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Home My WebLink About20242385.tiffLeft Hand Water District P.O. Box 210 Niwot, CO 80544-0210 Make checks payable to: LEFT HAND WATER DISTRICT (please use standard BLUE or BLACK ink on checks) Water Usage Billing Detail (Billed per thousand gallons) Level 1: 1000 Level 2: Level 3: Level 4: @ .00418 Usage Calculation Total: GALLONS USED T 5 3 9 Jai Aug Sep Oct Nov On Jan Feb Mar Curr 649 STATE HWY 52 ARCHDIOCESE OF DENVER 04128/2021 05/21/2021 3072.02 $37.'72 Mailing Address: P.O. Box 21{) a Niwot, CO 80544-0210 Office Address: 6800 Nimbus Rd.. Longmont, CO 80503 303-530.4200 Q www.tefthandwater.org Office Flours: M -P 8:30 a.m. - 4:30 p.m. PREVIOUS BALANCE PAYMENTS Through 04/28/2021, Thank You. WATER BASIC FEE Scanning Cover Sheet for Septic Permits Permit # Permit Type: SP -0400264 Health / Residential / Repair Situs Street Address 649 HWY 52 Situs City, State, Zip Sec/Town/Range: 31 -02N -68W Parcel # (12 digits) 131331000022-R5657386 Owner Full Name: TIMMRECK LIVING TRUST Owner Address: 649 SHWY 52 ERIE,CO 80516 Contact Name: EDELFELT DOUGLAS Contact Address: 5899 E CONSERVATION LONGMONT,CO,80504 Application Status: Finaled Application Date: 07/23/2004 Owner Phone #: 303.956.6650 Contact Phone# 303.684.8076 Information above has been Verified in Accela by employee noted below x .1. Processed y: May 09, 2008 Date Report ID: EHS00024v003 Page 1 of 1 Print Date -Time: 5/9/2008 8:49:31AM WE. L11O NTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, CO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 Permit #: SP -0400264 Sec/Twn/Rng: 31-02-68 Owner: TIMMRECK LIVING TRUST Applicant: EDE LT DOUGLAS Permit Typ - ' VLT r=Commercial, R=Residential + NEW, REPair, VauLT Parcel #: Location: 649 S HWY 52 ERIE Legal Descript' n: Installer: Pe 'bY lJiN LLG Finaled Status: ISSUED Applied: 07/23/2004 Issued: 07/23/2004 Finaled: Description: HOUSE Commercial: N Residential: Y Acres: # of Persons: 2 Basement Plumbing: Y # of Bedrooms: 5 Bathrooms - Full: 2 3/4: 0 1/2: 0 Water Public: Y Water Source: LEFT HAND Water Private: N Cistern: N Well: N Well Permit #: Percolation Rate: 0 Limiting Zone: 0 ft 0 in Description: % Ground Slope: 0 Dir: Soil Suitable: (Y/N) Engineer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N) N 9 Minimum Installation Septic Tank: 500 gallons Actual Installation Septic Tank: l5W Absorption Trench: 0 square feet or Absorption Bed: 0 square feet gallons Absorption Trench: J , • . afe feet fAbsorption Bed: �1� square feet Design Type: Chamber Mod Chambers* 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 b s. inai permit approval was contingent upon the final inspection of the completed system by the Weld Co ur ty Department o is ealth and Environment. x Form: S_FINAL Environmental Health Specialist Date FOR OFFICE USE ONLY ISDS APPLICATION FLOW SHEET Owner �mr�,��I� LlViru Permit #:-{}4 �[ Location: 1pt"1 S 5� i Er 1 e Date B Legal Description: 3!' Comments Parcel Number Received _„3 a' c' Information Form Complete Authorization Form Received I' Map Drawing Received Flood Plain? Yes/No Site InspectiqnDate Engineer Design? Yes/No Date Engineer Design Received Customer Notified? Yes/No Date Staff Approval Sent bate Staff Approval Rec'd Perc Data Entered in Computer r7- ,(jit pp y,;k t.u' s ksue� ;n huts Date of BOH Approval f Eng Approval Letter