HomeMy WebLinkAbout20082353.tiff rill ell tift; 9 MS
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• WATER TAP ASSIGNMENT
FOR VALUE RRCF.IV&D,I/we hereby sell,transfer and assign to Marvin .7• Tevelde and Sandra Mae g'eve7.de
,ono ',.sn P water tap in the CEENTRA I.WELD COUNTY WATER DISTRICT,on my/our
property described as follows situate in Weld County,Colorado,to wit
SEE ATTACHED
1T IS UNDERSTOOD(hut Were tape ware purchased for the above describeed land and may not be transferred to sites
land,without express.written tamsern,In addition to the below consent,of the CENTRAL WELD COUNTY WATER
DISTRICT. I/we further authorize the Secretary of said District in do uny and all things necessary to ultimatum this
transfer on the books and records of said District....lAve hereby State that all water talus and charges and ether monies
owed to the District have been paid and If not,shall be held out et the closing of the cab of my/oar premises,
IN TESTIMONY WI IEREOF,I/wu have set my/our signature this 15th day of
December zo 05
** /G`'�""r " r�a�(� �
�- — +1 S&L,ilt:Stott D. Busker Trust
SELLER: Scott D. Busker
1 Ste, c • /
,te , ++SLiLLGR:Susan J. Busker Trust
SELLER: Susan J. Busker
I/WE FURTHER AGRCI3 to pay any and ell charges hereinafter levied by said District lie said taps and In abide by nil
regaladons adapted by said District.
ACCEPTED:
e•BUYER:Marva . Tevelde
fi..11UVI lt:Sandra M. Tavel
ejj
CONSENT TO AS51rU1 If fv RNT�G
1.Jahn W.7adel,Central Manager of the CENTRAL WELD COUNTY WATER DISTRICT, Hereby consent la
the aboveassignment on hehalfol'snid District.
EY, W. AD i CENERAL MANAGER
DATE;, i�9/!(�/�{
+"TO PERSON EXECUTING ASSIGNMENT•NAMES AS THEY APPEAR ON TITLE MUST Ill
AT THE APPROPRIA'T'E SPACES,FAILNHP TG DO SO WILL NEUA'fE'IYIIS'FltANSFIRIt. I'WO ORIGINAL
TAP ASSIGNMENTS MUST BE COMP]A t'EO AND SENT TO CEN'T'RAL WEl l)COUNTY WATER DISTRICT
RIC"I'
FOIL DISTRICT CONSENT.
EXHIBIT
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2008-2353
TB/TO 39Vd (]MONO S989E9ECL6 BZ:ET 800Z/£1/E0
Form No. OFFICE OF TISTAlE ENGINEER •
pws.25 • COLORADO DIVISION OF WATER RESOURCES
.y r 81 ���Bldg., 1313 Sherman St,Denver,Colorado 50203
• • 698
WELL PERMrT NUMBER 046527 -
APPLICANT DIV, 1 CNTY. 62 WD 2 DES. BASIN MD
Lot Block: Filing:1 aubdly:
APPROVED WELL LOCATION
WELD COUNTY
scorr D BUSKER SE 1/4 NW 1/4 Section 28
7678 WCR 17 Thorp 2 N RANGE 67 W 6th P.M.
FT LUPTON CO 80621-
DISTANCES FROM SECTION LINES
(303)833-3317 3340 Ft. from South Section Line
1600 Ft from West Section Line
PERMIT TO CONSTRUCT A WELL
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDEMNS OF APPROVAL
1) This well shall be used in such a way as to cause no material Injury to existing water rights. The Issuance of the permit does
not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested water right
from seeking relief in a civil court action.
2) The construction of this well shell be In compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval of a
variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in
accordance with Rule 18.
• 3) Approved pursuantto CRS 37-0.137(4)andthefindings of the State Engineer dated May /,3` X94
4) Production is limited to the Laramie-Fox Hills aquifer which S located at a depth of apprbJxdmatey 365 feet below land surface
and extends to a depth of approximately 640 feet. Plain casing must be installed and sealed to prevent the withdrawal of ground
water from other aquifers and the movement of ground water between aquifers.
5) This well shall be constructed at least 600 feet from any existing well completed in the same aquifer that is not owned by the
applicant.
6) This well shall be constructed not more than 200 feet from the location specified on this permit.
