HomeMy WebLinkAbout20031029.tiff LONGS PEAK WATER DISTRICT
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9875 Vermillion Road • Longmont, CO 80504 • (303) 776-3847 office • (303) 776-0198 fax
December 2, 2002
Corrine Lewis
14504 Weld County Road#3
Longmont, CO 80504
RE: 14504 Weld County Road#3
Longmont, CO 80504
Account: 00160020
Dear Sir or Madam:
This letter is to confirm that there is a standard double residential water tap at 14504
Weld County Road#3. Also, a residential fire sprinkler tap has not been purchased. The tap has
been installed, and the District will continue to provide service in accordance with District By-
Laws, Policies, and Regulations. Please be advised that the District requires one tap per
residence, and a double tap can serve two residences.
If you need more information,please do not hesitate to contact our office at 303-776-
3847.
Sincerely,
C A, -
Celeste St. Martin
Office Manager
2003-1029
APPLICATION FOI INDIVIDUAL SEWAGE DISPQAL SYSTEM' No.
WELD COUNTY HEALTH DEPARTMENT New
ENVIRONMENTAL HEALTH SERVICES
1518 Hospital Road, Greeley, CO 80831 Repair —
353-0540 EXT. 270 BP
OWNER • ., :;. �:/ �,.-i ADDRESS r 'l , , PHONE
ADDRESS OF PROPOSED SYSTEM
LEGAL DESCRIPTION OF SITE: PT .`7:,) (V, ^i S T ,
SUBDIVISION LOT , BLOCK , FILING
USE TYPE: RESIDENTIAL i fi E % ' ! r'nr Ef INSTITUTION
COMMERCIAL OTHER
SERVICES: PERSONS ,.pL BATHROOMS ' LOT SIZE '? /• 2 _ .•
BEDROOMS 2 BASEMENT PLUMBING ' /`- WATER,SUPPLY
TYPE OF SEWAGE DISPOSAL REQUESTED: . et)% , !' 17,:, iE I'= r'kr /, !', : , y
Applicant acknowledges that the completeness of ttfis application Is conditional upon further mandatory and additional tests
and reports as may be required by the Weld County Health Department to be made and furnished by the applicant or by the
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 10,
Title 25,CRS 1973, as amended.The applicant certifies that the proposed system will not be located within 400 feet of a corn-
' munity sewage system.The undersigned hereby certifies that all statements made, information and reports submitted here-
with and required to be submitted by the applicant are, or will be, represented to be true and correct to the best of my knowl-
edge and belief,and are designed to be relied on by the Weld County Health Department in evaluating the same for purposes
of issuing the permit applied for herein. I further understand that any falsification or misrepresentation may result in the 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 /
I
Rec'd by a {- �: i �• �i Dated 1 OwnerlAgent Signature Date
• • • • • • • • • • 4 • . • .64
CcR DEPT. PERCOLATION RATE 'S'?" i WATER TABLE DEPTH
E ONLY SOIL TYPE .S.r .// J f/st-,7 PERCENT GROUND SLOPE
REQUIRES ENGINEER bESIGN( )'YES No -
INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
From the application information supplied and the on-site soil percolation data, the following minimum Installation specifi-
cations are required: y tA
SEPTIC TANK !r 2, id ;•'.' GALLONS, ABSORPTION TRENCH IV / i SQ. FT.
or
ABSORPTION BED SQ. FT.
In addition,this Permit is subject to the following additional terms and conditions:
,/ft C /4/t .•F l,}..(-r2':e ,/' l .\ ... •''.'a.
This Permit is granted temporarily to'allow construction to commence.This Permit may be revoked or suspended by the Weld
County Health Department for reasons 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.
/.1 .? ;
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
p c eted system by the WeldCounty
PHealth YDepartment.
P
SYSTEM CONTRACTOR FINAL INSPECTION
e4YSTEM ENGINEER APPROVAL
ra Environmental Specialist Date
The issuance of this Permit does ly compliance with other state, county or local regulatory or building requirements,
nor shall it act to certify that the subject system will operate in compliance with applicable state,county and local regulations
adopted pursuant to Article 10,Title 25, CRS 1973, as amended,except for the purposes of establishing final approval of 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
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