Sent (Letter, Permit, BOH Review) Date of Final Inspection 1j]l1 Eng Final Inspection Letter Reed Variances Needed? Yes/No Sent Variance Staff Approval Recd Variance Staff Approval Variance BOH Approval Variance BOH Approval Sent (Variance, BOH Review) IP' ---mummig M:IENVIRONMENTAL HEALTH SERVICES\SEPTIC\FLOWSHEET WELD -COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, COLORADO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 Permit #: Owner: Applicant: Permit Type: Parcel #: Location: Legal Desc: SP -0400264 Sec/Twn/Rng: 31-02-68 TIMMRECK LIVING TRUST EDELFELT DOUGLAS RVLT C=Commercial, R=Residential + NEW, REPair, VauLT 1313-31- - - 649 S HWY 52 ERIE PERMIT Applied: 07/23/2004 Expires: 07/23/2005 Description: HOUSE Commercial: N # of Persons: # of Bedrooms: Residential: Y 2 Basement Plumbing: Y 45 Bathrooms - Full: 2 3/4: 0 1/2: 0 Water Public: Y Water Source: LEFT HAND Water Private: N Cistern: N Well: N Well Permit Number: Acres: 9 Percolation Rate e— Limiting Zone —ft — in Description % Ground Slope — Direction Soil Suitable (Y/N) Engineer Design Required (Y/N) Li In 100 Year Flood Plain (Y _ From the application information supplied and the on -site soil percolation data the following minimum installation specifications are required: Septic Tank S x) gallons, Absorption Trench square feet or Absorption Bed square feet Chambers In addition, this permit is subject to the following additional terms and conditions:! .a.i a iL e: —c2 Ca t• ,,r S 4►` ► '7Sr' e S3 a w+�. 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 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. This permit 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. This permit expires one year from the application date. Form: S_PERMITR ntal Health Specialist WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411 WEBSITE: WWW.CO.WELD.CO.US Copy Reprinted on 07-23-2004 at 16:25:50 APPLICATION / RECEIPT Initials: MS Permit Number: SP -0400264 Receipt Number: HAP -04267 07-23-2004 Amount: $150.00 Payment Method: Check Notation: 1386 Owner Name: TIMMRECK LIVING TRUST Applicant Name: EDELFELT DOUGLAS Parcel Number: 131331 Location: 649 S HWY 52 ERIE Account Code 2560-41400-4221-4203 2560-41400-4221-4203 2560-41400-4221-4203 2560-41400-4221-4203 Description: HOUSE Commercial: (Y/N) N Number of Persons: .2 Number of Bedrooms: 45 Water Public: (Y/N) Y Water Private: (Y/N) N Description New Septic Permit Repair Septic Permit Vault Permit Variance Request Residential: (Y/N) Y Acres: 9 Basement Plumbing: (Y/N) Y Bathrooms: Full - 2 3/4: 0 Water Supply: LEFT HAND Cistern: (Y/N) N Well: (Y/N) N 1/2: 0 Amount $0.00 $0.00 $150.00 $0.00 Well Permit Number: TERMS AND CONDITIONS A permit fee, as set by separate ordinance of the Board of Weld County Commissioners, shall be required of applicants for new individual sewage disposal systems (ISDS), payable at time of application. Permit fees are no refundable: permit applications are non -transferable. If both a building permit and an ISDS are issued for the same property and construction is not commenced prior to the expiration date of the building permit, the ISDS permit shall expire at the same time as the building permit. If an ISDS permit is issued for a property that does not require a building permit, the ISDS permit shall expire one year after its issuance if construction on the septic system