** 7) The entire length of the hole shall be geophysically logged as required by the Statewide Nontributary Ground Water Rules prior
t0 installing casing. ** Logging requirement waived; see attached sheet.
8) A totalizing flow meter must be installed on the well and maintained In good working order. Permanent records of all diversions
must be maintained by the well owner (recorded at least annually) and submitted to the DMsion Engineer upon request.
9) The owner shall mark the well In a conspicuous place with well permit numbers(s), name of the aquifer, and court case
numbers(s) as appropriate. The owner shall take necessary means and precautions to preserve these markings.
10) The maximum pumping rate shall not exceed 30 GPM.
11) The allowed average annual amount of ground water to be withdrawn is 21.4 acre-feet
12) Pursuant to CRS 37-90-137(9)(b) and the Denver Basin Rules, no more than 98% of the nontributary ground water withdrawn
annually shall be consumed and the well owner shall demonstrate to the reasonable satisfaction of the State Engineer that no
more than 98%of the water withdrawn will be consumed.
13) This well is subject to administration by the Division Engineer in accordance with applicable decrees, statutes, rules, and
regulations.
NOTE: The ability of this well to withdraw its authorized amount of water from this non-renewable aquifer may be less
than the 100 years upon which the amount of water in the aquifer is allocated, due to anticipated water level
declines. /
• APPROVED 4
DAM 741Az e
State Engineer
Receipt No, 0398896 DATE ISSUED MAY 131996 EXPIRATION D E 1
Form.No. OFFICE OF STATE ENGINEER •
GM-bar; COLORADO DMSION OF WATER RESOURCES
ate Centennial Bldg., 1313 Sherman St,Denver,Colorado 00203
(303) 906.3581
• 698
WELL PERMIT NUMBER 043793 - -_
APPLICANT DiV. 1 CNTY, 62 WD 2 DES. BASIN MD
Lot: Block: Filing: Subdiv:
APPROVED WELL LOCATION
WELD COUNTY
SCOTT BUSKERNE 1/4 SW 1/4 Section 28
9743 WCR 16 Twp 2 N RANGE 67 W 6th P.M.
FT LUPTON CO 80621
DISTANCES FROM SECTION LINES
(303)857-9323 2310 Ft from South Section Line
1600 Ft. from West Section Line
PERMIT TO CONSTRUCT A WELL
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF APPROVAL
1) Thls well shall be used in such a way as to cause no material injury to existing water rights. The Issuance of the
permit does not assure the applicant that no injury will occur to another vested water right or preclude another
owner of a vested water right from seeking relief In a Civil court action.
2) The construction of this well shall be in compliance with the Water Well Construction and Pump Installation Rules
2 CCR 402-2, unless approval of a variance has been granted by the State Board of Exam)_rg m Water Well
Construction and Pump Installation Contractors in accordance with Rule 17. \' .' -'
• 3) Approved pursuant to CRS 37-90-137(4) and the findings of the State Engineer dated July12)1994.
4) Production is limited to the Laramie-Fox Hills aquifer which is located 385 feet below land surface and extends to
a depth of 660 feet. Plain casing must be installed and sealed to prevent the withdrawal of ground water from
other aquifers and the movement of ground water between aquifers.
5) The maximum pumping rate shall not exceed 30 GPM.
6) The allowed average annual amount of ground water to be withdrawn is 23.8 acre-feet.
7) The entire length of the hole shall be geophysically logged as required by the Statewide Nontributary Ground
Water Rules prior to installing casing.
8) A totalizing flow meter must be installed on the well and maintained in good working order. Permanent records
of all diversions must be maintained by the well owner (recorded at least annually) and submitted to the Division
Engineer upon request.
9) The owner shall mark the well in a conspicuous place with well permit numbers(s), name of the aquifer, and court
case number¢(s) as appropriate. The owner shall take necessary means and precautions to preserve these
markings. /
10) This well shall be constructed at least 600 feet from any existing well.
11) This well shall be constructed not more than 200 feet from the location specified on this permit.
12) Pursuant to CRS 37-90-137(9)(b) and the Denver Basin Rules, no more than 98% of the nontributary ground water
withdrawn annually shall be consumed and the well owner shall demonstrate to the reasonable satisfaction of the
State Engineer that no more than 98% of the water withdrawn wilt be consumed. u -f.4l
NoTe; CoA ,T-,uh cvf Anpvowtt /W7 is )ter&tcr waR.447 we t a y/i' 'T fin Pall a"L °4
erod. iE-La o P a.6 ale 1, !'� — 7
APPROVED D
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DWR A'G
Sanvt ..
