HomeMy WebLinkAbout991159.tiff COLORADO DWR - WELL DATA
Applicant: HOWARD WAYNE Receipt No 0254728 Permit 140236
Address: P O BOX 367 GREELEY CO 80632 Phone: 9703530982
Well Location: T5N,R65W Sec 32 NWSW PM=S COORDINATES: 1440S, 148W
Division 1 WD 02 County: WELD
Yield(GPM) : 50.00 DEPTH(FT) : 80 WATER LEVEL(FT) : 0
Uses: DOMESTIC
Driller: LR
Activation: PERMIT ISSUED 04/22/85
Status: OC 01/30/98 New Permit : 07/09/85
COLORADO DIVISION OF WATER RESOURCES - 01/29/99
991159
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I"1SF'1 06F INI)IVIDUI^iI_. SEWAGE DISPOSAL SYSTEM PERMIT NO. G-0502
• WELD COUNTY Y HEALTH DEPARTMENT T NEW PERMIT
ENVIRONMENTAL HEALTH SERVICES
1516 HOSPITAL ROAD, GREEI...EY, CO 80631
353-0635 EXT.,2'225
O"!f\II::I;. EWING ,JOi"IN G. ADDRESS 1515 15 GI_.ENMEI:iE I:u, . PH I
.I.i..i...1...EY CO 80631
AODRESS OF PROPOSED SYSTEM 24302 WCR 3{
LA SALLE CO 80645
L..E:,::}'i^AI... DESCRIPTION H. SITE : N2 C'W4 SEC 3;? TWP 5 I- i'IG 65
SUBDIVISION : LOT. 0 BLOCK 0 FILING
U:7,'ETYPE : RESIDENTIAL
1:A:1ENT':[r•'}I...
SERVICES : PERSONS `'} 1 ,' 00 ti,I_,[..
• BATHROOMS LOT SIZE 1 .72 ACRES
BEDROOMS 3 BASEMENT PLUMBING NO WATER SUP'F'I...Y P'WFI..I...
APPLICATION FEE $150.00
F•'i=:C; ' D BY RANGEL, MARY SIGNED BY EWING REX
1:;AiE 09/i8/85 _
/85
PERCOLATION RATE 6.2 MIN PEr: INCH WATER TABLE DE1''I'H 5 FEET
SOIL I... TYPE SUITABLE PERCENT CENT• GROUND ELOPE 0% DIRECTION
T:I:ON
REQUIRES ENGINEER DESIGN NO
FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON-SITE SOIL.. PERCOLATION i;i::t'T'{':;
THE FOLLOWING MIrNIfUM INSTALLATION SPECIFICATIONS ARE REQUIRED :
SEPTIC TANK 1000 GALLONS, ABSORPTION TRENCH 722,, `•Q. FT..
OR
. ABSORPTION BED 939 SQ., FT.
,i•,I ADDITION, THIS PERMIT IS SUBJECT TO THE FOLLOWING I._OWING ADD:i:T.I:ONrll... TERM:: AND
CONDITIONS :
THIS PERMIT IS GL: ANTI:::I) TEMPORARILY CONSTRUCTION
'MAY
f.,,:' REVOKED OR �'1 " ... .. .. .... ... .. .. .. i',..i..11''I�vlr::.r`:`. .. .. ..; ... •.';'
E... . ...I SUSPENDED I i::.I'J )i::.) BY '1"H i WELD) HEALTH S
. ;: ;j..l ,...I THE WELD COUNTY..:., .. . DEPARTMENT T� FOR i:: :!:.1: ,... ,
ALLOW' �' 1 i' 1 T.j
t:llLli•
I I W E I. .1.1 L ,I INDIVIDUAL ....
,... :. .;.I . ..... MEET
...• I .. I. .. .. ')L. SEWAGE. ... DISPOSAL SYSTEME I)i REGULATIONS
•I i �i 'I i•�l')'f'1+ Jial SI::-LfJf�,li:�
. . ..11..1... ,TO ME:i:.. 1 CONDITION '
. •. .- ,••,I� , TERM OR (:: . �!I)]:'T':I:i:li•,: IMPOSED Ti'll:::l:::l:::t1h! DURING ;;• r
APPROVAL THE, ,..... OR
.. ... •, .. ... OE THIS ... .. DOES e..... NOT CONSTITUTE ASSUMPTION � 1�5 ;
6FPART ... ..i.I..I I ;;' PERMIT I..1.. ...�r.t I._;., i.t.�.
I
' I..I� t t l''• :I:T,.. E�`11•�i r'I;i:: : . OLIABILITY I I !!t FAILURE
,..,,...: .... DISPOSAL ....... ... .. .. ...i4 ... ..15 .I.I'��i�•'11. r... ,^.I,... i�l.
