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I••1;::! ':l.c:,, P ND:1:'v i:i:UAL SEWAGE_ ):):rSPdSAL. SYSTEM F:ERM:1:'T' NO. G-929092
EXHIBIT
,..► WELD COUNTY HEALTH AE._T'I•'I DEPARTMENT MENT NEW PERMIT
T
1 11? ENVIRONMENTAL HEALTH SERVICES
1517 16TH AVENUE COURT, (I:E:E:L..I :Y„ CO .:3(>d):S:L
.-------------
353-063'5 .2225
OWNER II:R VANT1••EU Y NE:,, MARK/PHYLLIS ADDRESS 229 1.4 CNTY RD 17 PH (303) 532-250c
I:�Ei::RT'I••IOUI) CO 80513
r°,).) )+F:I::SS OF PROPOSED SYSTEM 2505 WCR 46 ! i
E ERTHOLJI) CO €30 :I.3
LEGAL DESCRIPTION:I:F'T:ION OF SITE. SE4 SEC 9 TWF' 4 RNG 6
SUBDIVISION::'. :1:'::>:1:CJN.. LOT 0 BLOCK FILING 0
1.1::51..: ;TYPE: RESIDENTIAL ISDS #034•".92
V BATHROOMS 2.00 1._(:)T SIZE: 2.00 ACRES
SERVICES: PERSONS �A�r�1-IIF:
BEDROOMS S 5 BASEMENT PLUMBING NO, WATER SUPPLY 1...'TI••ii '
APPLICATION FEE:: $0,.00 I
RI:::C:'D BY MoRR:I:SON„Lc:'RRA:LNE SIGHED BY MARK VAN•(•L•H YNE
DATE 05/:1.3/92. DATE 05/1 3/92
F'�:......:;CJ............ON RATE o..0 MIN PER INCH �L'1'MIITII'IG LONE 0 FEET'
SOIL. TYPE SUITABLE PERCENT GROUND SLOPE 0% DIRECTION
.... ....;.Rl:::;:i ENGINEER DESIGN NO
FROM THE APPLICATION INFORMATION SUF`PLIE::I)I AND THE: ON--SITE SOIL .PERCOLATION DATA
T'1••11::. F'C31...I..OWING MINIMUM INSTALLATION SPECIFICATIONS ARE: REQUIRE:D2
SEPTIC TANK 1000 GALLONS, ABSORPTION TRENCH' 400 SQ., FT.
,� l OR
At St3HPTION BED 80. FT .
ADDITION, THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND
t (.ND I:T•IOHS: _......_........__...._.._........_.._••___..._._.._....._......_.. .._........_..... _.._.. __.. _....._._..- .._ _...._....._...__.._.._._... .._. ......_____________•Ti•'lrs PERMIT :IS GRANTED TEMPORARILY TO AI._LO CONSTRUCTION TO COMMENCE. THIS PERMIT
MAY BE REVOKED OR SUSPENDED BY THE WELD COI NTY HEALTH DEPARTMENT FOR REASONS SET
FORTH IN •WI` WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDING
' FAILURE TO MEET ANY TERM OR CONDITION :II•IF'CJ€IEI) THEREON DURING TEMPORARY OR FINAL
APPROVAL. THE ISSUANCE OF THIS PERMIT DOES: NOT CONST:I:'TtU•TE ASSUMPTION BY THE
I)';:. AI:;TIYIENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILUREOR INADEQUACY OF "I'I.•IE
SEWAGE DISPOSAL SYSTEM..
ST'OL..L.F, JEFF 05/13/92
; ENVIRONMENTAL SPE'CIAI._IE:T DATE:
I
111:I:S PERMIT IS NOT TRANSFERABLE AI'II) SI••IAI..,I... BECOME VOID IF SYSTEM CONSTRUCTION HAS
NOT COMMENCED WITHIN ONE:: YEAR OF ITS ISSUANCE. BEFORE E: ISSUING F:I:NAL. APPROVAL OF
THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT ME"1.1'T RESERVES THE RIGHT. TO IMPOSE AJ:)r):I:—..
•.'C.'.•h.t:•'J._ TERMS AND CONDITIONS REQUIRE!) TO MEET OUR REGULA'T'IONS ON A CONTINUING BA—
SIS. F'INAt... PERMIT APPROVAL IS CONTINGENT, UPON THE FINAL INSPECTION OF THE COM—
PLETED SYSTEM BY TI•'IE:: WELT) COUNTY 11EAL..TI-1 DEPARTMENT.