WE. 7/f' 9Y ante Engineer
Receipt No. 0369822 DATE ISSUED JUL 14 1994 EXPIRATION DATE"JUL 141995
.. r•PARTMENT OF PUBLIC HEALTH 4WD ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE (970) 304-6415 FAX (970) 304-6411
Finai.•ri
Wrmit #: SP-0500203 Sec/Twn/Rng: 28-02-67 Status: ISSUED
Owner: BUSKER-SCOTT Applied: 06/08/2005
Applicant: FRAZER SHARYN Issued: 06/28/2005
Permit Type: CNEW C=Commercial,R=Residential+NEW, REPair, VauLT Finaled:
Parcel #: 1311-28-3-00-051
Location: 7678 WCR 17
Legal Description:
Installer: Pry p, CU MQ.r
Description: OFFICE/SCALEHOUSE
Commercial: Y Residential:N Acres: 80
# of Persons: 4 Basement Plumbing: N
# of Bedrooms: 0 Bathrooms - Full: 1 3/4: 0 1/2: 0
Water Public: Y Water Source: CWCWD
Water Private: N Cistern: N Well: N Well Permit #:
Percolation Rate: 33.1 Limiting Zone: 7 fl 0 in Description: CLAY
% Ground Slope: 0 Dir: Soil Suitable: (Y/N) Y
weer Design Required: (Y/N) Y In 100 Year Flood Plain: (Y/N) N
Minimum Installation Chambers*
Septic Tank: 1000 gallons Absorption Trench: 0 square feet
or Absorption Bed: 197 square feet
Actual Installation
Septic Tank: /coo gallons Absorption Trench: square feet
Absorption Bed: - square feet E'>
Design Type: G .4 Chamber Model
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 non transferable and non refundable. The Weld County Department of Public Health and Environment 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 completed system by the Weld County Department of Public Health and Environment.
En ironntal Health Specialist Date
�:S_FINAL
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WELD COUNTIIIIEPARTMENT OF PUBLIC HEALAND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE (970) 304-6415 FAX (970) 304-6411
Finaled
ermit #: SP-0300306 Sec/Twn/Rng: 28-2-67 Status: ISSUED
Owner: BUSKER SCOTT Applied: 08/04/2003
Applicant: BUSKER SCOTT Issued: 08/06/2003
Permit Type: KNEW C=Commercial,R=Residential+NEW,REPair,VauLT Finaled:
Parcel #: 1311-28-3-00-051
Location: 7678 COUNTY ROAD 17,
Legal Description: ,} "
Installer: ��u e J {�Q�C Q ed
Description: MOBILE HOME
Commercial: N Residential:Y Acres: 80
# of Persons: 3 Basement Plumbing: N
# of Bedrooms: 4 Bathrooms - Full: 2 3/4: 0 1/2: 0
•
Water Public: Y Water Source: CENTRAL WATER DISTRICT
Water Private: N Cistern: N Well: N Well Permit #: N
Percolation Rate: 44.4 Limiting Zone: 8 ft 0 in Description:
% Ground Slope: 0 Dir: Soil Suitable: (Y/N) Y
iingineer Design Required: (Y/N) In 100 Year Flood Plain: (Y/N)
Minimum Installation Chambers
Septic Tank: 1250 gallons Absorption Trench: 1200 square feet
or Absorption Bed: 1552 square feet
Actual Installation
Septic Tank: l dt.. gallons Absorption Trench: 13y-1f square feet 4rc>
Absorption Bed: square feet
Design Type: C-•,,,Q .
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 non transferable and non refundable. The Weld County Department of Public Health and Environment 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 completed system by the Weld County Department of Public Health and Environment.
