HomeMy WebLinkAbout990684.tiff r',1
I•1SFI06P INDIVI.Dl.IAL. SEWAGE DISPOSAI... SYSTEM PER'ti:I:1 . NO, G785023
WELD COUNTY I••IEAI...TH DEPARTMENT NEW PERMIT
ENVIRONMENTAL Hi- -iL1 ll SERVICES
1516 HOSP.I.TAL. ROAD, GREELEY, CO 80631
353-0635 EXT.;:'L?::- i
OWNER EW:I:NC; JOHN G, ADDRESS 1515 (:;•I...Ei`!t1i:::I:iL: RD, PH (303) 353-15
tXI;I..:I.:I...EY CO 80631
ADDRESS PROPOSEDSYSTEM 2430' WCR 39
LA S A i...1...E CO l.. 80645
LEGAL DESCRIPTION OF SITE : N:' r'W4A x2 TWP ,:,
SUBDIVISION : LOT 0 BLOCK 0 FILING 0
USE TYPE : RESIDENTIAL
IAL..
SERVICES :: PERSONS .. A} BATHROOMS 2,00 -
IZE 1 .72 ACRES
BEDI~i00MHr 3 BASEMENT PLUMBING NO WATER SUPPLY F'WEL.L..
APPLICATION FEE $150.00 -
k C' i) BY RANGEL, MARY SIGNED BY EW1:NG REX
DATE:: . 09/18/85. DATE. 09/18/8'
PERCOLATION RATE 6.2 MIN PER INCH WATER TABLE DEPTH 5 FEET
SOIL TYPE SUITABLE PERCENT GROUND ELOPE 0% DIRECTION
REQUIRES ENGINEER DESIGN NO
FROM THE APPLICATION CATION INFORMATION SUPPLIED AND THE ON-SITE SOIL. PERCOLATION DATA
THE FOLLOWING. MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED :
:EF:'T:I:C: TANK 1000 GALLONS, ABSORPTION TRENCH 729 SQ. FT. '
OR
ABSORPTION BED 939 E( . FT.
IN ADDITION, THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND
CONDITIONS :
THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION T(•• COMMENCE. THIS PERMIT
MAY BE REVOKED OR .SUSPENDED BY THE WE -D COUNTY HEALTH DEPARTMENT FOR REASONS SET
FORTH IN THE WE.L_D COUNTY INDIVIDUAL SEWAGE DISPOSAL SPO.:yAI... SYSTEM ECM REGULATIONS INCLUDING
FAILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPORARY OR I'INAI..
APPROVAL . THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE
DEPARTMENT OR I'T'S EMPLOYEES OF: LIABILITY T•Y FOR THE FAILURE
SEWAGE DISPOSAL SYSTEM, _ (.1i"L: OR INADEQUACYOFri E.
VARG(.JLICI••I, GEORGE 09/24/85
ENVIRONMENTAL SPECIALIST DATE
THIS PERMIT LS NOT TRANSFERABLE AND :i-(AI...i... BECOME VOID IF SYSTEM CONSTRUCTION HAS
NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE,' BEFORE ISSUING FINAL.. APPROVAL OF..
THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE:: RIGHT 1'O IMPOSE ADDI•-
TIONAL. TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA-
SIS. FINAL PERMIT APPROVAL. IS. CONTINGENT UPON THE F:I:NAL.. INSPECTION OF THE - COM-
PLETED SYSTEii BY •101 WELD
COUNTY HEALTH DEPARTMENT,tc io-21- V-5- A /
�
SYSTEM INSTALLER d� ��
W_. ..w FINAL INS
SYSTEM ENGINEER: NI. �____... _.. APPROVAL _.w
TYPE: OF SYSTEM INSTALLED rl -
.-��-..-...-- E:NV:I:F'tC:+l`..i`'if::T:! i"AI_. 'f:::(;:CAL_IS'T
THE ISSUANCE O1- THIS PERM:I.... DOES NOT IMPLY COMPLIANCE WITH OTHER S'T'ATE, COUNTY
OR L..00AL.. REGULATORY OR BUILDING REQUIREMENTS, NOR SHALL :i:T ACT TO CERTIFY . .