I I
S''!STEM INSTALLER UNKNOWN FINAL. INSPECTION DATE 05/13/92
::S'i S is M ENGINEER APPROVAL.. STOLI_.., OE»F I •
I.E OF SYSTEM INSTALLED TANK ENVIRONMENTAL SPECIALIST
t .,.S::1..AI••tC;!": OF THIS PERMIT DOES NOT IMPLY ;COMPLIANCE id:l:"fI—I OTHER STATE. COUNTY
UF, i..UCAL, REGULATORY OR BUILDING REQUIREMLI•4S., NOR SI•IAI...I._ IT ACT TO CERTIFY THAT
THE SUBJECT SYSTEM WI.L.i. OPERATE :I:H COMPLIANCE: WITH APPLICABLE STATE., COUNTY ANI)
l...rti;::;A;._ F:EG(.JI...AT:E:ONS ADOPTED PERSUANT TO ARTICLE 10, T'ITI...E 25, CRS 197:>, AS. AMENDED,
E ..::::::...>T FOR THE PURPOSE OF ESTABLISHING F IHAL. APPROVAL. OF AN INSTALLED 5131 EM FOR
:(:` ..JAl'•ICE. OF A LOCAL... OCCUPANCY F•'ERN:I:T PURSUANT TO CRS 1973 2.5'•—:10••••1:1.:;. (2) .
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WELD COUNTY HEALTH DEPARTMENT �� : r/i
'oE it .
,ENVIRONMENTAL PROTECTION SERVICES LOANit
517 16th Avenue Court
ISDS 0 C` C-.!:' C
Greeley, Colorado 80631 -- REPAIR 6 - ���z
(303)353-0635 Weld County Health Department
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
(PLEASE FILL OUT IN {BLACK`' INK ONLY)
OWNER OF RECORD: ,-c-\Rei y cI (�)Nq 1...11/4.7..c) VAl� l N a.T v, PHONE: ;3D-1 - 5 -L —, 5'dc2
MAILING ADDRESS: 4019 NORTH CM NT`l 20An n 1 )PRA7-1JUn Co g)5 C 3
City State Zip
SITE ADDRESS: -1555 (i). 0_, R • q , RTItOwU CC ` c-) /3
City State Zip
LEGAL DESCRIPTION: PT: Cjt C' PT: SECTION: 9 TOWNSHIP: HIV RANGE; {0�( (l5 Pte
SUBDIVISION: LOT:_ BLOCK:_ FILING: I\_____
NUMBER OF PEOPLE: 4 BEDROOMS: cj BATHROOMS: rQ WATER SUPPLY: Lrrrke 1/00-lSOdJ
CRESIDENTIZI, / COMMERCIAL BASEMENT PLUMBING: Y LOT SIZE: ,-,1 acres
SYSTEM SIZE: Tank is constructed of C'rACI$-fl and has It1flO gallons capacity
(material) aN
FIELD: Bed or Trench ' r(' square feet. DATE SYSTEM INSTALLED: .4104)
83
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.
Q
5 —I 3 -92 :.+Q tan /,11 Y\ t_ i a_ua.•� o
Date ,1J Owners--
Subscribed and sworn to before me this ! ? day of /7 4 , 1992,
by pc 4 !,4 qt. 1/9,q-vim •1- /14 /Le j'4ti'
Witness my hand and official seal. My commission expires: S '2:20 ?cam
") •l'— ,2 -%._ R-t _- -Li-i' '' C/
Date n No ry Public-
7/0 pt. tAi f:•t L r',--u p C.. /nt 4
STATEMENT OF EXISTING REVIEWED BY: C. 4, '9 • / /
14-e
ir0P entai Protection Specialist
LITTLE THOMPSON WATER DISTRICT
Telephone(970)532-2096
DIRECTORS.
Torn Reynolds 835 E.Highway 56
Rtmtdem June 27, 2000 DrawerG
Lao Bake( Berthoud.Colorado 80513
Keith Croonquot
Glenn W Gibson
Dean Meetson
Carey.) Satomonson
James W.Sttah
MANAGER:
Richard H H Yminet
Amanda L. Sanchez
Intermill Land Surveying
1301 N. Cleveland
Loveland, CO 80537
Dear Ms . Sanchez :
This letter is in response to your request for a water service
commitment for the existing residence at 2505 WCR 46 .
The District provides water service within its service area as
defined by the District . The provision of water service by the
District to the above property is done under the terms of the Rules
and Regulations of the District established by the Board of the
District from time to time . You may obtain a copy of the Rules and
Regulations from the District . This letter outlines the provisions
of the Rules and Regulations, however this letter does not change
any provisions of the Rules and Regulations . The Board of the
District may alter and amend the Rules and Regulations at any time,
and the provisions of this letter are subject to alteration and
amendment based on changes in the Rules and Regulations of the
District .
We currently serve the single residence through tap # 473 and
will continue to serve the tap at this location subject to the
Rules and Regulations of the District .
YOU ARE HEREBY ADVISED THAT THE RULES, REGULATIONS AND TARIFFS
OF THE DISTRICT ARE SUBJECT TO CHANGE WITHOUT NOTICE; AND THIS
LETTER IS ISSUED WITH THE SPECIFIC LIMITATION THAT THE DISTRICT MAY
CHANGE THE RULES, REGULATIONS AND TARIFFS APPLICABLE TO THE ABOVE
PROPERTY AT ANY TIME WITHOUT NOTICE TO YOU OR ANY PERSON.
If you have questions, please contact me .
i-- Regards
Michael T. Cook P . E .
District Engineer EXHIBIT
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