (feet) (f8et) (gpm) (psi) 6 0 0 0 0 0 0 0845 16 30 - 15 19 15 0900 40 35 14.45 40 1000 :41 35 12.40 41 1100 41 35 12.40 41 1200 41 35 12.40 41 1300 41 35 12.40 41 1110 8.0 3315 6.0 8. DISINFECTION: Type 'wing. Amt Used XX 9. Water Quality analysis available. ❑ Yes ® No t0. Remarks Very Good Recovery t 1 CONTRACTOR Mailing I have [Pursuant degree read the statements made herein and know the contents thereof, and that they are true to my knowledge to Section 24-4-104 (13)(a) C.RS., the malting of false statements herein constitutes perjury in the recon• and is punishable as a class 1 misdemeanor.) Ror-ky Mountain Drilling & Pump SerP 1e (470) 434-8554 Lic. No.1372 . Addressp.n.ROX 40061 Grand Junction, Colo. 81504 Name/Title (Please type or print) James M. Logue,CWD/PI S. . -Ire A / , G Date 05/29/2013 Form No. GWS -68 10/2011 EXISTING WELL INFORMATION AND INSPECTION FORM Division of Water Resources, 1313 Sherman St., Ste 821, Denver, CO 80203 PLEASE COMPLETE THIS FORM IN BLACK INK RECEIPT NO: 911 / DIV: tZ_ WD: 39 PERMIT NO: 76,6 8g - F Existing Well Location: NE 1/4 of the N E 1/4, Sec. 5 , Twp (e,oS, RngT"L, CD P.M. 123 feet fromeIS sec. line, ci DD feet from th F W sec. line; CountycAtE: Existing well owner: Name: Ct pt?..& 6 , 1 JU t Ftil Mailing Address: 00041-1 73-S SAD City/State/Zip tLT . cofo S1CoS,L Telephone: (20$) (-log.0 v Description of parcel (subdivision, lot, bik, flg) NOA•C- Size ac Existing well location and visual conditions: If stating no, please explain Type of Existing WelOrillediand Dug, Spring Well, Gallery Well, Gravel Pit, Other Distance to nearest se is ank/sewer line (approximate) 1DO feet Distance to nearest leach field (approximate) yD feet Is the well in a clean and sanitary location? 'yF5 Is the well maintained in a clean and sanitary condition? N/ ES Is the ground at the surface sloped away from the well for proper drainage? Y ES Is the surface surrounding the well firm and stable? \,ES Is the well situated in a well house or vault? NO If so, is the well house or vault in good repair and condition? Existing well construction and materials: If stating no, please explain Is the well equipped with a sanitary well seal/cap? NES Is the well constructed with steel casing at the surface? '•-/E 4 Does the casing extend at least one (1) foot above the surface? 'iES Casing size Sjg in; Estimated well depth (4,7.- feet Who constructed well? LIG #* -78 - Who installed pump? }-10111C vwN� Current uses of existing well: Were the existing uses initiated prior to May 8, 1972? )vv X Household use in 2- single-family dwellings X Watering of poultry and/or domestic animals Watering of livestock on farm or ranch; approximately how many head? Is this a feedlot? ; How many head? \(.. Lawn and/or garden (coo square feet Crop Irrigation acres Fire Protection Commercial exempt for Other: Estimated date well constructed 01- 22 - 1g12. ; Estimated date pump installed ,)SS - 2Q - )12 - Estimated date of first use CSS -a)- )6112 ; Estimated flow rate 2 gpm How many other wells are located on this parcel? ; Uses: Permit/Case Nos.: Existing Well Owner Signature: Date: For Office Use Only Has information above been verified? If not, please note accordingly. List any problems you have identified: (if none, please state so) Date of inspection: os- 013. Phone Number R73 1-13U- Inspected by (print):.3Arr, 5 tt1. LO JC 1572. (signed)- ., Attach photo(s) if available or needed for further evaluation. Additional comments or info ation on back. Qualifierl John W. Hickenlooper, Governor Christopher E. Urbina, MD, MPH, Executive Director and Chief Medical Officer STATE OF COLORADO Dedicated to protecting and improving the health and environment of the people of Colorado Laboratory Services Division 8100 Lowry Boulevard Denver. CO 80230 PO Box 17123 Denver, CO 80217 303-692-3090 www.cdphe.state.co.us/Ir Laboratory Results For Sample Number: ENV -2013006398 - Site ID/PWSID Site Address Site Description LOT 1 WELL # 76688F Customer ID Customer 00014305 Bagley George 6044 CR 233 Silt Test Name Deluxe Colorado Package* Arsenic, Total Cadmium, Total Calcium (Carbonate) Copper, Total Iron, Total Lead, Total Magnesium, Total Manganese, Total Sodium, Total Uranium, Total Zinc, Total Hardness Total Nitrogen, Nitrate/Nitrite Alkalinity, Total Co 81652 Colorado Department of Public Health and Environment Contact Bagley George Phone 208-409-0610 Fax Email kbagley73@gmail.com Collected By KB Collected 05/29/2013 12:21:00 Received 05/30/2013 07:35:00 Reported 06/14/2013 11:30:00 Bottles 1-LNEUT 1-250M 1-250N 1-BACT 1 -CUBE Matrix Ground Water Field Fluoride Residual Chlorine Temperature at Receipt 18.6 Result Units <0.001 mg/L 0.0012 mg/L 87 mg/L 0.44 mg/L 0.10 mg/L 0.011 mg/L 26 mg/L 0.022 mg/L 580 mg/L 0.017 mg/L 4.2 mg/L 190 mg/L 6.7 mg/L 440 mg/L mg/L Alkalinity, Phenolphthalein <10 pH 7.9 MCL MRL Method Name Date Analyzed 0.01 0.001 EPA 200.8 05/31/2013 00:00:00 0.005 0.0006 EPA 200.8 05/31/2013 00:00:00 No limit 0.01 EPA 200.7 06/04/2013 establishe 00:00:00 1.3 0.004 EPA 200.7 06/04/2013 00:00:00 [0.3] 0.003 EPA 200.7 06/04/2013 00:00:00 0.015 0.001 EPA 200.8 05/31/2013 00:00:00 No limit 0.06 EPA 200.7 06/04/2013 establishE 00:00:00 [0.05] 0.002 EPA 200.7 06/04/2013 00:00:00 No limit 0.1 EPA 200.7 06/10/2013 establishE 00:00:00 0.03 0.001 EPA 200.8 05/31/2013 00:00:00 [5] 0.01 EPA 200.7 06/06/2013 00:00:00 No limit 1 EPA 200.7 06/04/2013 establishE 00:00:00 10 0.05 EPA 353.2 05/31/2013 00:00:00 No Limit 10 SM 23208 06/04/2013 Establish( 00:00:00 No Limit 10 SM 2320B 06/03/2013 Establish( 00:00:00 [6.5-8.5] NA SM 4500 -H+ -B 06/03/2013 00:00:00 MRL - Minimum Reporting Limit. MCL - Maximum Contaminant Limit per EPA regulations. BDL - Below Detection Limit. H - Holding Time exceeded. Q - Quality Control limit exceeded. NT - No Test. Units: mg/L - milligrams per liter (ppm), ug/L - micrograms per liter (ppb), pCi - picoCuries LSD Internet Address: http://www.cdphe.state.co.us/Ir/Irhom.htm John W. Hickenlooper, Governor Christopher E. Urbina, MD, MPH, Executive Director and Chief Medical Officer Dedicated to protecting and improving the health and environment of the people of Colorado STATE OF COLORADO Laboratory Services Division 8100 Lowry Boulevard Denver. CO 80230 PO Box 17123 Denver, CO 80217 303-692-3090 www.cdphe.state.co.us/Ir Laboratory Results For Sample Number: est Name Solids, Dissolved Conductivity Chloride Fluoride Sulfate Corrosivity-Langlier Sodium Adsorption Ratio Test Group -Total Coliform PA** Escherichia coli PA Total coliforms PA Gross Alpha/Beta Package (Water)* Gross Alpha Gross Beta Result J1Units 1500 * mg/L 2300 uS/cm 190 mg/L 1.1 mg/L 670 mg/L 0.48 18 mg/L ug/L E. coli NOT ug/L DETECTED Coliform ug/L ABSENT or less than one (<1), indicates a microbiologically safe sample 10 +/- 4 pCi/L 4 +/- 4 pCi/L Comments: Water Package Interpretation ENV -2013006398- MCL 500 /876. Colorado Department of Public Health and Environment M RL 10 Method Name 1Date Analyzed 1 EPA 160.1 05/30/2013 00:00:00 06/09/2013 00:00:00 EPA 300.0 06/05/2013 00:00:00 EPA 300.0 06/06/2013 00:00:00 EPA 300.0 06/05/2013 00:00:00 D 3739-83 06/11/2013 00:00:00 06/11/2013 00:00:00 no limit 0.5uS/cSM 2510 B establishE [250] 1 4.0 0.02 [250] 1 SM 9223 B.2.b. 05/30/2013 00:00:00 SM 9223 B.2.b. 05/30/2013 00:00:00 15 3 EPA 900.0 50 4 EPA 900.0 06/10/2013 00:00:00 06/10/2013 00:00:00 HUMAN HEALTH Arsenic, Cadmium, Copper, Lead, Uranium, Fluoride, Nitrate/Nitrite concentrations are below EPA health -based standards. Iron, Manganese, Zinc, pH, Sulfate and Chloride levels meet EPA aesthetic - based standards. Hardness 190 >80 mg/L. The water is hard and may cause scaly residues and soap scum, and decrease the cleaning action of soaps and detergents. Solids -Dissolved 1500 >500 mg/L MRL - Minimum Reporting Limit. MCL - Maximum Contaminant Limit per EPA regulations. BDL - Below Detection Limit. H - Holding Time exceeded. Q - Quality Control limit exceeded. NT - No Test. Units: mg/L - milligrams per liter (ppm), ug/L - micrograms per liter (ppb), pCi - picoCuries LSD Internet Address: http://www.cdphe.state.co.us/Ir/Irhom.htm Qualifier John W. Hickenlooper, Governor Christopher E. Urbina, MD, MPH, Executive Director and Chief Medical Officer STATE OF COLORADO Dedicated to protecting and improving the health and environment of the people of Colorado Laboratory Services Division 8100 Lowry Boulevard Denver. CO 80230 PO Box 17123 Denver, CO 80217 303-692-3090 www.cdphe.state.co.us/Ir Laboratory Results For Sample Number: ENV -2013006398 - Hardness; scaly deposits; sediments; cloudy, discolored, odorous water; salty or bitter taste. Sulfate 670 >250 mg/L Bitter medicinal taste, scaly deposits, laxative effects. Based on these results, the water is safe for human consumption. Colorado Department of Public Health and Environment CORROSIVITY -0.5 to 0.5 The Corrosivity Index is 0.48, which indicates that the water is nearly balanced (will not deteriorate plumbing or cause scale build-up) IRRIGATION The sodium adsorption radio (sodicity) is 18. The conductivity (salinity) is 2300 uS. The sodium and chloride concentrations (toxicity) are 580 mg/L (recommended level <46mg/L) and 190 mg/L (recommended level < 140 mg/L), respectively. The alkalinity is 440 mg/L (recommended level <92 mg/L). Based on the measured sodicity, salinity, toxicity and alkalinity the water is considered a severe irrigation risk and should not be used for irrigation. Sodium >46 mg/L Use of irrigation water high in sodium will usually result in a soil high in sodium but it may take several irrigations to cause the change. The crop takes up sodium with the water and it is concentrated in the leaves as water is lost by transpiration. Damage (toxicity) can result if sodium accumulates to concentrations that exceed the tolerance of the crop. Leaf burn, scorch, and dead tissue along the outside edges of leaves are typical symptoms. Alkalinity >92 mg/L Bicarbonates and carbonates can clog the nozzles of pesticide sprayers and drip tube irrigation systems and reduce the activity of some pesticides. High carbonates cause calcium and magnesium ions to form insoluble minerals leaving sodium as the dominant ion in solution. LIVESTOCK AND POULTRY Levels of metals, fluoride and nitrate/nitrite are suitable for animal ingestion. Registry Comments: MRL - Minimum Reporting Limit. MCL - Maximum Contaminant Limit per EPA regulations. BDL - Below Detection Limit. H - Holding Time exceeded. Q - Quality Control limit exceeded. NT - No Test. Units: mg/L - milligrams per liter (ppm), ug/L - micrograms per liter (ppb), pCi - picoCuries LSD Internet Address: http://www.cdphe.state.co.us/Ir/Irhom.htm John W. Hickenlooper, Governor Christopher E. Urbina, MD, MPH, Executive Director and Chief Medical Officer STATE OF COLORADO Dedicated to protecting and improving the health and environment of the people of Colorado Laboratory Services Division 8100 Lowry Boulevard Denver. CO 80230 PO Box 17123 Denver, CO 80217 303-692-3090 www.cdphe.state.co.us/Ir Laboratory Results For Sample Number: ENV -2013006398 - LOT 1 WELL # 76688F Colorado Department of Public Health and Environment MRL - Minimum Reporting Limit. MCL - Maximum Contaminant Limit per EPA regulations. BDL - Below Detection Limit. H - Holding Time exceeded. Q - Quality Control limit exceeded. NT - No Test. Units: mg/L - milligrams per liter (ppm), ug/L - micrograms per liter (ppb), pCi - picoCuries LSD Internet Address: http://www.cdphe.state.co.us/Ir/Irhom.htm �WRJ-5-66 STATE OF COLORADO A PERMIT TO USE GROUND WATER APPLICATION FOR: /� A PERMIT TO CONSTRUCT A WELL L/ OTiiER Application must be completed satisfactorily before acceptance PRINT OR TYPE 012 APPLICANT G V e. 157A -71a)/ Street Address T 1 13a X 1 City s.State rfiftg, eft 1,6 water ST; !r /( iii/A T f Use of ground Owner of land on which well is located Number of acres to be irrigated Legal description of irrigated land Other water rights on this land Owner of irrigated land Aquifer(s) ground water is to be obtained from ESTIMATED WELL DATA Est. quantity of ground water to be claimed: Est. Max. Yield /1 'fAL,. GPM or CFS Est. average annual a3unt to be used in acre -feat Storage capacity AF Anticipated start of dril1ingaikeggl9 40, Hole DI/meter: 1J' in. from Q ft. to /44) ft. in. from ft. to ft. Casing: Plain7 In. from a ft. In. from ft. Perf. 7 in. from -75 -ft. In. from ft. PUMP DATA: Type 0 ---kir HP %'7.,— to /eD ft. to f t. to167z:Lft. to ft. Outlet Size This application approved PERMIT NUMBER 30718 DATE ISSUED 16.967 11111r %waft+ COUNTY LOCATION OF WELL 4:thr T. 4.7r► • , R. Ground Water Basin Water Management District sec. 1* WWII Ma mow SIAL OWEN 4- hL P.M. USE DIAGRAM ON THE BACK OF THIS _SHEET_ TO LOCATE WELL. Dr! l l er!, S j//Ar o. Driller's Address a /oZ- / .,c f// (OVER) Signature Ap.^icant CONDITIONS OF APPROVAL This application approved CONDITIONAL PERMIT NO. (Permit good for one (1) year after date of Issuance) DATE ISSUED 1j. A '• l L ' Chairman Ground Wafter Commission ••1 by J THE LOCATION OF THE PROPOSED IIELL SHALL BE SHOWN ON THE DIAGMM BELOW. THE LOCATION WILL BE INDICATED BY THE DISTANCES FROM THE SECTION LINES, OA THE DISTANCE AND BEAR- ING FROM GOVERNMENT SURVEY CORNERS OR MONUMENTS. IF WELL IS FOR IRRIGATION, THE AREA TO 8E IRRIGATED MUST BE 4DED OR CROSS -HATCHED. Domestic wells may be located by the following: i Lot Block Street Address or City Subdivision The diagram represents nine (9) sections. Use the center square the location of the well. (section) to indicate THE SCALE OF THE DIAGRAM IS TWO INCHES EQUALS ONE -MILE John W. Hickenlooper, Governor Christopher E. Urbina, MD, MPH, Executive Director and Chief Medical Officer Dedicated to protecting and improving the health and environment of the people of Colorado Laboratory Services Division 8100 Lowry Boulevard Denver. CO 80230 PO Box 17123 Denver, CO 80217 303-692-3090 www.cdphe.state.co.us/Ir Laboratory Results For Sample Number: ENV -2013006397 - STATE OF COLORADO Site ID/PWSID Site Address Site Description LOT 2 WELL # 1172A Customer ID Customer 00014305 Bagley George 6044 CR 233 Silt Co 81652 C°to it Colorado Department of Public Health and Environment Contact Bagley George Phone 208-409-0610 Fax Email kbagley73@gmail.com Collected By KB Collected 05/29/2013 11:55:00 Received 05/30/2013 07:35:00 Reported 06/14/2013 11:30:00 Bottles 1-LNEUT 1-250M 1-250N 1-BACT 1 -CUBE Matrix Ground Water Field Fluoride Residual Chlorine Temperature at Receipt 18.6 Test Name Result Units MCL MRL Method Name Date Analyzed Qualifier Deluxe Colorado Package* Arsenic, Total Cadmium, Total Calcium (Carbonate) Copper, Total Iron, Total Lead, Total Magnesium, Total Manganese, Total Sodium, Total Uranium, Total Zinc, Total Hardness Total 0.0016 <0.0006 32 0.016 5.7 ** 0.0058 5.1 0.036 430 0.0037 0.56 53 Nitrogen, Nitrate/Nitrite 3.1 Alkalinity, Total 300 Alkalinity, Phenolphthalein <10 pH 8.0 mg/L 0.01 0.001 EPA 200.8 05/31/2013 00:00:00 mg/L 0.005 0.0006 EPA 200.8 05/31/2013 00:00:00 mg/L No limit 0.01 EPA 200.7 06/04/2013 establishE 00:00:00 mg/L 1.3 0.004 EPA 200.7 06/04/2013 00:00:00 mg/L [0.3] 0.003 EPA 200.7 06/04/2013 00:00:00 mg/L 0.015 0.001 EPA 200.8 05/31/2013 00:00:00 mg/L No limit 0.06 EPA 200.7 06/04/2013 establishE 00:00:00 mg/L [0.05] 0.002 EPA 200.7 06/04/2013 00:00:00 mg/L No limit 0.1 EPA 200.7 06/10/2013 establishE 00:00:00 mg/L 0.03 0.001 EPA 200.8 05/31/2013 00:00:00 mg/L [5] 0.01 EPA 200.7 06/04/2013 00:00:00 mg/L No limit 1 EPA 200.7 06/04/2013 establishE 00:00:00 mg/L 10 0.05 EPA 353.2 05/31/2013 00:00:00 mg/L No Limit 10 SM 2320B 06/03/2013 