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Home My WebLink About20241192.tiffScanning Cover Sheet for Septic Permits Permit # Permit Type: Situs Street Address Situs City, State, Zip 619910098 1 Health / EHS History / EHS Conversion History iqrmf1 =2*-CR 86 Sec/Town/Range: 32 -08N -65W Application Status: Finaled Application Date: 03/11/1996 Parcel # (12 digits) 055132000014-R0624286 Owner Full Name: Owner Address: Contact Name: Contact Address: THORNTON CITY OF 203 1ST STREET AU LT, CO 80610 • Owner Phone #: 303 8342785 Contact Phone# Information above has been Verified in Accela by employee noted below X Processed by: October 21, 2008 Date • Report ID: EHS00024v003 Page 1 of 1 Print Date -Time: 10/21/2008 1:53:09PM • a • 4 1•• a P1 I: •• i.r •. i.e.). N .1. 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S 1 t McRAE & SHORT, INC. 11231•- 8th Avenue Greeley, Colorado 80631 Telephone (303) 356-3101 Engineering, Surveying, Planning & Land Development October 7, 1991 PROJECT NO. 91098 Environmental. Health Services Weld County Health Department 1517 16th Avenue Court Greeley, Colorado 80631 RE: ISDS PERMIT NO. G 910098 CITY OF THORNTON, COLORADO 19757 WELD COUNTY ROAD NO. 86 (SITE LOCATION) Gentlemen, This is to certify that I inspected the installation and construction of this sewage disposal system.on on September 14, 1991. . I find that the system was in- stalled i n accordance with the design dated June 17, 1991. A 1000 gallon septic tank, plastic liner and absorption bed of approximately 4000 square feet with distribution pipes was installed. See attached sketch of the installation prepared by the contractor, John Brunner & Co. Yours truly, McRae & Short, Inc. Gerald B. McRae, Professional Engineer and Land Surveyor, Colorado Reg. No. 6616 GBM:bkm Y Copy to: City of Thornton Farm Management 204 1st Street Ault, Colorado 80610 aif sI �r. dS 4 . ': I�r r� %e k. io li gu fier3tel- et? 4Jvc• 41O ceigt-% •P,a0% F: ists4 6616 * 22 4 • 1`r MEMHtt�3�}1 I • a 10 • - tiler • east e a • • war a a .5. • • I • pa a ••• ........ Pa g" 1, Ael al anal • • • • • 1 COI • • • • • • • • • • • I I • I 1 44 •Ialli•serrt•Olar•A; II . •* I" re. 1 ' .I I I • • • • • • • • • • • • • • • • • • • • • • • • • • • I I I I p t • 19/ 0H,„9/ i. . a - ., . . • • • • • • • • • • • I • • • • • • 3 • • fee 1111111)e COLORADO July 1, 1991 Shari Jo Schreiber City of Thornton 203 1st Street Ault, Colorado 80610 DEPARTMENT OF HEALTH 1517 - 16 AVENUE COURT GREELEY, COLORADO 80631 ADMINISTRATION (303) 353-0586 HEALTH PROTECTION (303) 353-0635 COMMUNITY HEALTH (303) 353-0639 RE: Individual Sewage Disposal System Permit No.: G-910098 Dear Ms. Schreiber: This is to inform you that your engineer designed septic system has been reviewed by the Weld County Board of Health and approved. 