has not commenced. Any change in plans or specifications after the permit has been issued invalidates the permit unless approval is secured from the Health Officer or his/her designated agent. Expired permits can be renewed by payment of the permit fee only if: A. There has been no change in the plans and specifications of the proposed system as set out in the original application or such change is reviewed and approved by a Division Representative. B. The surrounding, land, its use or zoning has not changed so -as -to cause the original application not to be acceptable under these regulations. NOTICE The completeness of this application is conditional upon further mandatory and additional tests and reports as may be required by the Weld County Department of ' .. is Health and Environment (WCDPHE). The issuance of the permit is subject to such terms and conditions as deemed necessary to insure co • fiance ith rules and regulations adopted under article 10 title 25, CRS as amended. The applicant certifies that the proposed system will not b ❑rated w- i 400 feet of a community sewage sys • . The undersigned certifies that all statements made, information and reports submitt:+ herewit r will be, represented to be tru ' correct to the best of his/her knowledge and are designed to be relied on by the WCDP E for ev:. . ti• for purposes of issuing th • . rmit applied for herein. Applicant further understands that falsification or misrepresentation may r suit in the n' - of the application or rev. .lion of any permit granted, and in legal action of perjury as provided by law. X Owner/ r plicant Date. Form: RT_HAPP SEPTIC INFORMATION FORM WIND COLORADO PARCEL NO.: / 3/3 31 0000,2.R 0 b ,2.R (12 DIGIT NUMBER) CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650 PROPERTY OWNER: .7/P1 Al &i< S T MAILING ADDRESS: 6 7 9 s£ s- c- CITY �02-/ ST ZIP CI) -(6 HOME PHONE: (?03 ) 96-6 —6 (c 56 WORK PHONE ( ) FAX C__) APPLICANT NAME: 0o J c - MAILING ADDRESS: 519'9 Q Jf WA -4J CITY Alt50( /C4T Gd ZIP 1)(35-d / HOME PHONE: (? � � b �7 -f Th WORK PHONE ( ) FAX ( ) To obtain an I.S.D.S. permit, one must file an "application for Individual Sewage Disposal System" at the Weld County Environmental Health Services office and pay the application fee. A "repair" fee shall be charged for the expansion, replacement, or repair of an existing system. The following information must, be provided on the septic information form. . LEGAL DESCRIPTION PT PT SEC 31 TWN oZ RNG CPS ACRES 9 r SUBDIVISION LOT BLOCK FILING DESCRIPTION OF BUILDING (EX: HOUSE, MOBILE HOME, MODULAR, SHOP, OFFICE) / U SE SITE ADDRESS 6 I S H. Sc?- b J C/ ASV/ DIRECTIONS TO SITE ?"114 Al / i OC N c / 0 Ai S A Sr 2 - NEW PERMIT REPAIR PERMIT VAULT PERMIT IC $ 400 $ 400 $ 150 IF OBTAINING A REPAIR PERMIT, PLEASE LIST PREVIOUS OWNERS OF THE PROPERTY: FLOOD PLAIN RESIDENTIAL NUMBER OF PERSONS 2 - NUMBER OF BEDROOMS WATER SUPPLY: PUBLIC PRIVATE YES. CENSUS TRACT I90. 01 COMMERICAL YES BASEMENT PLUMBING YE ` / NO BATHROOMS: FULL 2-- 3/4 1/2 CISTERN YES / NAME Z /./n i() WELL YES O WELL PERMIT # PERC HOLES MARKED FOR INSPECTION BY SPECIALIST YES / NO FIELD INSPECTION FORM ISDS Request No: 04068 Plan Referral No.: Date Received: 06/21/2004 Received By: MS Fee: $100.00 Date Inspected: Owner Name: Timmreck Living Trust Phone of Contact Person: 303.828.4361 Mailing Address: 649 Highway 52 Erie, CO 80516 Site Address: 649 Highway 52, Erie, CO 80615 Legal Description: PT PT Sec 31, Twn 02 N, Rng 68 W Subdivision: Lot Bllc Flg Water Supply: Erie Cit Residential/Commercial Total Acres: 9 Permit on Record: WILTS WENDELL Permit No: F19820071 S.O.E.: N System Size: Tank loco gallons Trench square feet Bed Ci:/z) S square feet Percolation Rate: minutes per inch �-�•�,�.