Establish( 00:00:00 mg/L No Limit 10 SM 2320B 06/03/2013 Establish( 00:00:00 [6.5-8.5] NA SM 4500 -H+ -B 06/03/2013 00:00:00 MRL - Minimum Reporting Limit. MCL - Maximum Contaminant Limit per EPA regulations. BDL - Below Detection Limit. H - Holding Time exceeded. Q - Quality Control limit exceeded. NT - No Test. Units: mg/L - milligrams per liter (ppm), ug/L - micrograms per liter (ppb), pCi - picoCuries LSD Internet Address: http://www.cdphe.state.co.us/Ir/Irhom.htm John W. Hickenlooper, Governor Christopher E. Urbina, MD, MPH, Executive Director and Chief Medical Officer STATE OF COLORADO Dedicated to protecting and improving the health and environment of the people of Colorado Laboratory Services Division 8100 Lowry Boulevard Denver, CO 80230 PO Box 17123 Denver, CO 80217 303-692-3090 www.cdphe.state.co.us/Ir Laboratory Results For Sample Number: ENV -2013006397 - Test Name Solids, Dissolved Conductivity Chloride Fluoride Sulfate Corrosivity-Langlier Result 1100 * 1700 120 2.1 540 -0.01 Sodium Adsorption Ratio 26 Test Group -Total Coliform PA** Escherichia coli PA Total coliforms PA Gross Alpha/Beta Package (Water)* Gross Alpha Gross Beta E. coli NOT DETECTED Coliform ABSENT or less than one (<1), indicates a microbiologically safe sample Units mg/L MCL uS/cm mg/L mg/L mg/L mg/L ug/L ug/L ug/L 500 MRL 10 Colorado Department of Public Health and Environment Method Name EPA 160.1 no limit 0.5uS/cSM 2510 B establishE [250] 1 EPA 300.0 4.0 0.02 EPA 300.0 [250] 1 EPA 300.0 D 3739-83 Date Analyzed 05/30/2013 00:00:00 06/09/2013 00:00:00 06/05/2013 00:00:00 06/06/2013 00:00:00 06/05/2013 00:00:00 06/11/2013 00:00:00 06/11/2013 00:00:00 SM 9223 B.2.b. 05/30/2013 00:00:00 SM 9223 B.2.b. 05/30/2013 00:00:00 6 +/- 3 pCi/L 15 3 EPA 900.0 < 4 pCi/L 50 4 EPA 900.0 Comments: Water Package Interpretation 06/10/2013 00:00:00 06/10/2013 00:00:00 HUMAN HEALTH Arsenic, Cadmium, Copper, Lead, Uranium, Fluoride, Nitrate/Nitrite concentrations are below EPA health -based standards. Manganese, Zinc, pH, and Chloride levels meet EPA aesthetic -based standards. Iron 5.7 ** > 0.3 mg/L Brackish color; rusty sediments; bitter metallic taste; brown -orange stains; iron bacteria. Solids -Dissolved 1100 >500 mg/L Hardness; scaly deposits; sediments; cloudy, discolored, odorous water; salty or bitter taste. MRL - Minimum Reporting Limit. MCL - Maximum Contaminant Limit per EPA regulations. BDL - Below Detection Limit. H - Holding Time exceeded. Q - Quality Control limit exceeded. NT - No Test. Units: mg/L - milligrams per liter (ppm), ug/L - micrograms per liter (ppb), pCi - picoCuries LSD Internet Address: http://www.cdphe.state.co.us/Ir/Irhom.htm Qualifier John W. Hickenl000er, Governor Christopher E. Urbina, MD, MPH, Executive Director and Chief Medical Officer STATE OF COLORADO Dedicated to protecting and improving the health and environment of the people of Colorado Laboratory Services Division 8100 Lowry Boulevard Denver. CO 80230 PO Box 17123 Denver, CO 80217 303-692-3090 www.cdphe.state.co.us/Ir Laboratory Results For Sample Number: ENV -2013006397 - Sulfate 540 >250 mg/L Bitter medicinal taste, scaly deposits, laxative effects. Based on these results, the water is safe for human consumption. Colorado Department of Public Health and Environment CORROSIVITY -0.5 to 0.5 The Corrosivity Index is -0.01, which indicates that the water is nearly balanced (will not deteriorate plumbing or cause scale build-up) IRRIGATION The sodium adsorption radio (sodicity) is 26. The conductivity (salinity) is 1700 uS. The sodium and chloride concentrations (toxicity) are 430 mg/L (recommended level <46mg/L) and 120 mg/L (recommended level < 140 mg/L), respectively. The alkalinity is 300 mg/L (recommended level <92 mg/L). Based on the measured sodicity, salinity, toxicity and alkalinity the water is considered a severe irrigation risk and should not be used for irrigation. Sodium >46 mg/L Use of irrigation water high in sodium will usually result in a soil high in sodium but it may take several irrigations to cause the change. The crop takes up sodium with the water and it is concentrated in the leaves as water is lost by transpiration. Damage (toxicity) can result if sodium accumulates to concentrations that exceed the tolerance of the crop. Leaf burn, scorch, and dead tissue along the outside edges of leaves are typical symptoms. Alkalinity >92 mg/L Bicarbonates and carbonates can clog the nozzles of pesticide sprayers and drip tube irrigation systems and reduce the activity of some pesticides. High carbonates cause calcium and magnesium ions to form insoluble minerals leaving sodium as the dominant ion in solution. LIVESTOCK AND POULTRY Levels of metals and nitrate/nitrite are suitable for animal ingestion. The fluoride level is above the recommended limit of 2.0 mg/I for animal ingestion. Fluoride interacts with copper in dietary minerals. Excessive levels can cause loss of tooth enamel, resulting in rapid, uneven wear. Secondary effects disturb metabolism, causing semi -starvation conditions of for livestock. MRL - Minimum Reporting Limit. MCL - Maximum Contaminant Limit per EPA regulations. BDL - Below Detection Limit. H - Holding Time exceeded. Q - Quality Control limit exceeded. NT - No Test. Units: mg/L - milligrams per liter (ppm), ug/L - micrograms per liter (ppb), pCi - picoCuries LSD Internet Address: http://www.cdphe.state.co.us/Ir/Irhom.htm John W. Hickenlooper, Governor Christopher E. Urbina, MD, MPH, Executive Director and Chief Medical Officer Dedicated to protecting and improving the health and environment of the people of Colorado Laboratory Services Division 8100 Lowry Boulevard Denver. CO 80230 PO Box 17123 Denver, CO 80217 303-692-3090 www.cdphe.state.co.us/Ir Laboratory Results For Sample Number: ENV -2013006397 - STATE OF COLORADO Registry Comments: LOT 2 WELL# 1172A Colorado Department of Public Health and Environment MRL - Minimum Reporting Limit. MCL - Maximum Contaminant Limit per EPA regulations. BDL - Below Detection Limit. H - Holding Time exceeded. Q - Quality Control limit exceeded. NT - No Test. Units: mg/L - milligrams per liter (ppm), ug/L - micrograms per liter (ppb), pCi - picoCuries LSD Internet Address: http://www.cdphe.state.co.us/Ir/Irhom.htm IV Mountain States • ACCLi-TEST l ADDrtAI O141E5 Technical Report for Ray' s Well Done Pumps, LLC Bagley Land Split/Subdivision Accutest Job Number: D33884 Sampling Date: 04/23/12 Report to: Ray' s Well Done Pumps, LLC PO Box 863 Rifle, CO 81650 welldonepumps@gmail. com ATTN: Ray Latham Total number of pages in report: 20 `��O 1N ACCoR00� anel c Test results contained within this data package meet the requirements of the National Environmental Laboratory Accreditation Conference and/or state specific certification programs as applicable. Client Service contact: Shea Greiner 303-425-6021 /71- or/4— Brad Madadian Laboratory Director Certifications: CO, ID, NE, NM, ND (R-027) (PW), UT (NELAP C000049), TX (T104704511-12-1) This report shall not be reproduced, except in its entirety, without the written approval of Accutest Laboratories. Test results relate only to samples analyzed. Mountain States • 4036 Youngfield St. • Wheat Ridge, CO 80033-3862 • tel: 303-425-6021 • fax: 303-425-6854 • http://www.accutest.com 1 of 20 .o.CctJT'EST. D33884 Table of Contents Sections: -1- Section 1: Sample Surnmary 3 Section 2: Sample Results 4 2.1: D33884-1: 2695814382624 5 Chain of Custody 8 D D ■ 2 of 20 • ACL1TEST D33884 Accutest Laboratories Sample Summary Ray's Well Done Pumps, LLC Bagley Land Split/Subdivision Job No: D33884 Sample Collected Matrix Client Number Date Time By Received Code Type Sample ID D33884-1 04/23/12 13:30 RL 04/24/12 DW Drinking Water 2695814382624 3 of 20 ACCLlTEBT D330E4 1111 Mountain States ;1.). f',F;LSTEB-T- •-• ORA1: Sample Results Report of Analysis Section 2 Accutest Laboratories Report of Analysis Page 1 of 1 Client Sample ID: 2695814382624 Lab Sample ID: D33884-1 Date Sampled: 04/23/12 Matrix: DW - Drinking Water Date Received: 04/24/12 Percent Solids: n/a Project: Bagley Land Split/Subdivision Total Metals Analysis Analyte Result MCL RL Units DF Prep Analyzed By Method Prep Method Antimony < 0.00080 0.0060 0.00080mg/1 2 04/27/12 05/04/12 GJEPA 200.82 EPA 200.87 Arsenic 0.0022 0.010 0.0016 mg/1 2 04/27/12 05/04/12 GJ EPA 200.8 2 EPA 200.8 7 Barium 0.029 2.0 0.0040 mg/1 2 04/27/12 05/04/12 GJ EPA 200.8 2 EPA 200.8 Beryllium < 0.00040 0.0040 0.00040mg/1 2 04/27/12 05/04/12 GJ EPA 200.8 2 EPA 200.8 Cadmium < 0.00020 0.0050 0.00020 mg/1 2 04/27/12 05/04/12 GJ EPA 200.8 3 EPA 200.8 Chromium < 0.0040 0.10 0.0040 mg/1 2 04/27/12 05/04/12 GJ EPA 200.8 2 EPA 200.8 Mercury < 0.0010 0.0020 0.0010 mg/l 1 04/25/12 04/25/12 JB EPA 245.1 1 EPA 245.1 6 Nickel 0.0046 0.0040 mg/I 2 04/27/12 05/04/12 GJ EPA 200.8 2 EPA 200.8 7 Selenium 0.094 0.050 0.00080mg/1 2 04/27/12 05/08/12 JM EPA 200.8 4 EPA 200.8 7 Sodium 387 25 mg/1 50 04/27/12 05/09/12 GJ EPA 200.8 5 EPA 200.8 Thallium < 0.00040 0.0020 0.00040m02 04/27/12 05/04/12 GJ EPA 200.8 3 EPA 200.8 Uranium 0.033 0.00040mg/I 2 04/27/12 05/04/12 GJ EPA 200.8 2 EPA 200.8 (1) Instrument QC Batch: MA2364 (2) Instrument QC Batch: MA2391 (3) Instrument QC Batch: MA2394 (4) Instrument QC Batch: MA2402 (5) Instrument QC Batch: MA2404 (6) Prep QC Batch: MP7356 (7) Prep QC Batch: MP7364 RL = Reporting Limit MCL = Maximum Contamination Level (40 CFR 141) ■ 5of20 A..CGUTEBT D33S84 Accutest Laboratories Report of Analysis Page 1 of 1 Client Sample ID: 2695814382624 Lab Sample ID: D33884-1 Date Sampled: 04/23/12 Matrix: DW - Drinking Water Date Received: 04/24/12 Percent Solids: n/a Project: Bagley Land Split/Subdivision General Chemistry Analyte Result MCL Units DF Analyzed By Method Cyanide, Total < 0.0050 0.20 mg/1 1 05/07/12 JK 5M20 4500CN E Fluoride 1.1 4.0 mg/1 2 04/24/12 13:58 JML EPA 300 Nitrogen, Nitrate 15.8 10 mg/l 25 04/24/12 17:42 JML EPA 300 Sulfate 647 mg/1 50 04/24/12 17:57 JML EPA 300 MCL = Maximum Contamination Level (40 CFR 141) ■ 6of20 AGGIJTEST 033884 Mountain States ,AGGIJmEESm 1. ABORAT ORIt t. Misc. Forms Custody Documents and Other Forms Includes the following where applicable: • Chain of Custody 7of20 • ▪ AccumaST D33884 CHAIN OF CUSTODY PAGE OF 4 :..�.- Acartrat LS•ee itu in S,ar L:i ., CI :-•, , !1 at 1 E s 4036Yeonglield Street Meat Ridge. Co 80033 TEL 303.425-6021 877.737.4521 FAX 303425-6821 E%T, FEDarainge Sore ONn CocoOia Arm.04 Come Requested Analysis ( see TEST Arevasuaae (Us- s ✓/ CODE sheet) Motrin Codes Client 3 Reporting Infommtion Prect Inf0rtlmtion CFun, Item ,,sf���oo4epL.1p .rr Prcre.t 1 .I4,1 spin (,, Y 'Cls.,„ .r > c..“, t�t�. (fit \, C1i L Q M �� ' v.7 U u t8) , v �s O X DW-Dmk'^Sl/uzr GW -Ground Water WW.WeterW SW -So- SO Water So- Sol St- Sl. Sludge 01 -Oil UQ -Other Lquld AIR •A'.r SOL -01F.¢r Sold WP-W.pe FBReldElora EB-cga;pment Blur:, RB -Rinse Monk TB -Trip Blank Street Address Street <; :' .' .. : (` Po 8,2x is63 ti, Billing lnternmiion (11 d;licrept;toot :open to) Ci Store Lo ,P/, c. FliGs, City. Cco army Noe, Pro'ect Contort E -mai; ,el/ � ,r 0. •1+R.7G/d 4� Prejecte Street Address Phone Foxe 99� 37 ��i7 Client POO City 5010 Ztp - Xc.d¢(s$ PF.00et e\Q is) /Z1 /2 _q p key//� -377- r/6./7 Project *.7eaaoe, Attention. POO Co'eUrn Nuriier of vas .:.� ae 5 s�'pe Field lD/Point oi Collection NEov,mvde oas T1me snot Iv wax Oollarfss oSg�0001S a � z - s 3 w LAB USE ONLY A 69 './Y/3 $262 9 'I -J -3,r2_ ir. o Rc Dia x It x X x x f] 1 ( Outn Deliverable Information Comments 3 Special b iettuctfons .-.... Ternaraand ram 1 During. day;) Apo/avec BY 1A.culast Feta) nal: OS W. 10Buslness Days Q Commercial "A° :Level 1) Q 52088 Forms Q Cameo:viol"B"( Level 2) 0 EDD Format LL `17�6p'{, 8`10.8 f re51,1115 710 ❑ 5td. 5 Business Days (By Connect only'', Q Cotmmerdol"B°.Nuuuliva 0 PDF 6 t //irl VLW/ass ❑ 500514 58 Q FULLT1 (Level 3+41 0 30ay EMERGENCT J o 2 Day EMERGENa Commercial 'A" = Results Only 01Day0E70ORNO ETA. gamy3fi. ,T.7: let¢ s:uu3:e VIAL:L3M. Canurenc.;13=Remits ♦CCS.,;ra:wy ' Sun pie Caatud must be 4ucur ruled . *Samples change possession, including courier delivery.f _•rp , 1 D/ya{JC.Y�cieisl,•/W�a//j� /�vt�a _ -,[L/ Rawly 1 IR+Onnef:S+0 am V •• I�nt+,q+ial:xE eat= Tim= Rece der. 1 I,.va+„ 2s._ .^. els 'ilicd 9y 5a�.� 3 8,0 0nrro. Received BY: 3 By: 4 N. I0 I S. 4 Ro:.alc,abed ea 5 BOL Tine. Received By: 5 LLatady Seal, Lllnt4 wed euppacebk an. Cady Temp 0.i_ -LL . Y D33884: Chain of Custody Page 1 of 13 2. 2 848:14 8 of 20 aaccu-res-r 033584 Accutest Laboratories Sample Receipt Summary Accutest Job Number: D33884 Client: RAYS WELL DONE PUMP SERVICES Date / Time Received: 4/24/2012 10:15:00 AM No. Coolers: Project: BAGLEY LAND SPLIT Cooler Security 1. Custody Seals Present: 2. Custody Seals Intact: Y or N ❑ © ❑ 3. COC Present: 4. Smpl Dates/Time OK Cooler Temperature Y or N 1. Temp criteria achieved: © ❑ 2. Cooler temp verification: Infared gun 3. Cooler media: Ice (bag) Quality Control Preservation 1. Trip Blank present / cooler. 2. Trip Blank listed on COC: 3. Samples preserved property: 4. VOCs headspace free: Comments Accutest Laboratories V(303) 425-6021 Y or N 1 Immediate Client Services Action Required: No Client Service Action Required at Login: Airbill Ws: Fedex Sample Integrity - Documentation 1. Sample labels present on bottles: 2. Container labeling complete: 3. Sample container label / COC agree: Sample Integrity - Condition 1. Sample recvd within HT: 2. All containers accounted for: 3. Condition of sample: Sample Integrity - Instructions 1. Analysis requested is clean. 2. Bottles received for unspecified tests 3. Sufficient volume recd for analysis: 4. Compositing instructions clear. 5. Filtering instructions clear. 4036 Young0eld Street F: (303) 425-6854 No Y or N ❑ ❑ Y or N ❑� ❑ ❑ Intact Y or N N/A ❑ ❑ ❑ ❑ ❑ Wheat Ridge, CO wwwlaccutest.com D33884: Chain of Custody Page 2 of 13 ■. 9of20 ACCIJTEST D33884 CHAIN OF CUSTODY D33884: Chain of Custody Page 3 of 13 ■ 10 of 20 ▪ ACOLJTEST 1333884 iiii&Irr . ACCUTEST 4036 Youngfield St, Wheat Ridge, CO 80033 303-425-6021 FAX: 303-425-6854 Accutest Job #: D33884X Accutest quote it: 0 AMS P.O. #: Project No.: Client Information Subcontract Laboratory Information Analytical Information ... Name Accutest Mountain States (AMS) Name Industrial Lab Q o_ O Comments Address 4036 Youngfield St. Address 4046 Youngfield St. City State Zip Wheat Ridge, CO 80033 City State Zip Wheat Ridge CO 80033 Send Report to: Andrew Fluegel Any questions contact: Renes Jackson Contact: Sample Management Phone/Fax#. (303) 425-6021; (3031425-6854 Phone: (303) 287-9691 Collection Preservation Field ID / Point of Collection Date Time Matrix ft of_, bottles i zo 2 mo a I i 3 D33884X -1 4/23/12 1:30 PM DW 1 X 1 Tumaround Information . Data Deliverable Information ; Comments / Remarks 010 Business Day Standard Approved By: 0 Other (Days) 0 Commercial "A'° ED PDF 0 Commercial"B" 0 Compact Disk Deliverable Please use Colorado regulations and RLs. 0 Commercial "BN" Electronic Delivery: 0 Reduced Tier 1 D State Forms 10 Day Turnaround Hardcopy, RUSH is FAX Data unless previously ■ Full Tier 1 E] Other (Specify) approved. Sample Custody must be documented below each time samples change possession, Including courier delivery. For Subcontract Laborartory Use Only •. mgu,a .... 1 .a , . .me. •,.,e.:y: 1 a .me. 1 ea ea. apace: Yes ❑ No ❑ NA ❑ Relinquished by: 2 /late & 1 Rammed By: 2 Date & lime: 2 Preserved where applicable: ❑ RoHngu,ahed by: 3 UataS rime: Received By: 3 thud l fele: 3 ce Temperature °C ❑ D33884: Chain of Custody Page 3 of 13 ■ 10 of 20 ▪ ACOLJTEST 1333884 N N N N E" N `1 m g er v co O P. v � PM 4~ Cki • x C) 4Y c VI o 2 „ z" • d n n a to N 00 2 VJ L U 0 m W 00 0 0 ('1 O 00 O Result Units Test Sample Description Method D33884X-I, • Total Coliform 4:23+12, 1:30pm 7. 