HomeMy WebLinkAbout20101350.tiff �\ Weld County Er nmental Health Services Departmen
1555 N. 17th Avenuf
Greeley, CO, 8643'
(Phone: 304-641!8063
Fax: (970) 304-641'
lipwww.co.weld.co.u!
C.
COLORADO ISDS Field Inspection Form
Application Number: ISDS-0900019 Applied: 05/26/2009
App Type: Health\Residential\ISDS\na
Applicant Name: LOPEZ LAWRENCE & LINDA
LOPEZ LAWRENCE & LINDA
5096 CR 18
LONGMONT, CO 80504-9487
Owner Name: LOPEZ LAWRENCE & LINDA
Parcel #: 131325201017-R5642986
Legal Desc: DA 12-A W80' BLK12 & E100' BLK13 DREAM ACRES SITUS. 5096 18 CR WELD 0
Site Address: 5096 CR 18
LONGMONT, CO 80504
Percolation Rate St> clo Limiting Zone --ft in Description
% Ground Slope — Direction — Soil Suitable (Y/N)
engineering Design Required (Y/N) 1`. In 100 Year Flood Plain (Y/N)
The septic system identified above IS / IS NOT of sufficient size to accomodate the proposed alteration(s) indicated
below to the structure(s) served by this system.
EHS ISDS Reseach:
Absorption Bed Size UNK
Absorption Trench Size UNK
Engineering Design
Other Public Water Supply Utility
Private Water Supply
Private Water Supply Permit Reference
Number
Public Water Supply Yes
Public Water Supply Utility CWCWD
Research Comments
Septic Permit Recorded No
Septic Permit Reference Number
Septic Search Yes
Septic Tank Size 750
Year Installed UNK
EHS ISDS Current Flow:
Current Flow 1/2 Bathrooms 0
Current Flow 3/4 Bathrooms 0
Current Flow Basement Plumbing No
rrent Flow Comments ADDITION
rrent Flow Description SMALL HOUSE W/SIDING
Current Flow Full Bathrooms 1
Current Flow Number of Bedrooms 1
Current Flow Number of Persons 4
2010-1350
( Weld County F •ironmental Health Services Departmen
it/ 1555 N. 17th Avenuf
Greeley, 8
Phone: (970) 3304-641!641!Fax: (970) 304-641'
IIDc
www.co.weld.co.u!
COLORADO ISDS Field Inspection Form
EHS ISDS Research Changes:
Additions 1/2 Bathrooms 0
Additions 3/4 Bathrooms 0
Additions Basement Plumbing No
Additions Description SMALL HOUSE W/SIDING
Additions Full Bathrooms 0
Additions Number of Bedrooms 2
Additions Number of Persons 0
EHS ISDS Pronosed Total:
Addition Comments SMALL HOUSE W/SIDING
Proposed Basement Plumbing No
Proposed Total 1/2 Bathrooms 0
Proposed Total 3/4 Bathrooms 0
Proposed Total Full Bathrooms 1
Proposed Total Number of Bedrooms 3
Proposed Total Number of Persons 4
EHS Inspection Corrections:
roved
rections Comment
Field Area Undersized By
Field Undersized By
Increase Field Area To
Tank Construction
Tank Undersized By
The existing septic system is REQUIRED / RECOMMENDED to have the following alterations made to accomodate
the proposed alterations to the structure(s) served.
NOTICE
This permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the Weld County
Department of Public Health and Environment for reasons set forth in the Weld County Individual Sewage Disposal System Regulations
including failure to meet any term or condition imposed theron during temporary or final approval.The issuance of this permit does not
constitute assumption by the department cr its employees of liability for the failure or inadequacy of the sewage disposal system. This Dermit
is non-transferable and non-refundable. Before issuing final approval of this permit 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 is contingent upon the final inspection of the completed system by the Weld County Department of Public Health and Environment.