C .ro.Da
En rrornne al Health Specialist Date
Forth:S_FMAL
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WELD COUNTY•PARTMENT OF PUBLIC HEALTI ND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE (970) 304-6415 FAX (970) 304-6411
Permit #: SP-0200445 Sec/Twn/Rng:28-02-67 Status: ISSUED
Owner: BUSKER SCOTT & SUSAN Applied: 09/30/2002
Applicant: BUSKER DAIRY Issued: 10/09/2002
Permit Type: RNEW C=Commercial, R=Residential + NEW, REPair, VauLT Finaled: i I . '1 -01s_
Parcel #: 1311-28-3-00-051
Location: 7678 CR 17 28-02-67
Legal Description:
Installer: D
Description: MOBILE HOME
Commercial: N Residential:Y Acres: 220
# of Persons: 3 Basement Plumbing: Y
# of Bedrooms: 3 Bathrooms - Full: 2 3/4: 0 1/2: 0
Water Public: Y Water Source: CENTRAL WELD
Water Private: N Cistern: N Well: N Well Permit #:
Percolation Rate: 48.6 Limiting Zone: 8 ft 0 in Description:
% Ground Slope: 0 Dir: Soil Suitable: (Y/N) Y
•gineer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N) N
Minimum Installation Chambers
Septic Tank: 1000 gallons Absorption Trench: 948 square feet
or Absorption Bed: 1230 square feet
Actual Installation
Septic Tank: i cc'o gallons Absorption Trench: /Oo square feet 3 3
Absorption Bed: square feet
Design Type: Cn. A .
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 Department of Public Health and Environment reserves the right to impose
additional terms and conditions required to meet our regulations o:).___:ontinuing basis. Final permit approval was contingent upon
the final inspection of the completed system by the Weld County Department of Public Health and Environment.
Env onme Health Specialist Date
Form: S_FINAL
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WELD COUNTY•PARTMENT OF PUBLIC HEALTIOND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE (970) 304-6415 FAX (970) 304-6411
Fil'.aled
'Permit #: SP-0200047 Sec/Twn/Rng:28-02-67 Status: ISSUED
Owner: WANgitalt Applied: 02/01/2002
Applicant: BUSKER SCOTT D Issued: 02/0 /200
Permit Type: RREP C=Commercial, R=Residential + NEW, REPair, VauLT Finaled: 03/oz_i ( ]J. )
Parcel #: 1311-28- - - v i�
Location: 7678 CR 17 28-02-67
Legal Description:( ,
Installer: A
Description: MOBILE HOME
Commercial: N Residential:Y Acres: 80
# of Persons: 4 Basement Plumbing: N
# of Bedrooms: 3 Bathrooms - Full: 2 3/4: 0 1/2: 0
Water Public: N Water Source:
Water Private: Y Cistern: N Well: Y Well Permit #:
Percolation Rate: 52 Limiting Zone: 7 ft 3 in Description: BEDROCK
% Ground Slope: 0 Dir: Soil Suitable: (Y/N) Y
•gineer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N) N
Minimum Installation Chambers
Septic Tank: 1000 gallons Absorption Trench: 1000 square feet
or Absorption Bed: 1305 square feet
Actual Installation
Septic Tank: i(A-)J gallons Absorption Trench: 1 (3\,-D square feet 3cL
( /tSna Absorption Bed: square feet
Design Type: ci A
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 Department of Public Health and Environment reserves the right to impose
additional terms and conditions required to meet our regulations on a continuin basis. Final permit approval was contingent upon
the final inspection of the completed system by the Weld County Departmeftof �hlic FIe lh and Enviro�ent.
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Environmental Health Specialist Date
Form: S_FINAL /
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WELD COUNTY DEPARTMEOOF PUBLIC HEALTH AND ENVIROENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE (970) 304-6415 FAX (970) 304-6411
Omit #: SP-0100042 Sec/Twn/Rng: 28 02 67 Status: ISSUED
Owner: BUSKER DAIRY Applied: 01/25/2001
Applicant: BUSKER SCOTT' D Issued: 01/25/2001
Permit Type: RNEW C=Commercial, R=Residential +NEW, REPair, VauLT Finaled:
Parcel #: 1311-28-0-00-003000001
Location: 7678 WCR 17 FT LUPTON
Legal Description: 20414 IMPS ONLY MH N W4/N2SW4/S2NE4 28 2
67 ATLANTIC 87-47r,
,,
Installer: 2O t f 1
Description: MOBILE HOME
Commercial: N Residential:Y Acres: 125
# of Persons: 4 Basement Plumbing: N
# of Bedrooms: 3 Bathrooms - Full: 2 3/4: 0 1/2: 0
Water Public: N Water Source:
Water Private: Y Cistern: N Well: Y Well Permit#: 643799F
Percolation Rate: 55 Limiting Zone: 8 ft 0 in Description
go Ground Slope: 0 Dir: Soil Suitable: (Y/N) Y
Illsneer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N) N
Minimum Installation Chambers
Septic Tank: 1000 gallons Absorption Trench: 1050 square feet
or Absorption Bed: 1380 square feet
Actual Installation
Septic Tank: I ZSr=, gallons Absorption Trench: I I Z 5 square feet
Absorption Bed: square feet
Design Type: C-J—a
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 Department of Public Health and Environment 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 completed system by the Weld County Department of Public Health and Environment.
