HomeMy WebLinkAbout991402.tiff #c.aetl Ne hth U.Dy� WELD COUNTY HEALTH DEPARTMENT SE#
�LL�iWVtiV ENVIRONMENTAL PROTECTION SERVICES ORG PERMIT#CYIi l?Sf9
1517 16TH AVENUE COURT REPAIR#
GREELEY, COLORADO 80631 LOAN#
. ,. PHONE: (970) 353-0635 ISDS#
FAX: (970) 356-4966 -L)10,91R4v,
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
(PLEASE FILL OUT IN BLACK INK ONLY)
PARCEL# CPIL( C17
PROPERTY OWNER (y€42 W6- (.QKvi Q ut uS PHONE NO. 11 3361-3Zr:}3
MAILING ADDRESS D (-a/1k
City State Zip
DESCRIPTION OF BUILDING (ex. house, mobile/modular home,shop,office)
SITE/LOCATION ADDRESS 0 w 0 - C�t0. vy W
City State Zip
LEGAL DESCRIPTION • tr.'. PT SECTION TOWNSHIP RANGE
SUBDIVISION 11,@w LOT lo BLOCK FILING
CENCUS TRACT u LOT SIZE/ACRES I
COMMERCIA. YE . N I RESIDENTIAL YES/NO
NUMBER OF PERSONS Z- BASEMENT PLUMBING YES/NO
BEDROOMS BATHROOMS FULL j 3/4 1/2
WATER SUPPLY PUBLIC YES/NO UTILITY NAME
'RIVATE YES/NO CISTERN YES/NO WELL YES/NO WELL PERMIT#
SYSTEM SIZE: Septic tank material is constructed of W r Lr& and has 10w gallons capacity.
�
FIELD: Trench square feet or Bed 459c)c) square feet YEAR INSTALLED ( ,/
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/is not in good working order and to the best of his/her knowledge is/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.
3 I' 7 2of -e_t -
DATE OWNER
Subscribed and sworn to before me this day of , 199 ,
by
Witness my hand and official seal. My commission expires:
DATE NOTARY PUBLIC 991402
STATEMENT OF EXISTING REVIEWED BY
ENVIRONMENTAL PROTECTION SPECIALIST
1`�rX112 `i
_
WELD COUNTY HEALTH DEPARTMENT
1555 17th Avenue /? ---7 /
Greeley, Colorado
1�Ct{Ct(C I U�(OI cosPh. 353-0540 RECEIPT N0. 7
Application for permit to Install, Construct, Alter, or Repair an Individual Sewage Disposal System.
e
o J �i
Owner .,f' y //
Address /. / /'F `�x`I Phone -/�:�-?��D
---i �t� '/% — 4/it/i0�(.�O1O.Uy
Direction to site `� %t ,J ',<..1 - '�- /Legal De§cr:p ion »T
r
I General Information I'� S�eS.`C.R` Dept. Use Only
No. Bedrooms I No. Persons ex-• Pere. Rate (Avg. of 3) l -um-04'nrsrl
No. Baths / Basement Plumbing — i,, ,,._ Soil Type %.-410•n� - 1°t`.
Size of Lot
t(y,PC II 20 Table Depth (!
. , , 6 /2.Ik Lot Grade .<Win
H20 supply (if well give depth) ; / ' ' s "" f
Type of sewage disposal requested: Requires Engineer Design Yes .)e. No
Septic tank k' Privy Other If yes — reason
Comments:
Installation Instructions: 4.______--
Septic Tank
T5O Yh .Gals. Absorption Field 100 , Sq. Ft.
Other Seepage bed 1 3 a .__ASg, Ft.
Special Instructions
P. Xh Q—r. tr".10. -,F'T
This system will be constructed and installed in accordance with the above specification and regulations
regarding individual sewage disposal systems in Weld County, Colorado.
This permit shall expire at the same time as the building permit, or, if no building permit is issued, the permit
shall expire 120 days after its issuance, if construction has not been commenced.
/
Date: �i ( / / � Owner: 179 ove.4 4 r/"`'
Applicant: d
The plans and specifications as shown are approved pending payment of permit fee.
Date: 5/94/75'
Sanitaria
The above system inspected and found to comply with plan and description.
Systems Contractor: :: :rian
: �4�`%
Engineer Review:
(Date) N/ /O (Signature)
I
Permit Fee: $ --:./C, !.' J
1
Received by: V,/L,,/ 44 ' �+ e Date: .� X C/ '',/� /� I
BOARD OF DIRECTORS NORTH WELD COUNTY WATER DISTRICT
GARY SIMPSON
ERNEST ROSS r HIGHWAY 85 • LUCERNE, COLORADO 80646
W.M. McKAY CHARLES ACHZIGER a ;fill DON POSSELT, MGR.
ROBERT ARNBRECHT 1- P.O. BOX 56 • PHONE 970-356-3020 • FAX 970-395-0997
January 12, 1999
Mr. Ben Patton We4i no; nflt Oi-rnanp Dept.
WC Planning & Zoning
1400 N. 17th Avenue
Greel ey Co 8O631 JAN 1 f- 1999
RE: Water Service `"" E
Dear Sirs,
This letter is in response to your inquiry regarding water service to the following described
property:
5OO N. 1st Avenue
1. X Water service is presently being provided to the above described property.
#146733 - 5O6 N. 1st Avenue, Greeley
2. Water service can be made available to the above described property and provided all
requirements of the District are satisfied.
Yes,North Weld County Water District can provide water service to the above mentioned
property with approximately ft. of line extension and provided all requirements of the
District are satisfied.
If contracts have not been completed with North Weld County Water District within one year from
the date of this letter, this letter shall become null and void.
Additional comments:
7ec.rely, •
Don Posselt, Manager Don Carl i sl e
North Weld County Water District
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