The URL can be used to link to this page

Browse Search

Home My WebLink About20253161 �k.c BOUNTY HEALTH DEPARTMENT .Z-.r1 FEE $10.00: =ENVIRONMENTAL PROTECTION SERVICES SOE it: 9 3 9 6 6 a 1517 16th Avenue Court , LOAN *: Greeley, Colorado 80631 4 Health ISDS It: 0.2-V _ 9 3 (303)353-0635Weld h Department ent REPAIR *: STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN BLACK INK ONLY) OWNER OF RECORD: Larry 1. a,r,.A" /14►o at e,( L.ear(se°n PHONE: 667-a819 1 . MAILING ADDRESS: /367 S(,U, �3 31 , L vdet/At 07 F0537 City State Zip SITE ADDRESS: 4-7 y i, Weld Ce,(i. STD Love kfti CD 1.0537 City State Zip LEGAL DESCRIPTION: PT: , 2 PT:NV q SECTION: 2 TOWNSHIP: it- N RANGE: a W SUBDIVISION: -�- LOT: BLOCK: FILING: NUMBER OF PEOPLE: V BEDROOMS: 3 BATHROOMS: / WATER SUPPLY:L(A c-A_/ RESIDENTIAL / COMMERCIAL BASEMENT PLUMBING: Y (9 LOT SIZE: 4/77 acres SYSTEM SIZE: Tank is constructed of COYIc -11er and has //-0 gallons,capacity (material) ('j��u,�/6- . FIELD: Bed or Trench,n knrn,rrt' square feet. DATE SYSTEM INSTALLED: l.04.rowT./ 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 in good working order and to the best of his/her knowledge is 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 legal action for perjury as provided by law. akt,/ ',-.2(1(,' /9.73 , r‘f27,% .1, C/L&,,e,-__ At,;,.....e<=v_aef,44, , ) ' ,Date:'--` " Owner Su scr-ibe674m� swor`n to before me this , � �� day of , 199 , .-2',,,-.''>--- - ----e-- ; 2 Witness my and and official seal. My commission expires: 96 /., ,r/9 3 ___O VA,0 0 aA Date Notary Publi STATEMENT OF EXISTING REVIEWED BY: Environmental Protection Specialist . . —_._ . . ---cr _ iii....., . ., . • -wt. a. ..--.-0 . _ --„, - .ot.. . ...•„„.•. . CI,. . 17g6 to, e,e, s-o r , , . ktgviAL_ . r. . . 1 \.... 7 c?' lit . Siocic ._,ID, EH 1(.:_ •._ 7 . , 1 . . , . \ . \ . t c)‘•eki , \ ' . ! . . • ---,-. __ afermew)644 lorAfian — , — 5 S-- ig,ack.11-4<. qs eii-eri tRit . . bz'Areo.)tittds cum er•(re L.!, - S o fne. I 6c1.‘c_e.,...±to n c- .e6•,riN 1 vne_, .e,a5fal-)i U ri able_46 . 14—Pt. so - . vf f) Vetely.ri 4:11‘.. 75 "(6'54 114r)N 6 r .. a_S--Ft. SOL;Cl tt;\ :.e.-,:l.trA04,e- eck'e-..•sl.'- ,. Crivi-V-r-;1,1.4; trik -- \!,,•.;';?;,...--- 1)7 Qoviia, _ "-,\i ,,,..)/ .,.‘ I a_ .:, ''.-:f; ',4-,-.4, -,-,-- - T. '' -•..... riot ':%,':`1::- ''•-•.. . • . -or -. -1\) ,•:A- BLACK INK,ONLY! • . N •.,..' W ' E • • -S . . • WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, COLORADO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 STATEMENT OF EXISTING SEPTIC PERMIT Permit#: SE-0300126 Sec/Twn/Rng: 02-04-68 PERMIT Owner: MILLER KENNETH C Applied: 12/08/2003 Applicant: MILLER KENNETH C Parcel#: 1061-02-0-00-024 Location: 4786 WCR 50 Legal Desc: Description: HOUSE Commercial: N Residential: Y Acres: 10.6 #of Persons: 2 Basement Plumbing: N # of Bedrooms: 2 Bathrooms - (Full): 1 (3/4): 0 (1/2): 0 Water Public: Y Water Source: LITTLE THOMPSON Water Private: N Cistern: N Well: N Well Permit Number: Septic Tank: 1250 Tank Material: CONRETE Absorption Trench: 0 sq. ft. Absorption Bed: 0-800 sq. ft. Year Installed: 1949 • NOTICE The property owner/agent has certified by Notary Seal