1 120424009-01A N 2 N 0 00 D33884: Chain of Custody Page 4 of 13 11 of .20 • Aapcu-rEs-r 033884 CHAIN OF CUSTODY s AccutestJob #: D33884X UAYV Es !' at ,`� 4036 Youngfietd St., Wheat Ridge, CO 30033 Accutest Quote 6: 0 303-425-6021 FAX: 303-425-6854 AMS P.O.5: Project No.: Client Information 1.`. Subcontract Laboratory Information Analytical Information Name Accutest Mountain States (AMS) Name Reservoirs Environmental, Inc. ' Address 4036 Youngfield St. Address 5801 Logan Street, Suite 100 City State Zip Wheat Ridge, CO 80033 City State Zip Denver CO 80216 Send Report to: Andrew Fiuegel Any questions contact: Renea Jackson Contact Gina Vettraino - ' Phone/Fax rt: (303) 425-6021; (303)425-6854 Phone: (303) 964-1986 ,n Collection Preservation m Field ID ! Point of Collection Date Time Matrix #of bottles ,A om S 9 m 3 9 Q .. :. - • Coirintents D33884X -1 4123112 1:30 PM DW 1 X r i 1 Turnaround Information Data Deliverable Information Comments / Remarks Q10 Business Day Standard Approved By: Other (Days) Q Commercial "A" O PDF ® Commercial "B" Q Compact Disk Deliverable Please use Co orado regulations and RLs. Q Commercial "BN" Q Electronic Delivery: Q Reduced Tier 1 El State Forms 10 Day Turnaround Hardcopy, RUSH is FAX Data unless previously approved. of Full Tier 1 • Other (Specify) Sample Custodyyy JJ{nnnust be documented below each time samples �jhange possession, including courier delivery. Relinquished by For Subcontract laborartory Use Only 1�� Heturqufshed by: i ate �. Time: IG fl1Z' �Qa ke�w+.,.n By: ^ (r 1. cam--• bate �Toee: 1 +-( -2.5 2_ Seal 0: �Hesdspacn: Yes 0 No E3 NA El 2 Relinquished by: Ime: bate Received By: '}fate 2 &Time: 2 'Preserved where app [cable: 0 3 & l :me: Racelved By: 3 rate & tone: 3 Un Ice Temperature °C D33884: Chain of Custody Page 5 of 13 ■ 12of20 • ACC2LJTEBT 033884 C 0 .t. V3.3 0_82 T^a mm_ NTo_i•- QU EG c '----e-1-0= -0E2=2 N �y N p p L g T W¢ W H O N a J¢ a.0 a'Z KGZ TC C C p a c2 3 E N N t N Y�m_ O c Ea O qk O O V a O OZ 01� ¢a.c0 acmo Z' t ® ', 00 J N 0 0 2E2‹. a0 0 o �O W= L aa0 o o mIii- _1 u J _ _Z'J T C aj O 1 pin ON @ C O N •V .0.2 o o c t` O 0 V 0 0> ▪ x¢20 T o 2 N a N C ,N .15.5-2 5 V 0 f O Z m= Q 0 c m W m 8 E 0 LO- O _g.2-1 O 0. 0 O V N C � r M 5V-02 M EO N 6 O2aU m W +�C 0 c�E W ,WatF- o4 m. N Qa0 ca cTi N 1-45j1 7 O> N O U , W 'cU (T6 g (Oj M t N LI -0.3z034.§ ¢ v 'S D: m U m a a T N 0 N aaPc m y o 5 .3 o f C — N , 7 N a y 0)Z o o 4 c O r TL_ C 8Y3-9.4 N O) . Q T p�C QNwaM L 0 0 C ..Ti 0 '022..3-25Q N 5O N V O N 0 D N 0 X 2 N a p_ l 0 r 0, C — N N O j C C O O O a a O Q y N 0 C � d $ m 'v - N N 0 0 0 >c▪ aEc03N >O @ 0 oc` 00Na0 ;;;;;;; mNON' 0£ 3 m E c o E o UI p 0 C 0 C V O O> C f, 0« c O W > oLcinU2 ragEmo y N 0) O= N 0 OQ 0 0 tea' N Q N N O E O &IN E F T O 2 Nm '° V C N M 0 0 0 0 0 N ,s 0' j. 0 o N TQo K m 3, 00 m N 8 a fir g D33884: Chain of Custody Page 6 of 13 13&20 • ▪ AGCIJTEST D33U4 Reservoirs Environmental, Inc. Effective January 1. 2012 Reservoirs Environmental OA 6lanval T: MOAOCILabIReservoirs Environmental OA Alanual.doe RESERVOIRS ENVIRONMENTAL, INC. NVLAP Lab Code 101896-0 TABLE 1. TEM WATER SAMPLE ANALYTICAL RESULTS RES Job Number: RES 234498-1 Client: Accutest Client Project Number/P.O: None Given Client Project Description: D33884X Date Samples Received: April 25, 2012 Analysis Type: TEM, Water Turnaround: 10 Day Date Samples Analyzed: May 2, 2012 Client Lab Aliquot Dilution TOTAL Greater than 10 Analytical TOTAL Greater than 10 ID Number ID Number Deposited Factor ** Number of Micron Length Sensitivity Asbestos Micron Length on Asbestos Asbestos Concentration Asbestos Filter Structures Structures Concentration (ml) Detected Detected (million struct/liter) (million struct/liter) (million struct/liter) D33884X-1 EM 878526 5 1 ND ND 0.69 BAS BAS NA = Not Analyzed ND = None Detected BAS = Below Anaytical Sensitivity P. 303.984-1986 F: 303-177-4275 Lzv ?ft filgT 5801 Lagan Street, Sulte 100 Denver, C080218 1-868-RE5I-ENV www.re'4ab.mm Page 2 oft D33884: Chain of Custody Page 7of13 ■ 14 of 20 A.GCLJMEST D33884 Due Date: '4 - ao - - - z DueTiilne- loz.M— r+�t LAB /Qct 9G!-v0/r5' Er0vws—vr►maryta/. 5801 1220 St. Denver. CO e0216•Ph 303660.1866• Fax 3034774275• TO Rea 266 RESBENV After Hours Cell Phone: 720-3399228 INVOICE TO: (IF DIFFERENT) CONTACT INFORMATION: RES 234498 can8a"' A- r , -t- - + 005120 Cantos[ Aeaase: Y...( C L_ "sins. rl1Gt> 1.1 5'h. L.43 N! : .`!ri! , -- 'T.,"3 Z ITane: Fac PYs s:e➢tpagm 25.22.2r 2rarmP.o.# 1.), 33Y$3e-i x N. DMA 0a'Iver.2En CIAde/es. 'ASBESTOS)RATORY;HO11R83We'skdayiIONtfp:l7pm, !PLM / Pere TEM _ RUSH (Same Day) _ PRIORITY (Next Day)STANDARD (Rush PCM• 2hr, TEM = Shit.) .) 1515 �. 1;;RE41JESVEDANAl esist!1 , .;n; ,:: 111;:-i 'a•V$1113MASRgC600E9 i! LAB NOTES.: OMEMMIT' IAMIO.RATORMIHDISIO WeekiiajIhti. aMiit8M Metal(s)/ Dust _ RUSH 24 hr. _3-5 Cay RCRA 8l Metals 8 Welding RUSH _ 5 day _10 day Fume Scan J TCLP '-_ Organics _24 hr. _3 day_5 Day OH:IM AitektlayMiiisise'-bpm:It:; Mr'cRolsiOLOMY.15A84RAToR'T; "Prior notification Is rogellad Por RUSH tumaraundc'• E.coll 0157527 CoDforma S aureus _24 hr. 2 Day _3-5 Day Salmonella, LIsteda, E.coli APC, Y ti M 48 H _3-5 Day Mold RUSH 24 Hr 48 Hr 3 Day 5 Day ? mumai unbsavpnehzlabdiiidir namywhled rltwMorg vbiddialpam .NON. t d.Adek al Ws Special Instillations: Glientsain iaa:uunlbet:; 1 D -o ---q38 :(,a^arixA+e'10's itip� 0@'tM�i q(7Cluii�iiii�i.i�!:II�;: S 1 e 37 a s2 3 s 01 8 i 6 6 O 0 s i '3!{ 8 Iia MICROBIOLOGY 15 t 1 A'r=A Dust =D Solt= Swab SW Sulk = B Palm= P Wipe = W F=Food Chinking Water= DW Waste Water= WW 0 = Omer "'ASTM E 792 approved wipe media OMlr. 7 9 E > 3 8 Date Collected mmKayr lime Collected mom* EM Numbec4tatle erory =8--1 - , Number of samples recdved NOTE• RaPaarutywfisaanaaaaps+ guy.. 2.20 en am ch. of r..F l (Additional samples shall be listed on attached tong o'0.) .pan refined andw7 not be re.e.bieOramt 2. 2.2ens..2212[ nrvdna fmn the aaWxary of iWel data BYna^Mg ri22 425,92 0222523aas Nal aA.tisbnM no 1dbMf6 szm29fa/11.1.1101 al Wady.** services a4wnadvrohpeymek Wand NET 30 days. ralwmeamplya0prym.0, 202 mayr.•sae 1.50 monlMy 2222 12.. 8X0 t, -s.t, 0 3 s -t le -L 2 9,47 Relinquished 5y: Laboratory Use Only / o ` - Received By: rl/� .Results: Contact Contact Date/Timm 04:1101: y-25 12 (c zoo Carder. lA.av'..• Sample Condition: On Ice Sealed Intact Ten.p.(F') _ Yes/No Yes l No Cf)N Phone Email Fax Date Tkne Inttiah Phone and Fax Date Ccmact P5002 Fa Date %o--- Mole Time Initials Contact Phone Date .9929 Initials U 7-2017 version 1 D33884: Chain of Custody Page 8 of 13 ■ 15of20 ■ LITE D33884 Attachment I s Type followed by a Structure Type Structures identifications consist of an Asbe Structure Types ? 0.0 )2 a a au u2w ted with a matrix 1 width unit = 1 mm on screen = 0,0556 micron TEM Analis • 0) °Ivl °/pg\/oD_ Upper end Lower 95% confidence bounds for the number of structures con { 033884: Chain of Custody Page 9 of 13 16 of 20 ■ ▪ AccuTEem D33884 Laboratory name: REI Instrument JEOL 100 CX ® S Voltage (KV) KV Magnification //100 X Grid opening area (mm2) V10I 0.01 Scale: 1L = 0.28 um Scale: 10 = 0.056 urn Primary fitter area(mm2) 385 Secondary Filter Area (mm2) QA Type Reservoirs Environmental, Inc TEM Asbestos Structure Count Client : A(LI31eg% Sample Type (A=Air, D=Dust): 0.4 Air volume (L) or dust area (cm2) Counting rules I Date received by lab .I T 17410- Lab Jab Number, -1..5ggqr Lab Sample Number: Si} W511/ F•Faetor Calculation (Indirect Preps Onty): Fraction or Ornery filter used Total Reeuspsnabn Volume (mi) Volume noosed to secondary finer (m0 �ML Page 1 of Analyzed by S9 Analysis date .11IZ. Method (D=DirecI, I=lndirecl, IA=Indirect, asked) Counting rules (ISO, AHERA, ASTM) L1 iJ Grid storage location Month Analyzed Scope Alignment Date Analyzed Grid Grid Opening Structure Type No. of Structures Primary K3- 1 L.+ 1 E3-1 b 6q -i JD A�7 Dimensions Identification Mineral Class Total width Am Mole C NAM ketddC s 1= blank =no Sketch Photo EDS A .irtJ tit S- /a! fir -614.S 1 ND LA = Libby -type amphibole OA = Other (non -Libby type) amphibole C = Chrysolite rrwonometin TES Bend, Sneetd.= NAM = Non asbestos material D33884: Chain of Custody Page 10 of 13 17of20 ■ UMEBT D33884 8,2;•88'48t8- dAtA y ..51-5-6 T1.G § y m ', 8 0.8r, -e..18...1. L;4 '11 8 Wn a av> o .a °sa ° y y'tq m° -o o'o El ° pA wg.gO.03U1 -C I XU yp y 0.O by o A >4O�A .av �ioao y arbop . 0 0 mt ,a 48 m 0 .dis 0b . aa yQo y>Um �5^0oEy3 wa y ' ay, -dg;ti :: 0 o; V) w 3 v 5 5 '6 ° 0 0. X F,i - oy a bill 0 P. O R V°'fvmuIa E.o_,bgo, � 0 0.vr3 oE o3m A a a go d NmvdwNA ya tg Aah¢� �0 8 o co q�°o25g o .6 ow 0 b m gea 0NmNfl2.gg° ° i, <E1 o •W° ° y U a. >.MNHO ayQ?:N 'd .s U _ 0 <0 ASu O .51 i .N% aLi)7 0 v -- 0„08by bA0U -0, o d 4 tia°° iy a -ci°RX A �'0 O �C o U N 'Uv sUm8 o m m 7 X.' , ag t; n Yo o s P Env o .0 y ° o,o o to a. as 0p3 g -5 O•b3 VN+ U9NNOU A A/y boob "' ca ° 3 �w y. °: 5 dOA oo n o m m chi 1. q do A. X. y 0x i.w 0 pN...�, r�r g Ay8 A O00 o4 3" s4'3 0 3 w. v.° y Rjii° w m m Yv 3 11 0 as -5 '� 0 �~4 g,3).9..0)a a o o; aEg.'41dw y ::T. w tie d .1 m 6" j W O g .... > ,g m A =A It .O Q m 0. t) F a�F 3E. Z,F 3 w yam. ° yQ m k..� At 5 U. 2 0. g y Equations Used for Calculations 0 O # AsbestosStructures D33884: Chain of Custody Page 11 of 13 18 of 20 ■ ©c�uTEs 03388,1 CHAIN OF CUSTODY 4036 Youttgfield Hc.d.LNUTEST Accutest JODnot #: UJ3884X St., Wheat Ridge, CO 80033 til 303 425-6021 Accutest Quote #: 0 FAX: 303 425-6854 C AMS P.O. #: Project No.: Client Information1 Name Subcontract Laboratory Information Analytical Information Name Accutest Mountain States (AMS) Hazen (Radiological) Address 4036 Youngfield St. Address 4601 Indiana Street City State Zip Wheat Ridge, CO 80033 City State Zip Golden CO 80403 Send Report to: Andrew Riegel y questions contact: Renes Jackson Contact: Sample Management n Phone/Fax#: (303) 425-6021; (303)425-6854 Phone: (303) 279-4501 = Collection Preservation m Field ID / Point of Collection Date Time *of -, o $ 0, o w 0 Matrix bottles 2 2 2 _ 2 i9 Comments D33884X -1 4/23/12 1:30 PM DW 1 X 1 Tumaround Information Data Deliverable Information Comments /Remarks 010 Business Day Standard Approved By: O Other (Days) • Commercial "A" - PDF MI Commercial "B" Please use Co orado 0 Compact Disk Deliverable I. Commercial "BN" 0 Electronic Delivery: regulations and RLs. • Reduced Tier 1 gm State Forms 10 Day Turnaround Hardcopy, RUSH Is FAX Data unless previously appro ed. II Full Tier 1 Other (Specify) ( p fy) jhr ie Custody must be documen ed below each time samples change possession, including courier delivery. R ed by: Date -Receive For Subcontract Lahorartoty ,�)� � r� � etmgw4,4i' Z el6-1c' 7 & me: J • Ea 81ime: `2 :.A -21 . -.4, • "Koc��'_^-r ate &Time: - ..?J'�..7 /'27�a. Use Only Seat#: Headspace: )Yes D No ❑ 2 linquished by: ReEl et Date Race ve y: 22 'Reamed trate ,me{ NA ❑ reserved where app ,cable: 3 & rime: uy: 3 Lata & rime:on 3 Ice Temperature °C ❑ D33884: Chain of Custody Page 12 of 13 ■ 19of20 LI -FEST 033884 ... UEI REPORT OF ANALYSIS az 0 w co , a0 22TA g $f e 0c i. \ 0 000 D33884X-1 - Drinking Water- Sampled en 04123/2012(g 1330 SAMPLE IDENTIFICATION: zcof gg \w\ 0 ; (2 0 PARAMETER Gross Alpha (+-Preci Gross Beta (+-Precision'), pCi/l (T) o 00 An Employee -Owned Company D33884: Chain of Custody Page 13 0 13 % 20of20 AGLJTEST 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 CHARLES A BAGLEY 627 N HAPPY VALLEY ROAD NAMPA, ID 83687 - Lois 3 4 Li - (hi(; EXST WELL PERMIT NUMBER 75924 -F DIV. 5 WD39 DES. BASIN MD Lot: 3 Block: Filing: Subdiv: DUTCH MAJOR EXEMPTION (208) 989-6939 CHANGE/EXPANSION OF USE OF AN EXISTING WELL APPROVED WELL LOCATION GARFIELD COUNTY NE 1/4 NE 1/4 Section 5 Township 6 S Range 92 W Sixth P.M. DISTANCES FROM SECTION LINES 1563 Ft. from North Section Line 1314 Ft. from East Section Line UTM COORDINATES (Meters,Zone:13 NAD83) Easting: Northing: ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS QF 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 37-90-137(2), on the condition that this well is operated In accordance with the West Divide Water Conservancy District Augmentation Plan approved by the Division 5 Water Court in case no. 02CW0123. 1f this well is not operated in accordance with the terms of said decree. it will be subject to administration including orders to cease diverting water. WDWCD contract 4110421 CB(a) (amended). 4) Approved for an expansion of use. of an existing well, constructed on September 24, 2011. to a depth of 97 feet and with a pump being installed on November 22, 2011, under permit no. 75024-F (canceled). Issuance of this permit hereby cancels permit no. 75024-F. 5) The use of ground water from this well is limited to fire protection, ordinary household purposes inside two (2) single family dwellings. the irrigation of not more than 12,000 square feet of gardens and lawns, and the watering of twelve (12) head domestic animals. This well is known as C Bagley Well. 6) The pumping rate of this well shall not exceed 15 GPM. 7) The annual withdrawal of ground water from this well shall not exceed 1.69 acre-foot (550,787 gallons). 8) 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. 9) The owner shall mark the well in a conspicuous place with well permit number(s), name of the aquifer, and court case number(s) as appropriate. The owner shall take necessary means and precautions to preserve these markings. 10) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions must be maintained by the well owner (recorded at least annually) and submitted to the Division Engineer upon request. 11) This well shall be located not more than 200 feet from the location specified on this permit and at least 600 feet from any existing well, completed in the same aquifer, that is not owned by the applicant. NOTE: This well is to be located on a residential site of 12.723 acre(s) described as tot no. 3, and serving lot nos. 3 & 4, proposed Dutch Major Exemption, Garfield County. NOTE: Section 5 is an irregular "Tall" section, approximately 5700 feet North/South. j/ 7-s‘ 2, - NOTE: Parcel Identification Number (PIN): 23-2179-051-00-040 NOTE Assessor Tax Schedule Number: R200338 (totaling 52.0 acres) 0 2 /� t'/ L APPROVED DMW Receipt No. 9503544 Y 4"' State Engineer DATE ISSUED 04-02-2012 /51 By EXPIRATION DATE ORDER OF THE STATE ENGINEER 6 I I IN THE MATTER OF WELL .PERMIT NO. 75024-F ! APPLICATION RECEIPT NO. 9503452 LOCATION: NE 1/4, NE 1/4, SECTION 5, TOWNSHIP 6 SOUTH, RANGE 92 WEST, 6th PAVE., GARFIELD COUNTY (WDWCD CONTRACT #1 10421 CB(a)) APPLICANT: CHARLES A BAGLEY THE STATE ENGINEER FINDS: The well permit was issued on May 2, 2011, with an expiration date of May 2, 2012. A well construction report was submitted on September 28, 2011, indicating that the well was constructed on September 24, 2011, to a depth of 97 feet, and a pump installation and test report was submitted January 30, 2012 showing that a pump was installed in the well on November 22, 2011, under permit no. 75024-F (WDWCD #1 10421 CB(a)). On April 2, 2012, the current well owner (Charles A Bagley) submitted an application to expand the use of the existing well, permit no. 75024-F. The new permit (pennit no. 75924-F) allows for the change of use of the existing well (C Bagley Well) in accordance with the West Divide Water Conservancy District contract no. #110421CB(a) (amended), approved February 16, 2012. The well permit is hereby canceled and is of no further force or effect. . Dated April 2, 2012 �I 61 Dick Wolf State Engineer By:?. 