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Home My WebLink About20101559.tiff nuv-0I-cuue iuc uo.uj nI w u cw7lrculvnrwltiL tttNLIiI NTA NU. y(t.1 JU4 ti411 1 , U5 • DEPARTMENT OF PUBLIC HEALTH AND E NVIRO 1555 N 17TH AvE • . GREELEY, CO 80531 WEBSITE: www.co Weld o,us ADMINISTRATION (970) 304 64us FAX (970) 304-641 Ifigk PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420 coLORADo FAX (970) 304-6416 ENVIRONMENTAL HEALTH SERVICES (970) 304-6415 FAX (970) 304-6411 March 31, 2003 Roswell&Kerry Checketts 21566 CR 43 LaSalle,CO 80645 RE: ISDS No.: 03042 Permit No.: SE-0300040 Dear Roswell& Kerry Checketts: On March 28,2003 an evaluation of the existing individual septic disposal system at 21566 CR 43, LaSalle; Section 15, Township 04 North,Range 65 West, was conducted by Pam Smith, an Environmental Specialist of this department. The existing individual septic disposal system is of sufficient size and capacity to adequately handle the proposed load. This evaluation is based on a final treatment capacity for a 2 bedroom residence, • 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, Pam Smith Environmental Health Specialist • 2010-1559 ,vuv i r-0004 J ur w Uy rri w tP V t Uh ltPI IHL HtHL I H IHX NU. y(U 304 6411 P. 04 • • \4. • f • 1 Sepirl Tank M1. en.St. r � NOV lY ZUUy liE U3 LW Y1 W U ENVIKQNCEN7RL H�RL'1'H FAX N0. 970 304 6411 p, 03 • HEALTH AND ENVIRONMENT"s ur r C SOE# O 3 0 :,'. d0 �- 1555 N. 17' AVENUE ORG #____________------- p„ IT# GREELEY, COLDRADO 80631 REPAIR EliDe ' PHON(: (970) 304.6415 LOAN IL__ _FAX: 870 304-6411 'SOS# , 1� • COLORADO STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN BLACK INK ONLY) PARCEL NO. /OSs/5'OCG AI PROPERTY OWNER OSt,J f 7 err t , cP" S PHONE NO. f?� MAILLNG ADDRESS a �Qsc//i= / 5-4 6 r ' 8o s Y b / J , e, y...,-- DESCRIPTION OF BUII DCity State Zip LVG (ex. house,mobile/modular home,shop,office) /!O G($ SITE/LOCATION ADDRESS a1 C 3 ✓O q / o C o 530 6 Y.S` LEGAL DESCRIPTION pT-thPT City State Zip ✓ 4 SECTION /S- TOWNSHIP Z RANGE 6.5 w SUBDIVISION --- � LOT — BLOCK — FILING CENCUS TR4CTi — ` LOT SIZE/ACRES S0 COMMERCIAL YES lvvo i RESIDI1NTLa YE /11.10 NUMBER OF PERSONS_c BASEMENT PLUMBING YES I. 0 BEDROOMS Z BATHROOMS-FULL WATER SUPPLY-PUBLICS NO NAME /s 3/4 IIZ -- PRIVATE YES �� ', O • /NO WELL YES/NO CISTERN YES/NO WELL/CISTERN# SYSTEM SIZE: Septic tank material is constructed of Ce4C reT and has✓0OD FIELD: Trench 611? square feet or Bed gallons opacity. square feet YEAR INSTALLED . 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 identified by the above legal description and further states that the system is/is not in good working order and to the best of his/her knowledge is/iis 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 leg/LU perjury as provided by law. ' DATE OWNER SIGNATURE Subscribed and sworn to before me this -Y LC.`?}I` day of 'I'� 1C P\r_('� �t 20 C?, By fl is^P ( 1 (.11 cC'_{�P-6 5 Witness my hand and official seal. s ! ?Ay co mtsfiion expi I � — � �— "fi 3—• —03 DATE NOTARY P ' LIC en•TATEIV1ENT OF EXISTING INSPECTED&REVIEWED By t.EU'1 1\kU 1 l 31 t)03 ENVIRONMENTAL HEALTH SPECIALIST DATE NUV-11-2UUU TUE U3109 PM W C ENVIRONMENTAL HEALTH FAX NO. 970 304 6411 P 02 • • VP ppL } J' 1'i ,l �7 / cx1 ° r � . �A�c �� WS opic5 (,�1 it )' pox 6 ( .., ' J ti 6- �I, I -,-._ _ ate`-u • (.00 \ 1 G� 9,s V I i LI , ,,, 4• Nov-l (-2009 111, U3:09 FM N 0 ENVIRONMENTAL HEALTH FAX NO. 970 304 6411 P. 01 • PHONE (970)304-6415 FAX (9.04-6411 Finale. Permit#: SP-0300201 Sec/Twn/Rng: 15 04 65 Status: ISSUED Owner: CHECKETTS ROSWELL & KERRY Applied: 06/02/2003 Applicant: CHECKETTS ROSWELL Issued; 07/25/2003 II Permit Type: RNEW C=Commercial,R..Residcntial*NEW, 5� REPair,VauLT Finaled: I I/ • 1 ' OS Parcel#: 1055-15-0-00-021 Location: 21506 CR 43 LASALLE Legal Description: 11 949 S2NW4 15 4 65 (1R) %21566 WCR 43% 21566 43 CR WELD �� Installer: Description: RANCH HOUSE Commercial: N Residential:Y Acres: 14 #of Persons: 2 Basement Plumbing: N #of Bedrooms: 3 Bathrooms -Full: 2 3/4: 0 1/2: 0 Water Public: Y Water Source: CWWD Water Private: N Cistern: N W_WelL1N Well Permit#: 76 Percolation Rate: 31.6 Limiting Zone:: O$ 0 in Description:g. % Ground Slope: 4 Dir: 1R Soil Suitable: (Y/N) Engineer Design Required: (Y/N')RV. Q In 100 Year Flood Plain: (YIN) N Minimum Installation Chambers Septic Tank: 1000 gallons Absorption Trench: 774 square feet • or Absorption Bed: 1020 square feet Actual Installation Septic Tank: /000 gallons Absorption Trench: 774 square feet aj,s Absorption Bed: square feet Design Type: 6-4 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'eeld Count Pep ent