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Home My WebLink About20133199.tiff�:JIJIJJJ Diviti1sn Ji Well Constructed Receipt: Permit it: Wel Name / #: Designated Basin: Case Plumber: WDr: 3604760 269729- - Division: Water District: County: Management District: 1 2 WELD Help I Last Refresh: 7/9/2013 12:00:59 AM [-] Appicant/Owners History Date Range Unknown - Present Appkant/Owner Name MENDEZ3 SANTOS Address PO BOX 683 Cky/State/ip PLATTEVILLE, CO 80651- [ - ] Location Information Approved Wel Location: Q40 Q160 Section Township NE SE 32 4.0N Northing (t/WM y): Location Accuracy: Physical Address City/State/lip Parcel ID: 1057-32-000011 Range PM Footage from Section Lines 66.0W Sixth 1421 5 300 E 4457152.5 Easting (UWM x): Spotted from section lines 517597.7 Subdivision Mime 1057-32-4 RE4214 Piing Block Lot A Acres in Tract: 4 [-3 Perrot Detals Date Issued: 07/12/2006 Use(s): HOUSEHOLD USE ONLY Special Use: Area which nay be irrigated: Maximum annual volume of appropriation: Statute: Permit Requirements: Cross Reference Peritit(s): Date Byires: 07/12/2008 Aquifer(s): LARAMIE FOX HILLS Totafaing Flow Meter Geophysical Log Abandonment Report No No No Permit Number Receipt Description Comments: Location is actually on Lot Efof Rec Ex; see file memo & drawing in Content Mgr from 8/17/06. Modified permit in CM to show permit for Lot B. GMB Aquifer interval modified based on site specific info provided by Contractor 09/24/2007 MPS [ - ] Construction/ Usage Details Wel Construction Date: 09/21/2007 Wel Plugged: Devotion 4770 Drier Drier Puny Instaiation Date: 1st Beneficial Use: Depth Perforated Casing (Top) Perforated Casing (Bottom) Static Water Level Puny Rate 340 160 Lk # Name 332 DREILING, A . GREGORY 332 DREILING, ANTON F 340 Address 19349 CR 25 LOT 13 BRUSH, CO 80723 446 PAWNEE ST HOLLY, CO 81047 35 Phone Minter 970-867-7160 719-537-6974 [ - ] Application/Permit History Well Construction Report Received Well Constructed Permit Issued Application Received 11/19/2007 09/21/2007 07/12/2006 06/05/2006 [-] Imaged Documents Document Mime Date Imaged Annotated 01/07/2008 No A-2 Search I Search Ul Weld County> Home ( About i Departments 'Services I Contact Us I Property Information Home Planning Building Public Works Health Enforcement Search Applications Record SP -0500276: Health/Residential/New/Septic - A notice was added to this record on 0 511 512 0 0 7. Condition: LUST Severity: Notice Total Conditions: 1 (Notice: 1) Hide additional details Conditions Showing 1-1 of 1 Condition Name Status Severity Applied Date Effective Date Expiration Date ► HIST Applied Notice 08/012005 08/01/2005 Work Location 18331 CR 29 CO Record Details Applicant: LAFFERTY ]ILL B LAFFERTY JILL B 20 CHERRY AVE EATON, CO, 83615 Home Phone:970-454-3591 Monde Pnone:970-590-4156 Project Description: HOUSE ► More Details ► Fees mr Inspections Upcoming Licensed Professional: NORTHERN COLORADO GEOTECH INC-DOUG LEA FG REN 9013144 2956 29 ST UNIT 21 GREELEY, CO, 83631 Hcme Phone:(970) 506-9244 Septic Engineer 9010144 View Additional Licensed Professionals>> Owner: GU:DENCE ENTERPRISES CORP/.AFFERTY JILL B 20 CHERRY AVE EATON CO 80615 You have not added any inspections. Scanning Cover Sheet for Septic Permits Permit # Permit Type: SP -0500276 Health / Residential / New Situs Street Address 18331 CR 29 Situs City, State, Zip Sec/Town/Range: 32 -04N -66W Parcel # (12 digits) Owner Full Name: Owner Address: Contact Name: Contact Address: 105732400001-R4105406 Application Status: Finaled Application Date: 