241 Dwight M. Whitehead Engineering Tech (Ground Water) cc: Division Applicant :dmw/075024-F existing well order to cancel: Bagley. Charles A 04-02-12.doc Ray's Well Done Pump Service, LLC Ray Latham July 28, 2013 Attn: Kelly Caves RE: Well Test © 1211 C.R. 229/Rifle On 12/6/2011, a well test was conducted on a well located at 1211 C.R. 229/Rifle. The following information was obtained: Approx. Well Depth 93' Casing Size 6" steel X 4.5" pvc Standing Water Level 69.0 ft. Total Test Time 24 hours Draw Down (approx.) 70.2 ft. Production (at Intake) 15 GPM Test Pump 3/4 HP Remarks: The above referenced well is adequate to provide for two family dwellings. The well water level made a full recovery in two minutes. Please see attached report for water quality as required by Garfield County. If there are any questions regarding this well test, please contact me at 970-379-8017. Sincerely, Cc Ray Latham Ray's Well Done Pump Service, LLC 970-379-8017 welldonepumpsCa}gmail.com Lic. # 1419 P.O. Box 863 Rifle, CO 81650 970-379-8017 welldonepumps@gmail.com Lic. #141.9 fwd Ray's Well Done Pump Service, LLC Service Purrps/Ciaerns,/Welf Tests Ray Latham January 28, 2012 Attn: Kelly Caves RE: Well Test @ 1211 C.R. 229/Rifle On 12/6/2011, a well test was conducted on a well located at 1211 C.R. 229/Rifle. The following information was obtained: Approx. Well Depth (according to Well Permit # ) 93' Casing Size 6" steel X 4.5" pvc Standing Water Level 69.0 ft. Total Test Time 24 hours Draw Down (approx.) 70.2 ft. Production (at Intake) 15 GPM Test Pump 3/4 HP Remarks: The well is more than adequate for a single family dwelling. The well water level made a full recovery in two minutes. Please see attached report for water quality as required by Garfield County. If there are any questions regarding this well test, please contact me at 970-379-8017. Sincerely, ay's Well Done Pump Service, LLC 70-379-8017 elldone'um.s • imail.com ic. # 1419 P.O. Box 863 Rifle, CO 81650 970-379-8017 welidonepumps@gmail.com Lk. #1419 4 Jan 25 2012 12:14 Rspen San. Laboratory 9709257278 p.1 STANDARD BACTERIOLOGICAL WATER TEST ASPEN CONSOLIDATED SANITATION DISTRICT 0400 SERVICE CENTER DRIVE ASPEN, COLORADO 81811 (070) 826.7202, Ext.109 ♦l PWS ID a Sample (=alien L(ier/ SAMPLE AKEN DATE) r1 80Yi TIME $. SUPPLYOF ,�B)i,. COUNTY 6"44/44,4, SAMPLER .. RESIDIAL a#c' Mc3'L 1 ) COMMUNITY 6U ?PLY ( ) ROUTINE BIETRIB • ION SYSTEM SUPPLY ( I NONCOMMUNITY ( CHECK SAMPLE ( ) PROCESS WATER I 1 OTHER PUBLIC ( RAW ( 1 GROUND 1 ) SURFACE 11:41.RNATE ( 1 PECIALPURPOSE SAMPLE '°NOTE:IF ALL INFORMATION 18 NOT SUPPLIED, THE BAUPI.E WLl BE DISCARDED. REMARKS: L/11 ,/ / �j �//� RETURN TO /IiR. 4Ve /V�% r / M, re -- ADDRESS Phdoe ©( * 5 CITYSTATE i2. (1.4 -/4 54•d PHONE FAX e2 --036'© - SEE INSTRUCTIONS ON BACK PAGE— SEE REVERSE FOR TIME LIMITATIONS. SAMPLING INSTRUCTIONS AND DEFINITIONS, OFF iCY20m Analyst ' I UIT1 ES (-r FO ES RESULTS MEMBRANE FILTEROU DIRECT COUNT: COLONIES ADJUSTED COUNT COLONIES/IOOML TOTAL COLIFORM: PRESENT FECAL COLIFORM: .. PRESENT MEDIA LTD 24 LTB 4D EGB MPN COLIFORMIIOOML PRESENCE OF COLIFORMS INDICATE NON. COMPLIANCE WITH MINIMUM DRINKING WATER STANDARDS. )(Compliance 0 Non•Ccmpliance 0 Invalid I g John W. Hickenlooper, Governor Christopher E. Urbina, MD, MPH, Executive Director and Chief Medical Officer STATE OF COLORADO Dedicated to protecting and improving the health and environment of the people of Colorado Laboratory Services Division 8100 Lowry Boulevard Denver. CO 80230 PO Box 17123 Denver, CO 80217 303-692-3090 www.cdphe.state.co.us/Ir Laboratory Results For Sample Number: ENV -2013006399 - Site ID/PWSID Site Address Site Description LOT 3 WELL # 75924F Customer ID Customer 00014305 Bagley George 6044 CR 233 Silt Test Name Deluxe Colorado Package* Arsenic, Total Cadmium, Total Calcium (Carbonate) Copper, Total Iron, Total Lead, Total Magnesium, Total Manganese, Total Sodium, Total Uranium, Total Zinc, Total Hardness Total Co 81652 Colorado Department of Public Health and Environment Contact Bagley George Phone 208-409-0610 Fax Email kbagley73@gmail.com Collected By KB Collected 05/29/2013 12:04:00 Received 05/30/2013 07:35:00 Reported 06/14/2013 11:30:00 Bottles 1-LNEUT 1-250M 1-250N 1-BACT 1 -CUBE Matrix Ground Water Field Fluoride Residual Chlorine Temperature at Receipt 18.6 Result Units <0.001 mg/L <0.0006 mg/L 170 mg/L 0.45 mg/L <0.003 mg/L 0.0012 mg/L 56 mg/L <0.002 mg/L 270 mg/L 0.025 mg/L 0.21 mg/L 400 mg/L mg/L 400 mg/L mg/L Nitrogen, Nitrate/Nitrite 2.3 Alkalinity, Total MCL MRL ][Method Name Date Analyzed Qualifier] Alkalinity, Phenolphthalein <10 pH 8.0 0.01 0.001 EPA 200.8 05/31/2013 00:00:00 0.005 0.0006 EPA 200.8 05/31/2013 00:00:00 No limit 0.01 EPA 200.7 06/04/2013 establishe 00:00:00 1.3 0.004 EPA 200.7 06/04/2013 00:00:00 [0.3] 0.003 EPA 200.7 06/04/2013 00:00:00 0.015 0.001 EPA 200.8 05/31/2013 00:00:00 No limit 0.06 EPA 200.7 06/04/2013 establishE 00:00:00 [0.05] 0.002 EPA 200.7 06/04/2013 00:00:00 No limit 0.1 EPA 200.7 06/10/2013 establishE 00:00:00 0.03 0.001 EPA 200.8 05/31/2013 00:00:00 [5] 0.01 EPA 200.7 06/04/2013 00:00:00 No limit 1 EPA 200.7 06/04/2013 establishE 00:00:00 10 0.05 EPA 353.2 05/31/2013 00:00:00 No Limit 10 SM 2320B 06/04/2013 Establish( 00:00:00 No Limit 10 SM 23208 06/03/2013 Establish( 00:00:00 [6.5-8.5] NA SM 4500 -H+ -B 06/03/2013 00:00:00 MRL - Minimum Reporting Limit. MCL - Maximum Contaminant Limit per EPA regulations. BDL - Below Detection Limit. H - Holding Time exceeded. Q - Quality Control limit exceeded. NT - No Test. Units: mg/L - milligrams per liter (ppm), ug/L - micrograms per liter (ppb), pCi - picoCuries LSD Internet Address: http://www.cdphe.state.co.us/Ir/Irhom.htm John W. Hickenlooper. Governor Christopher E. Urbina, MD, MPH, Executive Director and Chief Medical Officer STATE OF COLORADO Dedicated to protecting and improving the health and environment of the people of Colorado Laboratory Services Division 8100 Lowry Boulevard Denver. CO 80230 PO Box 17123 Denver, CO 80217 303-692-3090 www.cdphe.state.co.us/Ir Laboratory Results For Sample Number: ENV -2013006399 - Test Name Solids, Dissolved Conductivity Chloride Fluoride Sulfate Corrosivity-Langlier Sodium Adsorption Ratio Result 1100 * 1700 170 0.96 380 0.84 Units mg/L uS/cm mg/L mg/L mg/L 5.8 mg/L Test Group -Total Coliform ug/L PA** Escherichia coli PA E. coli NOT ug/L DETECTED Total coliforms PA Coliform ug/L ABSENT or less than one (<1), indicates a microbiologically safe sample Gross Alpha/Beta Package (Water)* Gross Alpha MCL 500 Colorado Department of Public Health and Environment MRL 10 IMethod Name EPA 160.1 no limit 0.5uS/cSM 2510 B establishE [250] 1 EPA 300.0 4.0 0.02 EPA 300.0 [250] 1 EPA 300.0 D 3739-83 Date Analyzed Qualifier 05/30/2013 00:00:00 06/09/2013 00:00:00 06/05/2013 00:00:00 06/06/2013 00:00:00 06/05/2013 00:00:00 06/11/2013 00:00:00 06/11/2013 00:00:00 SM 9223 B.2.b. 05/30/2013 00:00:00 SM 9223 B.2.b. 05/30/2013 00:00:00 12 +/- 4 pCi/L 15 3 EPA 900.0 Gross Beta < 4 Comments: Water Package Interpretation pCi/L 50 4 EPA 900.0 06/10/2013 00:00:00 06/10/2013 00:00:00 HUMAN HEALTH Arsenic, Cadmium, Copper, Lead, Uranium, Fluoride, Nitrate/Nitrite concentrations are below EPA health -based standards. Iron, Manganese, Zinc, pH, Sulfate and Chloride levels meet EPA aesthetic - based standards. Hardness 400 >80 mg/L. The water is hard and may cause scaly residues and soap scum, and decrease the cleaning action of soaps and detergents. Solids -Dissolved 1100 >500 mg/L MRL - Minimum Reporting Limit. MCL - Maximum Contaminant Limit per EPA regulations. BDL - Below Detection Limit. H - Holding Time exceeded. Q - Quality Control limit exceeded. NT - No Test. Units: mg/L - milligrams per liter (ppm), ug/L - micrograms per liter (ppb), pCi - picoCuries LSD Internet Address: http://www.cdphe.state.co.us/Ir/lrhom.htm John W. Hickenlooper, Governor Christopher E. Urbina, MD, MPH, Executive Director and Chief Medical Officer Dedicated to protecting and improving the health and environment of the people of Colorado STATE OF COLORADO Laboratory Services Division 8100 Lowry Boulevard Denver. CO 80230 PO Box 17123 Denver, CO 80217 303-692-3090 www.cdphe.state.co.us/Ir Laboratory Results For Sample Number: ENV -2013006399 - Hardness; scaly deposits; sediments; cloudy, discolored, odorous water; salty or bitter taste. Sulfate 380 >250 mg/L Bitter medicinal taste, scaly deposits, laxative effects. Based on these results, the water is safe for human consumption. Colorado Department of Public Health and Environment CORROSIVITY >0.5 The Corrosivity Index is 0.84, which indicates that the water is scale -forming and may cause scale build-up. IRRIGATION The sodium adsorption radio (sodicity) is 5.8 The conductivity (salinity) is 1700 uS. The sodium and chloride concentrations (toxicity) are 270 mg/L (recommended level <46mg/L) and 170 mg/L (recommended level < 140 mg/L), respectively. The alkalinity is 400 mg/L (recommended level <92 mg/L). Based on the measured sodicity, salinity, toxicity and alkalinity the water is considered a slight to moderate irrigation risk and may have detrimental effects on sensitive crops such fruit trees, clover, radishes, celery and green beans. Less sensitive crops such as tomatoes, broccoli, cabbage, peppers, cauliflower, lettuce, sweet corn, potatoes, carrots, onions, peas, squash and cucumbers may also be affected. Sodium >46 mg/L Use of irrigation water high in sodium will usually result in a soil high in sodium but it may take several irrigations to cause the change. The crop takes up sodium with the water and it is concentrated in the leaves as water is lost by transpiration. Damage (toxicity) can result if sodium accumulates to concentrations that exceed the tolerance of the crop. Leaf burn, scorch, and dead tissue along the outside edges of leaves are typical symptoms. Alkalinity >92 mg/L Bicarbonates and carbonates can clog the nozzles of pesticide sprayers and drip tube irrigation systems and reduce the activity of some pesticides. High carbonates cause calcium and magnesium ions to form insoluble minerals leaving sodium as the dominant ion in solution. LIVESTOCK AND POULTRY Levels of metals, fluoride and nitrate/nitrite are suitable for animal ingestion. MRL - Minimum Reporting Limit. MCL - Maximum Contaminant Limit per EPA regulations. BDL - Below Detection Limit. H - Holding Time exceeded. Q - Quality Control limit exceeded. NT - No Test. Units: mg/L - milligrams per liter (ppm), ug/L - micrograms per liter (ppb), pCi - picoCuries LSD Internet Address: http://www.cdphe.state.co.us/Ir/Irhom.htm John W. Hickenlooper, Governor Christopher E. Urbina, MD, MPH, Executive Director and Chief Medical Officer Dedicated to protecting and improving the health and environment of the people of Colorado STATE OF COLORADO Laboratory Services Division 8100 Lowry Boulevard Denver. CO 80230 PO Box 17123 Denver, CO 80217 303-692-3090 www.cdphe.state.co.us/Ir Laboratory Results For Sample Number: ENV -2013006399 - Registry Comments: LOT 3 WELL# 75924F Colorado Department of Public Health and Environment MRL - Minimum Reporting Limit. MCL - Maximum Contaminant Limit per EPA regulations. BDL - Below Detection Limit. H - Holding Time exceeded. Q - Quality Control limit exceeded. NT - No Test. Units: mg/L - milligrams per liter (ppm), ug/L - micrograms per liter (ppb), pCi - picoCuries LSD Internet Address: http://www.cdphe.state.co.us/Ir/Irhom.htm N oi 3'; e -Hardcopy 2.0 Automated Report Technical Report for Ray's Well Done Pumps, LLC Bagley Land Split/Subdivision Accutest Job Number: D30005 Sampling Date: 12/06/11 Report to: Ray's Well Done Pumps, LLC PO Box 863 Rifle, CO 81650 welldonepumps@gmail.com ATTN: Ray Latham Total number of pages in report: 11 `$ ACC9RO to - Test results contained within this data package meet the requirements of the National Environmental Laboratory Accreditation Conference and/or state specific certification programs as applicable. Client Service contact: Shea Greiner 303-425-6021 Brad Madadian Laboratory Director Certifications: CO, ID, NE, NM, ND (R-027) (PW) UT (NELAP C000049) This report shall not be reproduced, except in its entirety, without the written approval of Accutest Laboratories. Test results relate only to samples analyzed. Mountain States • 4036 Younglield St. • Wheat Ridge, CO 80033-3862 • tel: 303-425-6021 • fax: 303-425-6854 • itttp://www.accutest-com i of 11 j,CCL,TEBT a30005 Accutest Laboratories is the sole authority Rsr authorizing. edits or modifications to this document, unauthorized modification of this,report is strictly prohibited. A Table of Contents Sections:III -1- Section 1: Sample Summary 3 Section 2: Sample Results 4 2.1: D30005-1: BAGLEY WELL 5 •ti(q'tifors 3: Mkc., Forms Chain of Custody 8 2of11 E ACC UTE D30005 Accutest Laboratories Sample Summary Ray's Well Done Pumps, LLC Bagley Land Split/Subdivision Job No: D30005 Sample Collected Matrix Client Number Date Time By Received Code Type Sample ID D30005-1 12/06/11 10:05 RL 12/07/11 DW Drinking Water BAGLEY WELL ffle, 3of11 cu-rEST D30005 Sample Results Report of Analysis 4 of 11 Ac c ui sT 030005 Accutest Laboratories Report of Analysis Page 1 of 1 Client Sample ID: BAGLEY WELL Lab Sample ID: D30005-1 Date Sampled: 12/06/11 Matrix: DW - Drinking Water Date Received: 12/07/11 Percent Solids: n/a Project: Bagley Land Split/Subdivision Total Metals Analysis Analyte Result MCL RL Units DF Prep Analyzed By Method Prep Method Antimony 0.00085 0.0060 0.00080 mg/1 2 12/08/11 12/08/11 GJ EPA 200.81 EPA 200.8 4 Arsenic < 0.0016 0.010 0.0016 mg/1 2 12/08/11 12/08/11 GJ EPA 200.8 1 EPA 200.8 4 Barium 0.021 2.0 0.0040 mg/I 2 12/08/11 12/08/11 GJ EPA 200.8 1 EPA 200.8 4 Beryllium < 0.00040 0.0040 0.00040 mg/1 2 12/08/11 12/08/11 GJ EPA 200.8 1 EPA 200.8 4 Cadmium <0.00020 0.0050 0.00020mg/1 2 12/08/11 12/08/11 GJ EPA 200.81 EPA 200.8 4 Chromium 0.0062 0.10 0.0040 mg/1 2 12/08/11 12/08/11 GJ EPA 208.81 EPA 200.8 4 Mercury <0.0010 0.0020 0.0010 mg/I 1 12/14/11 12/14/11 J1; EPA 295.13 EPA 295.15 Nickel 0.0041 0.0040 mg/1 2 12/08/11 12/08/11 GJ EPA 200.8 1 EPA 200.8 4 Selenium 0.0060 0.050 0.00080mg/I 2 12/08/11 12/08/11 GJ EPA 200.81 EPA 200.8 4 Sodium 248 25 mg/1 50 12/08/11 12/09/11 GJ EPA 200.8 2 EPA 200.8 4 Thallium <0.00040 0.0020 0.00040 mg/1 2 12/08/11 12/08/11 GJ EPA 200.81 EPA 200.8 4 Uranium 0.024 0.00040mg/1 2 12/08/11 12/08/11 GJ EPA 200.8 1 EPA 200.8 4 (1) Instrument QC Batch: MA2036 (2) Instrument QC Batch: MA2038 (3) Instrument QC Batch: MA2049 (4) Prep QC Batch: MP6428 (5) Prep QC Batch: MP6465 RL = Reporting Limit MCL = Maximum Contamination Level (40 CFR 141) 5of11 Accutest Laboratories Report of Analysis Page 1 of 1 Client Sample ID: Lab Sample ID: Matrix: Project: BAGLEY WELL D30005-1 DW - Drinking Water Bagley Land Split/Subdivision Date Sampled: 12/06/11 Date Received: 12/07/11 Percent Solids: n/a General Chemistry Analyte • Cyanide, Total Fluoride Nitrogen, Nitrate Sulfate Result MCL Units DF <0.0050 0.20 mg/1 1 1.2 4.0 mg/I 1 0.91 10 mg/l 2 248 mg/1 10 Analyzed By Method 12/16/11 JK 12/14/11 C] 12/07/11 11:06 JML 12/07/11 11:21 JML SM20 4500CN E SM20 4500F C EPA 300 EPA 300 MCL = Maximum Contamination Level (40 CFR 141) 6 of 11 .o.ccr.��Es-r 3 8 . x Mounta Rn •yv�.;, • GDL_I Misc. Forms Custody Documents and Other Forms Includes the following where applicable: • Chain of Custody 7of11 ,4CCVTEST.. D30005 A AC CHAIN OF CUSTODY PAGE OF •... -- — - - mama lAlsaalosmabard,111 bsolca LABORATORIES MK Yosagfleld5s. Who, Rif" Os 110033, FEASOrocktra 0 sel.oderce..1. ,,,, 1-- TEL 3034214021 817-737.4521 PAX 503-4254011 orroodal000k • feas.foab o 7313ov, .