Envif'onmental Health Specialist Date
Fnnv. S_FINAL \
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WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
•555 NORTH 17TH AVENUE, glIEELEy, CO 80631
PHONE (970) 304-6415 ETM (970) 304-6411
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Permit # : SP-9900336 Sec/Twn/Rng: 28 02 67 Status: CeS1SI
•ermit Type : RNEW C=commercial, R=residential r NEW, REPair, VauLT
Applied: 07/13/1999
Parcel No : 1311 28 000040 000002 Issued : 07/13/1999
Finaled: ct_ u_ / 7
Location : 7678 WCR 17 FT LUPTON 28-2-67
Legal Desc : 20414-C IMPS ONLY MH N2SW4/S2NE4 28 2 67 TIN 84-22
APPLICANT BUSKER SCOTT AND SUSAN Phone : 303 -833-3294
7678 , FT LUPTON CO 80621
OWNER BUSKER DAIRY
C/O BUSKER SCOTT D & SUSAN J, FORT LUPTON CO 80621
SEPT-ENGR ALPHA ENGINEERING Phone : (303) 857-23
PO BOX 392 , FORT LUPTON COLORADO 80621
SEPT-INSTL SELF Phone : (970) 999-99
X, GREELEY CO 80631
Description : TRAILER B
•
Commercial (Y/N) : N Residential (Y/N) : Y Acres : 76 . 00
Number of Persons : 3 Basement Plumbing (Y/N) : N
Number of Bedrooms : 3 Bathrooms-> Full : 2 3/4 : 1/2 :
Water Public (Y/N) : Utility Name :
Water Private (Y/N) : Y Cistern (Y/N) : Well (Y/N) : Y
Water Permit No :
•Percolation Rate : 52 . 0 Limiting Zone : >08 ft 00 in Desc :
Ground Slope : 1 Dir : N 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: 1026 sq. ft .
Absorption Bed: 1341 sq. ft .
Actual Installation
Septic Tank :/}^'i gal Absorption Trench: /297 sq. ft . vo t,; i/o
Absorption Bed: sq. ft .
Design Type : .r
Gi��/�ro(tti,_
NOTICE
Toe .ssuance 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) .
.o_s 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
r:pleted system by the Weld County Health Department.
• x // / f- ??2,V9Environmental Specialist Date
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WELD COUNTY HEALTH DEPARTMENT
• 1517 16TH AVENUE COURT, GREELEY, CO 80631
(970) 353 -0635 EXT 2225 FAX (970) 356-4966
Fincibd
Permit # : SP-9700430 Sec/Twn/Rng: 28 02 67 Status : V''d`""
Permit Type : RNEW C=commercial, R=residential NEW, REPair, VauLT
Applied : 09/29/1997
Parcel No : 1311 28 000040 Issued: 10/03/1997
Finaled: ��� � � � ?y9"
Location : 7678 WCR 17 TRAILER A
Legal Desc : 20414-C N2SW4/S2NE4 28 2 67 EXC E1487 . 41 ' N2S2NE4
7678 17 CR WELD
APPLICANT BUSKER SCOTT D & SUSAN J
7678 WELD CO RD 17, FT LUPTON CO 80621
OWNER BUSKER SCOTT D & SUSAN J
7678 WELD CO RD 17, FT LUPTON CO 80621
SEPT-ENGR CROWE CECIL R ALPHA ENGINEERING Phone : (970) 857-230
PO BOX 392 , FORT LUPTON, COLORADO 80621
Description: TRAILER, •
Commercial (Y/N) : N Residential (Y/N) : Y Acres : 76 . 00
Number of Persons : 3 Basement Plumbing (Y/N) : N
Number of Bedrooms : 3 Bathrooms-> Full : 2 3/4 : 1/2 :
Water Public (Y/N) : Utility Name :
Water Private (Y/N) : Y Cistern (Y/N) : Well (Y/N) : Y
•Water Permit No :
Percolation Rate : 52 . 0 Limiting Zone : >08 ft 00 in Desc :
% Ground Slope : 19 Dir : N 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: 1026 sq. ft .