of Public Health and Environment, x f '�1� 'V�" L Environmental Health Specialist batc� Forms P n1 �it,o ` pry a. (Sc_e_ lamer- 1ti Tlb. lem ksj tiAxil 1sisnAex \J ai.....cMt e , • c r- «v:: • • Revised 4/30/96 ACTIVE TAP . Ig'5 TAP FEE AGREEMENT • THIS AGREEMENT, made and entered into this AI day of .5c 20 O by and between the CENTRAL WELD COUNTY WATER DISTRICT, hereinafter called the District, and Roswell L. Checketts and Kerry Checketts hereinafter called Customer, WITNESSETH: WHEREAS, District has been organized as a legal body and is known as the Central Weld County Water District, and WHEREAS, Customers arc taxpaying electors within said District, or desiring to join said District, or and, WHEREAS, Customers arc desirous of acquiring one water tap of 3/4 inches in diameter from the said District, NOW, THEREFORE, in consideration of the premises and the terms of this agreement, it is mutually agreed as follows: 1. Customer agrees to pay the tap fee of$ 23,150.00 Twenty Three Thousand One Hundred Fifty0 and No/100 Dollars. 2. The description of the premises for which this tap is being purchased is as follows: • S '/7 NW 'A Section 15, Township 4 North, Range 65 West of the G''P.M., Weld County, Colorado. 3. This agreement, when approved by the Board of Directors, shall become a legal and binding contract upon all parties hereto. 4. Customer further agrees to execute any and all easements needed by District at no expense to District, across Customer's property for the purpose of installing the District's service line and meter pit constructed by District. District shall be responsible for restoring surface area back to reasonable condition at District cost. • 5. It is further mutually agreed that this agreement shall extend to and be binding upon the heirs, executors, administrators and assigns of the parties hereto. 6. Customer further agrees to the following special provisions: • N/A 7. Customer further agrees to abide by the rates established and the rules and regulations of the District. IN WITNESS WHEREOF, the parties hereto have hereunto and hereunder set their signatures the day and year first hereinabove written. CUSTOMER SIGNATURE CENTRAL WELD COUNTY WATER DISTRICT (Property Owner) J i fLG 'L� 1 iG Gt "_ Roswell L. Checketts �1 ;.(Er ( ATTEST cc, ,0, �� Kerry C lecketts • Revised 4/30/96 ACTIVE TAPS 'Y It/I TAP FEE AGREEMENT °P • THIS AGREEMENT, made and entered into this 3rd day of S%(Yi el , 19 94 by and between the CENTRAL WELD COUNTY WATER DISTRICT, hereinafter called the District, and Roswell L. Checketts and Kerry Checketts hereinafter called Customer, WITNESSETI4: WHEREAS, District has been organized as a legal body and is known as the Central Weld County Water District, and WHEREAS, Customers are taxpaying electors within said District, or desiring to join said District, or and, WHEREAS, Customers are desirous of acquiring one water tap of 3/4 inches in diameter from the said District, NOW, THEREFORE, in consideration of the premises and the terms of this agreement, it is mutually agreed as follows: I. Customer agrees to pay the tap fee of$ 12,150.00 Twelve Thousand One Hundred Fifty and 00/100 Dollars. • 2. The description of the premises for which this tap is being purchased is as follows: S 1/2 of the NW 'A of Section 15, Township 4 North, Range 65 West of the 6"' P.M., Weld County, Colorado. 3. This agreement, when approved by the Board of Directors, shall become a legal and binding contract upon all parties hereto. 4. Customer further agrees to execute any and all easements needed by District at no expense to District, across Customer's property for the installation of the meter pit and appurtenances constructed by District. District shall be responsible for restoring surface area back to reasonable condition at District cost. 5. Customer further agrees to execute any and all easements needed by District at no expense to District, across Customer's for the purpose of installing the District's service line and meter pit constructed by District. District shall be responsible for restoring surface area back to reasonable condition at District cost. 6. Customer further agrees to the following special provisions: Water main extension contract. • 7. Customer further agrees to abide by the rates established and the rules and regulations of the District. IN WITNESS WHEREOF, the parties hereto have hereunto and hereunder set their signatures the day and year first hereinabove written. • CUSTOMER SIGNATURE CENTRAL WELD COUNTY WATER DISTRICT (Property Owner) 0 Z, BY Roswell L. Checketts - C� l�-��.b°�: ATTEST _ Cz Kerry C cketts Hello