„, -'4W-Ii.1=7',,e,..A0/6.,252.--LaS.S1C'Z.A.7.4.,M.V.aaSke.M..11:CMY:;%gennIFW rAvell Dive golp5 Lit . • . "tet9 9 Land .I.L. Ecliviston FW -DRiiii Woo I 1 1 laikam Rch. . BlYtolOnnatiOn If OrMlIfoRI RPM 10) Off - Gourd War W14- Wolof SW- &Soo, Wow . , F I e. co Ruoso Comoro osno , SO • 5.41 SI.Olotp. SEDSBananl Wl.aa182/hgepu'v"Inc"-' Bono Minos to 0 ,) Of - Cla LIO. OAR Lk* AIR-Ak ' pfhIreetwur) ctio-311-8017 agio-b25-WO ,CgamPos ,a,i Satm ZP in i ce E Q z SOL - Mar SAO PIP - BM RIFIERISonk B000k4s) Nom* ,P f 13 ,4,!, LILA, A P.I.C....3. AZIre,011: '19-7—. 1--- " • .-11: d ER- Moionan011o, RS- Rho Bk.* 113-Tdp Bonk Oblot.o Rabat! Raened RAW ,,,,N,r ..... .. i — I 1 .... Rs.. Roos BOB KV Point 41C.allecion tWINTIVIIMIN11111111111.11M111MEIWIWIMEINIE111111111 1' Niririnnuum , nri 11111111 I ....-'1 -- t & t ,t - i 8 x t c..i. r-- i 0 co 1 LAB USE ONLY (51 . ,, IfiffaRTM• .' ''" 1 1111111 • MIIIIITTLI -,- g • 1 1111111 It I i r ff! f f r a r5 I 1:12 i 1111111111111 IMAIIIMIli ' 11111111111111 ME•1111111 1111111111 IIIIIIIII 111111111111 MIIIIIIII . Hump ZELVEMIMMt:;SWAII5Maggia-53.V.E.V.Lb-2SM'aii0i7WM" "'"WIRRAMTalr'n7MTV:t:tfiriMn"Pr4B72,-,,i,!!';'1V,L,,,--L157'''''',. '-1-'''1.:-.'.44'''F''''''7's Tionamundlloto ( emalnes Aso) Aof.o.oflafB000.o.F10:14.. NIB 1014,44..4 Dor. El CoenesaislorA. (L.all) ID SSO,Fearra 1=1 Oxeolunial 11. ( lewd]) 1:3 MO Farrel APeS/ /3'3. 70 0 MA 5 Boob...40w Rly C ormou an/A E3 Coovasclorlr .4lonorn. r=1 PSF 54 0 5 Ss Flf Sff l= FULLT I L14) weia.,40 Asyk (3 0 4 0,16WERSENCf %,,e7ka--Coor 0 411.4/34365ENCI Conoromiol W.Reageganly }4...r.i: Ceflf, o I 04/13413439SI • Rool 4.,1¢74.4or liAlt Coranot:413, Resoles . OE Summary . 0441416 i:1,.' ‘EPC TO 3 ,,,1 .ilit.,=6,1a..,A • CuatO4y OM is documaolod below each Poo scowl. <hoop pastosclon, Includloa cowls &Rosy. 40avoicanwarisa WAISifativ 1ProgMT. nab/ II; in-u'n'tt, J. I7/7 9 lb" na es, Do. 4 1e.: waived 4 DP 4.6...khed Ina 5 ...R..; 4....1.4er 5 Co.1.4 Nall,trj , • . &.3c1 orarm.460.....01,44. Oni o. cad.... 114o ii. .2 i D30005: Chain of Custody Page 1 of 4 MO) 8 of 11 CCu - srn Accutest Laboratories Sample Receipt Summary 1 400C ifICNIEn Accutest Job Number: ^D30005 Client: RAY'S Immediate Client Services Action Required: No Date /Time Received: 12/7/2011 10:00:00 AM No. Coolers: 1 Client Service Action Required at Login: No Project: BAGLEY Cooler Security 1. Custody Seals Presets: 2. Custody Seals Intact Y or N 12 0 ® 0 3. COC Present 4. SmplDates/Time OK Cooler Temperature Y or N 1. Temp criteria achieved: D 0 2. Cooler temp verification: _ Infared gun 3. Cooler media: Ice (bag) Quality Control Preservation 1. Trip Blank present / cooler. 2. Trip Blank listed on COC: 3. Samples preserved properly: 4. VOCs headspace free: Comments Peoutest Laboratories 0 (303) 425.6021 Y or N N/A ❑ ❑ ❑ ❑ O 0 O 0 Y or N El 0 0 0 Alrbin #'s: FEDEX Semple integrity - Documentation Y or • N 1. Sample labels present on bottles: 0 0 2. Container labeling complete: e ❑ 3. Sample container label / COC agree: © ❑ Sample integrity - Condition Y or N 1. Sample recvd within HT: l 0 2. All containers accounted for. ® ❑ 3. Condition of sample: Intact Samplelntegrity- Instructions Y pr N NIA 1. Analysis requested is clear. © 0 2. Bottles received for unspecified tests 0 3. Sufficient volume recd for analysis: Q ❑ 4. Compositing instructions clear ❑ ❑ 5. Filtering instructions clear 0 0 l l 4036 Youngs td Street Wheat Ridgo. Co P. (303) 4256054 wwwfaccutestcont D30005: Chain of Custody Page 2 of 4 9 of 11 0 AGGLJ-rES-Tr ( CHAIN OF CUSTODY ®Mimi AccWniJob Q: D30003X 4036 Yolmgfield St, Wheat Ridge, CO 80033 AC©. /Ranted Quote A: 0 a 303425-6021 FAX: 303425-6854 ARS P.O. t ( PnjectNoa «'- Cnentintmmation P =gg Subcontract Laboratory bdortnaton • Analytical formation Aiy`1 1 'N? '�:5i? ;=-" Name II Aecutest Mountalh States (AMS) Name Industrial Lab ,tm P/A ''sl*•�Yy.., ��4 y.Lr m: - Address I Address nv,x�.rviz, ..-,� "' 4036 Youngfleld St. 4046 Yount:ditd St. �' City State 74 Wheat Ridge, I CO 80033 City step ap Wheat Ridge CO 80033 .U(Fti •.'t: �`Fs'?Pltl ' ..4.-, _,..„ maxatRe =- Send Report ta: I Tiffany. Pham Any queeumm contact Shea Greiner Content Sample Management ral U T..` +,�; " �y,, " Phone/Fax a: (303) 4715-6021• (303)425.6854 Phones (303) 287-9691 ,-., .-.i'x'".-. =. Collection Preservation _, ,- Field ID/ Point of Collection Date Rune MOlt, nomas d o l i i - FF Taf}it 1 D30005X -1 12/6(11 10:05 AM DW 1 X SiMaa. 1W: 4: 1 Ter nemi(nd lnbimations • €, _ „aia2: air-o.^a Data Dive able Information ;Weftxi?::A +-.. i,,'i:&''..�., Comments/ Remarks 1:E110 Badness DayStenlierd pother Approved By: (Days) ❑ Commercial 'A' 0poF 0CommerciatB' 0Compact DlekDeliverable Please use Co orado regulations and RLs. 10 Dayllsnareurid Her approved 0Commercial WIN' 0 Electronic Delivery: ❑ Reduced11er 1 Q Stale Forane y, RUSH la FAX Data unless previously • Fainter • Cthet (Spelt) Sample Custody m be documented below each Mee samples change possession. Incapable courier de wl/. For Subcontract LabarartayUse only Nelinqu h.dby: 1 pate 6Tima: neodwd Bei 1 , , a Timm 1 Reye: Yea 0 Na 0 NA 0 Relinquished by: 2 tine: -f Tfma: acwaiey: 'niroiTime 2 2 Ateoerved mime app cattle: 0 Relinquished by: 3 bales rims ohiadny: 3 tsW&Time-. 3 (In to Temperate= °C ❑ D30005: Chain of Custody Page 3 of 4 10 (All r A.ccuTEST_ o. #± ( §; E-1 - - \ ., 0 G 5 8 \� �� E /)k ƒk ].\�\a Da&g, ,r)�: ®v 22§ ;� 0 <no� a Attn: Renee Jackson k D30005: Chain of Custody Page 4 of 4 mR 1! of 11 # �c�UTesT Ray's Well Done Pump Service, LLC Service Pi mpsiCi.efps/W01 'fxt Ray Latham April 24, 2012 Attn: Kelly Caves RE: Well Test @ 6044 C.R. 233/Silt (George Bagley well) Permit # 1172-A On 4/22/2012, a 24 hour well test was conducted on a well located at 6044 C.R. 233/Silt. The following information was obtained: Approx. Well Depth (according to Well Permit #1172-A) 120' Casing Size 7" steel X 4.0" pvc Standing Water Level 13.6 ft. Total Test Time 24 hours Draw Down (approx.) 61.1 ft. Production (at Intake) 3 GPM Test Pump 1/2 HP Remarks: The well is adequate for a single family dwelling with cistern storage. The well water level recovered to 14.3 ft. in a 24 hour time frame. Water quality report is currently being processed by Accutest Labs. A full report will be provided as soon as available. If there are any questions regarding this well test, please contact me at 970-379- 8017. Sincerely, i' Ray Latham Ray's Well Done Pump Service, LLC 970-379-8017 welldoneournosnamail.com Lic. # 1419 P.O. Box 863 Rifle, CO 81650 970-379-8017 welldonepumps@gmail.com Lic. #1419 7-71 WEST DIVIDE WATER CONSERVANCYDISTRICT 818 Taughenbaugh Blvd., Suite 101 P.O. Box 1478 Rifle, Colorado 81650-1478 Tel: (970) 625-5461 Fax: (970) 625-2796 Web: wwwwdwcd.org Email: water@wdwcd.org August 16, 2012 Mr. George E. Bagley 6044 County Road 233 Silt, CO 81652 Dear Mr. Bagley Enclosed is approved contract # 120816GB(a). Please read the contract carefully if you have not already done so, but please especially note paragraph 2 concerning availability of water. West Divide obtains its augmentation water from a number of sources and operates its water supply program pursuant to a Temporary Substitute Supply Plan (TSSP) approved annually by the State Engineer's Office. TSSPs are common for water conservancy districts and West Divide has operated pursuant to a TSSP for several years with no significant reliability issues. Federal policy relating to endangered species, environmental concerns, and forces of nature are always such that no source of water can be guaranteed during any season or from year to year. Further, the State Engineer's Office periodically reviews the geographic area served by West Divide and has recently made a decision to reduce West Divide's Area A Service Area. While your structure is currently located within the West Divide Area A Service Area, the Division Engineer's Office could make another adjustment to the Service Area in the future and your structure could fall outside the Service Area and be subject to curtailment by the State Engineer's Office. West Divide continues to make good -faith efforts to obtain alternative long-term supplies in an effort to make reliable and predictable the water supply anticipated by your contract with us. West Divide also continues to make good -faith efforts to maintain its existing TSSP and keep its Area A Service Area intact. For most years, we expect to be successful in these efforts. This water allotment contract may require you to obtain a well permit from the State Engineer's office. Once your well is drilled you are required to install a measuring device and submit a meter reading to West Divide, upon request. Non-compliance with measuring and reporting requirements are grounds for cancellation of your water allotment contract with West Divide. This could result in action by the State Engineer which could prevent your further use of your well. Sincerely yours, aNui- Mc,oto6dk, et Maddock Enclosure cc Division No. 5 Water Resources w/enclosure Kerry D. Sundeen, Hydrologist w/enclosure Samuel B. Potter, President Kelly Couey, Vice President Robert J. Zanella, S ecretary Bruce E. Wampler, Treasurer Dan R. Harrison, Director This meter head has one dead zero So it reads 10, 20, 30 etc. Each Sweep of the hand is ten gallons. Remote reads every 100 gallons. The first two zeros don't move, They are considered dead. 1-H1-5 (2E,k Qi g (s o/Ji THaU5Aau_D GA&wnJS The head reads every ten gallons While the dial reads it to the flow Of zero to ten gallons. iJJHEO-'-EA))).1G- ` 0Jte - i,)a RE. -roc_ � i,\J C F P \4WD p W D KEA D -roc_ o Do me-rE2 /6\S n H o 1\l 'T1 0003579® This reading is thirty five thousand seven hundred ninety gallons. Specification Sheet Description Operation. The C700 is an oscillating piston style, positive dis- placement water meter. The product utilizes a piston that water use rotates in a measuring chamber, each piston revolution being equivalent to a known volume of water. The piston move- ment is transferred by a magnetic drive to a straight reading sealed register which contains the appropriate reduction gearing. Compliance to Standards. The C700 fully complies with American Water Works Association Standard C700, latest revi- sion, and is California Department of Weights and Measures approved. C700 low -lead bronze models are NSF -61 certified and comply with California Proposition 65. Installation. The meter must be installed in a clean pipeline, free from any foreign materials. Install the meter with direction of flow as indicated by the arrow cast in the meter case. The meter may be installed in horizontal, vertical or inclined lines. Application. The meter is for use only with POTABLE COLD WATER up to 120"F (50°C) and working pressures up to 150 psi. The meter will register between 98.5% and 101.5% at nor- mal and high flows and between 97% and 101% at the AWWA specified low flow. Accuracy tests are made before shipment, so no adjustments need to be made before installation. Construction. The meter consists of a straight through -flow main case, dual inlet measuring chamber, vertically grooved oscillating piston, high capacity strainer, removable bottom plate, full rubber liner, body bolts with integral washers and a magneti- cally driven register. The main case is cast in waterworks or low -lead bronze with raised characters designating model, size and direction of flow. A choice of polymer, cast iron, waterworks or low -lead bronze bottom plate is available. The 2 -piece snap - fit measuring chamber is of a top and bottom inlet, side output design and features a unique self -flushing sediment well. Printed on recycled paper C700 Positive Displacement Meter Waterworks or Low -Lead Bronze, Magnetic Drive, External Threaded Spuds Size: 3/4" x 3/4', 3/4" x 3/4"S & 3/4" x 1" Specifications Sizes: 95%101% Accuracy GPM 97%-101% Poaracy GPM 98.5%-101.5% PmraryGPM Continuous Flow GPM Maximum Flow GPM Operating Pressure psi Operating Temperature °F Sweep Hand Registers: US Gallons Cubic Feet Cubic Meters (Canada) Cubic Meters (Intl.) 3/4" x 3/4" 1/4 12 2-30 15 30 150 120 10 1 1/10 1/100 Capacity of Register (millions) : US Gallons 10 Cubic Feet 1 Cubic Meters (Canada) 1/10 Cubic Meters (Intl.) 1/10 Register Type: Materials: Main Case Bottom Plate Options Bottom Gasket -Liner Body Bolts Measuring Chamber Division Plate Piston Thrust Bearing Insert Driving Bar Strainer Register Can Register Lens Register Housing and Lid 3/4" x 3/4"S 1/4 12 2-30 15 30 150 120 10 1 1/10 1/100 10 1 1/10 1/10 3/4" x 1" 1/4 12 2-30 15 30 150 120 Permanently sealed direct reading 10 1 1/10 1/100 10 1 1/10 1/10 Standard waterworks or optional low - lead Bronze Waterworks or low -lead Bronze, Cast Iron or Polymer Nitrite Stainless Steel Compounded Polymer Loaded Nylon High Impact Polymer Loaded Nylon Loaded Nylon Polypropylene 90% Copper Alloy Tempered Glass Polymer or Bronze Represented By DODSON ENGINEERED PRODUCTS, INC. 0033 Marand Rd. P.O. Box 248 GLENWOOD SPRINGS, COLO. 81602 �� ® " •• (970) 945-2233 Types of Meters Positive Displacement (disc, piston) are well suited to residential and other applications where lower flow rates can be expected. Turbine or current type meters are specified where low flow is of little concern and where higher volumes of water are used. Measuring well output or as master supply meter are typical uses. Sand and sediment have little effect on turbines which is important to consider if metering unfiltered raw water containing any sediment. They have a higher capacity than a PD meter of the same size. For accuracy, turbines need to be installed horizontally with straight pipe equal to at least 5 times the pipe diameter before the meter and 2 times the diameter after the meter. Compound meters are two meters in one. Usually a combination of positive displacement and current type meters from a design standpoint and satisfy a need for accuracy for very low flows as well as high flows. They are also the most expensive of the three. INSTAL LAT/ON ACCESSORIES Includes washers. MCDONALD SERIES# 4620 4620 4620 METER SIZE 5/4 X 1/2 3/4; 5/4 X 3/4 1 TAIL PIECE THREAD 1/2" NPT 3/4" NPT 1" NPT M.ulti,jet Meters - • Better design for turbid conditions • Flow measurement capability with remote output option If your positive displacement meters are prone to getting clogged with small particles, multijet meters may offer a solution to your problem. Multijets share some characteristics with turbines in Straight Meter Installation Couplings Swivel nut x NPT thread. Nut is drilled for wire seal. Tail piece ribbed for easy grip. Rubber washer included. Order two meter couplings for each meter to be installed. STOCK # EACH QTY 12+ 48814 48816 48818 S2.14 3.97 6.34 S3.38 4.02 5.73 -: _; READ THIS °'BEFORE YOU ::ORDER ...,'; that their rotors will allow small particles like sand to pass. They will function better than positive displacement meters in sandy or coastal areas or where line breaks occasionally allow debris to enter the line. Bronze bodies are equipped with frost plugs. These meters meet or exceed all sections of AWWA Standard C-708. Rotors are equipped with sapphire bearings for long life. Magnetic drive provides linkage between measurement element and register so that no part of the gear train is exposed to water, and a built-in 360° strainer protects the measurement element. Note that a short version of the 3/4 size is offered that will fit in 5/8 x 3/.setters but will provide the capacity