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Home My WebLink About20243178.tiffScanning Cover Sheet for Septic Permits Permit # Permit Type: SP -0100388 Health / Residential / New Situs Street Address 22815 CR 52 B Situs City, State, Zip WELD. CO. 80631 Sec/Town/Range: 26 -05N -65W Parcel # (12 digits) 096126400070-R2821204 Owner Full Name: FORD GLEN Owner Address: 22811 CR 52 GREELEY,C0 80631 Contact Name: Contact Address: FORD GLEN 22811 CR 52 GREELEY,CO,80631 Application Status: Finaled Application Date: 07/26/2001 Owner Phone #: 9703309825 Contact Phone# 9703309825 information above has been Verified in Accela by employee noted below X Processed A-111; February 23, 2010 Date Report ID: EHS00024v003 Page 1 of 1 Print Date -Time: 2/23/2010 9:02:08AM Permit #: Owner: Applicant: Permit Type: Parcel #: Location: 228 VCR 52 26 05 65 Legal Description: 12839-R PT SEA 26 5 65 BEG S4 COR OF SEC S89D36'E 88 ' N2 Installer: WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE . GREELEY, CO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 SP -0100388 Sec/rwn/Rng: 26 05 65 EOR1GLEN ' `FORD GLEN RNEW R=Residential + NEW, REPair, VauLT 0961-26-0-00-061 Finaled Status: ISSUED Applied:. 07/26/2001 Issued: 07/27/2001 Finaled: Q 13-01 Description: HOUSE Commercial: N Residential: Y Acres: 26 # of Persons: 4 Basement Plumbing: N # of Bedrooms: 3 Bathrooms - Full: 1 3/4: 0 1/2: 0 Water Public: Y Water Source: WCWD Water Private: N Cistern: N Well: N Well Permit #: Percolation Rate: 7.5 Limiting Zone: 8 ft 0 in Description % Ground Slope: 0 Dir: Soil Suitable:. (Y/N) N Engineer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N) N Minimum Installation Septic Tank: 1000 gallons Absorption Trench: 435 square feet or Absorption Bed: 570 square feet Actual Installation Septic Tank: ) 00O gallons Design Type: 6'4 i Absorption Trench: 3 s square feet Absorption Bed: square feet Chambers ( C� NOTIC& 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 W. 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). Thls permit is not transferable. 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 continuin • . Final permit approval was contingent upon the final inspection of the completed system by the Weld County Department of and x S's Fen: SJINAL vironmental ealth SQecialist 4- ictd. '41( ot itqL ix* ut\ki- tin*. Iciakt_ tafr 4. 41614en f_ 104)4 cuartais pho4) - ,bl FOR OFFICE USE ONLY • —Owner Location: �d 8l ISDS APPLICATION FLOW SHEET qie,r„ Cie 5a Permit #: SP 61 CD 3 Date B Legal Description: c2% -6- - 67S Comments Information Form Complete I' 2(o Authorization Form Received Flood Plain? Yes/No 7,0 Parcel Number Received Map Drawing Received Site Inspection Date --Z-4-C3 r5 1]I'dEngineer Design? Yes/No j Date Engineer Design Rec'.d Customer Notified Date Staff Approval Sent \ Date Staff Approval Rec'd Pero Data Ent?d'in Computer Date of BON Approval Eng Approval Letter Sent (Letter, Permit, BOH Review) e" ----- Date of Final Inspection g'j3b( (6 , Eng Approval Letter Recd Variances Needed? Yes/IVo Sent Variance Staff Approval Rec'd Variance Staff Approval Variance BOH Approval Variance BOH Approval Sent (Variance, SOH Review) i Additional Comments: Mfenvpratseptkelawaneet.doawpd • 9 NOTICE 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: S89D36'E 880.50' N2 SP-O1OO388 FORD GLEN FORD GLEN SecfFwn/Rng: 26 05 65 RNEW C=Commercial, R=Residential + NEW, REPair, VauLT 0961-26-0-00-061 22811 CR 52 26 05 65 12839-R PT SE4 26 5 65 BEG S4 COR OF SEC PERMIT Applied: 07/26/2001 Expires: 07/21/2002 045 eke Description: HOUSE Commercial: N Residential: Y Acres: 26 # of Persons: 4 Basement Plumbing: N # of Bedrooms: 3 Bathrooms - Full: 1 3/4: 0 1/2: 0 Water Public: Y Water Source: WCWD Water Private: N Cistern: N Well: N Well Permit Number: Percolation Rate 5 Limiting Zone a ft --in Description To Ground Slope f Direction Soil Suitable (Y/N) y Engineer Design Required (Y/N) i�I In 100 Year Flood Plain (YIN) _ From the application information supplied and the on -site soil percolation data the following minimum installation spediicadons are required: Chambers Septic Tank i trap gallons, Absorption Trench 4435 square feet or Absorption Bed 6 square feet In addition, this permit is subject to the following additional terms and conditions: vl.V.>ST. ►-1,4n.• S 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 not transferable. 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 nermit expires onuear from the application dates x . 