� Engineer Design: Y ) Percent Ground Slope Direction The septic system identified above NO • f sufficient size to accomodate the proposed alteration(s) indicated below to the structures) served by this system. Current Flow Description: HOUSE Persons: 3 Bedrooms: 4 Bathrooms: 2 Bsmt Plumb: N Th exist' ' : 'c system is Required/Rec ac date the pr.: +sed altera ' ie structure(s) serve Additions 0 1 1 N Proposed Total HOUSE 3 N ave the following a l_te zade to Env onmeh al Health Specialist form: isdsinsp Date 1 1-itr Lli Aci.-1 ct.Lh • IS A o tea. A 53ZI:)¢ 15voc,A4- Scanning Cover Sheet for Septic Permits Permit # Permit Type: SP -9900262 Health / Commercial / New Situs Street Address 649 HY 52 Situs City, State, Zip Sec!Town/Range: 31 -02N -68W Parcel # (12 digits) 131331000022-R5657386 Owner Full Name: TIMMRECK DENNIS & WENDY Owner Address: 649 STATE HWY 52 ERIE,CO 80516 Contact Name: Contact Address: TIMMRECK DENNIS & WENDY 649 STATE HWY 52 ER I E, CO, 80516 Application Status: Finaled Application Date: 06/01/1999 Owner Phone #: (303)828-4361 Contact Phone# (303)282-4361 Information above -has been Verified in Accela by employee noted below May 09, 2008 Processed by: Date Report ID: EHS00024v003 Page 1 of 1 Print Date -Time: 5/9/2008 8:51:47AM WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE.(970)304-6415 FAX (970)304-6.411 .Finaled Permit # : SP -9900262 Sec/Twn/Rng: 31 02 68 Status: TAMED - Permit Type : CNEW C=commercial, R.residential Parcel No: 1313 31 000022 Location: Legal Desc: APPLICANT OWNER + NEW, REPair, VauLT 649 STATE HWY 52 ERIE 31-2-68 25268 PT SW4SE4 31 2 68 BEG 678.25'E & 649 52 HWY WELD TIMMRECK DENNIS & WENDY 649 STATE HWY 52, ERIE CO 80516 TIMMRECK DENNIS & WENDY, 649 STATE HWY 52, ERIE ;CO 80516 Applied: 06/01/1999 Issued: 06/25/1999 Finaled: 30'N OF S4 Phone: (303)282-4361 Phone: (303)828-4361 Description: COMMERICAL SHOP Commercial (Y/N): Number of Persons: Number of Bedrooms: Water Public (Y/N): Water Private (Y/N) :. Water Permit No: Percolation Rate: % Ground Slope: N Residential (Y/N): Y Y Acres: 10.00 10 Basement Plumbing (Y/N): N Bathrooms-> Full: 3/4: Utility Name: Cistern (Y/N): 1/2: LEFT HAND WATER Well (Y/N) : 20.0 Limiting Zone: >08 ft 00 in Dir: Soil Suitable (Y/N): Y Engineer Design Req'd (Y/N): N Minimum Installation Septic Tank: 1000 gal Actual Installation Septic Tank: two gal Design Type: 0104 In 100 Yr Absorption Trench: Absorption Bed: Absorption Trench: Absorption Bed: Desc: Flood Plain (Y/N): N sq. ft. 374 sq. ft. sq. ft. 0 sq. ft.. 1 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 not transferable. The Weld County Health Department 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 Health Department. X Environmental Specialist Date SvA T N 1152_ WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970)353-0635 EXT 2225 FAX (970)356-4966 Permit # Permit Type: Parcel No: Location: Legal Desc: APPLICANT OWNER SP -9900262 Sec/Twn/Rng: 31 02 68 CNEW C=commercial, R=residential + NEW, REPair, VauLT 