of a full 3/4 meter. The remote read units utilize a switch contact instead of generating a low voltage pulse to actuate the remote. Unlike meters with pulse remote outputs, the counter's unit of measurement corresponds to that on the meter head (10 gal increments through 1" and 100. gal. increments for P/2" and 2" meters). The environmentally sealed remote contains a lithium battery that is capable of 10 to 15 years of operation and can be mounted up to 500' from the meter. Counters listed here are non -reset. Resettable counters are available and are listed separately in this section with meters equipped with 1 -contact per gallon registers used for flow measurement and batching as well as totalizing. NEW METERS LAYING SIZE LENGTH 5/4X1/2 5/a X 3/4 3/4 (SL) 1/4 (REGULAR) 11/2 FLG 71h" DIRECT READ I GALLONS STOCK # 67854 71/2" 67857 71/2" 67861 9" 67859 103/4 " 67862 13" 67864 DIRECT READ CUBIC FEET STOCK # EACH QTY 10+ 67855 67856 67858 67860 67863 67865 5 40.69 40.69 60.58 74.14 104.89 253.18 S 38.61 38.61 57.49 70.36 99.53 24n 3d titer1nstallatlon Gujcf Threaded Meters (THRD) - 1" To Install a threaded meter, you will need a meter setter, with mete nuts OR 2 meter couplings (below) which are supplied with NPT rm thread. Meter thread cannot be connected directly to NPT fittings. METERING & FLOW NEW WATER METERS -' New Neptune T-10 Positive Displacement Meters The remote read unit for 5/4"through 1" meters registers 100 gallons (or 10 cu. ft.) for each pulse received from the meter. For 11/2" and 2" meters, each pulse registers 1,000 gallons (or 100 cu. ft.) DIRECT READ - GALLONS END/ SIZE #BOLTS STOCK # EACH QTY 10+ 5/4X'/2 THRD 5/8 X 3/4 THRD 3/4 THRD 1 THRD 11/2 FU2 2 FU2 69118 S 38.79 69119 38.79 69120 76.79 69121 119.58 69122 285.73 69123 420.76 S 36.85 36.85 72.95 113.60 271.45 399.72 DIRECT READ - GALLONS END/ SIZE #BOLTS STOCK # EACH OTY 10+ 5/4 X 1h THRD 69072 $ 31.03 5/8 X 3/4 THRD 69073 31.03 3/3 THRD 69074 76.79 1 THRD 69075 119.58 11/2 FU2 69076 285.73 2 FU2 69077 420.76 'connecting wire not included 5 29.48 36.85 72.95 113.60 271.45 399.72 WITH REMOTE READ' STOCK # EACH OTY 10+ 69060 S 75.27 S 71.50 69061 75.27 71.50 69062 118.04 112.14 69063 164.92 156.67 69064 351.89 334.30 69065 504.01 478.81 WITH REMOTE READ" STOCK # EACH OTY 10+ 69066 S 67.91 S 71.50 69067 67.91 71.50 69068 101.24 112.14 69069 137.28 156.67 69070 309.92 334.30 69071 436.46 471.68 2" Turbine New Neptune Turbine Meters DIRECT READ GALLONS WITH REMOTE READ• SIZE OVERALL STOCK# EACH STOCK# EACH 2" 10" 69125 S 443.04 69105 S 528.91 3" 12" 69078 624.00 69106 664.96 4" 14" 69079 1,163.27 69107 1,206.19 6" 18" 69080 2,216.24 69108 2,267.23 8" 20" 69081 3,328.00 69109 3,411.20 '2", 3" & 4' meters pulse every 10,000 gallons; 6" and 8" pulse every 100,000 gallons. . DIRECT READ CUBIC FEET WITH REMOTE READ• SIZE OVERALL STOCK # EACH STOCK # EACH 2" 10" 69083 S 443.04 69112 S 528.91 3" 12" 69084 624.00 69113 664.96 4" 14" 69085 1,095.12 69114 1,206.19 6" 18" 69086 2,218.32 69115 2,267.00 8" 20" 69087 3,328.08 69116 3,411.20 7" 3° & 4"meters pulse every 1,000 cubic feet; 6" and 8" pulse every 10,000 cubic Teel. APPLICATION TO LEASE WATER FROM WEST DIVIDE WATER CONSERVANCY DISTRICT 818 Taughenbaugh Blvd. #101, P. O. Box 1478, Rifle, Colorado 81650 Contract #120816GB(a) Map #653 Date Activated: 8/16/12 1. APPLICANT INFORMATION Name: George E. Bagley Mailing address: 6044 County Road 233 Silt, CO 81652 Telephone: 970-3098349 Email: kbagley73@gmail.com Authorized agent: (Kathy Bagley) 2. COURT CASE #s: Decree Case No. Augmentation Plan Case No. 3. USE OF WATER RESIDENTIAL Number of main residences: 2 No. ADU's Subdivision: No. constructed units: No. vacant lots Home garden/lawn irrigation of 12000 Method of irrigation: flood_ sprinkler x other Non-commercial animal watering of 5 animals Fire Protection Evaporation: Maximum water surface to be exposed: Description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amount of diversion of any water withdrawn from the pond: total sq. ft. Well Sharing Agreement . for multiple owner wells must he submitted. If greater than two owners, application must be made rudder a homeowners association. COMMERCIAL Number of units: Total sq. ft. of commercial units: Description of use: INDUSTRIAL Description of use: Evaporation: Maximum water surface to be exposed: Description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amount of diversion of any water withdrawn from the pond: DIRECT PUMPING Tributary: Location: 4. SOURCE OF WATER Structure: Well Structure Name: G E Bagley Well Source: surface storage ground water X Current Permit # 47466 (attach copy) 5. LOCATION OF STRUCTURE Garfield NE1/4 NE1/4 County 5 Section Quarter/quarter 6S Township Distance of well from section lines: 92W Range Quarter 6th P. M. Elevation: 6000 Well location address: 6044 County Road 233, Silt (Attach additional pages for multiple structures) 6. LAND ON WHICH WATER WILL BE USED (Legal description may be provided as an attachment.) Approximately 20.5 acres of Lot 1, S5, T6S, R92 W Number of acres in tract: 20.5 Inclusion into the District, al Applicant's etperse, may be required. 7. TYPE OF SEWAGE SYSTEM Septic tank/absorption leach field X Central System Other_ District name: 8. VOLUME OF LEASED WATER NEEDED IN ACRE FEET: One (minimum of I acre foot except augmentation from Alsbury Reservoir where a lesser amount is allowed) Provide engineering data to support volume of water requested Commercial, municipal, and industrial users must provide diversion and consumptive data on a monthly basis. A totalizing flow ureter with remote readout is required to be installed and usage reported to West Divide. Applicant expressly acknowledges it has had the opportunity to review the Distr'ict's form Water Allohnen! Contract and agrees this application is made pursuant and subject to the terms and conditions contained dyer it Awi . +. tca ':I Ir Applicant Signature Application Date: r, -- 6 - -7- ISSUED AS AREA B CONTRACT YES X NO Printed portions of this form, except differentiated additions or deletions, have been approved and adopted by the West Divide Water Conservancy District. Form : WDWCD 2009 APPLICATION WATER USE ESTIMATES COLORADO RIVER SERVICE AREA WEST DIVIDE WATER CONSERVANCY DISTRICT 0.73 acre feet Contract Amount w/ 5% Transit Loss = F - z U J 0_ 0 Transit Loss= 5.0% Total Contract Amount , (AR Cod CID r•Or`tiO)0)tOU)CON r - N O M V •- OD 0) - .- 0000-rry-000 OP ' O 0 0 0 0 0 0 0 0 0 0 0 V) 0 O) O P- C0 (0 -(Oct(0UO D LL 0 •<000OOrrrOOOO(O H U0rO(•M COU0LON- •-- c- t- Cq CD co 4 .,. OD 0) r .- O O O O O O O O O O O O i • c O B '` LT. o 6< I"- > `-'000000000000<- 0 U0 OD UO P- (0 O 'q' V' (A M U0 f-- (O I- OD OD N V' O CO co f- f- O O O O r N N N r O O O Livestock Diversion & C.U. (AF) O r r r r r r r �- C;18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 616 OOOc-ODN 0)0 r -N OON 0 0 0 0 0 r r r 0 0 0 0 o000000000000 O00N-0 t(ON O)N00L0 OOOON-r-rc-0000(.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00000000000C/0 o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 r r r r r r r r O O O O O O O O O O O O E) O O o o 0 0 0 0 0 0 0 0 1- CO N CO r- CO n N- CO N- CO N- 000000000000N do000O000OO00N- 0 0 0 0 0 0 0 0 0 0 0 0 (D 0 (0 0 0 0 0 0 0 N r 0 CO - 0 Irrigation C.U. (AF) Irrigation Diversion (AF) Commercial C.U. (AF) Commercial Diversion (AF) In House C.U. (AF) In House Diversion (AF) Unit Value: Irrigation C.U. (ft) (D ,- (Q 01 l0 O) M O)N(O(O(0CID p- 0 Cs) ON V' V•Cr) (NI 0 CO 0000000 r (A Ct(O O(O COr co 000NCID V T- co NJ - CD (h (n U() .4' Cl 0 (0 M 0 0 0 0 0 0 0 N • Unit Value: Irrigation Diversion (ft) O J Za ZJ00 f->0< <w< <D W00 W1- -) <n-»Qcnoz00 (n 0 0 .N c ti Q) (6 O.: u7 1 E n U rn� c•• cc aai0 EE rn•- ( ° 0 " 0 0 U U 'G .G CO an m a m c .O C " 0 003a)EE mai U U- 7 7 0 G 0 W O) Q, O O 0 •c c caUU« ac mm2r+m oa N N O v� 2 U 0 CO CO To c a3 13'31 E c o CO t° c_ 7 E Ul c c Q) m +-. O O N 0 U (oUU 7 N. - u++ a CO .0 • W E m O G ,-- c E°EEE �c 7 7 O, 7 7 7 c N O O> 0 0 0 0 se 00000 0 U O N .0 C N Q? v,-55--Q,ccc a c wG .., 0 O N a) U CO C 0 aim CO G 0 c 0 0 N •W O oc a O co OO E E m W 2 -EG G CO 7 0 CO O N N , N o rn E 0) -O C m 0 -) , 0)-6 N O N O u) G O' (Oj N N a C w C CO tq (n U S, y 3 v 0 o c 0 O C NCO 0 O (n U O ` O 0) LO a E 2008 Colorado River Water Use Estimates.xls Name of Applicant: Quantity of Water in Acre Feet: WEST DIVIDE WATER CONSERVANCY DISTRICT WATER ALLOTMENT CONTRACT eiC1 Contract #120816GB(a) Map #653 Date Activated: 8/16/12 Applicant, hereby applies to the West Divide Water Conservancy District, a political subdivision of the State of Colorado, organized pursuant to and existing by virtue of C.R.S. 1973, Section 37-45-101, et seq., (hereinafter referred to as the "District") for an allotment contract to beneficially and perpetually use water or water rights owned, leased, or hereafter acquired by the District. By execution of this Contract and the attached Application, Applicant hereby agrees to the following terms and conditions: 1. Water Rights: Applicant shall own water rights at the point of diversion herein lawfully entitling Applicant to divert water, which will be supplemented and augmented by water leased herein. If Applicant intends to divert through a well, it must be understood by Applicant that no right to divert exists until a valid well permit is obtained from the Colorado Division of Water Resources. 2. Quantity: Water applied for by the Applicant in the amount set forth above shall be diverted at Applicant's point of diversion from the District's direct flow water rights, and when water is unavailable for diversion pursuant to administration by the Colorado State Engineer during periods when said direct flow water right is not in priority, the District shall release for the use of Applicant up to said quantity in acre feet per year of storage water owned or controlled by the District. It is understood that any quantity allotted from direct flow, storage or otherwise, to the Applicant by the District will be limited by the priority of the District's decrees and by the physical and legal availability of water from District's sources. Any quantity allotted will only be provided so long as water is available and the Applicant fully complies with all of the terms and conditions of this Contract. The District and the Applicant recognize that some of the District's decrees may be in the name of the Colorado River Water Conservation District, and the ability of the District to allot direct flow right to the Applicant may be dependent on the consent of the Colorado River Water Conservation District. If at any time the Applicant determines it requires less water than the amount herein provided, Applicant may so notify the District in writing, and the amount of water allotted under this Contract shall be reduced permanently in accordance with such notice. Rates shall be adjusted accordingly in following water years only. 3. Beneficial Use and Location of Beneficial Use: Any and all water allotted Applicant by the District shall be used for the following beneficial use or uses: industrial, municipal, domestic and related uses, or commercial (except for commercial use from Alsbury Reservoir and except to the extent that Ruedi Reservoir water may not be available for commercial as that term is defined on Page 5 of Contract No. 2-07-70-W0547 between the United States and the West Divide Water Conservancy District). Applicant's beneficial use of any and all water allotted shall be within or through facilities or upon land owned, leased, operated, or under Applicant's control. 4. Decrees and Delivery: Exchange releases made by the District out of storage from Ruedi Reservoir, Green Mountain Reservoir, Alsbury Reservoir, or other works or facilities of the District, or from other sources available to the District, shall be delivered to the Applicant at the outlet works of said storage facilities or at the decreed point of diversion for said other sources, and release or delivery of water at such outlet or points shall constitute performance of the District's total obligation. Delivery of water by the District from Ruedi Reservoir or Green 1 Mountain Reservoir shall be subject to the District's lease contracts with the United States Bureau of Reclamation. Releases from other facilities available to District shall be subject to the contracts, laws, rules, and regulations governing releases therefrom. Furthermore, the District hereby expressly reserves the right to store water and to make exchange releases from structures that may be built or controlled by the District in the future, so long as the water service to the Applicant pursuant to this agreement, is not impaired by said action. Any quantity of the Applicant's allocation not delivered to or used by Applicant by the end of each water year (October 1), shall revert to the water supplies of the District. Such reversion shall not entitle Applicant to any refund of payment made for such water. Water service provided by the District shall be limited to the amount of water available in priority at the original point of diversion of the Districts applicable water right, and neither the District, nor those entitled to utilize the District's decrees, may call on any greater amount at new or alternate points of diversion. The District shall request the Colorado Division of Water Resources to estimate any conveyance losses between the original point and any alternate point, and such estimate shall be deducted from this amount in each case. Water service provided by the District for properties located within the Bluestone and Silt Water Conservancy Districts is provided pursuant to Agreements with said Districts. The Intergovernmental Agreement between the District and the Silt Water Conservancy District, dated January 25, 2001, is recorded as Reception No. 575691, Garfield County Clerk and Recorder's Office. The Intergovernmental Memorandum of Understanding between the District and the Bluestone Water Conservancy District, dated April 26, 2001, is recorded as Reception No. 584840, Garfield County Clerk and Recorder's Office. 5. Alternate Point of Diversion and Plan of Augmentation: Decrees for alternate points of diversion of the District's water rights or storage water may be required in order for Applicant to use the water service contemplated hereunder. Obtaining such decree is the exclusive responsibility of Applicant. The District reserves the right to review and approve any conditions which may be attached to judicial approval of said alternate point of diversion as contemplated or necessary to serve Applicant's facilities or lands. Applicant acknowledges and agrees that it shall be solely responsible for the procedures and legal engineering costs necessary for any changes in water rights contemplated herein, and further agrees to indemnify the District from any costs or losses related thereto. Applicant is solely responsible for providing works and facilities necessary to obtain/divert the waters at said alternate point of diversion and deliver them to Applicant's intended beneficial use. Irrespective of the amount of water actually transferred to the Applicant's point of diversion, the Applicant shall make annual payments to the District based upon the amount of water allotted under this Contract. In the event the Applicant intends to apply for an alternate point of diversion and to develop an augmentation plan and institute legal proceedings for the approval of such augmentation plan to allow the Applicant to utilize the water allotted to Applicant hereunder, the Applicant shall give the District written notice of such intent. In the event the Applicant develops and adjudicates its own augmentation plan to utilize the water allotted hereunder, Applicant shall not be obligated to pay any amount under Paragraph 19 below. In any event, the District shall have the right to approve or disapprove the Applicant's augmentation plan and the Applicant shall provide the District copies of such plan and of all pleadings and other papers filed with the water court in the adjudication thereof. 