37-Z Fonn: S_PERMT Env onm Health Specialist Date • WEL1J 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 Permit Number: SP-O1OO388 07-26-2001 Amount: $315.00 Payment Method: Cash Owner Name: FORD GLEN Applicant Name: FORD GLEN Parcel Number: 0961-26-0-00-061 Site Address: Location: 22811 CR 52 26 05 65 APPLICATION / RECEIPT Initials: SKE Receipt Number: HAP -01386 Notation: CASH Total Fees: $315.00. This Payment: $315.00 Total All Payments: 315.00 Balance: $0.00 Account Code 256041400-4221-400 2560414004221-400 256041400-4221-400 256041400-4730-400 Description: HOUSE Commercial: (Y/N) N Number of Persons: 4 Number of Bedrooms: 3 Water Public: (Y/N) Y Water Private: (Y/N) N Description New Septic Permit Repair Septic Permit Vault Permit Potable Water Amount $315.00 $0.00 $0.00 $0.00 Residential: (Y/N) Y Acres: 26 Basement Plumbing: (Y/N) N Bathrooms: Full - 1 3/4: 0 Water Source: WCWD Cistern: (Y/N) N Well: (Y/N) N 1/2: 0 Well Permit Number: 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 Department of Public Health and Environment to be made and furnished by the applicant or by the Weld County Department of Public Health and Environment 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 theat 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 Department of Public Health and Environment 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 appin and in legal ion ofperjury as provided by law. This application expires one year from the signature date. "'Owner/Applicant Da Form: RT_HAPP Wilk COLORADO 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: `dPARCELNO.:0 I a.(aOOOC.) G1 ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650 PROPERTY OWNER G /e RJ Fo MAILING ADDRESS �// W . C , Q S� CITY 6 Yg� �.5e, `- ST o ZIP 04 3 HOME PHONE (9?dl 3 3 O -a- .5 WORK PHONE( ) FAX THIS CAN BE OBTAINED FROM THE APPLICANT NAME G k e y cry d - MAILING ADDRESS .-J// tJ, CAR. . CITY kr� ST e,u ZIP a 63 \. HOME PHONE (1')0) .3a - WORK PHONE ( L FAX L LEGAL DESCRIPTION PT PT SEC a (Q TWN 5— RNGje ACRES iiirl g, SUBDIVISION LOT BLOCK FILING: 11045e - DESCRIPTION; OF BUILDING (ex: House-, Mobile Home, Modular, Shop, Office)- ill,, V 1 r-) . SITEILOCATION_ ADDRESS 7// 'c.d. C IK , S.1- G VQe\02-_V (lQ DIRECTIONS TO SITEA"YJ - •i‘- 7 re., 'II Lij 0 - h, e d. S .2- 7/.._.-- Lci .-1— _ WWW v , J� D/I s...i ki& 1aei≤ a •/-h& L:114----_ NEW. PERMIT X REPAIR PERMIT / VAULT PERMIT $31.5 $315 $1'50 IF OBTAINING A REPAIR PERMIT, PLEASE LIST PREVIOUS OWNERS OF THIS PROPERTY FLOOD PLAIN YES / NO. CENSUS TRA5T lib RESIDENTIA O COMMERCIAL YESCN-O7) NUMBER OF PERSONS q BASEMENT PLUMBING YES /c) NUMBER OF BEDROOMS 3 BATHROOMS: FULL_/ 3/4 1/2 WATER SUPPLY: PUBLIC YES NO NAME �... ) e- - PRIVATE YES / NO CISTERN YES / NO WELL YES / NO WELL PERMIT # 3p ot 003 S PLEASE DRAW A MAP TO YOUR. PROPERTY Oy5E • , . FREESE ENGINEERING J18432 :$Y FP�SE REIMBRS) IJW3aRied:R July 24; 2001 - Mr. Trevor Jiricek Director Environmental. Protection Services Weld County Departrnent.of.Pubkk Heath and Environment 1555 -North- 17 ' Avenue - Greeley, CO 80631 RE: Glen Ford - Percolation Test 22811 WCR 52 SE' Section 26, Township 5 North, Range 65 West Dear Si P.O. BOX 913 15236' AVENUE' GREELEY, COLORADO 60632 (970) 352-0100 On July 21, 2001, I conducted a percolation test on the subject property and found the percolation rate to be approximately 7.5 minutesAnch. The test pit was 0 —1.0 foot topsoti,1.0 — 8.0 feet fine sir sand. No ground water was observed in the test -hole, For a three- (3) bedroom .home, a minimum -1000 -melon septic tank and a 570 -square foot septic field wilt:be required: As an-alternati ie, are irrtttrator® system may be used; eighteen (18) units (three (3) rows.of siic (6). units each)wilt be required. If you have any questions, please feel free to contact me at (970) 352-0100. Account Number Description 003405-02 u'20 C.i'Inm Meter Readings Previous Present Previous Balance 311 r1r'- r A. .I„ 111 r, h 1111. on!, Auto P. y i5 <,rJ r 1 s 311 .-e-trop rsn, nr.. Public Rate Hearing �....-, 1tn....',•.'. t'-i. '....... It I1 123. Water O 0 Central Weld County Water District 223 Sri3 A'Jr_11rar 1mti l Ily CO 80631 l t:tt , Rr4u0l Sorvlre Ilcyur,;'.b:d Read Dates Usage Read Code Previous Present A,.11, d 0'1 27 2021 10 2U 2323 "INVOICE E NCLOSF-D" Total Current Charges 519.27 Total Amount Due $19.27 EBill Bill ID 0432 00008772 Customer Service Address Billing Dare Account Number Due Date Amount Due Annual Allocation YTD Usage "Surcharges apply 11 Allocation is exceeded" 11: Central Weld County Water District �1r ..._._.... Nil 1r -'hl I It'H ,till ,11.11 ^Illlllunllrhlllrlllllllllrl,lgllrltrrtrrlrrlrnl�u,min, ,814 rN•1 IA1 n din r 1,111111 r1 1,111 Ert, it; R....1 r.,ln Presort First Class US Postage PAID Permit x 910 Albuyun•rriuc- Si! Hello