THE SUBJECT SYSTEM WILL OPERATE 1 N 1,O!'Mi"'LIANC:;E. WITH APPLICABLE STA
LOCAL.. Ri GULAT IONS •ADOF'•T'LD 1"'E:R,SUANT TO ARTICLE 10, TITLE 25, CRS 1
EXCEPT T FOR THE PURPOSE OF ESTABLISHING FINAL APPROVAL. OF AN IN ;'1 sl
ISSUANCE OF A LOCAL.. OCCUPANCY PERMIT PURSUANT 'rn CRS 1973- 25-10-1
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DEPARTMENT OF HEALTH
1517 16TH AVENUE COURT
GREELEY, CO 80631 ADMINISTRATION C 586
• HEALTH PROTECTION 970) 353-0635
COMMUNITY HEALTH (970) 353-0639
CO ORADO FAX (970) 356-4966
December 19, 1997
Terra Holding, LLC
P.O. Box 367
Greeley, Colorado 80632
RE: Terra Holding, LLC. ISDS No. : 97-065
Septic Permit No. : SE-9700119
Dear Sir:
On December 12, 1997, an evaluation of the existing disposal semindividual septic
3 , Township t05 North, Range at 24300 d65 was cony unty oad 39,
Troy Swain.
Section
There is not enough information to determine if the individual
dividualasewage
disposal system referred to in Statement of Existing SE-9700119 is
adequate to accommodate the mobile home served by this system.
The compliance m recommends
ncewith curentregulations. At permit tmust ems bbetbobtainednand a
site evaluation conducted prior to any alerations to the systems.
Be advised, neither the County of Weld nor any of its agents or
employees undertake or assume any liability to the owner of the above
property, to any purchaser of the above property or to any lending
agency making a loan on the above property or in the report.
This
inspection
with curentregulations conducted compliace
andforrdetecting the ohealthdhazardslobservablenat
the time of inspection. This does not constitute a warranty that the
system is without flaw or that it will continue to function in the
future. Inspections requested during periods of snow cover and high
soil saturation may be of questionable value to potential buyers due to
inadverse conditions. Evaluations based on yyStatements of Existing
dicatingecurrent statusaofothehe systemeand repres owner enting to theebesttof
his/her knowledge the system is not failing to function properly.
If we can be of any further assistance, please contact our office at
353-0635.
Sincerely,
Troy Swain
Environmental Protection Specialist
TS/rb-3188
Enclosure (1)
cc:Weld County Planning Department
HELD COUNTY HEALTH DEPAP tE- r ([(��''TTT.:-'r� SOE 0 P7Oo/IC/
ENVIRONMENTAL PROTECTION SERVICES LOAN a
1517 16th Avenue Court L5DN a 97 _neos
Greeley, Colorado 80631 REPAIR °
(303)353-0635 \raid County Health Department pgaQT a
STATEMENT OF EXISTING FOR SEPTIC SYSTEM .
(PLEASE FILL OUT IN BLACK INK ONLY)
OWNER OF RECORD: egg* ik,,,,,,, Lcc PHONE: 3�"1a SFZ-
MAIIL*IGADDRESS: l? e . /34. 367 6i-eel/el `O PS632--
ci State Zip
SITE ADDRESS: act 306 Wc-2 3 / („aSGYX9_ do t06'FY
. City State Zip
LEGAL DESCRIPTION: PT: PT: SECTION: 33, TOWNSHIP: 5-4-/ RANGE: e Sic./
SUBDIVISION: /14. LOT:_ BLOCK:_ FILING:
NUMBER OF PEOPLE: 3 BATHROOMS: I i''Z- LOT SIZE: go e /¢c. BEDROOMS: .j
C -7:-. nn
RESIDENTIAL or COMMERCIAL BASEMENT PLUMBING: Yes N. WATER SUPPLY: l�tA/ -�C
SYSTEM SIZE: Tank is constructed of eetes_.t and has (OOO gallons capacity
(material)
FIELD: Bed P%J .sq. ft. or Trench Dw46,rw—sq. ft. DATE SYSTEM INSTALLED: 19?/
You are required to draw a diagram of the system on the reverse side of this form in
black ink only and indicate location, 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 failing to function properly.
I further understand that any falsification or misrepresentation may result in revocation
of any permit granted based upon this information hereby submitted and in legal action
for perjury as provided by law.
z1g ,C77 (itt0 .
bats Owner �7
Subscribed and sworn to before this �' day of / ''p'ep'"'' . 199 /
/ G /1 -- — -
by (_)/.[,(�ir'�l� r(-�li`t�/1.�' `—._-. Q �)
Witness my a hand and official. seal. My commission e pires: (W C2
Date Cr Notary Pu c t
STATEMENT OF EXISTING REVIEWED BY:
Environmental Protection Specialist
BLACK INK ONLY!
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