6. Contract Payment: Non-refundable, one time administrative charge, in the amount determined by the Board of Directors of the District from time to time, shall be submitted with the application for consideration by the District. 2 Annual payment for the water service described herein shall be determined by the Board of Directors of the District. The initial annual payment shall be made in full, within thirty (30) days after the date of notice to the Applicant that the initial payment is due. Said notice will advise the Applicant, among other things, of the water delivery year to which the initial payment shall apply and the price which is applicable to that year. Annual payments for each year thereafter shall be due and payable by the Applicant on or before each January 1. If an annual payment is not made by the due date a flat $50 late fee will be assessed. Final written notice prior to cancellation will be sent certified mail, return receipt requested, to the Applicant at such address as may be designated by the Applicant in writing or set forth in this Contract or Application. Water use for any part of a water year shall require payment for the entire water year. Nothing herein shall be construed so as to prevent the District from adjusting the annual rate in its sole discretion for future years only. If payment is not made within fifteen (15) days after the date of said written notice, Applicant shall at District's sole option have no further right, title or interest under this Contract without further notice, and delivery may be immediately curtailed. The allotment of water, as herein made, may be transferred, leased, or otherwise disposed of at the discretion of the Board of Directors of the District. Upon cancellation of this water allotment Contract with the District, the District shall notify the Division of Water Resources offices in Denver and Glenwood Springs. The Division of Water Resources may then order cessation of all water use. 7. Additional Fees and Costs: Applicant agrees to defray any expenses incurred by the District in connection with the allotment of water rights hereunder, including, but not limited to, reimbursement of legal and engineering costs incurred in connection with any water rights and adjudication necessary to allow Applicant's use of such allotted water rights. 8. Assignment: This Contract shall not inure to the benefit of the heirs, successors or assigns of Applicant, without the prior written consent of the District's Board of Directors. Any assignment of Applicant's rights under this Contract shall be subject to, and must comply with, such requirements as the District may hereafter adopt regarding assignment of Contract rights and the assumption of Contract obligations by assignees and successors. Nothing herein shall prevent successors to a portion of Applicant's property from applying to the District for individual and separate allotment Contracts. No assignment shall be recognized by the District except upon completion and filing of proper forms for assignment and change of ownership. In the event the water allotted pursuant to this Contract is to be used for the benefit of land which is now or will subsequently be subdivided or held in separate ownership, the Applicant may only assign the Applicant's rights hereunder to: 1) No more than three separate owners all of whom shall be party to a well sharing agreement satisfactory to the District or 2) A homeowners association, water district, water and sanitation district or other special district properly organized and existing under the laws of the State of Colorado, and then, only if such parties, association or special district establishes to the satisfaction of the District that it has the ability and authority to perform the Applicant's obligations under this Contract. In no event shall the owner of a portion, but less than all, of the Applicant's property to be served under this Contract have any rights hereunder, except as such rights may exist pursuant to a well sharing agreement or through a homeowners association or special district as provided above. Upon the sale of the real property to which this Contract pertains, Applicant shall make buyer aware of this Contract and proper forms for assignment and change of ownership must be completed. 3 9. Other Rules: Applicant shall be bound by the provisions of the Water Conservancy Act of Colorado; by the rules and . regulations of the Board of Directors of the District; and all amendments thereof and supplements thereto and by all other applicable law. 10. Operation and Maintenance Agreement: Applicant shall enter into an "Operation and Maintenance Agreement" with the District under terms and conditions determined by the board of Directors of the District, if and when, the Board of said District determines in its sole discretion that such an agreement is required. Said agreement may contain, but shall not be limited to, provisions for additional annual monetary consideration for extension of District delivery services and for additional administration, operation, and maintenance costs; or for other costs to the District which may arise through services made available to the Applicant. 11. Change of Use: The District reserves the exclusive right to review, re -approve or disapprove any proposed change in use of the water allotted hereunder. Any use other than that set forth herein or any lease or sale of the water or water rights allotted hereunder without the prior written approval of the District shall be deemed to be a material breach of this Contract. 12. Use and Place of Use: Applicant agrees to use the water in the manner and on the property described in the documents submitted to the District at the time this Contract is executed, or in any operation and maintenance agreement provided by Applicant. Any use other than as set forth thereon or any lease or sale of the water or water rights herein, other than as permitted in paragraph 8 above, shall be deemed to be a material breach of this agreement. 13. Title: It is understood and agreed that nothing herein shall be interpreted to give the Applicant any equitable or legal fee title interest in or to any water or water rights referred to herein. 14. Conservation: Applicant shall use commonly accepted conservation practices with respect to the water and water rights herein, and hereby agrees to be bound by any conservation plan adopted hereafter by the District for use of District owned or controlled water or water rights. 15. Restrictions: Applicant shall restrict actual diversions to not exceed the contract amount for ordinary household purposes, the watering of domestic livestock, fire protection, and the irrigation of lawn and garden as specified in the Application. Applicant shall also comply with all restrictions and limitations set forth in the well permit obtained from the Colorado Division of Water Resources. Watering of livestock shall be restricted to Applicant's domestic animals not to be used for commercial purposes unless Applicant obtains approval from the Colorado Division of Water Resources for commercial use/livestock watering, provided that in no event shall actual diversions exceed the amount of water provided by this Contract. Violation of this paragraph 15 shall be deemed to be a material breach of this Contract. 16. Well Permit: If Applicant intends to divert through a well, then Applicant must provide to District a copy of Applicants valid well permit before District is obligated to deliver any water hereunder. 17. Measuring Device or Meter: Applicant agrees to provide, at its own expense, a measuring device deemed acceptable by the District's Engineer after consultation, or a totalizing flow meter with remote readout to continuously and accurately measure at all times all 4 water diverted pursuant to the terms of Applicant's water right and the terms of this Contract. Applicant agrees to provide accurate readings from such device or meter to District upon District's request. Applicant acknowledges that failure to comply with this paragraph could result in legal action to terminate Applicant's diversion of water by the State of Colorado Division of Water Resources. By signing this Contract, Applicant hereby specifically allows District, through its authorized agent, to enter upon Applicant's property during ordinary business hours for the purposes of determining Applicants actual use of water. 18. Representations: By executing this Contract, Applicant agrees that it is not relying on any legal or engineering advice that Applicant may believe has been received from the District. Applicant further acknowledges that it has obtained all necessary legal and engineering advice from Applicant's own sources other than the District. Applicant further acknowledges that the District makes no guarantees, warranties, or assurances whatsoever about the quantity or quality of water available pursuant to this Contract. Should the District be unable to provide the water contracted for herein, no damages may be assessed against the District, nor may Applicant obtain a refund from the District. 19. Costs of Water Court Filing and Augmentation Plan: Should the District, in its own discretion, choose to include Applicant's Contract herein in a water court filing for alternate point of diversion or plan of augmentation, then Applicant hereby agrees to pay to the District, when assessed, an additional fee representing the Districts actual and reasonable costs and fees for Applicant's share of the proceedings. Applicant shall be assessed a pro -rata share of the total cost incurred by the District in preparing, filing and pursuing to decree the water court case. The pro -rata share shall be calculated by dividing such total cost by the number of contractees included in the filing. To the extent that the District is caused additional costs because of objection filed specifically due to the inclusion of Applicant's Contract in the filing, such additional costs may be charged specifically to Applicant and not shared on a pro -rata basis by all contractees. 20. Binding Agreement: This agreement shall not be complete nor binding upon the District unless attached hereto is the form entitled "Application to Lease Water From West Divide Water Conservancy District" fully completed by Applicant and approved by the Districts engineer. Said attachments shall by this reference thereto be incorporated into the terms of this agreement. All correspondence from the District to Applicant referring to or relating to this agreement is by this reference incorporated into this agreement as further terms and conditions of this agreement. 21. Warning: IT IS THE SOLE RESPONSIBILITY OF THE APPLICANT TO OBTAIN A VALID WELL PERMIT OR OTHER WATER RIGHT IN ORDER TO DIVERT WATER, INCLUDING THE WATER ACQUIRED UNDER THIS CONTRACT. IT IS THE CONTINUING DUTY OF THE APPLICANT TO MAINTAIN THE VALIDITY OF THE WELL PERMIT OR WATER RIGHT INCLUDING FILING FOR EXTENSIONS OF PERMITS, FILING WELL COMPLETION REPORTS, FILING STATEMENTS OF BENEFICIAL USE, OR OTHERWISE LAWFULLY APPLYING THE WATER TO BENEFICIAL USE ON A REGULAR BASIS WITHOUT WASTE. 22. AREA B. CONTRACTS: IF APPLICANT'S WELL OR OTHER WATER RIGHT THAT IS THE SUBJECT OF THIS CONTRACT IS LOCATED OUTSIDE "AREA A" AS DESIGNATED BY THE DISTRICT, THEN THIS PARAGRAPH APPLIES: THE AUGMENTATION WATER PROVIDED BY THE DISTRICT UNDER THIS CONTRACT MAY ONLY PROTECT APPLICANT"S WATER RIGHT FROM A CALL ON THE COLORADO RIVER AND MAY NOT PROTECT APPLICANT FROM A CALL FROM ANY OTHER 5 SENIOR RIGHT. NO REPRESENTATION OTHERWISE IS MADE BY THE DISTRICT. IF THIS ISA CONCERN TO APPLICANT, THIS CONTRACT MAY BE RESCINDED UPON WRITTEN NOTICE DELIVERED TO THE DISTRICT BY THE APPLICANT WITHIN THE NEXT 30 DAYS FOLLOWING THE AFFIXING OF SIGNATURES ON THIS CONTRACT IN WHICH EVENT ALL SUMS PAID BY APPLICANT FOR THIS CONTRACT SHALL BE IMMEDIATELY REFUNDED TO APPLICANT. STATE OF J.) 0 ro-X. 6 ) ss. COUNTY OF (1r c Applicant The foregoing instrument was acknowledged before me on this to day of Witness my hand and official seal. My commission exp STATE OF ) ss. COUNTY OF ) The foregoing instrument was acknowledged before me on this day of , 20 , by . Witness my hand and official seal. My commission expires: Notary Public ORDER After a hearing by the Board of Directors of the West Divide Water Conservancy District on the Application, it is hereby ORDERED that said Application be granted and this Contract shall be and is accepted by the District. WEST DIVIDE WATER CONSERVANCY DISTRICT By President gJ, & /ice Date This Cohtract includes and is subject to the terms and conditions of the following documents which must accompany this Contract: 1. Map showing location of point of diversion (use map provided) 2. Application and Data Form fully completed and signed The printed portions of this form, except differentiated additions or deletions, have been approved and adopted by the West Divide Water Conservancy District. Form: WDWCD 01-01-08 CONTRACT. 6 Due Upon Receipt. Total $391.65 West Divide Water Conservancy District -General Stored Water 818 Taughenbaugh Blvd. #101 P. O. Box 203 (970) 625-5461 Rifle, CO 81650 water@wdwcd.org BILL TO George E. Bagley 6044 county Road 233 Silt, CO 81652 DATE INVOICE 8/6/2012 4807 Please reference the Invoice # on your check. On any shared well non-payment of any portion of the fees due deems the whole contract cancelled. CONTRACT # ACRE FEET RATE IDENTIFICATION 120816GEB(a) 1 out/domestic DESCRIPTION QTY RATE AMOUNT Contract Administration Fee 1 250.00 250.00 Recording Fee 20.00 20.00 Colorado River Augmentation Plan Assessment 1 55.00 55.00 Augmentation Water Contract 66.65 66.65 C, --.A4 1( (4 5 West Divide Water Conservancy District P.Q. Box 1478 Rifle, CO 81650-1478 On any shared well non-payment of any portion of the fees due deems the whole contract cancelled. COLORADO DIVISION OF WATER RESOURCES DEPARTM ENT OF NATURAL RESOURCES 1313 SHERMAN ST., Ste 821, DENVER, CO 80203 Main: (303) 266-3581 Fax (303) 866-2223 dwrpermitsonline@state.co.us RESIDENTIAL Note: Also use this form to apply for livestock watering Water Well Permit Application Review form instructions prior to completing form. Hand completed forms must be completed in black or blue ink or typed. 1. Applicant Information Name(s) .. _. .. Ce)R6E E gCZ'2 �-ey --— r- — Maibng address -'- ---. 