HomeMy WebLinkAbout20032965.tiff WELD COUNTY HEALTH DEPARTMENT
1517 16TH AVENUE COURT, GREELEY, CO 80631
(970) 353-0635 EXT 2225 FAX (970) 356-4966
Permit # : SP-9800317 Sec/Twn/Rng: Status : ISSUED
Permit Type : RNEW C-commercial, R-residential . NEW, REPair, VauLT
Applied: 07/07/1998
Parcel No: 0963 20 Issued: 07/09/1998
Finaled:
Location : 25621 WCR 54 1/4 KERSEY RE-2174 LT A 20 05 64
Legal Desc :
APPLICANT LOUIS RAY LLC/RICHARD SMOLIK Phone : 970-353-4260
1347 52ND AVE CT, GREELEY CO 80634
OWNER LOUIS RAY LLC/RICHARD SMOLIK Phone : 970-353-4260
1347 52ND AVE CT, GREELEY CO 80634
SEPT-ENGR TERRACON CONSULTANT Phone : (970) 351-0460
PO BOX 1744 , 1289 FIRST AVE, GREELEY CO 80632
SEPT-INSTL FORMAN' S BACKHOE SERVICE Phone : (970) 339-3518
3118 TRINIDAD ST, EVANS CO 80620
Description: HOUSE
Commercial (Y/N) : N Residential (Y/N) : Y Acres : 1 . 00
,Humber of Persons : 4 Basement Plumbing (Y/N) : Y
nber of Bedrooms : 3 Bathrooms-> Full : 2 3/4 : 1/2 :
Water Public (Y/N) : Y Utility Name : CENTRAL WELD
Water Private (Y/N) : N Cistern (Y/N) : N Well (Y/N) : N
Water Permit No :
Percolation Rate : 10 . 5 Limiting Zone : 08 ft 06 in Desc : BEDROCK
% Ground Slope : Dir : Soil Suitable (Y/N) : Y
Engineer Design Req' d (Y/N) : N In 100 Yr Flood Plain (Y/N) : N
Minimum Installation
Septic Tank : 1000 gal Absorption Trench: sq. ft .
Absorption Bed: 868 sq. ft .
Actual Installation
Septic Tank : \ Dot) gal Absorption Trench: sq. ft .
Absorption Bed: 1p,71-1j sq. ft .
Design Type : C R
NOTICE
The issuance of this permit does not imply 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 persuant to Article 10, Title 25, CRS as amended, except for the purpose of establishing final approval of installed
system for issuance of a local occupancy permit persuant to CRS 1973 25-10-111 (2) .
This permit is not transferable. 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 was contingent upon the final inspection of the
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c xetl system by the weld County Health Department.
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2003-2965
WEB ' COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL PROTECTION SERVICES DIVISION
1517 16TH AVENUE COURT, GREELEY, COLORADO 80631
353-0635
NOTICE
This individual sewage disposal system has been inspected and appears to have been
installed in accordance with the regulations regarding individual sewage disposal
systems in Weld County, Colorado.
APPROVED / I
Owner Location S b f 1 Li' �/z s �(
Permit No..5 `IStOili Datehh /12k" Environmental
Specialist
19-4170-162
jifiltlfrtP°
Septic Diagram
November 1998
Owner ._ L.ouisRay LLC 25621 IJCR 54 1.14
/ Richard Smolik
Contractor - Gary Schneider
Plumber - Joe Lira P&H
Septic Installed by:
Forman 's 8;-.chhoe Service PH : 339-3518
R,ac u i red by Health Dept. : Permit # 9300317
1000 gal tank & 868 sq ft leachfield
Installed :
1000 gal tank & 1080 sq ft leachfield
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Aug-11-99 09:05A P.02
AEC'D SEP 2 9 1999
WATER TAP ASSTGUMFNT
FOR VALUE RECEIVED, I/we hereby sell, transfer and assign to
Leslie Anne Windyka 1 water tap(5) in the
CENTRAL WELD COUNTY WATER DISTRICT, on my/our property described as follows
situate in Weld County, Colorado, to wit:
Lot A of Recorded Exemption No. 0963-20-4-RE2174, recorded March
23, 1998 as Reception No. 2601122, being a part of the N1/2 of the
SE1/4 of Section 20, Township 5 North, Range 64 West of the 6th
P.M., County of Weld, State of Colorado.
IT IS UNDERSTOOD that these taps were purchased for the above described land and may not
be transferred to other land, without express, written consent, in addition to the below consent,
of the CENTRAL WELD COUNTY WATER DISTRICT. I/we further authorize the Secretary
of said District to do any and all things necessary to effectuate this transfer on the books and
records of said District. I/we hereby state that all water rates and charges and other monies
owed to the District have been paid and if not, shall be held out at the closing of the sale of
my/our premises.
IN TESTIMONY WHEREOF, I/we have set my/our signature this 16 day of
September , 19 99 .
sr '� E Lou'jay
""SELLER:
I/WE FURTHER AGREE to pay any and all charges hereinafter levied by said District for said
taps and to abide by all regulations adopted by said District.
ACCEPTED:
a,,„,i
"" BUYER: Leslie Anne Wi yka
" BUYER:
CONSENT TO ASSIGNMENT
I, John W. Zadel, General Manager of the CENTRAL WELD COUNTY WATER
DISTRICT, Hereby consent to the above assignment on behalf of said District.
DATE: �seefi
"" TO PERSON EXECUTING THIS ASSIGNMENT - NAMES AS THEY APPEAR ON
TITLE MUST BE TYPED AT THE APPROPRIATE SPACES, FAILURE TO DO SO WILL
NEGATE THIS TRANSFER. TWO ORIGINAL TAP ASSIGNMENTS MUST BE
COMPLETED AND SENT TO CENTRAL WELD COUNTY WATER DISTRICT FOR
DISTRICT CONSENT.
AUC. II ' 99 (WED) 09:16 COMMUNICATION N. 51 PACE. 2
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