,;::..:I l l.•E ,`.S' T•I:�:I"i .. I'
VAI LLJI...:[CI••I, GEORGE .
ENVIRONMENTAL SPECIALIST D..1.::
THIS PERMIT :[S NOT TRANSFERABLE AND SI"IAL..L. BECOME VOID IF SYSTEM CON!S'I r::CJi:.'. n':t: I A
NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL I=1P'r'i (:i A OF
THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE: RIGH-'IT. TO IMPOSE I', D:I:'-•T:i ONAL. TERMS iMS• AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTIiNUIi`^iG BA.-
SIS. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL. INSPECTION OF T-Hi::: COM-
PLETED
SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT.
;::'Y";' 11=iii :i:\S"T'r=y E..I...C.:Ei ,F
SYSTEM ENGINEER ......../.942/ 1/4.1,t4......._......_.............._...__.. ...__F :I:NAL INSF'E�i- ]:W': -,) IE /G /. 7. -.F ' -
;. Y N1/�-. __......_............................ AI::'P'RO'' AL. /_...__ ) k .... , '
TYPE OF SYSTEM INSTALLED
__.B..G.�-...._. .... . . �....... C�Z 4.._� '... ;.._. .............._.....
I:::T'2'',+':i.i•iOKIMEtN'I AF E i:`IAl._:I..:, I
THE ISSUANCE E:JI::- THIS PERMIT DOES NOT :I:Ml::'LY COMPLIANCE WITH OTHER R 'TA l E:: , cc UN-I 'r'
L..On.Ai..- RE.:GIJLATCJI:;Y OR BUJ.I...D:I:N(.Y R.I..:QUIi:R'EME::NTS, N(:1R SHALT... IT ACT TO i E::i''` If-`, '' '
T HE SUBJECT SYSTEM k:1:1...1... OPERATE :I:N COMPLIANCE WITH APPLICABLE .:T ATE ,'E:: , i.OU 's i ,,ND
LOCAL REGULATIONS ADOPTED F'I:::R.S'L.1i•1UT TO ARTICLE •it)
!', •'I:"i:::. i:�'i11:� '1"L.iL-. PURPOSE - 25, l': Fi.:. •i L�'". .. i�,.:. i-•,i•I:.: l.�7:::... ,
: OF ESTABLISHING S I"IING FINAL APr=ROVA1... OF AN INSTALLED SYSTEJ i''r:1i:;
ISSUANCE I..: UI A I._lit:AL.. OCCUPANCY II RU.i L PURSUANT S'UAN'T' TO CRS 1973 ?': ••• :i ,:•...11i
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HELD COUNTY t[EA1-Ti3 .)E:PAR"I CF -�III :TOE 0ENVIRONMENTAL. PROTECTION ,-RVICES LOAN 41517 16th Avenue Court ui ISDS 4
Greeley, Colorado 30631 - REPAIR a_
(303)353-0635 - �Health Depa tnh"11t f3 PII'fri 0
6) / STATEMENT OF EXISTING FOR SEPTIC SYSTEM
Y. vl-3 `,17
0.
} ( PLEASE FILL OUT IN BLACK INK ONLY)
OWNER OF RECORD: cre,e/e-/+ /Y6k(//ir�3 Lc/ C PHONE: 3. 3 -J ?J2
MAILLNG ADDRESS: p, D, fs 36 7 6/d'!Gy (b' aE''6SL_
/ City State Zip
SITE ADDRESS: 2_44360 WO 3 `j la,S- A_ ( a etc,64fS-
City State Zip
LEGAL DESCRIPTION: PT: PT: SECTION: 31 TOWNSHIP: Si✓ RANGE: 6._S- 1-c/
SUBDIVISION: LOT: BLOCK: _ FILING: -
NUMBER OF PEOPLE: 3 BATHROOMS: / ' LOT SIZE: 6O Ac, BEDROOMS: j
CSIDENTIAL) or COMMERCIAL BASEMENT PLUMBING: Yes CIO, ) WATER SUPPLY: tde//
SYSTEM SIZE: Tank is constructed of eeflea and has // CVO gallons capacity
(material)
FIELD: Bed 7 $0 sq . ft. or Trench ---" sq. ft. DATE SYSTEM INSTALLED: /77/ _
You are required tc draw a diagram of the system an 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./43o /21 zi/a e� a �- oz_f��
Date / er
Subscribed and sworn to before me this . J( ) day of L,,fliY7,/,,E, . 199 7
by C 1 z, ,e c r-rtf r _
Witness my hand and official seal. My commission expires_: 2 � '/2 1 OOG __
/ Dal:e� ki
Notary
Pub:Vic
STATE?:ENi OF EXISTING REVIEWED BY: /�'sk j�l y2 __ -
Environmental Environmental Protection Specialist _
BLACK INK ONLY !
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