HomeMy WebLinkAbout20131698.tiffScanning Cover Sheet •
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• Septic Permits
Permit #
G19899136
Permit Type: Health / Residential / Statement of Existing
Situs Street Address
Situs City, State, Zip
34018 CR 15
Sec/Town/Range: 08 -06N -67W
Parcel # (12 digits)
080708300003-R1423902
Owner Full Name: KIRBY BILL
Owner Address: P.O. BOX 220
WINDSOR,CO 80550
Contact Name:
Contact Address:
Application Status: Finaled
Application Date: 03/11/1998
Owner Phone #: 303 6862321
Contact Phone#
Information above has been Verified in Accela by employee noted below
X Q/�
October 31, 2008
Pr by: Date
Report ID: EHS00024v003 Page 1 of 1
Print Date -Time: 10/31/2008 8:40:42AM
HSP106P
INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
WELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH' SERVICES
1517 16TH AVENUE COURT, GREELEY,-Co 80634
353-0635 EXT . 2225
NO. G-099136
NEW PERMIT.
OWNERKIF:BY, BILL ADDRESS P.O. BOX 220 PH (303) 6.86-2321
WINDSOR CO 80550
ADDRESS OF PROPOSED SYSTEM 34018 WCR ¶5
WINDSOR CO 80550
LEGAL DESCRIPTION OF SITE: SEC 8 TWF' 6 RNG 67
.SUBDIVISION: - - - -- -
. _.._.......___ LoT - 0 BLOCK- 0-_ FI-L-IN6. n.
USE TYPE: RESIDENTIAL S.O.E./REPAIR-41-.G-890246
SERVICES: PERSONS 4 BATHROOMS 1.00 . -LOT SIZE 170.00 ACRES
BEDROOMS 3 BASEMENT PLUMBING YES WATER SUPPLY NWCWD
APPLICATION FEE x$0.00
REC'D BY COFFEY, DIANNE
DATE 10/06/89
SIGNED BY PEGGY T. STEEL
DATE 10/06/89
PERCOLATION RATE 15.0 MIN PER INCH . . LIMITING ZONE 0 FEET
SOIL TYPE SUITABLE PERCENT GROUND SLOPE 0% DIRECTION
REQUIRES ENGINEER DESIGN NO
FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON -SITE SOIL PERCOLATION DATA
THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED:.
SEPTIC TANK 00.GALLONS, ABSORPTION TRENCH SQ. FT.
OR
ABSORPTION BED .SQ. FT,
IN ADDITION, THIS PERMIT IS. SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND
CONDITIONS: ._ --- ----- ----
.THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT
MAY BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH'DEPARTMENT. FOR REASONS SET.
FORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDING'
FAILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMF'ORARY.OR FINAL
AF'F'ROVAL. -THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE
DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR,INADEQUACY OF THE
SEWAGE DISPOSAL SYSTEM..
WES POTTER 10/06/89'
ENVIRONMENTAL SPECIALIST DATE
THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS
NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF
THISPERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI-
TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA-
SIS. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE COM-
PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT.
SYSTEM INSTALLER UNKNOWN
SYSTEM ENGINEER
TYPE OF SYSTEM INSTALLED TANK
FINAL INSPECTION DATE 10/08/89
APPROVAL WES POTTER
ENVIRONMENTAL SPECIALIST
THE- ISSUANCE OF THIS PERMIT DOES NOT IMPLY COMPLIANCE WITH OTHER STATE, COUNTY
OR LOCAL REGULATORY OR BUILDING REQU:[REMENIS, NOR SHALL IT ACT TO CERTIFY THAT
THE SUBJECT SYSTEM WILL OPERATE IN COMPLIANCE WITH APPLICABLE STATE, COUNTY AND
LOCAL REGULATIONS ADOPTED PERSUAN TO ARTICLE 10, TITLE 25, CRS 1973, AS AMENDED,
EXCEPT FOR THE PURPOSE OF ESTABLISHING FINAL APPROVAL -OF AN INSTALLED SYSTEM FOR
ISSUANCE OF A LOCAL OCCUPANCY PERM:LT. PURSUANT TO CRS 1973.25-10-111 (2) .