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 HIS/HER SPECIFICATIONS. Should you have any questions regarding your septic system, please contact this office at your earliest convenience at 353-0635. Sincerely, 1.14‘6 Rif; 16 tim Pot Pam Smith Pinkstaff f Wes Potter, Director Environmental Protection Specialist Environmental Protection Services PSP/WP/lam-33 cc: Engineer Weld County Department of Planning I.S.D.S. File WELD COUNTY BOARD OF HEALTH ENGINEER DESIGNED SYSTEM REVIEW APPLICANT: ez:74/ o� -11-21,0 a-�/t de,. LEGAL DESCRIPTION: PT A/4/` V SEC <l SUBDIVISION N. SEA TteIN SITE ADDRESS: n �GP f� FACILITY:/2-ir"in PERC RATE: 4`CO NO: 4 - 2'/ooya LOT AR BLOCK P t& Ti erce, (do ‘3 8ED2w'n Mace" SOIL: derv7 tz-tr SLOPE: LIMITING ZONE: 37 ie ENGINEER DESIGN (3.5) ENGINEER:We., at- RNG &se FILING 1.)0 ACRES: 42O WATER SUPPLY: /(%Z41G� 1•tJ/:2 I�cc �"�vn cc).. EXPERIMENTAL DESIGN (3.14) �SAosT ) hero /0/ �� /Mc jag ADDRESS: ( Z3 fC A° G tt,e k`i ESTIMATED FLOW: Aligr44, °a' PRIMARY TREATMENT, / s /G l.•n �o s � DISPOSAL METHOD: rve5Per7'fl2>/2S,O,f` 4-- a�J REQUEST FOR VARIANCE: G.P.D. CAPACITY :e 0 SIZE: A/zeeS 9day O . STAFF COMMENTS : 4.67 a � � raaS e, w ruh Ai A. e 1 r'ca P.s rf r e ics f` 3i1ecty,ptOo sten 41 • STAFF RECOMMENDATION: ;) roue' ENVIRONMENTAL PROTECTION SPECIALIST: 444 letilap,e1^ REVIEWED BY BOARD: B.O.H. DECISION: , APPROVED DENIED TABLED Tom Cope, 'Chairman Weld County Board of Health ES24 !, COLORADO DEPARTMENT OF HEALTH 1516 HOSPITAL ROAD GREELEY, COLORADO 80631 ADMINISTRATION (303) 353-0586 HEALTH PROTECTION (303) 353-0635 COMMUNITY HEALTH (303) 353-0639 STAFF APPROVAL OF ENGIN -D ICNED SYSTEM The engineer -designed Individual property located at_/9ji �� C and designed approved sub j e. to i/s.d Disposal System proposed for the is hereby following conditions: ee ams- cr-c horn Y I iQ/1 L. Foss - w under the provision of the Weld County Individual Sewage Disposal System Regulations, do hereby understand and agree that after approval by the Director of Health Protection Services, I may proceed with the construction of s , applicant for I.S.D.S. Permit N /UY?Q my engineer -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. L._ wt, pa Director, Health 1otection L� olo 'ZOc-7/ Applicant Date Date w 1- IS r' 1 61t INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT NO. G-910098 WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICES 1 51 7 16TH AVENUE COURT/ 7RE::.E:«LEA r CO 80631 O WNER THORNTON, CITY OF ADDRESS 203 i A Ddl RLM, ,t 1 OF PROPOSED SYSTEM 19757 VJ(:.R 184 flflOc 2./ i L,'Tpl::s. -� A(JE...T CO 80610 F; In =` r :I. PERMIT '`ENE ( 30 ) B34-2785 DESCRIPTION j }� PIERCE }/� CO.3 0 6 " 0 '� J f'' 65 LEGAL f IM. 1 C R I P• . O i i OF SITE. • 1 S i E 4 EEC C 1 A.. W E•' f 1-1% 7 S ♦.