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a4 CENIRAL WELD COUNTY WATER DISTRICT
2235 2nd Ave. Ph.970-352-1284
Greeley,Colorado 80631
WATER BILL
PREVIOUS PRESENT PREVIOUS PRESENT
.DA ,( DATE READING READING
_3/01 ! 11/01 ' 37 55
-*** Dwellin Unit 3 .50
****** c„rrh rge 3 . 24
Pa � ' /�L JR •u
CUR'ENT CHA•GE - AST SUE
18, 42 . 90 2 . 34
Usage Shown in /22 ' PLEASE PAY
Thousands of Gallons I ?E,&7 THIS AMOUNT
ACCOUNT NO, ' TOTAL DUE
105741 �y. 51 ,98
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2008-0943
HSP106P INDIVIDUAL SEWAGE DISPOSAL SYSTEM IT NO. G-9401:
WELD COUNTY HEALTH DEPARTMENT NEW PERMIT
ENVIRONMENTAL HEALTH SERVICES
• 1517 16TH AVENUE COURT, GREELEY, CO 80631
353-0635 EXT. 2225
OWNER PIERSON, VICKI L. ADDRESS 15544 WCR 40 PH (303) 737-:
PLATTEVILLE CO 80651
ADDRESS OF PROPOSED SYSTEM 15544 WCR 40
PLATTEVILLEQ CO 80651
LEGAL DESCRIPTION OF SITE: NE4 SEC 34 TWP 4 RNG 66
SUBDIVISION: LOT 0 BLOCK 0 FILING 0
USE TYPE: RESIDENTIAL MOBILE HOME
SERVICES: PERSONS 2 BATHROOMS 2.00 LOT SIZE 160.00 ACRES
BEDROOMS 3 BASEMENT PLUMBING NO WATER SUPPLY CWCWD
APPLICATION FEE $150.00
RECD BY SIGNED BY VICKI L. PIERSON
DATE 03/28/94 DATE 03/28/94
PERCOLATION RATE 20.2 MIN PER INCH LIMITING ZONE 5 FEET
SOIL TYPE SUITABLE PERCENT GROUND SLOPE 3% DIRECTION N
REQUIRES ENGINEER DESIGN NO IN 100 YEAR FLOOD PLAIN ZONE NO
FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON-SITE SOIL PERCOLATION DATA
THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED:
SEPTIC TANK 1000 GALLONS, ABSORPTION TRENCH 675 SQ. FT.
OR
ABSORPTION BED 909 SQ. FT.
IlmipiTioN , THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND
C ITIONS:
THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERM
MAY BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SE
FORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDIN
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.
�� �/_ �� JOHN MILLIGAN 05/12/94
7 ENVIRONMENTAL SPECIALIST DATE
THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HP
NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL C
THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI
TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BP
:IS. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE COM-
PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT.
SYSTEM INSTALLER C ;.rner FINAL INSPEC Icie ATE '�9`f
-SYSTEM ENGINEER 'i�iil APPROVAL ,� c
TYPE OF SYSTEM INSTALLED %;+.r/*t &d ENVIRONMENTAL SPECIALIST
THE ISSUANCE OF THIS PERMIT DOES NOT IMPLY COMPLIANCE WITH OTHER STATE, COUNTY
JR LOCAL REGULATORY OR BUILDING REQUIREMENTS, NOR SHALL IT ACT TO CERTIFY THAT
OeRSUBJECT SYSTEM WILL OPERATE IN COMPLIANCE WITH APPLICABLE STATE, COUNTY ANI
L REGULATIONS ADOPTED PERSUANT TO ARTICLE 10, TITLE 25, CRS 1973, AS AMEND}
EXCEPT FOR THE PURPOSE OF ESTABLISHING FINAL APPROVAL OF AN INSTALLED SYSTEM FC
ISSUANCE OF A LOCAL OCCUPANCY PERMIT PURSUANT TO CRS 1973 25-10-111 (2 ) .
RIGIMAE-APPLICANT; COPY-WCHD WCHD-EHS MAY. 1984
WR" A)UNTY HEALTH DEPAIIIIIK .t.,, lb FEE $10.00: /.
..BONMENTAL PR CTION ICES SOE #: 3 l0
1517 16th Avenue t LOAN #: liL) -,23
Greeley, Colorado 80631 Id County Health Deparanent
LSDS #'
(303)353 0635 REPAIR #:
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
(PLEASE FILL OUT IN BLACK INK ONLY)
OWNER OF RECORD: FRANCRS MARTTN PHONE: 737-2289
MAILING ADDRESS?5544 WCR . 40 Platteville Colo. 80651
IIPIIISMISIIIIMMI ity State Zip
SITE ADDRESS: s8 me as nbove
I ity State Zip
LEGAL DESCRIPTION: PT:E2NW4 PT:W244 SECTION:34 TOWNSHIP: 4 N RANGE:�6 W
O ,` 01VISI BLOCK:_ FILING:
NUMBER OFF P LE: 7 i 4R S: 1 BATHROOMS: 1 WATER SUPPLY:CWCWD
�5�N / r jk ASESENT PLUMBING: N LOT SIZE: 160 acres
SYSTEM SIZE: Tank is constrillid of cement and has 1000 gallons capacity
(material)
FIELD: Bed xx or Tref* 800_ square feet. DATE SYSTEM INSTALLED: 19p?R
You a e re re dra� gram of the system on the reverse side of this form in
black ink only and indicaation, length, width, and distance from the dwelling.
e s opert wn hereby certifies that the above described septic system
r led, Aldltibed, and exists at this time on the parcel of ground
go
identified by the above lega escription 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.
7- / 3 - 9 /4_4--it —I• �Y2�
Date Owner
3
Subscribed and sworn to before me this 13 day of �` i � e� 1994,
it i
by� 1 �Z C) 0 : c r) 3 �)G\'i f i — —
Witness my hand and official seal. My commission expires: \k 'P.171.1
.
r ill ��i 3 L \,\ B (
A Q IC - CIA t_)-1 9 I\
Date Notary Public
STATEMENT OF EXISTING REVIEWED BY: 164 ,A. C Cy„,,
,K_
Environmental Protection Specialist
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