ORIGINAL -APPLICANT; COPY-WCHD WCHD--EHS MAY, 1984
i
STATEMENT OF EXISTING SEFTIC'SYSTEM
OWNER OF RECORD:
(PLEASE FILL OUT. IN INK)
MAILING ADDRESS: Q p B e3-4 �10
SITE ADDRESS: 3 L c g u -G R. 1S
iw� in&soy
•
City.
LEGAL DESCRIPTION: PT PT . Section
SUBDIVISION
Phone:
c
.
6 -G-aaad
't?oss°
State ,Zip
��hdsor co
£soSSo
City .State ;Zip
Township- .(o ►J - Range
LOT BLOCK FILING
NUMBER OF PEOPLE: 4 Bedrooms: -3 Bathrooms: I.' Water Supply ('.}.,. 0-c iiree�<�
RESIDENTIAL OR COMMERCIAL: Q.o asn Lot dine: N. -P4 Acres
• SYSTEM SIZE: Tank is Constructed of ' Nelz Tc and has FS!)': - gals capacity
material _
FIELD: Bed or Trench sq.'ft. Date System Installed: .
• You are required to draw a diagram of the aystem.'on the reverse side of .this
form and indicate position, length, -width, and distance from the dwelling.
The undersigned property- owner hereby certifies' that the -above described septic'
system is in. fact'- installed, as described, and exists at this time on the
' parcel of ground •identified' by the above-' legal description .and further states
that the system is in good working order and to the best of his/her knowledge is not
falling to function properly.. -
I further 'understand that •any' falsification. or misrepresentation 'may: result in
revocation of any permit granted based ,uponthis information hereby submitted
and in legal action for perjury as provided bylaw. •
Daal.
Subscribed and'sworn to before me,this --% day of
by
Owner
r-6--9/
Witness my hand -and official seal. v= alit' commission expires
(Pr.', ..Date /-9t9 �N''`-.; C
ti p V T► �s t/t�
K Notary Public Q
?ireelcy
City of Greeley —
Director of Finance
P.O. Box 1928
Greeley, CO 80632-1928
Account Number 070-776009-01
Service Location
34018 WCR 15
MURDOFF GORDON A
8209 SPINNAKER BAY DR
WINDSOR CO 90550
Readings.
=:. Current_..
;.:. __..Previous ..
-....:. _
..:...:.Usage :...
..:
Meter ID
Date. ,;Reading .
Date .. Reading
(In Thousands)
06251477 • 08/01
Consumption History
Usage On em,nand gMae7
48
39
938
07/02
905
To pay online go to www.greeleygov.com
To pay by phone call (970)350-9722 or (9701350-9723
For watering restrictions call (970)336-4134 or go to www.greeleygov.com
33
Last Last this
Year Month Month
33
Statement of Account ibr Utility Service(s)
THANK YOU FOR YOUR PROMPT PAYMENT.
QUESTIONS? CALL REBECCA 970-350-9721
Previous Charges
379.49
Payments 379.49-
Bal Fwd 0.00
METER 0.00
OUTRESWT 263.94
Current Charges 263.94
TOTAL BALANCE
BAL FWD DUE IMMEDIATELY
CURRENT CHARGES ARE DUE BY
DETACH AT PERFORATION AND RETURN BELOW PORTION WITH YOUR REMITTANCE
Please Return with Payment
City of Greeley Statement of Account for Utility Service(s)
Account Number 070-776009-01
MURDOFF GORDON A
8209 SPINNAKER BAY DR
WINDSOR CO 80550
Service Location 34018 WCR 15
AMOUNT PAID
263.94
08/21/12
TOTAL BALANCE 263.94
19070-776009010000263945
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