� SUBDIVISION: LOT 0 BLOCK 0 FILING 0 U SF TYPE- N >_r :I• «. N es I••' I~. S.O.E. —919065 S ERVICES: PERSONS M .. TI»I I -s. .l C) 1 S 1.00 LOT SIZE 120.00 -•• nuc. E". ' BEDROOMS BASEMENT PLUMBING NO WATER S(JE"'`IN'I.MY E' C#T APPLICATION FEE $110.00 I t r' f BY COO IF E Y, D I ANNI«': DATE 05/08/91 r'cI.iC,'(JI.NA'T' :I: (J ! I• rr 'T j- ' .� . �� c� is i_ SIGNED BY SHARI JO SCHREIBER DATE 05/08/91 MIN PER .NC:H PFRUENT GROUND REQUIRES ENGINEER DESIGN M .M. LIMITING ZONI cif lo ::. 3 r- tAkuliA DIRECTION ..M .... •... (.JTHE: �.APPLICATION IY- (.J I•, �- .I. (.l SUPPLIED » ..•• THE (.l � ` . 'T� 1... SOH. (a (J I... M(' .(: CJ N Y(. EYI l.w FOLLOWING MINIMUM I.NTALLATION SPECIFICATIONS SE T 1(4. ARE REQUIRED: : TANK _� .... GALLONS, ABSORPTION Te.1555.CINI—..... SQ. OR gloomX1.1 '-�.1. . • • I X ( A 4 I'•� . J ADDITION, 1.1“1_3_ r1"N.E•''I .1. TI I /�> SUBJECT •Oj:1-IE FOLLOWING ADDITIONAL TERMS AND CONDITIONS jjV1AVA •N I .... ... ��I.. 11 •. 1.26-;.4.. .... .u. .M. •... .... MM wM ..M MM .•1• ••N •.M •... •... .M. .••• .M. 4• .1.• •... M.. .N. ..M M.• •..• ..N .... ...• •... •.•. .1.. .1.. •..• •N• •••• .... O A T• A •. •. .... N.. ...• M.. M.• •w. .•.. w.. M.. ..M .1.. •MI M.. •M. .1.. •..• •... .... aM MM .... M.f ✓.. .M• .M• ..•. ...• ..M ••Y I.I. .... .... fM. .... •... M.. ...I •.1• •.•. •Mf M.. •M. I... ..M .... .N• a.• ..-. ..N YM .Y. .M• .1.♦ .MI •.I. •... •Y. .IM a.M •..• .f.. MY ..M wI•'1.1.1" PERMIT �. Ise GRANTED I'M.J TEMPORARILY LY TO ALLOW CONSTRUCTION TO COMMENCE. ••fE'"1.E.>. PERMIT MAY BF REVOVED FORTH IN FAILURE TO APPROVAL. SUSPENDEDBY WELD COUNTY WELD COUNTY INDIVIDUAL I. � ' :.WAG1«. HEALTH • Z J. L re' / • I DEPAPfMEN 'T REASON IS I:.:: T� ... .S Y l ` T' E:.. I� I« CY lJ E.« 'T' . (JE 1" INCLUDING ANY TERM OR CONDITION IMPOSED THEREON DURING TI.MMPCJRAE- Y OR.FIN:I; i A I... ISSUANCE (J F THIS IM` I•M. I•� M �1• DOES r (J �T (•f (J M 4' T� .I• #.J I L ASSUMPTION BY .rI•'E I.N DEPARTMENT OR :E. TIS EMPLOYEES (.JIM LIABILITY IN• (J R TIME E.M FAILURE OR INADEQUACY OF THE E... vFWACE DISPOSAL SYSTEM. ,A 5er' C 7/ Qcp 5�4�R�k•••. ENVIRONMENTAL E .M. .I.. Mw .... Mw M.. .... ..N THIS PERMIT IS NOT T TRANSFERABLE A N D SHALL BECOME VOID IF SYSTEM CONSTRUCTION i'i (i . N OT COMMENCED C;E :X WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE I, 'SU : E Cx FINAL APPROVAL VAL OF THIS PERMIT TIn' E::: WELD COUNTY HEALTH DEPARTMENT RESERVES T- I -•I Ee:. RIGHT TO IMPOSE ADDI— TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON 1 CONTINUING BA— SIS. FINAL PERMIT APPROVAL IS CONTINGENT UPON TH E FINAL INSPECTION OF 'r I --I I~. COM— PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT. (J R i G :I: E .. I —APP .CANT C. (. P Y W C.1" I D WCHD—EHS MAY, 1 984 WELD COUNTY (HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICES I SITE EVALUATION G --(11009g ICI-1�-P�- 219 Rau)Application No. Site Date Sub P T iM SKIS 3,? T Oce Lot Block Filing -PERCOLATION TEST DATA: Start Time .ni..