that the above described septic system is in fact installed as described,and exists at this time on the parcel identified above by the parcel number and/or legal description,and further states that the system IS/IS NOT in good working order and to the best of his/her knowledge IS/IS NOT failing to function properly. The property owner/agent further understands that any falsification or misrepresentation may result in the revocation of any permit granted based upon this information hereby submitted and in legal action for perjury as provided by law. The Statement of Existing Record relies on information the property owner or his/her representative provides,under oath,indicating current status of the system and representing to the best of his/her knowledge that the system IS/IS NOT failing to function properly. Issuance of the Statement of Existing Permit for any system does not constitute assumption that the site was evaluated or inspected during any phase of construction by this Department to meet regulations. Ic9 9 0"3 En ironmel.4tal Health Specialist Date Form:S_EXIST t _`8,, WELD COUNTY DEPARTMENT OF PUBLIC SOE# 0330 tZk) ��t HEALTH AND ENVIRONMENT ORG PERMIT# 1555 N. 17T"AVENUE REPAIR# V GREELEY, COLORADO 80631 LOAN# PHONE: (970)304-6415 ISDS# n30 0 C. FAX: (970) 304-6411 COLORADO STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN BLACK INK ONLY) PARCEL NO. /04 /— O z - 0- co - 02 PROPERTY OWNER /�hh P.7‘ C AAy, PHONE NO. (9170) G3 6- GI4&?/ MAILING ADDRESS g'G W/e e/ Cav4 /a67) 4#- hn/ CO, ,Occ ? 7 City State Zip DESCRIPTION OF BUILDING (ex. house,mobile/modular home,shop,office) , a a 3 e_ SITE/LOCATION ADDRESS 1 7 ii/ ed e /q' 00 y a f R,/ S City State Zip LEGAL DESCRIPTION PT G ) PT Ng"1 SECTION 2- TOWNSHIP U RANGE (. 4ie Sf SUBDIVISION / LOT BLOCK FILING CENCUS TRACT 21 - LOT SIZE/ACRES /0, 6 COMMERCIAL YES/11,5 RESIDENTIAL &NO NUMBER OF PERSONS '2 BASEMENT PLUMBING YES 0 ..Rooms ( _ BATHROOMS-FULL I 3/4 1/2 • WATER SUPPLY-PUBLIC YES NO NAME LI lr 7 .c0A 1.1/07Y w ,O 5 f1"/C 74 ., PRIVATE YES/NO WELL YES/NO CISTERN YES/NO WELL/CISTERN# SYSTEM SIZE: Septic tank material is constructed of Ce li cf r' and has /2 cf O gallons capacity. FIELD: Trench square feet or Bed 2 - kofi square feet YEAR INSTALLED /yy 9 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 'ption and further states that the syste i.C.I.is-nst in good working order and to the best of his/her knowledge ' is no failing to function properly. edes 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 ac o for perjury as provided by law. /2'-. s'-d C DATE _ OWNER SIGNATURE Subscrib d and sworn to efore me this �5 day of V J.-Q•C.¢•1 ,4'i k •, 20 0 3 ,, By pir� �. �,� �� Witness my hand:and official seal. My ommissio pires DATE NOTARY PUBLIC STATEMENT OF EXISTING INSPECTED & REVIEWED B p,d 4 .03 E 0 TAL HEALTH SPECIALIST DATE N( 1 .. Wou6e_ \ ..?s' 0 \„ ss s;,0/, 3o' _ tv T h/{ - f e,..5` 1. .r r • r . a WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, CO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 figer)1/4._ Permit#: SP-9900604 Sec/Twn/Rng: 02 04 68 Status: Owner: MILLER KENNETH C & PATRICIA A Applied: 11/30/1999 Applicant: MILLER KENNETH C Issued: 12/02/1999 Permit Type: RNEW C=Commercial,R=Residential+NEW,REPair,VauLT Finaled: ,- a Oc Parcel#: 1061-02-0-00-020 Location: 4998 WCR 50 LOVELAND 2-4-68 Legal Description: PT E2NE4 2-4-68 LOT A REC EXEMPT RE-1488 (12S.91R) SITUS: 47 Installer: Description: HOUSE ' Commercial: N Residential:Y Acres: 2.24 #of Persons: 4 Basement Plumbing: Y #of Bedrooms: 3 Bathrooms -Full: 2 3/4: 0 1/2: 0 Water Public: Y Water Source: LITTLE THOMPSON WATER Water Private: Cistern: Well: Well Permit#: Percolation Rate: 47 Limiting Zone: 6 ft 0 in Description GROUNDWATER % Ground Slope: 0 Dir: Soil Suitable: (Y/N) Y Engineer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N) N Minimum Installation Chambers Septic Tank: 1000 gallons Absorption Trench: 0 square feet or Absorption Bed: 1230 square feet Actual Installation Septic Tank: l 2Se gallons Absorption Trench: square feet Absorption Bed: t g20 square feet Design Type: C 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 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 an viro t. 411 4b Env' on tal Health Specialist Date Form:S_FINAL 4 -107-P co- \ N1D , I t '51 is [-M5 Scanning Cover Sheet for Septic Permits Permit # G19939062 • Permit Type: Health / Residential/Statement of Existing Situs Street Address 4786 CR 50 Situs City, State, Zip Sec/Town/Range: 02-04N-68W Application Status: Finaled Application Date: 03/11/1996 Parcel # (12 digits) 106102100029-R2833404 Owner Full Name: CARLSON LARRY & MICHAEL • Owner Address: 1307 SW 23RD ST LOVELAND,CO 80537 Owner Phone #: 303 6672819 Contact Name: Contact Address: Contact Phone# Information above has been Verified in Accela by employee noted below X 62-- August 20, 2008 Processed by: Date Report ID: EHS00024v003 Page 1 of 1 Print Date-Time: 8/20/2008 9:22:27AM k.mc`i -COUNTY HEALTH DEPARTMENT FEE $10.00: =ENVIRONMENTAL PROTECTION SERVICES SOE #: 9 3 9 66 a 1517 16th Avenue Court LOAN #: Greeley, Colorado 80631 ISDS #• O -V _ 9 3 (303)353-0635 Weld County Health Department REPAIR #: STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN BLACK INK ONLY) OWNER OF RECORD: Larry L, a.w.c, /14iG('iQe ( L r(sue PHONE: 667-,.28/9 1 MAILING ADDRESS: /367 SCV, Lye/10W Co F0537 City State Zip SITE ADDRESS: 4 77(„ Weld ce SD L, e44 CQ KQ537 City State Zip LEGAL DESCRIPTION: PT: 2 PT:NV q SECTION: 2 TOWNSHIP: '7r N RANGE: a W SUBDIVISION: LOT: BLOCK: FILING: NUMBER OF PEOPLE: V BEDROOMS: 3 BATHROOMS: / WATER SUPPLY:Lt --r „,A_, RESIDENTIAL / COMMERCIAL BASEMENT PLUMBING: Y LOT SIZE: (p 7 acres SYSTEM SIZE: Tank is constructed of Co?icre-ie_ and has /O-OD gallons,gapacity (material) ('j��ud/�- �.. FIELD: Bed or Trench,n knau rt' square feet. DATE SYSTEM INSTALLED: (.04.4101 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 in good working order and to the best of his/her knowledge is 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 legal action for perjury as provided by law. 4/1"A"' Owner S4sc:r-ibe4_ ncswor`n to before me this IN day of , �: Witness my and and official seal. My commission expires: 94 /9,r/9 3 ___e ; Date Notary Publi STATEMENT OF EXISTING REVIEWED BY: Environmental Protection Specialist 166117 • •C, a, . . • 17g6 e,e, s-o kouiriAL_ qi sorilc EH. c)‘•zci Cfer,67e1(r)644 5S- 1.fAck.11-4.