X 9 c 6, ,c c,c)
Envirbnmentalth Specialist Date
•
(\ Weld County Environmental Health Services Department
1555 N. 17th Avenue
Gre
eley,ey, CO 80631 Phone: (970) 304-6415
Fax: (970) 304-6411
"Nig C
COLORADO RECEIPT
May 26, 2009
Application Number ISDS-0900019
App Type: Health\Residential\ISDS\na
Owner Name: LOPEZ LAWRENCE & LINDA
5096 CR 18
LONGMONT, CO 80504-9487
Site Address: 5096 CR 18
LONGMONT, CO 80504
Rcpt# Pmt Type Pmt Method Ref# Pmt Date Amount Cashier Comments
ENS-0900185 Paid Check 1562 05/26/2009 $ 150.00 SGARCIA
Total Payments: $ 150.00
•
•
air
• Weld County Environmental Health Services Department
1555 N. 17th Avenue
Gre
eley,ey, CO 80631 Phone: (970) 304-6415
Fax: (970) 304-6411
C
COLORADO RECEIPT
May 26, 2009
Application Number: SE-0900027
App Type: Health\Residential\Statement of Existing\na
Owner Name: LOPEZ LAWRENCE & LINDA
5096 CR 18
LONGMONT, CO 80504-9487
Site Address: 5096 CR 18
LONGMONT, CO 80504
Rcpt# Pmt Type Pmt Method Ref# Pmt Date Amount Cashier Comments
ENS-0900186 Paid Check 1562 05/26/2009 $ 10.00 SGARCIA
Total Payments: $ 10.00
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CENTRAL WELD COUNTY WATER DISTRICT
February 11, 2010
Customer File 1= Meter Data 2
Acct# : 108941 Nw:N 833-3893 Act:Y P:N Route# : 2,108.00 New: 21,105
Cust : LOPEZ, LAWRENCE& LINDA Rate Code : 1 Node#:441
Add 1 : 5096 COUNTY ROAD 18 Meter Size : 1 Test Circle: 01
Add 2 : Dwell Unit: 2 Device Code: Z
City : LONGMONT, CO 80504- Meter Loc : B13/25-2-68 Book:0018
Owner : County Rd : DREAM ACRES
Add 1 : Serial# : 88470699 AMR#81310594
Add 2 : Manufacture: BADGER- NEW (R)
City : - Inst Date : 10/01/1989
Billing Records 3= Inst Read : 0
•
Present Balance : 43.30 Conn Date : 04/15/1994
Current Bill 43.30 Disconnect : / /
Amount Past Due : 0.00 Current Meter Readings=4=
Water Charge 36.30 Current Reading : 218
Dwelling Charge : 7.00 Prior Reading : 204
Surcharge 0.00 Current Use : 14
Not BB or WG Account : 0.00 YTD Use 34
Termination Charge : 0.00 Account Transactions
Restoration Charge : 0.00 Date :01/27/2010
Pre Billing Balance : 0.00 Amount : 43.30 CHG
Central Weld County Water District is aware that the address of 5096 County Road 18 has multiple
dwelling units on the property and that an addition to the second residence will be in process during
• 2010. The District does not restrict the use of the water service to either dwelling and has no conflict
with this process.
2235 2nd Avenue • Greeley,Colorado 80631 • Phone(970)352-1284 • Fax(970)353-5865
John W.Zadel,General Manager
CEN AL WELD COUNTY WATER DIS• CT
'_235 2i°Avenue
Greeley.CO 80631
970-352-1284
METER WATER RATES AND SERVICE CHARGES
• Effective January I,2010
MINIMUM CHARGE WATER QUANTITY
CHARGE
Meter Size I Monthly Gallons *Annual **Windy I Number of Cost Per
• Minimum Available Allotment I Gap Water j Gallons 1,000 '
Charge For (Metered I Monthly I Gallons
Minimum Gallons) Surcharge
•
• Charge
5/8" ] $16.50 2_,000 300,000 $2.10 0-2.000 $16.50
$37.95 15,000 450,000 I $5251 2,000-20.000 $1.651
I" $87.50 60.000 750,0001 $10.50 I 20,001-50.000 $1.10
IS" $203.70 I 200.000 1,500.000 1 $22.75 50,001-250,000 I $0.83
• $344.20 400,000 2.400.000 $42.00 - Over 250,000 . $0.66
3" $674.20 I 900.000 5,250,0001 $84.00 I
4" 1 $1,070.20 j 1,500.000 9,000,000 $140.00 I
6" $2.139.73 I 3,120.000 18,750.000 I
NOTES:
1. Meter Reading and Customer Service: Meters are read and billed on a monthly basis. Customer must pay for all water
registered by the meter.regardless of how the water has been used. Customer is responsible for the water system on customer
side of the meter. The District assumes no responsibility for failures from high pressure.freezing,etc.