07/27/2005 GUIDENCE ENTERPRISES CORP/LAFFERTY JILL B 20 CHERRY AVE EATON,CO 80615 LAFFERTY JILL B 20 CHERRY AVE EATON,CO,80615 Owner Phone #: 970-454-3591 Contact Phone# 970-454-3591 Information above has been Verified in Accela by employee noted below x Processed by: May 01, 2008 Date Report ID: EHS00024v003 Print Date -Time: 5/1/2008 9:32:04AM Page 1 of 1 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, CO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 Permit #: SP -0500276 Sec/Twn/Rng: 32 04 66 Owner: GUIDENCE ENTERPRISES CORP/LAFFERTY JILL B Applicant: LAFFERTY JILL B Permit Type: RNEW C—ormr ercial, R -Residential + NEW, REPair, VauLT Parcel #: 1057-32-0-00-011 Location: 18331 WCR 29 Legal Description: 17232A PT N2SE4 32 4 66 LYING E & S OF U PRR (1R) %18331 WCR Installer: Vane.. OCAOYNer Finaled Status: ISSUED Applied: 07/27/2005 Issued: 07/28/2005 Finaled: IO- lq-C6 Description: HOUSE Commercial: N # of Persons: # of Bedrooms: Water Public: Water Private: Residential: Y Acres: 4 Basement Plumbing: N .5,1\ Bathrooms - Full: 1 3/4: 0 1/2: 1 N Water Source: Y Cistern: N Well: Y Well Permit #: 264052-A Percolation Rate: 22 Limiting Zone: 8 ft 0 in Description: % Ground Slope: 0 Dr: Soil Suitable: (Y/N) Y Engineer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N) N 8 Minimum Installation Septic Tank: 1250 gallons Absorption Trench: 868 square feet or Absorption Bed: 1172 square feet Actual Installation Septic Tank: 15O gallons Design Type: 6't'1 Absorption Trench: square feet Absorption Bed: 1?'YO square feet Chamber Model au l,Ck4 Chambers* 7.� NOTICE The issuance of this permit does not imply compliance with other state, county or local regulatory or building requirements, nor shall it act to certify that the subject system will operate in compliance with applicable state, county and local regulations adopted persuant to Article 10, Title 25, CRS as amended, except for the purpose of establishing final approval of installed system for issuance of a local occupancy permit persuant to CRS 1973 25-10.111 (2). This Penult is non transferable and non refundable, The Weld County Department of Public Health and Environment reserves the right to impose additional terms and conditions required to meet our regulations o continuing basis. Final permit approval was contingent upon the final inspection of the completed system by the Weld Co ugt�0 ,grtmepro f public Health and Environment. Form: S_FINAL Env nmental ealth Specialist Date 9 �S 690 0% (56 tut q1us • X &u* ak '\i.L Off 5" N P ate. thavbiatiirS 15 GPI n.P .S (go,c.kLi) 13gt l GA -60 0 G ats't ilirs.‘ ref* `ct,\‘` ,(r 1 41--)5 I s 0K- Sr Stems. FOR OFFICE USE ONLY ISDS APPLICATION FLOW SHEET Owner:k cut/t- pQ `L�.Z Ol° Permit #:`E' Q5 002-1-C, Fier y $kjiLt ,6 Location: l kot.3 / i1 0 -1 - Date B Legal Description: .32-04-41,0 Comments Parcel Number Received Information Form Complete Authorization Form Received Map Drawing Received Flood Plain? Yes/No Site Inspection Date Engineer Design? Yes/No Date Engineer Design Received Customer Notified? Yes/No Date Staff Approval Sent Date Staff Approval Rec'd Perc Data Entered in Computer 'frI<6 1 Date of 8011 Approval Eng Approval Letter Sent (Letter, Permit, BOH Review) Date of Final Inspection Io—t1 6 Eng Final Inspection Letter Recd Variances Needed? Yes/No Sent Variance Staff Approval Rec'd Variance Staff Approval Variance BOH Approval Variance BOH Approval Sent (Variance, BOH Review) Additional Comments: Mlenvprotsopiklelowaoat 500.wya WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, COLORADO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 Permit #: Owner: Applicant: Permit Type: Parcel #: Location: Legal Desc: SP -0500276 Sec/Twn/Rng: 32 04 66 PERMIT GUIDENCE ENTERPRISES CORP/LAFFERTY JILL B Applied:07/27/2005 LAFFERTY JILL B RNEW C=Commercial, R=Residential + NEW, REPair, VauLT 1057-32-0-00-011 18331 WCR 29 17232A PT N2SE4 32 4 66 LYING E &S OF U PRR (1R) %18331 WCR Description: HOUSE Commercial: N Residential:Y Acres: 8 # of Persons: 4 Basement Plumbing: N # of Bedrooms: , Li. Bathrooms - Full: 1 3/4: 0 1/2: 1 Water Public: N l Water Source: Water Private: Y Cistern: N Well: Y Well Permit Number: 264052-A Percolation Rate 8,D Limiting Zone ft in Description % Ground Slope l Direction Soil Suitable (Y/N) \g Engineer Design Required (Y/N) In 100 Year Flood Plain (Y/N) 1+) From the application information supplied and the on -site soil percolation data the following minimum Installation specifications are required: Septic Tank gallons, Absorption Trench CAA sq ft or Absorption Bed 1112_ sq ft Chambers: Infiltrator or Hancor Standard or Hi -Capacity, EQ36 or BioDiffuser Trench ZS Bed 37 Infiltrator Quick4 Trench Bed Rancor Narrow (I Sin) Envirochamber Trench Bed In dition this permit is subject to the following additional terms and conditions: bk.° x,14-v=n .1a k o 1itti*At,\ n .Ixu,rQ 0. This permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the Weld County Department of Public Health and Environment for reasons set forth in the Weld County Individual Sewage Disposal System Regulations including failure to meet any term or condition imposed thereon during temporary or final approval. 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. This permit is non transferable and non refundable. Before issuing final approval of this permit the Weld County Department of Public Health and Environment reserves the right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval is co gent uporyt)ic final of the completed system by the Weld County Department of Public Health and Environment. Form: S PERMITN Environmental Health Specialist date ' WELt) COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 NORTH 17111 AVENUE, GREELEY, CO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411 WEBSITE: WWW.CO.WELD.CO.US APPLICATION / RECEIPT Initials: SC Permit Number: SP -0500276 Receipt Number: HAP -05281 07-27-2005 Amount: $400.00 Payment Method: Check Notation: 1694 Owner Name: GUIDENCE ENTERPRISES CORP/LAFFERTY JILL B Applicant Name: LAFFERTY JILL B Parcel Number: 105732000011 Location: 18331 WCR 29 Account Code 2560-414004221-4203 256041400-4221-4203 2560-41400-4221-4203 2560414004221-4203 Description: HOUSE Commercial: (Y/N) N Number of Persons: 4 Number of Bedrooms: 3 Water Public: (Y/N) N Water Private: (Y/N) Y Description New Septic Permit Repair Septic Permit Vault Permit Variance Request Residential: (Y/N) Y Acres: 8 Basement Plumbing: (Y/N) N Bathrooms: Full - 1 3/4: 0 1/2: 1 Water Supply: Cistern: (Y/N) N Well: (Y/N) Y Amount $400.00 $0.00 $0.00 $0.00 Well Permit Number: 264052-A TERMS AND CONDITIONS A permit fee, as set by separate ordinance of the Board of Weld County Commissioners, shall be required of applicants for new individual sewage disposal systems (ISDS), payable at time of application. Permit foes are non-refundable: pemtlt applications are non-trensferade. If both a building permit and an ISDS arc issued for the same property and construction is not commenced prior to the expiration date of the building