Absorption Bed : 1341 sq. ft .
Actual Installation
Septic Tank : ) ) c& gal Absorption Trench : IU 3D sq. ft .
Absorption Bed: — sq. ft .
Design Type : C-/l
NOTICE
Tne issuance of this permit does not imply compliance with other state, county or local regulatory or building requirements, nor
,ca_. _t act to certify that the subject system will operate in compliance with applicable state, county and local regulations
adopted persuant to Article lo, 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) .
..cis permit is not transferable. The Weld County Health Department reserves the right to impose additional terms and conditions
.c'qutred to meet our regulations on a continuing basis. Final permit approval was contingent upon the final inspection of the
-.-mpleted system by the Weld County Health Department.
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tWiE::I...X.' (:'t::iui.•#'T"( I..}E:::ril...'T#••! DEPARTMENT NEW PERMIT
ENVIRONMENTAL t:1N ll::NT'r",L HEALTH SERVICES
• :1. '.:':I.. 16TH AVENUE COURT, i:)f;IE::I...E::`r`• CO 806;:T:1.
353-0635 EXT..222.5
•i l. ..� „F;: BUSKER,t,... . SUSAN }7'j S S PH J.: 5
,;.JI 1,....', l:�i.....#.#::.!',. SCOTT(., f ( & ADDRESS I'!:I::. .
FT LUP T ON CO e06.<:'.:1
4DT!RIISS OF PROPOSED SYSTEM 7678 WCR 17
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.!'::;t::. T`!#"'#::.:: E'!:I:..::'r.l.T)}::.F`Ii .l.i:1l.., 2 lYI(J):?IL...l::. i•'!t.)I'1E:::3•••':1. SYSTEM
jI::.E : :.I CE:.:.. .. PERSONS(.JN;:> 6 BATHROOMS 2.00 0 SIZE c t; 0 ) ACRES
BEDROOMS 5 BASEMENT PLUMBING NO WATER SUPPLY (::W(::WI)
!=:F:'#...1(::( T:l:(:)I•,! FEE $150.00
'!EC ' I:> BY (::!'.I,:'i:D YOUNG SIGHED(.;F'II:::I? BY "''i.i"tr^sl'•} !11(''tll BUSKER:.s C.
DATE:: 06/28/94 DATE ?6/28/9
:'!::::;(::(:)I...;•^•sT':l:(:N RATE 55.0 MIN PER J:i4(:'I•I LIMITING r(:)h,E: 7 FEET
'.".I.EL 't'•`r'I".F:: iJi.J:l:T11BI...f:. F'I:::F;(::I :I.lT (::;F;(:)(.JNI) f:il...oF'I: 0% DIRECTION
;E:::Gti.J:):RI::S ENGINEER DESIGN YES :I:FI :1.00 YEAR FLOOD PLAIN ZONE h1c:f
(::.'(:)i'I THE APPLICATION INFORMATION '::i1.Jl:F:.,..:r,:::X) ,ll'lI) T.i•ii:: ON—SITE v:3(:):i:1... PERCOLATION I)iiT
:'!'II:: FOLLOWING JJ:}••(G MINIMUM INSTALLATION SPECIFICATIONS"J :1:(:)1'`1S r;I:l : REQUIRED::
SEPTIC TANK :I.{)I;)(? GALLONS,I:;3.. ( X':::::::(:)I:':F'T:1:()l.4 TRE::1•lC:l'•! £3C).. !: T..
OR
ABSORPTION BED 2:1'7ts S(:X.. FT.
: N ADDITION, THIS PERMIT IS SUBjECT TO THE F:'(71...1...(:1WJ:hl(:') ADDITIONAL TERMS r7l'.I)
(::D T:I.......:: .. ______________________________.........._......_.........._.........._........__......................................._.._.........................................................._..