___ Hole No. Hole Depth Remain H2 min. min. min.. min. m t min. min. min. min. min. inch 4 • 3 I 1 4 - 1 I _ y f . • _ i All * Environmental measurements - Add 1120 Health in .mm unless Specialistcha otherwise indicated. Sac n n , Total Average Rate PLOT P LAIN 11} SOIL PROFILE 41134.5tr;ta itOQtoKt vb1iLkd Uk.041MAILIt 40 tfridtriettkir 1/4utis‘ne • e +�t 0.../1" 6)(9 tvd VitiafruciN 9kihei '''`e to vs red. 3� M �e,zA Waltz ctpprot 2(111 qpimr5 kk meet4 tttbs Pdit it.0 del Nact, week 9t r• : 9' ^- .•.r -t •.. rr-^+•I' c --•.w.. w...1.0r. .ti. *aLJ `t'.-fri.+J r'' - =•A •..rc c.. •••••45- rte/ isia �.-.�.. er._v...6� .Ns.�i.c_ .- r 1 e l r, McRAE & SHORT, INC. Greeley, Colorado Engineering, Surveying MADE B e; CLIENT//O/NTOWPR0JECT NO. 9/`�v/ CL$ PROJECT �� ,57 wcE 86j �?e/c.cr, Co. ZaCAIrS)110/Vi 11.6 1 2F—aj's s A . ? wit .. _ _ �E�`/ C.. � a� ��?�'. . szecip-c- en.erd _ /c/a-ce-1,-;41 4-1 - 1/-r—tter -te490A'ic. .Cog a- --------- • . .40 Lb__ _aealeot DATE /9j CHECKED BY DATE SHEET_L0F e kM.__11.‘44,64_-.g.lar4 1--- c(-- t- KI--- • �_' le,17-19)iii_I ??6s7i-1 -Gas _ RM,_ _____ L____. ______ _____ _____ _....__ _ _ ;.?___ /deirc:_j_e____. 65•0,_ I .....H... 4.,.=, e.ef 6trlgtd, _u hcc4�tcy�f-�ietAfi• o-vCI>/i c.�-/f;_.1 ne_ 4i__ "XL' /tat e__. .J ate .„..._.,0,-_,_..,. i 1 I,„/I I I/ i i t /41 $€� ≥4N*1_1&(4t4 •I } o -o �O LSS _i I Alimili•••• die Mr 1 At. zeANsp_/ I reIe rct, Pick& 3°, S U r 86 86 • t(LIC .fvf ctit s 0:407.-k re s_�_- -,,-M ( I _4 Sit SNIIATICkl Dr fsI c %9 i 3_l4'k6/d�cs ep-maa-.______ ti. Til DEPT. .....-••••. .. .._.. f• • i .� err . a • J • McRAE & SHORT, INC. Greeley, Colorado Engineering, Surveying Cl1ENTS74 /"irk hN PROJECT NO. 9/Cal LJS '4' 197t7 L;.(l cgefr !'"%2/'Ge ,Co, MADE %1/ DATE /7 CHEC•KED BY DATE SHEET �G OF S gat• /At ± e -- ?cat &b,A iko itszerc._ e tr. ey41 ,..enree dent? el) sr aikzlit Ai 045; w.# • d • /I �C (7f�-� _. � P�POsri_ O. s�tCV_V �ou uLi4. 4//CL -1-1-Th•rAti% ht-Ar o .♦ At 4 - - . • • _ r 4 t , oe:4/. cad ek_Y_-o nanciP • • • LH • • • • • • • • • I � { t 4 • 1 • • • • 4 1 I • 4 1 • • • .1.•••:.•.._.• • - • ♦ i • 1 • • : • 1 • • 4 • • • • • • • • P • • • • McRAE & SHORT, INC. . Greeley, Colorado CLIENT C/7 d� Tlofnhnf@ROJECTNO. PROJECT Zt5 Engineering, Surveying MADE B � DATE Veit 4/08/ L ♦ ••• M••••, ••..a..♦•• 1 alier _ • • •• • {• I i 1 • • • • —.••. •••••.• 4 - •• • 1 I 1 111 • I 1-• 1 I• • �f { 1 I__ r 1 I; i 1 I; . I .. • ! _ • !--I A. ...s • —f- -•• •3 ...� •a t!_ t i 1 1 I �•- E • / { . • • *... t.•.... ♦ .•• .••••w ..r ..ia : 4 Hitt I , . 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I 4 i .......... 4 -• i • . t 11Y t 4.0.0 ••••••• • •.. •.•' 1 1 • i •••• its• [ -_ i + I 1i t iraiia. an• ...r •...s... 1 4 ••.•r-•.-• ,�,� ' 11 •ri • 1-!- 3 1- 1 ••.• 4 .♦• .•,R - • • • f- _ I. • i . ..a. a tab at. a . • • t a •.. w•• •..r_• • - i . ... •••• area. • • .•.. `.