2. Multiple Dwelling Units and/or Business Units: Where one meter serves more than one dwelling and/or business unit.
the following shall apply: A monthly surcharge of$3.50 for each dwelling and/or business unit for two or more units shall be
paid to the District in addition to the regular rate schedule in effect for the master meter. For motels, a S1.75 surcharge per
dwelling unit shall apply. Other services.such as laundry.etc.shall be considered as one or more equivalent dwelling unit for
basis of surcharge.
3.* C.B.T. Raw Water Surcharge: For C.B.T.Water.a surcharge of$.18 per 1,000 gallons shall be paid for all water used
• over the annual allotment for the applicable water year(November I"to October 31")_
4.*5 Windy Gap Raw Water Surcharge: In addition to the monthly surcharge shown for Windy Gap water,a surcharge in the
amount of 80% of the lowest base rate per 1,000 gallons shall be paid for all water used over the annual allotment for the
applicable water year(November 1"to October 31").
5. Pumping Surcharge: A 10%surcharge may be added to monthly water service charges where water is pumped for delivery.
6. Special Service Charges: Special service charges shall be applied to customers requiring services which are not used
regularly by all customers. A partial list of special service charges are as follows:
A. Inactive Service Status: A customer may transfer from an active tap status to an inactive service slams. The monthly
charge rate during the inactive status period shall be 50%of the normal monthly rates. The customer must provide
advance written request with a minimum of three(3)months prepayment and an advance service charge of$25.00 for
each meter shutdown and activation.
B. Delinquent Accounts: Payments for monthly service charges shall be due within 10 days following the billing date. ff
payment is not received in District on or before the 20111 of the following month,a Termination Notice will be sent and a
$10.00 handling charge will be assessed. If payment is not received within 10 days after the mailing date of the notice,
water will be shut off without further notification to the customer,
In order to restore water service,charges will be assessed as follows:
Il First Re-activation E'$25.00
2) Second Re-activation f S50.00
3) Third Re-activation and each re-activation thereafter$f$75.00
4) Following the third re-activation.the District Board shall have the right to discontinue service and establish
special conditions to assure that payment will be made for water service.
C. Water service may not be terminated without a 10 day prior written notification front the District to the landowner
and/or the tenant. This applies to water service fees either current or nut current. The District wiii not terminate water
service based on a landowner's intent to evict a tenant.
Any Monies paid for activation shall be paid at the District office.
Field personnel are not authorized to receive payment in the field.
•
rI;N
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
I D o C
PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420
FAX (970) 304-6416
ENVIRONMENTAL HEALTH SERVICES (970) 304-6415
COLORADO FAX(970) 304-6411
June 2,2009
Lawrence& Linda Lopez
5096 County Road 18
Longmont,Colorado 80504
RE: Lawrence& Linda Lopez ISDS No.: 0900019
Permit No.: SE-0900027
On May 29, 2009, an evaluation of the existing individual sewage disposal system at:
5096 County Road 18, Longmont, Colorado;
• Section 25,Township 02 North, Range 68 West,
was conducted by Steve Wiatrowski,an Environmental Health Specialist of this department.
