HomeMy WebLinkAbout20081087.tiff WELD COUNTY DEPARTMENT OF PUBLIC HEALTH&ENVIRONMENT
1555 NORTH 17TH AVENUE,GREELEY,CO 80631 PHONE: (970)304 6415 FAX:(970)304-6411
WEBSITE: WWW.CO.WELD.CO.US
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APPLICATION/RECEIPT
Initials: SKE
Permit Number: SP-0100654 Receipt Number: HAP-01649
12-17-2001 Amount: $315.00 Payment Method: Check Notation: 3021
Owner Name: TEMPEL SCOTT &NYBO LIZA
Applicant Name:NYBO LIZA
Parcel Number: 1467-03-3-00-049
Site Address:
I oration: 5454 CR 7 03 01 68
Total Fees: $315.00 Total All Payments: $315.00
This Payment: $315.00 Balance: $0.00
Account Code Description Amount
2560-41400-4221-4203 New Septic Permit $0.00
2560-41400-42214203 Repair Septic Permit $315.00
256041400-42214203 Vault Permit $0.00
2560-414004410-4203 Potable Water $0.00
*Description: HOUSE
Commercial: (Y/N) N Residential: (Y/N) Y Acres: 2.5
Number of Persons: 3 Basement Plumbing: (Y/N) Y
Number of Bedrooms: 3 Bathrooms: Full - 2 3/4: 0 1/2: 0
Water Public: (Y/N) Y Water Supply: LEFT HAND WATER
Water Private: (Y/N) N Cistern: (Y/N) N Well: (Y/N) N Well Permit Number:
NOTICE
Applicant acknowledges receipt of the individual sewage disposal system guide and that the completeness of this
conditional upon further mandatory and additional tests andreports as may beapplication is
Health and Environment to be made and furnished by the the by the Weld m ntof County Public Health ment andof Public
Environment for applicant or by Weld County Department of
purposes of the evaluation of the application; and 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 10, title 25, CRS as amended. The
applicant certifies theat the proposed system will not be located within 400 feet of a community sewage system. The undersigned
hereby certifies that all statements made, information and reports submitted herewith and required to be submitted by the applicant
w�r will be. represented to be true and correct to the best of my knowledge and belief, and are designed to be relied on by the
Weld County Department of Public Health and Environment in evaluating the same for purposes of issuing the permit applied for
herein. I further understand that any falsification or misrepresentation may result in the denial of the application or revocation of
any permit granted based upon said applicaion and in legal action of perjury as provided
from the sigpabnv rlst. by law. -a➢Llitatl4D expires one year• Q z ?� EXHIBIT
OrwnerHt Date
Form Rr
2008-1087
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WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, COLORADO 80631
• PHONE (970) 304-6415 FAX (970) 304-6411
Permit//: SP-0100654 Sec/Twn/Rng:03 01 68 PERMIT
Owner: TEMPEL SCOTT &NYBO LIZA Applied: 12/17/2001
Applicant: NYBO LIZA Expires: 12/12/2002
Permit Type: RREP C=Commercial, R=Residential + NEW, REPair, VauLT
Parcel #: 1467-03-3-00-049
Location: 5454 CR 7 03 01 68
Legal Desc:
Description: HOUSE
Commercial: N Residential:Y Acres: 2.5
#of Persons: 3 Basement Plumbing: Y
# of Bedrooms: 3 Bathrooms - Full: 2 3/4: 0 1/2: 0
Water Public: Y Water Source: LEFT HAND WATER
Water Private: N Cistern: N Well: N Well Permit Number:
Percolation Rate e204 Limiting Zone oft (j in Descriptio (i
% Ground Slope Direction Soil Suitable (Y/N) $j() f
'rimer Design Required (YIN) Nr6 In 100 Year Flood Plain (Y/N) ��j O
From the application information supplied and the on-site soil percolation data the fol
lowing minimum installation specifications are
required:
Chambers
Septic Tan" €20 O O gallons, Absorption Trench square feet
or
Absorption Bed ( 400 square feet
In addition, this permit is subject to the following additional terms and conditions:
CCIJbTeKY A Cco,O injQ yip ErlQ,0, trieys Dr-As J. f1 i r . lul:O
County 1505 12i E LA7fh&LS APPLY.
NOTICE
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 not transferable. 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 contingent upon the final inspection of the completed system by the Weld County Department of Public
Health and Environment. This permit expires one year from the application date.
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Form:s_PEanrr Environmental Health Specialist Date
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WELD COUNTY BOARD OF HEALTH
ENGINEER DESIGNED SYSTEM REVIEW
PROPERTY OWNER: Scott Tempel PERMIT NO.: SP- 0100654 (Rnew)
LEGAL DESCRIPTION: PT: SECTION: 03 TOWNSHIP: 01 RANGE: 68
SUBDIVISION: l LOT: BLOCK: FILING:
SITE ADDRESS: 5454 WCR 7, Erie.
FACILITY: Residential 3 Bedroom home ACRES: 2.5
PERC RATE: 204 SOIL: Unsuitable WATER SUPPLY: Left Hand
LIMITING ZONE: at grade, clay
XXX ENGINEER DESIGN (3.5) EXPERIMENTAL DESIGN (3.14)
ENGINEER: Sc'orr,coi aato AssoeiArts(69 yi}>SC;ot '\
• ADDRESS:
ESTIMATED FLOW: G.P.D. 675
PRIMARY TREATMENT: Standard tank CAPACITY: 2000 gallons
DISPOSAL METHOD: Absorption/ET bed SIZE: 6400 square feet
REQUEST FOR VARIANCE:
STAFF COMMENTS: The system is adequately sized for the proposed load. A low
pressure drip system will be used.
STAFF RECOMMENDATION: Approval
ENVIRONMENTAL PROTECTION SPECIALIST: Deborah Blandin
REVIEWED BY BOARD: 01/22/02
B.O.H. DECISION: APPROVED: )( DENIED: TABLED:
CT' •
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Chairman
Weld C. my Board of Health
• M:\ENVIRD$MENTAL HEALTH SERVICES\Deb11SOS ShellsVwh engineer review.wpd
II
• Left Hand Water District
December 10, 2007
Cito
5454 WCR 7
Erie, Co 80516
Re: 5454 WCR 7
TO WHOM IT MAY CONCERN:
The property located at the above address or legal
description is within the "SERVICE AREA" of Left Hand
Water District . The tap fee for the above named property
has been paid. This entitles one living unit and a
business if such business is operated by the occupant of
• the the business facility- a
h-iic residence and both tllc uuaa.♦icaa ia�.11lt;y and the
residence are situated in the same structure under the
common ownership of the person holding the residential
tap, to receive water service at this location.
If you have further questions regarding this matter, you
may contact me at the District office.
Sincerely,
Kim Lane
Administrative Assistant
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P_O. Box 21(1 Niwul, CO 80.344-0210 Phone 303-530-1200 r. I ax 303-510-5252 ti www.l cull a ndwa terurg
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