1313 31 000022 PERMIT Applied: 06/01/1999 Expires: 05/26/2000 649 STATE HWY 52 ERIE 31-2-68 25268 PT SW4SE4 31 2 68 BEG 678.25'E & 30'N OF S4 649 52 HWY COLORADO TIMMRECK DENNIS & WENDY 649 STATE HWY 52, ERIE CO 80516 TIMMRECK DENNIS & WENDY 649 STATE HWY 52, ERIE CO 80516 Phone: (303)282-4361 Phone: (303)828-4361 Description COMMERICALOP Commercial (Y/N): N Residential Number of Persons: Number of Bedrooms: Water Public (Y/N): Y Water Private (Y/N): Water Permit No: Percolation Rate: 2.O Ground Slope: Engineer Design Req'd (Y/N):T( From the application information supplied and the on -site soil are required: Septic Tank:1,000 gallons, (Y/N) : Y Acres: 10 Basement Plumbing (Y/N): Bathrooms-> Full: N 10.00 3/4: 1/2: Utility Name: LEFT HAND WATER Cistern (Y/N): Well(Y/N): Limiting Zone: >4 ft — in Desc: Dir: Soil Suitable (Y/N): In 100 Yr Flood Plain 1 1-fh (Y/N) VA percolation data the following minimum installation specifications Absorption Trench _ — or Absorption Bed sq. ft. sq. ft. Chambers In addition, this permit is subject to the following additional terms and conditions: � k'Ntelak.ris C. }1..o_;4 NOTICE This permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the Weld County Health Department for reasons set forth in the Weld County individual sewage disposal system regulations including 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. This permit is not transferable. Before issuing final approval of this permit the Weld County Health Department 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 Health Department. This permit expires one year from the signature date. XR1,1611W4 Environmental Specialist P ate WELD COUNTY BOARD OF HEALTH ENGINEER DESIGNED SYSTEM REVIEW PROPERTY OWNER: Dennis Timmerick PERMIT NO.: SP -9900262 - new LEGAL DESCRIPTION: PT: SECTION: 31 TOWNSHIP: 2 RANGE: 68 SUBDIVISION: n/a LOT: BLOCK: FILING: SITE ADDRESS: 649 HWY 52, Erie FACILITY: Commercial shop - 10 employees ACRES: 10.0 PERC RATE: 20.0 SOIL: Suitable WATER SUPPLY: Left Hand LIMITING ZONE: >8 feet XX ENGINEER DESIGN (3.5) EXPERIMENTAL DESIGN (3.14) ENGINEER: Ed Glassgow - Scott Cox and Associates ADDRESS: ESTIMATED FLOW: 225 G.P.D. PRIMARY TREATMENT: Standard tank CAPACITY: 1000 gallons DISPOSAL METHOD: Absorption bed SIZE: 374 square feet REQUEST FOR VARIANCE: n/a STAFF COMMENTS: The system is adequately sized for the proposed load. STAFF RECOMMENDATION: Approval ENVIRONMENTAL PROTECTION SPECIALIST: Pam Smith REVIEWED BY BOARD: June 22, 1999 B.O.H. DECISION: APPROVED: K DENIED: TABLED: e..SC)w\A- C..12_41 Ben Slater, Chairman Weld County Board of Health M:IPAMI IS D 5162. boh. wpd wID€. COLORADO June 30, 1999 Dennis Timmerick 649 Highway 52 Erie, Colorado 80516 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17TH AVENUE GREELEY, COLORADO 80631 ADMINISTRATION (970) 304-6410 PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420 FAX (970) 304-6416 ENVIRONMENTAL HEALTH SERVICES (970) 304-6415 FAX (970) 304-6411 RE: Individual Sewage Disposal System Permit No.: SP -9900262 Location: 649 Highway 52, Erie, Colorado Dear Mr. Timmerick: This is to inform you that your Engineer Designed Septic System has been reviewed by the Weld County Board of Health and approved. A copy of the Weld County Board of Health I.S.D.S. Review Form and your I.S.D.S. Permit are enclosed. PLEASE NOTE THAT THE SYSTEM MUST BE INSPECTED