permit, the ISDS permit shall expire at the same time as the building permit. If an ISDS permit is issued for a property that does not require a building permit, the ISDS permit shall expire one year after its issuance if construction on the septic system has not commenced. Any change in plans or specifications after the permit has been issued invalidates the permit unless approval is secured from the Health Officer or his/her designated agent Expired permits can be renewed by payment of the permit fee only if: A. There has been no change in the plans and specifications of the proposed system as set out in the original application or such change is reviewed and approved by a Division Representative. B. The surrounding land, its use or zoning has not changed so -as -to cause the original application not to be acceptable under these regulations. The completeness of this application is conditional upon further mandatory additional tests and reports as may be required by the Weld County Department of Public Health and Environment (WCDPHE). The issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under article ID title 25, CRS as amended. The applicant certifies that the proposed system will not be located within 400 feet of a community sewage system. The undersigned certifies that all statements made, information and reports submitted herewith are, or will be, represented to be true and correct to the best of his/her knowledge and are designed to be relied on by the WCDPHE for evaluation for purposes of issuing the permit applied for herein. Applicant further understands that falsification or misrepresentation may result in the denial of the application or revocation of any permit granted, and in legal action of perjury as provided by law. X Owner/ r plicant " Date Form: RT_HAPP r 4$74, op, 1111111 COLORADO SEPTIC INFORMATION FORM To obtain an I.S.D.S. permit, one must file an "application for Individual Sewage Disposal System" at the Weld County Environmental Health Services office and pay the application fee. A "repair" fee shall be charged for the expansion, replacement, or repair of an existing system. The following information must be provided on the septic information form. PARCEL NO.: 1 0 5 17 3 .2 00 00 ` (12 DIGIT NUMBER) CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650 r PROPERTY. OWNER: (� (Aide oc.e C n feria Y i seSf, Ant CD ri I I Lo- c-te4--- MAILING ADDRESS: 2-0 Cherry Ave_ CITY Ca+on ST Co ZIP 8061 HOME PHONE: ( 17P LIS y- 3 59I WORK r PHONE (47o)5g0 - Los (O FAX (990)1459-360'4 APPLICANT NAME: c I t 1\ BLa f'f e_r MAILING ADDRESS: 2-0 (1PXr,1 Ave_ -CITY CoL4DC) ST CO ZIP SOWS HOME PHONE: (9ri0) q5'/ 35Y1 f WORK PHONE 1 ) S9o-wIs4o FAX (9'7Qi 1st/ -36,01f LEGAL DESCRIPTION PT j'ag' PT Se Ihi SEC 3 d TWN 9 A/ RNG (4W ACRES SUBDIVISION LOT BLOCK FILING DESCRIPTION OF BUILDING (EX: HOUSE, MOBILE HOME, MODULAR, SHOP, OFFICE) \4O use. SITE ADDRESS I R 331 w CA a 9 P Ia-}+e vi l ie CO galas l DIRECTIONS TO SITE FLAN IkS SO�i Il thtr0k�h C� ilcresf. �Cq (yEast roxia rr,i �S Soct4-h o IIc-resf . t sf house on (J NEW PERMIT PAIR PERMIT VAULT PERMIT pr $ 400 $ 400 $ 150 IF OBTAINING A REPAIR PERMIT, PLEASE LIST PREVIOUS OWNERS OF THE PROPERTY: FLOOD PLAIN YES /® RESIDENTIAL E / NO NUMBER OF PERSONS 1 NUMBER OF BEDROOMS 3 CENSUS TRACT -i COMMERICAL YES /0 no ba.+h-oom BASEMENT PLUMBING S NO erneh_i BATHROOMS: FULL _ I WATER SUPPLY: PUBLIC YES /® NAME PRIVATE 3�4 IA 1 CISTERN YES WELL YE / NO WELL PERMIT # if05a - A PERC HOLES MARKED FOR INSPECTION BY SPECIALIST Hello