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PEASE MAKE I
CHECK CMCENTRAL WELD COUNTY WATER DISTRICT PLEASE RETURN THIS STUB WITH PAYMENT
PAYABLE TO 2235 2nd Ave. Ph.352-1284
Greeley,Colorado 80631 113310
EA DECWATER BILLRECD EC 0 1 2003 USAGE 1/01 2/O1
113310
PER 1000 GALLON +
ti
USAGE /j� I 3655 3866, 11. 7.9
PER 1000 GALLON 11/01 2/01 l
3855 3966 11 37.95
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Water Restrictions have been l if tet:
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Water Restrictions have been lift-?d 12/10/2003 0.00 37.9
I2/10/2003 0.00 37.95 ASERVICE DD SS
PANENERGY FIELD SERVICES, INC.
oDRS
ED C/O DUKE ENERGY
PANENERGY FIELD SERVICES, INC. 1324 NORTH 7TH AVENUE
C/Cl DUKE ENERGY GREELEY, CO 80651-
1324 NORTH 7TH AVENUE
GREELEY, CO 80631-
2004-0741
F-30y---i AP��.IC,4Tl0N �7R INDIVIDUALSEWAGE DIE,.-,
SYSTEM /FZ
Ale,---,boo r"- WELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTI+SERVICES New
1516 Hospital.Road, Greeley, CO 80631 Repair _
3534540 EXT. 270 OP
JWNER ' ' Pet,1 ,, d f j I t ADDRESS
ADDRESS OF PROPOSED SYSTEM ? "- ''., � : r> � „ 1
LEGAL bESCRtPTION OF SITE: PT _re S ".1-- 7_7_, R_ ,
SUBDIVISION LOT
USE TYPE: RESIDENTIAL
BLOCK FILING
INSTITUTION
COMMERCIAL X c "` .,t 11,./I ' r. } OTHER'
SERVICES: PERSONS
BATHROOMS LOT SIZE 'L.::y' ) ,rte.--
BEDROOMS BASEMENT P,LLIMBING
r WATER S,IPp1,Y TYPE OF SEWAGE DISPOSAL REQUESTED: 2 (7.2(7, ,7 r, ,f/- c; /! 4r ft -
Applicant acknowledges that the completeness.of this hnd
and reports as may be required by the Weld County HealthiDepartment totbe madonal e anon d furnished byter e applicantoabythe
Weld County Health Department for 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 to,
Title 25,CRS 1973, as amended The applicant certifies that the proposed system will not be located within-40a feet of a com-
munity sewage system. The undersigned hereby certifies that all statements made, information and'reports submitted,here-
ofwith and required to be submitted by the applicant are;or will be; represented to be true nd`correctto the best of my known
ssu ngthe permit applelief, and-are iedfor herein. Ined to rurthr unders andth t on by theWeld o ny falsification-or on-or misrepresentation/may esuth:Department in evaluating the same frorthe�denial
of the application or revocation of any permit granted based upon said application and in legal action for perjury as-provided by law.
Application fee 1- < f
Recd by ' r i :., .e y,$t.F Date . ' ?_ caner/A entSIgnature Date
r. r r r . t * r s r r t * t 0t r t f t t r ! 5. S * In t t t it w t r.1 * t * t t t * * t b t t s t * * b c
FOR DEPT. PERCOLATION.RATE
"` WATER TABLE DEPTH-BE ONLY SOIL TYPE ---.., ..L
PERCENT GROUND'SLOPE
REQUIRES ENGINEER DESIGN
l 3.YES(. )No _
t r r. t r r r R r • w t : t s tr tt w t t t r t t r. r t t r. r t rr. S :• t t t t r .. fe t t ♦ ♦ t t e t :- 11YDIVIDU L SEWAGE DISPOSAL SYSTEM PERMIT
From the application Information supplied and the on-site soil percolation date, the following minimum installation specif 1.
cations are required:
SEPTIC-TANK ,'' - GALLONS;ABSORPTION TRENCH
-' SQ: FT..
or
In addition, this Permit is subject to-the following additional terms and conditions: SQ.Ft
This Permit is granted temporarily to allow construction to commence.This Permit may be revoked orsuspended by the Weld
County Health Department forreasons 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.
re it- 7-93
Environmental Specialist Date
This Permit is not transferrable and shall 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 to impose additional terms
and conditions required to meet our regulations on a continuing basis. Final Permit approval is contingent upon the final In-
spection of the completed system by the-Weld.County Health Department.
SYSTEM CONTRACTOR
SYSTEM ENGINEER FINAL INSPECTIO _ /
APPROVAL , �L�,F e �i► L flI�
are
7/_2 Environmental Specialist /pate
f Issuance of this Permit does not imply compliance with other state, county or local regulatory or uilding,requirements,
nor shall it act to certify that the subject system will operate in compliance with applicable state,county and local
adopted pursuant to Article 10, Title 25, CRS 1973, as.amended, except for the purposes of establishing final app ovalaof an
Installed system for Issuance of a local occupancy permit pursuant to CRS 1973 25-10-111 (2).
Original-Applicant;Copy-WCHD
WCHD—EHS February, 1981
r• , 4e...0 a.0.041.0"."?•...4, V •
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SITE EvAtUAT1Oh' Owner rcbC N0.'fuaek
Application No .le(3-"t3Sicc M/c ,t 5j Y kne S. u' CVcpt Lie) PT •
S35 T �R
r /( { Fhj Sub Lot Block Filing
PERCOLATION TEST DATA : Start Time
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Hole Hole H2O min .
No . . Depth Remain min . min . min .: min . mina min . mina min . min . inch
•
2 • ,
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4 •
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6 — -- ---— -
No Fe.ir(a,._ ,gtn.c-. d b w . Cos-s4-0(4,0_," Gic e_¢-.Q.Qya,t S
5et151 kt-o tAdo 9 - Lth Total
Environmental Health Specialist ..-7911 Q d cs� C Average Rate
i
PLOT PLAN 1 SOIL PROFILE
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