12_0 - 33 Rd City I State Zip code Telephone.. ! E-mail online Ming it is required) 3,09— g?4L, 2. Type Of Application (check applicable boxes) ❑ Construct new well ❑ Replace existing well Ft Use existing well Change or increase use 3. Refer To (if applicable) Well permit #41 71 / J / Designated Basin Determination # ❑ Change source (aquifer) ❑ Reapplication (expired permit) 0 Rooftop precip. collection 0 Other. Water Court case # Well name or # Office Use Only . CMS E I t' SEPD7'12 WATER RESOURCE: PTA.TE ENGINEER GLENWOOD 6. Use Of Well (check applicable boxes) 1 Form GWS 44 (11/2011) See instructions to determine use(s) for which you may qualify 0 A. Ordinary household use in one single-family dwelling (no outside use) B. Ordinary household use in 1 to 3 single-family dwellings: Number of dwellings: -. Home garden/lawn irrigation, not to exceed one acre: area irrigated AO -dal R' sq. ft. C acre Domestic animal watering - (non-commercial) S �puci ❑ C. Livestock watering (on farm/ranch/range/pasture) 7. Well Data (proposed) Ma>amum pumping rate Annual amount to be withdrawn Total depth gpm feet Aqu 4 5 acre-feet 8. Water Supplier 4. Location Of Proposed Well (Important! See Instructions County Section Township N or S Range E or W Principal Meridian A 1- (91/. - Distance of wet from section lines (section fines am typically not property 1 nes) a 3 ,from( NI S toD Ft from IrEnW For replacement wells only- distance and direction from old well to new well ell location address (Include City. State, Zip) /U — /44 -the 1/4 feet Direction Is this parcel within boundaries of a water service area? OYES NO If yes, provide name of supplier. /I 9. Type Of Sewage System jg Septic tank / absorption (each field O Central system: District name: O Vault: Location sewage to be hauled to: O Other (explain) Check dwell address is same as in Item 1. Optional: GPS well location information in UTM format GPS unit settings are as follows: Format must be UTM I—Zone 12 or I- Zone 13 Easting: Units must be Meters Datum must be NAD63 i Northing: Unit must be set to true north Was GPS unit checked for above? 0 YES Remember to set Datum to NAD83 5. Parcel On Which Well Will Be Located (You must attach a current deed for the subject parcel) 10. Proposed Well Driller License #(optional):,L-,)' S7 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. Sign orRnty name(s) of person(s) submitting application Date (mMddfyyyy) A. You must check and complete one of the following: O Subdivision: Name Lot Block Filing/Unit County exemption (attach copy of county approval & survey) Name/# 7 u Lot # l 0 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 ❑ Mining claim (attach copy of deed or survey) Name/#: O 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 acres in parcel -- Q TZ D. Will this be the only well on this parcel? JYES ! .� NO (if no -list other wells) C. Are you the owner of this parcel? YES 0 No _— - - E. State Parcel ID# footional):, -�` % 17g--0 er' f - D 0-0 -Q If signing print na Office Use On- ly USGS map name AQUAMAP WE WR CWCB TOPO MYLAR SB5 DWR map no. Surface elev. 1 Receipt area only DIV . WD.BA MD Send to: Division of Water Resources 1313 Sherman Street, Room 818 Denver, goiorado; 80203 Fax: 303-866-3589 Phone: 303-866-3581 SE' 0 7 OWNER'S NOTICE OF CONSTRUCTED WELL Construction of Amy well° under Pernut No. 9 7i 64, completed. on ) (dad) , (year) The well was ddns ructed by 78 D WATER REse R ENS STATE ENGI E 'R GLENWo. p' was :dulling company) If the pumping eq The pump was msta1 on (month) (day) ent has been installed......... 1.4 e11'by:: (ydar): (pump :.eo. any)r'"° The well must be constructed and pump installed by hcenged water well construction and pump installation contractors, OR the well may be constructed and/or the pump may be installed by the well owner if the well is constructed and/or pump is installed using equipment owned and operated by the well owner and the well is constructed on his/her own property for his/her own use ("private driller"/"private pump installer"). Work reports must be submitted to the Division of Water Resources in accordance with Rule 17 of the Water Well Construction Rules. GEORGE E BAGLEY GINNY BAGLEY 6044 COUNTY ROAD 233 SILT, CO 81652-8795 970-876-5556 Pay to the se 6,,x.5 Order of, 7-iZ Date 1149 23-7/1020 1152 6173179877 44srea.4 1 $ ldb./ Do ars 8 Seariiy Feslures = oouu: o WELLS FARGO Wells Fargo BanI:NA Colorado weltsfargotom For t,(al4/11 1:1.020 000761: 61731798771 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit hr _ 2401i 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Owner's Name Ron. E. Bagley Present Address -__6044 233 Rd., Silt System Location 6044 233 laud, Silt Legal Description of Assessor's Parcel No SYSTEM DESIGN This does not constitute a building or use permit. Phone 876--2676 Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) LEACH FIELD ENLARGEMENT ONLY Required Absorption Area - See Attached Special Setback Requirements: Date _ _ Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering installation f 4 System Installer Septic Tank Capacity I '-. Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface Absorption Area Absorption Area Type and/or Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements Other Date , 4r- RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: 1. All installation must comply with all requirements of thb Colorado State Board of Health individual Sewage Disposal Systems Chapter 25, Article 10 C.R.S. 1973, Revised 1984. 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a requirement of the permit and cause for both legal action and revocation of the permit. 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 months in jail or both). Applicant: Green Copy Department: Pink Copy JNDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER . ( E. ()) 0, pi (.,..[ 11 ADDRESS + �.... . t, . �1 7 PHONE CONTRACTOR S� ADDRESS ,SOII'Y“Li PHONE PERMIT REQUEST FOR ( ) NEW INSTALLATION Qui ALTERATION () REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PROPOSED F ILITY: COUNTY (1(V e Near what City or Town S j Jt La Legal Description X301 ,C✓7 eJLQ'Y • WASTES TYPE: 0.1) Dwelling () Transient Use ( ) Commercial or Industrial ( ) Non-domestic Wastes () Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms. Number of persons -11 (14 Garbage Grinder ()() Automatic Washer (X) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: 9O WELL () SPRING () STREAM OR CREEK Give depth of all wells within 180 feet of system: If supplied by communtiy water, give name of supplier: GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent Ground Slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: t'Yli�-t'S Was an effort made to connect to community system? n0 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: Septic Tank ( ) Vault Privy ( ) Pit Privy ( ) Aeration Plant ( ) Composting Toilet ( ) Incineration Toilet ( ) Vault ( ) Recycling, potable use ( ) Recycling, other use ( ) Chemical Toilet ( ) Other - Describe: FINAL DISPOSAL BY: Q) Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? no • r . PERCOLATIONTEST RESULTS* (To be completed by Registered Professional Engineer) Minutes per inch in hole No. 1 Minutes per inch in Hole No. 3 Minutes per inch in hole No. 2 Minutes per inch in Hole No. Name, address and telephone of RPE who made soil absorption tests: Name, address and telephone of RPE responsible for design of the system: Applicant acknowledges that the completeness of the appliction is conditional upon such further mandatory and additional tests and reports as may be required by the local health department to be made and furnished by the applicant or by the local health department for purposes of the evaluation of the application; and the issuance of the permit is subject to such terms and conditions as deemed necessary to inusre compliance with rules and regulations adopted under Article l0, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements make, information and reports submitted herewith and required to be submitted by the applicant are or will be represented to be true and correct to the best of my knowledge and belief and are designed to bre relied on by the local department of health in evluating the same fro purposes of issuing the permit applied for herein. 1 further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application and in legal action for perjury as provided by law. Signed QCjcL PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY Date O3LJ • flli �y_i_g_o� s6'1)nu'sQ PLOT PLAN AND DESIGN FEATURES Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, water course, stream, dry gulch and show location of proposed system by direction and distance from dwelling or other fixed reference object, and additional submissions in support of this application such as data, plans, specifications statements and commitments. �} 00F"j4119'00UNTY BUfL' ncEKnown: Fee Only $25.00 INDIVIDUAL SEWAGE DISPOSAL PERMIT u0 Owner dir AND SANITATION 1.10) AVaitua nss, Colorado 81601 03) 948.8241 1919 George C. Bagley tilt 6044 233 County Road - Silt, CO System Location Licensed Installer * Conditional Construction approval is hereby granted for aq'' �— Septic Tank or Aerated treatment u It. Absorption area for dispersal areal computed as follows: DEPARTMENT This does not constitute a building or use permit. gallon Pere rate of one inch in 40 minutes requires a minin,lm of 285- sq ft of absorption area per bedroom. Therefore the no. of bedrooms 2 x 285 sq ft rninimum requirement a total of 570 sq ft of absorption area, May we suggest 12' x 48' x 3' or 18' x 32 x 3' �! .� Date 450,/, G.42e'oe" - L���-----�— FINAL APPROVAL OF SYSTEM: Inspector No system shall be deemed to be in compliance with the Si wage Disposal Laws until the assembled system is approved prior to cover- ing any part. 0 / Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. PProper materials and asse bly. C �lm 11 ®vTra no�septic ta�k or aerated trlment unit. 4r/k- Adequate absorption (or dispersal) area. Adequate compliance with permit requirements. Adequate compliance with County and State regulations/requirements. Other Date ! O 8f Inspector RETAIN WITH RECEIPT RECORDS A 0/4171 ONSTRUCTION SITE `CONDITIONS: 1. All installation must comply with all requirements of tI e County Individual Sewage Disposal Regulations, adopted pursuant to au- thority granted in 6644-4, CRS 1963, amended 66-3.14 ��CRS 1963. 2. This permit is valid only for connection to structures Ich have fully complied with County zoning and building requirements. Connection to or use with any dwelling or structures nth bpproved by the Building and Zoning office shall automatically be a viola• tion of a requirement of the permit and cause for both I' gal action and revocation of the permit. 3. Section III, 3.24 requires any person who constructs, alters, or installs an Individual sewage disposal system in a manner which in- volves a knowing and material variation from the terms 'or ✓specifications contained in the application of permit commits a Class I, Petty Offense (5500.00 fine — 6 months in jail or both). Applicant: Oman Coy Department: Pink Copy ai.aus.ar.mea.•-- „t --_- ..reran a. - - -aaaa r.a..aaa. . a aaaar,.� • • INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date Owner: Owner: Mail Address: / // & . , City: ArAel Zip g -/As --,2, Phone :(f INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable buildings, location of potable water wells, SQi1 percola- tion test holes, soil profiles in test holes (see Page 3). Near What 1. Location of Facility: County GARFIELD City or Town Location Address &/or, Legal Description to�yt Lot Size deA72.4,) 2. No. of Bedrooms Septic Tank Capacity 7"se) Aeration Unit Capacity N/A 3. Source of Domestic Water: Public (name): Private: Well ,/ Depth Other Depth to 1st ground water table 4. Is facility within boundaries of a city/town or sanitation district? 5. Distance to nearest sewer system: Have you attempted to arrange a connection with the system? `%La If rejected, what was the reason? 6. If R.P.E. tested, state rate of absorption in test holes shown on the location map, in minutes per inch of drop in water level after holes have been soaked for 24 hours: 7. Name, address, and telephone of R.P.E. who made soil absorption tests: 8. Name, address, and telephone of R.P.E. responsible for design of the system: 9. Express permission is hereby granted for the inspection of the above property by any member of the Garfield County Building & Sanitation Department and/or such persons as they may designate. Any withdrawal of this permission shall be in writing and receipt acknowledged by the County Building & Sanitation Department. 10. I have been given an opportunity to read the Individual Sewage Disposal Systems Regula- tions of Garfield County and I hereby agree to comply with all terms, conditions and requirements included therein. 9/ /, (TO BE RETURNED TO BLDG. & SANI. DEPT.) 4 soz 6_64. PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY INDICATE BELOW THE LOCATION OF YOUR BUILDINGS WATER SUPPLY AND DISTRI- BUTION LINES, STREAMS, IRRIGATIOIT DTIrCHES, ROADWAYS, AND BOUNDARY LINES /!c. /.? 6° (-77/ d&Le-Y 4 3, eAvi-Lti _ _ "etz, (ut,,,u,z.. 4/, ,71,AA.&re.4,u (- (TO BE RETURNED TO BLDG. & SANT. DEPT.) 72 CL) -7241 Glenn Hartmann From: Wyatt Keesbery Sent: Wednesday, April 24, 2013 10:16 AM To: Glenn Hartmann Subject: Kathy Bagley Driveway on CR 233 Glenn, I went and looked at the proposed location of the driveway that Mrs. Bagley is wanting to use off of CR 233. There is an existing driveway already in this location and I see no problems with them using this as a everyday entrance to the property. I told Mrs. Bagley that there would be a driveway permit that would need to be filled out and some work that would need to be done before she could get a certificate of occupancy, and she understood. Wyatt KeeArbe,ry Garfield County Road & Bridge District Forcinan 0298 C.R. 333A Rills, Co. 81650 Office: 970-625-8601 Cell: 970-309-6073 1 Glenn Hartmann From: Wyatt Keesbery Sent: Wednesday, May 01, 2013 10:09 AM To: Glenn Hartmann Subject: RE: Bagley Calewvt, The/ Cat/witty i oad/ and/ 3 rCdc-e' depavtkne vtt w a,L require a/ driveway pe rut it for each/ o f the propo .ed acce po-i vtt< After loo-k.i vjz at both/proposed/ c cce paints, they bath/ w a,L vi.eed ct phalt or concrete aprons; ct/nd' both/ w 1A L need/to- have/bra/J.1/ removed/ oved/ vv., both/ di v echo wa No✓ culverts, w tU L e' req ud v eco oneither c cce ; a o-nly one/ e/ c cce1-, w £W be/ all,o-wed/pev s,Gte- T1e,propeviy owne kwa,Lvteed/to-o-btaivi, pay for and/ -vva/peil/nit Wore/ gtavttvt.g, awy work% cu uir wwvat keep the/peril/IA- o -v te'throu.cd-ho vtt the/ d,w atw-w of cavt/stru.ctio-w. rhe, perwux wa,L lye/ Rood for 30 da yk after Lt 14, A cowvt ty Road/ a Id/arid.emsrepre/sevttatve'waLi/vi4pectthemedr ieway avtapproach/ ay.dL off o-wLt, befo-e/the/ dY veway i4- co-n4-,dered' complete: I hope/51.07 helps- w LtYv your p rote and/ (f there i a vt yth e e/ yow need/ please/ feel free/to- co-ntact wi e at dirty ttwLe/. Wyatt Kee y Garfield County Road & Bridge District Foreman 0298 C.R. 333A Rifle, Co. 81650 Office: 970-625-8601 Cell: 970-309-6073 From: Glenn Hartmann Sent: Tuesday, April 30, 2013 3:20 PM To: Kathy Bagley Cc: Wyatt Keesbery Subject: RE: Bagley Hi Kathy: I spoke with Wyatt and he was going to provide an additional email clarifying the Road and Bridge Department position regarding issuance of a future access permit for both lots in question (Lots 2 and 3). I understand that he might 1 also be able to clarify if any improvements (i.e. culverts would be needed). I think he was out of the office and I anticipate his email this week. Thanks. Glenn. Glenn Hartmann Community Development Department From: Kathy Bagley [mailto:kbagley73@gmail.com] Sent: Tuesday, April 30, 2013 10:43 AM To: Glenn Hartmann Subject: Bagley Hi Glenn, I was wondering what you found out in talking to Wyatt? 2 n -1r- OO --1r- C - c-;" C� 7-10 ..9+r- 0 • W O ;00 0 N O C0P) O A) N a N to 0 °A to 0 .. co Uy fa3 N— WNrJ ()W WNO 1. P 0% G1 �: Sll C) p� 017'. ,N CCC)rroa ii3° �, (T3 o flr to N_ N m H o • 17• rn r> 0 y • mai 0� --I en D 0 m 0 r (Q 3 0