•Y . •. • . . r ••_•. �•...•r.• •... •A•, •. s. ._ W♦-••.. .— .•N — • • • • ..., ./.,N _••-. t ! t .. I -_.. • •-1- .r. Y•.. -.!i ..... 4.-r . . a ..•..••• • • - 1 • • •M. •F,1 di' I es -1 %Cr _ • .1i..L1J • .M.I•.•_• i f- •• •.•. • ill a ., •., 4 •'a M 1 1'-1 t• j' 1 . {I t� J. I G�l� I e4. ..4,e4*.a. .] - . '.-••. h - 4--•.• i • I.!. at r � • • { • 1 1 • • ..1.71.1.1.1...11-1. J .. !•t. . •.•• .I. t .I • • ..-11 1- . I• •, • t....• .# . - 4 4 I # a.•_,r• le • t 1 _.I_•.r ._ !.. I • t 1 1 I _ 1 •. .. , •-+w • •. - ••••f_ ♦ I. i iii tr 4i 1 • !:1• II. _ ___ III 1 t_ i 1} w.i•. ••� •w.+�•••-.•.••, 1. • ••• •4. .. 1 II. }}[ r 1' , t 1 1} I 1 • • 1-- F.:I.- -....... r • : s1 i 1 1 1--i 1 I R i r _ / ... I •. ' 1 I — i ' tt I f 4 jii ! • I •• i • go/f, .se . al tj:ii • J • fItitil • • • • • • • • • • • 4 4 • • • • I • i• f t • • • • • • • • • • • • a • 4 • • • • • • • • • • • • • • • • • 4 • • I • I • • • • • • • • • • •vin.. !el 1 I ..1 i . • $ • • a • • • • • • • • • • • • • • • 4 • • • • • • • • • • • • • • • ▪ • t • • 1 McRAE & SHORT, INC. Greeley, Colorado Engineering, Surveying CLIENT PROJECT MADE B / of if PROJECT NO. 9/08/ Ds -ft -7575-7 fittea "severe CO 7DATELCHECKEDBY DATE SHEET OF ta • • • Posi tl vc 'draino9e off of and away eror» Bed /5 re quire d. Vat stilaT • • • f • S /41%s'e rzx 7�of/ 24 dMien• AWE: or ro i is h;, • • t • ,,,.,..4 • i -e fondy loans 4p ro!l w►'/h fege to /ion or, :s or 01414 ,benKnce eva poro/-r'on• Imp dininiehed in inc/an eniL Wee Mr; itivAPn pen / pi 4i l on end k ru per a lurras lower." Evopofran spin4 ion &'cl No Scold • • • 4" Clean Uniform Sorrd O.1 'run (DSO) 4a 0 Perforated Pipe Distribution Sy.3terri Clean 'Leach Field Rock = f'Ye //graded, rounded 3/4" to 2 'nay. w/rninimurn of fines la CAI layer or PA. 1 t I • • in IS 9oa/ nal 6- LISP i a6P APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM NO. G-910093 WELD COUNTY HEALTH DEPARTMENT 1 -REPAIR APF•I.. I CAT 101 ENVIRONMENTAL HEALTH SERVICES 1517 i6TH AVENUE COURT, GREELEY, CO 00631 353-06'35 EXT .2225 4NER THC1RNTON, CITY OF ADDRESS 203 i ST STREET F''1`! (303) 034-27f 2 AULT _ CO 80610 UDRESS OF PROPOSED SYSTEM 19757 WCR 86 PIERCE Co 80650 'GAL. DESCRIPTION OF SITE: NW4 SE4 SEC 32 TWP RNG 65 JDDIVISION: LOT 0 BLOCK 0 FILING 0 SI.. TYPE: RESIDENTIAL (JRIG PERM S.O.E. G -9i9065 ::RV 1 CES . PERSONS I. DATHRQW.. 1 .0O) LOT SIZE 120.00 ACRES . BEDROOMS 3 1 BASEMENT PLUMBING NO WATER SUPPLY NWCWD ..• "'I••11... t CAN'r ACKNOWLEDGES THAT THI... COMPLETENESS 'LETENESS OF THIS APPLICATION IS CCJND r .I.ONAL. :10N FURTHER MANDATORY AND ADDITIONAL. TESTS AND REPORTS AS MAY DI::: REQUIRED DY T I IE EI_.D COUNTY HEALTH DI..I"'AI.:'rMEN-r'. TO DE MAz)u' AND FURNISHED DY THE APPLICANT (JR r Y r H E :I._I> COUNTY HEALTH DEPARTMENT FOR PURPOSES OF •t HE EVALUATION OF THE APr'I...:C r::AT: O 4I) THE ISSUANCE OF THE rE1;1vi I -T• IS SUDJEC:'1' TO SUCH TERMS AN!) CONDITIONS AS DEEMED :CESSARY TO INSURE COMPLIANCE WITH RULES AND REGULATIONS ADOPTED UNDER ARTICLE TITLE 25, CRS 1973, AS AMENDED. THE APPLICANT CERTIFIES THAT THE PROPOSED 7 'STEM WILL NOT DE LOCATED WITHIN 400 FEET OF A COMMUNITY SEWAGE SYSTEM. 