4 ':,:t': PERMIT :1: :3 (:)F;1"Ih•IT'EI? TEMPORARILY T'(:) ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT
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: :)•..• NE:. F;I::'•.1(:)I<ED (:)F;: SUSPENDED BY ...fiI=: WELD COUNTY HEALTH DEPARTMENT FOR REASONS t''f
1,.'TI•''1 IN THE WE::I...X? COUNTY :I:I'IX):I:'vl:l:X)(.JF11_. F.3E::W(1(3l::. DISPOSAL SYSTEM REGULATIONS tJ1...r1T:LC)N::3 IN(::I._t.JX?I1'•1(:)
: r'rl:.!...i.JF.#::: T'(.) MEET ANY •T•I:::F;IYI OR CONDITION IMPOSED THEREON DURING TEMPORARY RY OR FINAL
:F'F:'E:;1::)V(ll..... THE:: ISSUANCE (:)I::' T'I.'I:}:;:3 PERMIT X)(:)E:::'::3 INIC)'T' CONSTITUTE ASSUMPTION BY T'I"li:::
1i:::F'r:iIf IYII::('lT OR ITS E:IYI1::'LOYEI:::S OF I...:I:A:(:.:1:1...:1:T'Y FOR •T'I••,i: FAILURE OF: INADEQUACY OF T•1'•II:::
4.i;Jr'1(;F: DISPOSAL(`11... SYSTEM.
�✓ PAM SMITH 07J;�`;>r�+'t'l
,� ?-1-9Y46 ENVIRONMENTAL SPECIALIST DATE
':TES PERMIT 'I:::3 Itic:'r T'I:::r::1h!'JI::'!:::Rr X::1...1::: A !':::, SHALL E1'>:I...L BE::(:;(:)I1E:: V•1(':):I:X? :I:}::' SYSTEM (:;(:?!'•If:3T'r':i.l(::T':I:(:)I••# HAS
'O1 (: OMMIi::HCEI:I? W:!:T1•.1:1:i.i DIII::: YEAR OP IT ..?, a:'::;StJ NCi :.. BEFORE ISSUING FINAL A1F:'I::.ROVA,... (::F
!:•1::F......I'TT THE tWJI:::I...I) COUNTY HEALTH DEPARTMENT lY#l:::I'IT RESERVES T'I••II::: RIGHT 1'.0 :I:MF'C)SE ADDI•...
TONAL TERNS AND CONDITIONS !:;;E(:)(+IRED ri.:I MEET' OUR REGULATIONS ON A CONTINUING BA-
FINAL f'I:::f:':IYI:I:'T 1^,I:'PI".(.)V111(... :I:',:.3 CONTINGENT l.Jl::'0N 1I•1F FINAL :rI•'1;:3F'I:::(::T":1:(:)N (:)F:' T'1••ll::: (::(:JIYF-
'I..ET I::D SYSTEM BY T'i"u::: tIJI:1...X::1 (::(:)i..IFIr' I'1!::,'1LT'F! DEPARTMENT.
'CSTEM INSTALLER r........... }:: .#:I'If-11... :I:I�I',:31:'#:::(::...:':' I ATE 07
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1. r.. 0,:: SYSTEM
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. .... .., . .., 1 is::I E INSTALLED� , Il...#...#:::X: .P..'�...(Tard.�rs if �O��� � ENVIRONMENTAL ..,Pi:::(:;J:i11...:1:'::3'1"
'! 1F ISSUANCE (:);::. THIS PERMIT X?(::!!: :3 l ,(:).T' IMPLY C:(:11Y#F'1..:L!`11•.!C:f:: EJJ:i....ii OTHER STATE:,. COUNTY
;':: (...f)('::U.. REGULATORY c,: ILJ:i:I...X):!:!••1(:) REQUIREMENTS,T':3,, NOR SHALL IT ACT TO CERTIFY THAT
lIVECT '::,' :s TI::.E'1 l:{.!.E...E... (.1}'•'I::.I•'.(,T'E :II t...(.!I.IE..'1....}.r•• I(...I::. W.I. T Fl (1F''l''1....I(.,t Ih!...I::. '. (/ T}::.« (.:l..iUF.I £Y r':�#1 '
:;i.Ji...i:t..1':{:(:)N'::S ADOPTED !::•!:. ;`: I}i::Il''.1..1. .('3 ARTICLE 10, 'T':f:'T'I...#: .t:.5.. CRS 1973, (•1a AMENDED,
:r l:::l:=..1 FOR THE J:''t.Jl•41''(:)`::3#: (:)i::. Es r:1X:•:1...:#:'::;'..(:#:#'IG I::'J:Nr'i#... APPROVAL OF AN INSTALLED SYSTEM FOR
. .. (.JA •I(:I::: OF A LOCAL OCCUPANCY PERMIT r !:t.Jl:.':::(.IANT. TO CRS :1.973 25-10-111 (2) .
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