BY A REPRESENTATIVE OF THIS DEPARTMENT AND BY THE DESIGNING ENGINEER, BEFORE THE SYSTEM CAN BE APPROVED FOR OPERATION. THE ENGINEER MUST CERTIFY TO THIS DEPARTMENT, IN WRITING, THAT THE SYSTEM HAS BEEN INSTALLED ACCORDING TO HISIHER SPECIFICATIONS. Should you have any questions regarding your septic system, please contact this office at your earliest convenience at 304-6415. Sincerely, Pam Smith Environmental Protection Specialist PS/rb-0549 cc: Ed Glassgow, Scott, Cox and Associates •.sir COLORADO DEPARTMENTOF PUBLIC HEALTITIAND ENVIRONMENT 1,555 N. 17?" AVENUE_ GREELEY, COLORADO 80631 ADMINISTRATION (970) 304-6410 PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420 FAX (970) 304-6416 ENVIRONMENTAL HEALTH SERVICES (970) 304-6415 , . . .i,'l FAX (970) 304-6411 STAFF APPROVAL OF ENGINEER -DESIGNED SYSTEM Owner Name: Dennis Timmerick Location Address: 649 HWY 52, Erie - Commercial shop The engineer -designed Individual Sewage Disposal System proposed for the above property, and designed by Ed Glassgow - Scott Cox and Associates is hereby. approved subject to the following conditions: Construct according to the engineer. ' 4 design. I, 7 '/'-s I/ 2 c--.Oi owner/applicant for I.S. D. S. Permit No.: SP -9900262 under the provision of the Weld County Individual Sewage Disposal System Regulations, do hereby understand and agree that after approval by the Directorof Health Protection Services, I may proceed with the construction of my engineer-.i designed sewage disposal system prior to approval by the Weld County Board of Health, but that the Board of Health reserves the right to disapprove any or all parts of the system design when it considers my application. I understand and agree that I proceed at my own risk and that I may be required by the Board to remove any or all of the system installed prior to Board of Health consideration of my application. Wv4i\mytkie-)1)50-0$.64\i-coprc-1' Environmental Protection Specialist Date wner/Applicant • ti Date r, • • r *************************************************************************** WELD COUNTY HEALTH DEPARTMENT (970) 353-0635 RECEIPT *************************************************************************** Receipt Number: 99001087 Payment Method: CHECK Amount: 315.00 Notation: 2847 06/01/1999 11:24 06/01/99 11:28 Init: RBUSTILL Owner Name: Applicant Name: Permit No: Parcel No: Site Address: Location: This Payment TIMMRECK DENNIS & WENDY TIMMRECK DENNIS & WENDY SP -9900262 1313 31 000022 5657386 649 HY 52 COL 649 STATE HWY 52 ERIE 31-2-68 315.00 Total Total ALL Fees: Pmts: 315.00 315.00 Balance: .00 *************************************************************************** Account Code 256041400-4221-400 256041400-4221-400 256041400-4221-400 256041400-4221-400 256041400-4730-400 Description New Septic Permit Repair Septic Permit Vault Permit Site Evaluation Potable Water Sample Amount 315.00 .00 .00 .00 .00 Description: Commercial (Y/N) : Number of Persons: Number of Bedrooms: Water Public (Y/N): Water Private (Y/N): Water Permit No: COMMERICAL SHOP N Residential (Y/N): 10 Basement Plumbing (Y/N): Bathrooms-> Full: Y Y Acres: 10.00 N 3/4: 1/2: Utility Name: LEFT HAND WATER Cistern (Y/N): Well(Y/N): 1 NOTICE Applicant acknowledges receipt of the individual sewage disposal system guide and that the completeness of this application is conditional upon further