1 HE wr R.S":I:GNEI) HEREBY CERTIFIES THAT ALL STATEMENTS MADE, INFORMATION AND RI:::1='OR'r 1.7f 1DM:€:.I TI_.I) IIIIREW:rl f) AND REQUIRED I.., ..I) t ... ARE, :. • I;• �1 S �� I:i M r L I} � Y THEAPPLICANT A �� 1+ , (.) I•< WILL I HE, I: Tr ES :.I I I:_D TO DE TRUE AND CORRECT TO THE PEST OF MY KNOWLEDGE AND DEL I EF , AND tE DESIGNED 10 DE RELIED ON DY 1HE WELD COUNTY . HEALTH DEPAR rMENT IN EVAL UA I.a:l` G IE SAME FOR PURPOSES OF ISSUING THE PERMIT APPLIED FOR HEREIN. FURTHER UNDER — LAND THAT ANY FALSIFICATION OR MISREPRESENTATION MAY RESULT IN THE DENIAL OF 1 i..11::: PI._ I CAT I (:)N OR REVOCATION OF ANY PERMIT IRAN FEED BASED UPON SAID APPLICATION AND 4 I`..' -GAL ACTION FOR PERJURY AS PROVIDED BY LAW4 TL t c;AT I ON FEE $110400 SI R I JO St;f r:;I :r•1 CC' I) BY COFFEY, DIANNE DATE 05/00/91 • • • r.• 4' @.•• M N.. .. ..r MM Pelt •N. ...• .•.. ••M r•.. •.4•. WNER/AG ',''r SIGNATURE • t 5/00/91 DATE IGINi,L—APPLICANT= CQPY'"WLj•v WCRP.w•EHS H' Y. /0F4 • • • p • . - qt. 49°6.5 RECEIVED - SANITATION D!VISION •t • f 4 ... Y STATEMENT OF .EXISTING SEPTIC SYSTEM I (PLEASE FILL OUT IN INK) OWNER OF RECORD: City of Thornton • MAILING ADDRESS: SITE ADDRESS: y 203 1st ST 19757: WCR 86 • • MAY - 3 1991. waD COUNTY IIE1tUH DEPT. r Phone: 834-2785 (Farm Mgmt) Ault CO 80610 City State Pierce Zip CO 80650 I E 1/2 of SE 1/4 & • City State Zip LEGAL.: DESCRIPTION: PT NW 1/4 PT SE 1/4 Secr4on .. 32 Township 8N Range 65W SUBDIVISION . LOT BLOCK FILING C NUMBER OF PEOPLE: 5 Bedrooms: • 3 Bathrooms: 1 Water Supply orth Weld • RESIDENTIAL OR COMMERCIAL: Residential .y SYSTEM -SIZE:- Tank is Constructed of Concrete FIELD: Bed 4+ 1 * * or Trench (material) * * Lot Size: 120: Acres and has 1,000 sq. f t . Date System Installed: 6 gals capacity * * You are required to draw a diagram of the system on the reverse side of this. form and indicate position, 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 orr' the parcel of ground identified by the above legal description and further states that the system is in good working order and to the best of his/her knowledge is not failing to function, properly. * a. I further understand that any falsification or. misrepresentation• may result in revocation of any permit granted based upon this information hereby submitted _ and. in legal action fo'r perjury as provided by law. *L'ea4h: \Field needs. i.replaididg **Unknown ; :an r i :unde.t.d.rtine d • Date Subscribed and sworn to before me this f/` " s day of i S by n/nan I Mir Owner Witness my hand and official seal. My commission expires • 19 9/ r Dade / Notary :public .STATEMENT OF EXISTING REVIEWED BY Environmental Protection Specialist D jt e • • • 4t: • 1.0 - 1 ice;.,.. • { • cc .M S • • A . ..