HomeMy WebLinkAbout20260532 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
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r'�lit Greeley, CO 80631 •
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Our vuron Together with the communities Ise serve.we are working to make Weld County the healthiest place to live,learn.work and play
Septic Permit - Final
Application Number:SP-1500024
Owner Name:WILLIAMSON LINDI &J
Site Address: 4158 CR 59
KEENESBURG, CO 80643
App Type: Health\Residential\New OTS\Septic Application Status:
W
LINDI WILLIAMSON Finaled
Applied Date:
4158 CR 59 01/28/2015
KEENESBURG, CO 80648 Issued Date:
02/06/2015
Parcel#: 147512300030-R2429203 Finaled Date :
Legal Desc: PT SW4 12-1-64 LOT A REC EXEMPT RE-3458 (1.02R) 03/18/2016
Work Description: AUXILIARY STEEL BUILDING-FOR PERSONAL USE
EHS SEPTIC GENERAL:
Associated Disaster Permit No
Location Description 4158 CR 59
KEENESBURG CO
Number of Persons 1
Parcel Acres 10.2
Public Water Supply No
Waive Fees No
EHS SEPTIC ACTUAL (FINAL):
Septic Tank Size, gallons 1000
Lift Station Yes
Lift Station Size 540
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 25-10-112(1)(b),C.R.S.
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.
Alex Clemments March 18, 2016
Environmental Health Specialist Date
Print Date Time: 3/18/2016 10:39:40AM Septic Permit- Final EHS033 Page 1 of 1
COLORADO DIVISION OF WATER RESOURCES For Office Use Only
Form No. DEPARTMENT OF NATURAL RESOURCES
GWS-11 1313 Sherman St., Ste 821, Denver, CO 80203
08/2016 (303)866-3581
dw state.co.us
CHANGE IN OWNER NAME/ADDRESS
PRIOR TO COMPLETING THIS FORM,SEE INSTRUCTIONS ON REVERSE SIDE
INCOMPLETE, POOR QUALITY, OR ILLEGIBLE FORMS CANNOT BE PROCESSED AND
WILL BE RETURNED
Name, address and phone number of person claiming ownership of the well permit:
Name(s): Scott Purcell and Marianne Purcell
Mailing Address: 12590 Valentia Street
City, St. Zip: Thornton, CO 80602
Phone Emailrai Address: scott.purcell1972@gmail.com
Well Permit Number: _ CO Op-813 I Receipt Number.: Case Number(optional):
WELL LOCATION: County: Weld Well Name or#(optional):
4158 County Road 59 Keenesbura CO 80643-9429
Street Address
,. / (City) (State) (Zip)
SW V 1/4 of the SW 1/4, Sec. IA ,Twp. / 'N.or CIS.,RangeePq ❑ E.or,a W., (o � P.M.
Distance from Section Lines: &FS Ft. From ❑ N.or S., 3/5 Ft. From ❑ E.or q W. Line.
Subdivision Name Lot Block Filing/Unit
NOTE: If changing/correcting the permitted location of a well, use Form No. GWS-42.
I (we) claim and say that I am (we are)the owner(s)of the well permit described above, know the contents of the statements made
herein,and state that they are true to my(our)knowledge. This filing is made pursuant to C.R.S.37-90-143.
Signature(s-of the Ne Owner Signatures)of the New Owner Date(mm/dd/yyyy)
'74a(-6a W2025
It is the responsibility of the new owner of this well permit to complete and sign this form. If an agent is signing or entering information,
please see instructions.
Please allow 4 to 6 weeks for processing of this form. Thereafter, you can view or print the accepted document at:
http://www.dwr.state.co.us/VVellPermitSearch
Signature of DWR staff indicates acceptance as a Change in Owner Name and/or Mailing Address.
For Staff Use Only
Staff Signature Date
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