mandatory and additional tests and reports as may be required by the Weld County Health Department to be made and furnished by the applicant or by the Weld County Health Department for purposes of the evaluation of the application; and the issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under article 10, title 25, CRS as amended. The applicant certifies that the proposed system will not be located within 400 feet of a community sewage system. The undersigned hereby certifies that all statements made, information and reports submitted herewith and required to be submitted by the applicant are, or will be, represented to be true and correct to the best of my knowledge and belief, and are designed to be relied on by the Weld County Health Department in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application and in legal action for perjury as provided by law. This application expires one year from the signature date. X A} e OWNER/APPLICANT ‘—/-” Date a‘81/7 -- q 9coacn2— SEPTIC INFORMATION FORM To obtain an I.S.D.S. permit, one must file an "Application for Individual Sewage Disposal System" at the Weld County Environmental Protection Services office, and pay the application fee. A "repair" fee shall be charged for the expansion, replacement, or repair of an existing system. The following information must be provided on the septic information form: PARCEL NO. /3133/ 0660 ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650 PROPERTY OWNER2)ei)4/5 9► uidri J,rrni,eerk MAILING ADDRESS, 49 hole. iheiy 501. CITY £,e/b HOME PHONE (&3) - '/36/ WORK PHONE Q1i3) THIS CAN BE OBTAINED FROM THE ST eu ZIP �c5/L, W9-- 91fo FAX (3031 S/q9~ f yyz. APPLICANT NAME Z i,,7 dl 77m rrt g - MAILING ADDRESS 4i9 s? fie. 7/14,,1 Sa CITY 4/4 — HOME PHONE ) #.1 S - 413b/ WORK PHONE 1419-999FO ST ed ZIP Jas/.C FAX (36) 5/519-1Sy2_ DESCRIPTION OF BUILDING (Ex.: House, Mobile Home, Modular, Shop, Office) SOW •CAa/ SITE/LOCATION ADDRESS 6.4 9 -stale- AI 5.Z CITY L•Z/6' DIRECTIONS TO SITE -7:075 La,c, lieur 5 2 2,'psf a 07 #4y 5 , 9 4c!A— � 7 , /946/O eitioiti, clidoo ivy LEGAL DESCRIPTION PTS f / PT SE -4 SEC 3/ TWN - RNG 6 ACRES /O SUBDIVISION LOT BLOCK FILING NEW PERMIT ✓ REPAIR PERMIT $315 $315 IF OBTAINING A REPAIR PERMIT, PLEASE LIST PREVIOUS OWNERS OF THIS PROPERTY CENSUS TRACT RESIDENTIAL Y O COMMERCIAL YES / NO NUMBER OF PERSONS /0 BASEMENT PLUMBING YES NUMBER OF BEDROOMS BATHROOMS: FULLS WATER SUPPLY: PUBLIC 3/4 1/2 NO UTILITY NAME .Ce� .d kieb0, al-jr PRIVATE i O CISTERN YES / i0 WELL Y S 1101 WELL PERMIT # COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17TH AVENUE GREELEY, COLORADO 80631 ADMINISTRATION (970) 304-6410 PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420 FAX (970) 304-6416 ENVIRONMENTALHEALTH SERVICES (970) 304-6415 FAX (970) 304-6411 AUTHORIZATION FORM RE: PERMIT APPLICATION ❑ I.S.D.S. EVALUATION O SALE OF PROPERTY ❑ WATER SAMPLE represent -IAA 0n e rs I , M#i4y 7rn 114 6 -44 - located at 6 41er S/aje .5 1o' Co LEGAL DESCRIPTION: SEC 3/ TWN RNG SUBDIVISION NAME: LOT BLK for the property I can be contacted at the following phone #'s: Home .353 - gag - Work 3O3 - 0/9-996 Other Fax # .303 - 41S<9 -‘54/z - The property owner can be contacted at the following phone #'s Home Work Other Fax # OWNER'S SIGNATURE]) lyrlim1p, DATE 6- I- V MAP TO PROPERTY INSTRUCTIONS: PLEASE DRAW A MAP TO THE SITE. / — b Hello