HomeMy WebLinkAbout20101081.tiff Little Thompson Water District • •
835 Eau Highway 56 FOR BILLING INFORMATION
Bathc.4.CO 80513-9237 CALL: 970-532-2096
www.hw.mg,1-866-739-0469
• Account# Bill Date TOTAL DUE
8134 10/20/09 $77.21
249
Type Due Date
CYCLE 2 11/15/09 •
AUTO"5-DIGIT 80534 AMOUNT PAID
=-w Vanif-an T2 P1 441
18690 County Road 17
Jn-b-stc.rt CO 80534-9211
Il,drllerrddreri681Edl41.rrrlsieT81L sllitiErIIE4J4rLl
DETACH AND RETURN MOVESTUB WON REMITTANCE CYCLE 2 8134
ccount#A LService Address Billing Period Bill Date Due Date TOTAL DUE
8134 18690 WC 17 09/21/09to 10/20/D9 10/20/09 11/15/09 $77.21
Previous Current Mult Usage Yr Ago Cd Description Charge
Date Read Date Read
PREVIOUS BALANCE 86.42
10/07/09 PAYMENTS -86.42
09/10/09 1657113 10/06/09 1679622 GAL 22509 15703 CU WATER 77.21
Usage cost on 6000 x .002000 12.00
Usage cost on 16509 x .002500 = 41.27
Base Fee:23.94
Little Thompson Water District Current Charges 77.21
TOTAL AMOUNT DUN $77.21
•
****Winterize your Sprinkler Systems to avoid damage****
Pay your bill Online @www.LTWD.org or by phone @ 1-866-739-0469.
We now accept credit cards, debit cards and e-checks 11111
PAY BILL ONLINE: www.LTWD.org or CALT: 1-866-739-0469
Previous Balance due upon receipt
* A 1% Penalty will be added to delinquent accounts.
Rates:Residential 5/B"Base = $23.94/mo
0-6,000 = $ 2.00/1000gals
6,001-30,000 = $ 2.50/1000gals
30,001-60,000 = $ 2.75/1000gals
>60,000 = $ 3.25/1000gals
gend: E - Estimated Reading Little Thompson Water District
illCU - Current Use(gallons) 835 H Hwy 56
MC - Miscellaneous Berthoud, CO 80513
CR - Credit 970-532-2096
2010-1081
DEC-30-2009 WED 08:59 AM W.NVIR0NMENTAL HEALTH FAX NO. 97( 4 6411 ��7 P. 02/04
iit*'1,2
WELD COUNTY DEPARTMENT OF PUBLIC SE# (/ t 00015
HEALTH AND ENVIRONMENT ORG PERMIT#
I 1555 N. 17Th AVENUE REPAIR #
•Wilk GREELEY, COLORADO 80631 LOAN #
PHONE: (970) 304-6415 ISDS# U n Du e
FAX: (970) 304-6411
COLORADO
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
(PLEASE FILL OUT IN BLACK INK ONLY)
PARCELS kO9133oaooZ
PROPERTY OWNER I--}t le vl L.e4e1 + ha h PHONE NO. (770) :3-8 7—-3-S-G a
Men INGADDRESS /3470 C e /7 JO 6ns7Lnal n lip E-8 S-3(1
City State Zip
DESCRIPTION OF BUILDING(ex. house, mobile/modular home,shop,office) H o U S-2
SITE/LOCATION ADDRESS Q C,/
City State Zip
LEGAL DESCRIPTION PT PT SECTION 3::3W TONSIIIP Li 41 RANGE(7 7 r,)
SUBDIVISION Ms ne- LOT BLOCK FILING
5dCENCUS TRACT oil LOT SIZE/ACRES )7 , ) Gt Lres
COMMERCIAL YES N RESIDENT .S/NO
NUMBER OF PONS BASEMENT PL T 1 t G YE /NO
BEDROOMS BATHROOMS FULL 3/4 1 1/2
WATER SUPPLY- PUBLIC 4YE 'Jl`NO NAME � '1,�, ,.
1 a PRIVATE S/NO WELL YES/NO CISTERN YES/NO WELL/CISTERN#
SYSTEM SIZE: Septic tank material is constructed of Con C re✓•L �-I �Sro, lons capacity.
L«r 9n�
P and has S�� gallons
FIELD: Trench V)C1/-Sewn square feet or Bed n(•t. knnoYsquarefeet YEAR INSTALLED lir-l- 4,wr
You are required to draw a diagram of the system on the reverse side of this form in black Ink only and Indicate
location,length,width,and distance from the dwelling.
The undersigned property owner hereby certifies that the above described septic system is in fact Installed,as described,
and exists at this time on the parcel of ground identi by the above : description and further states that the system
is is not in good working order and to the best of hi her owledge i is not ailing 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 legs ctio or perjury as provided by law.
-,10 7 I
DAT O R SIGNATURE
rd
Subscribed and sworn to before me this Li day of �P f i 20 7 ,
by }Li ken_ La i'n at,.cn..n b
Witness my hand and official seal. _
commission enpjr p 4 l ci. Zppb
DATE -
NOTARY PUBLIC
•ATEMENT OF EXISTING INSPECTION REVIEWED BY c Le-g-bq-,
ENVIIt( N NTAL HEALTH SPECIALIST DATE
DEC-30-2009 WED 09:00 AM W.NVIR0NMENTAL HEALTH FAX NO. 97.4 6411 P. 03/04
• � +Ifr ern x'10 u-.5-e_
'7. yI
down S ;rs
LJ eJ
•
•
DEC-30-2009 WED 09:00 AM W •NVIRONMENTAL HEALTH FAX NO. 97.4 6411 P. 04/04
a
• DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 N 17TH AVE
GREELEY, CO 80631631 WEBSITE: www.co.weld.co.us
ADMINISTRATION (970) 304-6410
FAX (970) 304-6412
O PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420
FAX(970) 304-6416
ENVIRONMENTAL HEALTH SERVICES (970) 304-6415
COLORADO - FAX(970) 304-6411
April 10, 2007
Helen Lenehan
18690 County Road 17
Johnstown,Colorado 80534
RE: Helen Lenehan ISDS No.:07016
Permit No.: SE-0700015
On April 5,2007,an evaluation of the existing individual septic disposal system at:
18690 County Road I7, Johnstown:
Section 33,Township 4 North, Range 67 West,
• was conducted by Stephen J.Wiatrowski,an Environmental Health Specialist of this depanment, •
This evaluation is based on a final treatment capacity for a 4 bedroom residence.
The septic tanks are adequate to serve the residence. However,there is not enough information to determine
if the leach fields are adequate.No visible signs of failure were observed at the time of inspection.
Be advised,neither the County of Weld nor any of its agents or employees undertake or assume any
liability to the owner of the above property,to any purchaser of the above property or to any lending agency
making a loan on the above property or in the report.
This inspection was conducted for the purpose of determining compliance with current regulations and for
detecting health hazards observable at the time of inspection. This does not constitute a warranty that the
system is without flaw or that it will continue to function in the future. Inspections requested during
periods of snow cover and high soil saturation may be of questionable value to potential buyers due to
adverse conditions, Evaluations based on Statements of Existing(S.O.E.)relies on information the
property owner provides,under oath, indicating current status of the system and representing to the best of
his/her knowledge the system is not failing to function properly.
If we can be of any further assistance,please contact our office at (970) 304-6415.
Sincerely,
n Tit
Stephen 1.Wiatrowski
Environmental Health Specialist
Hello