•......• 1••.. ...•...r...+'••.••• .-. • 1 • • • • r •H .fl w ....f r� t f R • ` S. I"I1,Ew' 1 06P APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM NO. G-910098 WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICES 1517 1 6TH AVENUE COURT, GRIE: LEA Y , CO 8 631 353-0635 EX'r A 22` .` REPAIR APPLICATION OWNER THORNTON, CITY OF ADDRESS 203 1ST STREET P ( 30 ) E334 7H`. AUJL T CO 8061 0 ADDRESS OF PROPOSED ; `'.'T'E i 19757 WCR 86 PIERCE CO 806`..>0 LEGAL DESCRIPTION Or SITE: NW4 SE4 SEC 32 TWP 8 RNG 65 SUBDIVISION I« t:I"i 0 BLOCK 0 FILING ) USE SIZE RESIDENTIAL f I�5 I G PERM S.O.E. € -91 9065 1 1 E•«: E 11 V ICES. ••' ... R 1 ' r j ';l 5 BATHROOMS •1 A SJ %f E.» �.! a 1 ` ACRES BEDROOM 3 BASEMENT PLUMBING NO WATER SUPPLY NWCWD . F' E"' I.w :I: i ::.. ` ` •i.i 1 l is bJ l... I ) CY E::. � ' THAT THE I:" COMPLETENESS 1 iJ r:. .• .1..1:E:1 " L::' I:' E...1: i : ' ' �: tJ [ : ; " i:.` t:� : `�' :l: C •• 1... 14 UPON FURTHER MANDATORY AND ADDITIONAL TESTS AND RE» I'R PO`T'S AS MAY BE». REQUIRED BY THE W I'•' I ••• 4.. o COJI.JNT'( HEALTH l DEPARTMENT TO BE MADI" WELD COUNTY HEALTH DEPARTMENT FO" AND THE ISSUANCE OF TE" 1 F PERMIT IS ' 1 ! ) FURNISHED BY TIE APPLICANT OR BY ' f E'•1 I... I»'u �n 1e'I:wf' SUB LiI:.i..' ` OF •I• EVALUATION OF • 'I`J .. Al:''I''I.w J: ( el.T.:I..JH 1'Cl SUCH 1 AND CONDITIONS t•f1 .1 • ... M• .M D l.5. E::. E�fI I... ) NECESSARY TO INSURE COMPLIANCE CEµ WITH RULES AND REGULATIONS JI` 1' ADOPTED UNDER Al, TT tl l— I..• . 1 •' , TITLE 25, C R 1 1 197 AS AMENDED A ! ' E'•1 .«` APPLICANT .i PROPOSED La«' E•Ii ` • . I'a• .la i.w t THAT THE SYSTEM WILL NOT ` ` I...CIt.f «C L:" WITHIN 400 FEET OF f COMMUNITY SEWAGE SYSTEM. 'I"En UNDERSIGNED „„ ri-s1"IrTro L.m IL THAT ALL STATEMENTS MADE, INFORMATION AI-tl:wE"'iJP�T�� SUBMITTED HEREWITH AND REQUIRED TO ! BF SUBMITTED BY "E E--1 I APPITCANT •• _:F , OR WILL B I~ , E',Ii.l-'I'�l."1'E:..N1.wV TO E `T`RUEN` AND CORRECT F_i. re T TO TI•-EU OF LAY KNOWLEDGE AND AND ARE DESIGNED TO Tin 1",1N1...J.E:•w ) ON BY .T.1«I E. irgre is »rl'II•• LI1..LD COUNTY 1«I fE:»I"'••k MI•'NT IN OF ISSUING TI'•11«. PERMIT A E«' I'•' I«. T I«. D Fill . HEREIN A A1.«UATINC t.J 1.4.8 .1'` I --I I...I:' lJ ) I::• L:N. STAND ) THAT ANY FALSIFICATION OR MISREPRESENTATION M •• Y L: I:::1f'1. I...' " TN T'HL: DENTAI». OF THE APPITCATION OP REVOCATION OF ANY PERMIT GRANTED BA1I'la: UPON SAID APPLICATION AND IN LEGAL ACTION FOR PERJURY AS PROVIDED DV LAW .w .I. 5.! ' 'D BY ION I•'' I::. .. $110a00 COFFEY D)A'rl::. 05/08/91 1 DIANNE MO I.? I'•I A I`4 •f Jo »« .JWl I.'R/••iY Fe i.Y illII `Y' 1. L'�':- • .... «.. «.• ..M 005/08/91 X) A'T` L.• ORIGINAL —APPLICANT, CJOF1Y_..WCfHD WCI.If).N.11::H.S' MAY, 1 984 Hello