<_ 4 01-4351.-t•e4 , i31rre0.je2tS LAflç (rOt.i SO frle Ivecith tve.., 4454)1 IA rlabi-e-48 14- A . of skeizi V-en eS)11cr•ar al'`Ft• e2VANSI , ) '1.4714.1‘. ) • 1:".9- (MAI' )7 VA•414.0,--, : ,;_"=•‘1;"‘. c t-) ':%`;12:•-• lit•..71- BLACK INK.ONLY!N • . • • W E • •S „:.i y�.d.�uJrW'aYoj'+?�'”'« y�"'`.r}'f"- Y j.�'u:-� ,v r5�`$ �,: �.t y ua'+ .,.✓ , ,�. , :, -.:I ,. ..� ,,,.{ �.• ± �Ol t-s . . ~' �Z, . REQUEST NO: (7,2 'I-�/ 3 . r INDIVIDUAL SEWAGE DATE RECEIVED: y A >/9 3 DISPOSAL SYSTEM EVALUATION RECEIVED BY: C2) Weld County Health Department FEE474.-o8-:- ►1 C - 4,63 - U700wJri;KcL. ?9- 2sr57(G.., ZG--.^ yJ OWNER: 0 r,r /c 0...-„,0...-„, 2 ft k-, •/ M ; C-/7 G t-l PHONE: f 7. :.Z?/% /11 MAILING ADDRESS: / -3 6 2 cf,/ 3. / ,-.0 v P�244 n/ (16' PO 3 CITY STATE ZIP SITE ADDRESS: G/2 F l� /, 0 7? cc-0 Z„ I, P/ .1../ (' 6 .5- 37 CITY STATE r/ZIP LEGAL DESCRIPTION: PT: F Q PT: `7f/ .% SEC: �Z TWN: y N RNG: Co �l W SUBDIVISION: LOT: BLK: FLG: WATER SUPPLY: L ,‘/ / /,w,_�.2 S-o•—,.-i RESIDENTIAL / COMMERCIAL TOTAL ACRES: 6' 7 PERMIT ON RECORD: Name:( Ur r /sc� /ci y f2ci/-a e Permit No. : 93��4 a2 S.O.E. : O N /System Size: Tank: 1( ,0 gallons Trench: kilt-- square feet Bed: square feet Percolation Rate: (c,O minutes per inch Soil Type: S �_� Engineer Design: Y N Percent Ground Slope: Direction: ri14�-4 D br of tolA (L b ebkolMAL, 4-41 .- 'The septic system identified above IS I1T of sufficient size to accommodate t s�d ifita�*or t' .,a(ea the structure(s) served by this systemt69.0ka-SvCi h if Cayi U C ^1jTtmz-il dam-. V CURRENT FLOW ADDITIONS PROPOSED TOTAL q ` Description: ge„„7/a/ Nor,c e Description: Description: )-/o u c e Persons: 0 Q Bedrooms: d 3 Bathrooms: ) 0 / Basement Plumbing: No N/A a4a= A1//2 The - . • • : - s . a► •: 10r�� . - o . • . _ : - _ 4 NO 1I�5 It ACC IS � &t flit e) i ' L1\ t& - Ciz- li a li tr 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. J 8.3.5 -7 State H cJ32..ay.56 Dcrtnouc.CC 80513 (970)5.32-2096 little Thompson Water District Uff cc riC•LirS OrC V0'3C.3:1-• 7 coy 7.CCOM-S.C.Com Haooy Ho cays from a trio staff at _TW2. If you nave any cuost ens m concerns o case too too to contact us at 970- 32-2096 0 0301112 ...o ov..,us on -acepooK at nttrlls.//nvaJafac011lOOk.com./_tt eTnomosonWatu Have you- :J oa c automat ca y coon month s to X:Drcss 3 •Day's Sass c-hoc Auto lay fcatu-c. E3 d s 478E WC.50 Account Numbc, d 0.02 4786 CC JNTY to sc _CV-7._A55 CC 80537 cc.oc Eno .1/20/2023 JOHNSTOWN.C:0 805 Account Tyoc Ut ty Due Date 2/.5/202.3 Sc cct 3 nc •Dc,oc './20/2023 /202.3 ./.6/2023 1210 - 20905E+ 2.33. L26 Nato!. Bose 331.84 Previous Payment Date 11./14/202. Previous Payment Amount 356.14 Watc: Jsa2o S12.02 Nate- Jsacic Statement Charges $43.86 Amount Due $43.86 Sc cct vote:. .2.0020=4 The nfo,mat on c Sc aycc s 0'0‘,••CCC: oy _tt c T:somoson Watcy 0 str ct. If tnc-c s a c sc,coancy case contact _tt c Tnomcson Water 0 str ct. °as°note that to s y c SO ay nc.i payments'woo os c, aft°, 11/21/2023. Daymonts mac°c root y to_tt 0 Tnel);DSO:)\A/Litc:' may o: may not 00 C Sp aycc n0,0. Hello