There is not enough information provided to determine if the system is 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.0.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,
• Steve Wiatrowski
Environmental Health Specialist
SW/sg
i . ......, ,,,r , 1, 7.,;,,,,, . i . jp.,,,-, . , - 44
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Company Name: A 1 SL"r/ /c Phone number:32g-637-- c6/O
Customer Name: 2�C-C >c ® O(7477 CA- 22 CZ LOA-0 GC
Address of Pumping: 5c 9-6 u 'c,c / p
Pumping Date: 3 ", S--o 7
1. Tank Size:?SD ‘/ Gallons Pumped: 7So 6Q'7
2. Lift Station: Yes No.C If yes, functioning: Yes No
3. Excessive water running back into tank from field? Yes No X
If yes, estimate in gallons:
4. Liquid level in tank over inlet line?Yes New
5. Tank Const ction (check one)
221
Concrete Metal Brick Plastic or Fiberglass
Cesspool or Seepage Pit Other
• 6. Tank Construction Observed:
One Compartment.X Two Compartment
7. Inlet/outlet tees and/or baffles in good condition? Yes-3C No
8. Filter on outlet cleaned and inspected (if applicable)? Yes No,...--\C" 4, 4i7
9. Access to clean-out lids within 8 inches of grade?
Inlet: Yes,C No Outlet: Yes?C No
10. 20 ml. plastic replaced and sealed over tank lid (flood plain only)? Yes Not
11. Tank/lid structurally sound and water tight? Yes X No
12. Obvious cracks/leaks observed? Yes NQ--C
If yes, explain area:
13. Other conditions noted which may affect proper functioning of system?
itiC ti -
14. Reason for Service:
Maintenance Real Estate Sale-< Emergency/Backup Other
S15. Notes: `` �j e?"--e ,� 29,OOO/ZIS
`neck1s
A-1 Septic Service •
P.O. Box 1015 0 Brighton CO 80601
303-659-0610
•TREET ADDRES: r
INSPECTOR NAME:
COLORADO PE #: NAWT # NA79587WT NSF#:
PUMPING AND INSPECTION CONDITIONS
Were all compartments of multi-compartment tanks pumped? s3 YES ❑ NO
Was all liquid and sludge removed leaving no more than 3 inches in tank? U YES ❑ NO
Was the owner notified of any deficiencies noted during pumping? A YES ❑ NO
Tank Type
D Concrete ❑ Plastic ❑ Fiberglass ❑ Other
ESTIMATED CAPACITY OF TANKS) • gallons
Absorption / Evaporation System
❑ chambered system ❑ drip irrigation ❑ seepage bed
❑ seepage pit ,*seepage trench ❑ ET bed
❑ Other
Tank Components
*Lidls) PASS FAIL 5
*Integrity PAn.: FAIL
*Dosing siphon PASS FAIL ,N'a'y LC-1
*Internal Tees / baffles r'P`ASS: FAIL NA <p
*Effluent Filters / screens PASS FAIL .WA, lt.) Cv
Back flow after pumping /14-6' YES t'ir)
SITE, WEATHER AND OCCUPANCY CONDITIONS DURING INSPECTION
*Erosion? BASS- FAIL
*Improper discharges? 'PASS' FAIL
Improper vegetative cover? HD: YES
Subject to compaction? NO fES-
Snow cover?
Property vacant? NO YES r
ABSORPTION / EVAPORATION SYSTEMS NA U
Visible Components
*Vent / observation pipe PASS FAIL (N?
*D Box / valve box PASS FAIL IfsIR,. NO
Surface Dampness? ,Ng; YES
Odors? FNO, YES ' ` '7:
Liquid in obs. / vent pipe? NONE Liquid depth is inches
ELECTRIC LIFT / PUMP STATIONS NAP,
*Lidls) PASS FAIL
*Tank integrity PASS FAIL
*Pump and controls PASS FAIL
I hereby certify that I have inspected the above individual sewage disposal system in accordance with the National
*Association of Wastewater Transporters and some County Department of Health and Environment regulations and
that my comments and observations accurately reflect the physical and operational status of the system and its
components on the date of inspection. This, however, is not a warranty of any kind.
Inspector Date
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