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Septic Permits
Permit #
Permit Type:
Situs Street Address
Situs City, State, Zip
G19830146
Health / EHS History / EHS Conversion History
13676 CR 3
Sec/Town/Range: 29 -03N -68W
Parcel # (12 digits) 120729001001-R4771886
Owner Full Name:
Owner Address:
Contact Name:
Contact Address:
IVERSON RICK
1651 S.VIVIAN
LONGMONT,CO 80501
Application Status: Finaled
Application Date: 03/11/1996
Owner Phone #: 303 7761172
Contact Phone#
Information above has been Verified in Accela by employee noted below
January 07, 2009
Date
Report ID: EHS00024v003 Page 1 of 1
Print Date -Time: 1/7/2009 10:26:33AM
1qV
. APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM No.
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OWNER
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ADDRESS OF PROPOSED SYSTEM / C 7 (r I/°f� -3 , ,l iv viiYh-7®•2 -
LEGAL DESCRIPTION OF SITE: PT f /1I si�s ;:25,---T - , R ( V • a
SUBDIVISION J,?/'( /I)r°<, P) (.(i S LOT - -? , BLOCK , FILING
USE TYPE: RESIDENTIAL X 11 4f S e INSTITUTION
COMMERCIALOTHER
SERVICES: PERSONS ---_ ' BATHROOMS v LOT SIZE Grvr'p.5
BEDROOMS ---�� BASEMENT PLUMBING l'j /1j) WATER supPLY
TYPE OF SEWAGE DISPOSAL REQUESTED: 5'•e,/,'c ,4 . //47/tr A./0
Applicant acknowledges 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 1973, as amended. The applicant certifies that the proposed system will not be located within 400 feet of a com-
munity sewage system. The undersigned hereby certifies that all statements made, information and reports submitted here-
with and required to be submitted by the applicant are, or will/be, represented to be,true an'd correct to the best of my knowl-
edge and belief, and are designed to be relied on by the Weld County Health-Deparitmentt in evaluating the same for purposes
of issuing the permit applied for herein. I further understand that any falsification orlmisrepresentation may result in the denial
of the application or revocation of any permit granted based upon said application and/in leal action for perjury as provided/by law.
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Recd by ( !'`�� � ly��Q ? ��,,7•=, Date 9 - 6
Spn
WELD COUNTY.HEA.TH DEPARTMENT
ENVIRONMENTAL HEALTH SERVICES
S.
New
1516 Hospital Road, Greeley, CO 80631 Repair
353-0540 EXT. 270 I /- BP
ADDRESS 4;C / S, Ii'rt){, ,r ,,4O,ti/t'' PHONE ///%.- /•'
Application fee
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Owner%Agent Signature Date
FOR DEPT.
USE ONLY
PERCOLATION RATE 1 t�1 / l// / fir c (.v
SOIL TYPE CT A.., r�/A-+yi/
REQUIRES ENGINEER DESIGN ( ) YES ( No
WATER TABLE DEPTH ''"•
PERCENT GROUND SLOPF
INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
From the application Information supplied and the on -site soil percolation data, the following minimum installation specifi-
cations are required:
SEPTIC TANK / O GALLONS, ABSORPTION TRENCH I l A- SQ. FT.
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Or
ABSORPTION BED / 23 6 SQ. FT.
In addition, this Permit is subject to the following additional terms and conditions:
ir'F�e n to Ln r `� t,! C4 -e -1 zrn l +-••/-4/zA o i,..a-„4 A•Ci h < , r 1,'C'("<-2-fO
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 far the failure or inadequacy of the sewage disposal system.
9-1�- / /, ; /11(16b7-
1 -#11`E n v I ro rime gal Specialist ;Date
This Permit is not transferrable and shall become void if system construction has not commenced within one year of its issuance.
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 in-
spection of the completed system by the Weld County Health Department.
SYSTEM CONTRACTOR Nd� C"ONt) CUict
SYSTEM ENGINEER
FINAL INSPECTION
APPROVAL
evo
Environmental Specialist
3- 27- Y
Date
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 pursuant to Article 10, Title 25, CRS 1973, as amended, except for the purposes of establishing final approval of an
installed system for Issuance of a local occupancy permit pursuant to CRS 1973 25.10.111 (2).
Original -Applicant; Copy-WCHD WCHD—EHS February, 1981
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-8301yc
Wi�Dc.
COLORADO
DEPARTMENT OF HEALTH
PHONE (303) 353-0540
1516 HOSPITAL ROAD
GREELEY. COLORADO 80631
Request No: 169-85
Date Received: 9-10-85
Date Forwarded: 9-16-85
Fee Paid: $35.00 Date: 9-12-85
TO WHOM IT MAY CONCERN: Review and inspection report regarding water and the sewage disposal
system for an existing dwelling.
Send tc: Rick Iverson
13676 WCR 3, Longmont, CO 80501
INFORMATION: Address: 13676 WCR 3, Longmont, CO 80501
Legal: Pt W2 NE4 , Sec 29 , T 3 N, R 68 W, Age of house 2 years
Subdivision Lake Meadows , Lot 3 Blk Filing
Property Owner: Rick Iverson Original Owner: same
Tank Pumped on: System installed 3-84 By:
DEPARTMENTAL RECORD SEARCH: Permit Found: G-830146 issued to Rick Iverson on 3-29-84
Tank capacity 1250
Other
gals. Field Size 1363 sq. ft. Water Supply Longs Peak
INSPECTION COMMENTS: Date of Inspection: 9-13-85
Soil Conditions: Dry X Saturated
Residence: Occupied X Vacant
FINDINGS: SEWAGE DISPOSAL SYSTEM: Satisfactory X
COMMENTS:
DATE:
Snow-covered
Other
BACTERIOLOGICAL WATER TEST: Acceptable X Other _
9-13-85 SIGNATURE:
Environmenta1,•ea1th Specialist
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 in connection
with either its examination of the property or in the report.
This inspection was conducted solely for the purpose of detectino health hazards
observable at the time of inspection, and does not constitute a warranty that the
system is without flaw or that it will continue to function in the future. Inspection
requested during periods of snow cover and high soil saturation may be of questionable
value to potential buyers due to adverse conditions. Water sample reports reflect the
bacteriological quality of the water supply at the time the sample was taken.
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