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Home My WebLink About20230459.tiffDeliver payment to: ARWP, INC. PO BOX 247 FT LUPTON, CO 80621 720-828-7366 FIRST-CLASS MAIL PRESORTED US POSTAGE PAID ZIP CODE 80621 PERMIT# 3 Previous Balance: 0.00 WATER USED 32331 308.72 PREV 1463455 PRES 1495786 YOU OWE 308.72 by 09/15/22 After 09/15/22 pay 339.59 Last Pmt $292.72 08/16/22 BRENDA HART SVC:07/31/22-08/30122 (30 days) Acct# MOR522 15607 CAROLINE AVE Web site: ARWPCO.com Office closed to public READ BACK OF THIS BILL for more information Return this portion with payment. YOU OWE 308.72 by 09/15/22 After 09/15/22 pay 339.59 Acct# MOR522 15607 CAROLINE AVE Return Service Requested BRENDA HART • 15607 CAROLINE AVE PT LUPTON CO 80621 Application Number: App Type: Applicant Name: Septic Permit - Final SP -0701103 HeaithlResidentiallRepair\Septic BYRON/ROSE LOCKWOOD 5347 E 118TH PLACE THORNTON, CO 80233 Owner Name: LOCKWOOD BYRON & ROSE Parcel#: 130927114009 Legal Desc: Site Address: 15607 CAROLINE AVE FORT LUPTON, CO 80621 Weld Co rnty Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone; (970) 304-6415 Fax: (970) 304-6411 www.co.weld.co.us Finaled Status: Ready to Final Applied: 07/2412007 Issued: 07/30/2007 Finaled: 8( 8io7 App Specific info: 112 Bathrooms 3/4 Bathrooms Application Date Associated Building Permit Associated Building Permit Number Basement Plumbing Full Bathrooms Location Description Number of Bedrooms Number of Persons Other Water Supply Utility Parcel Acres Private Water Supply Private Water Supply Permit Reference Number Public Water Supply Public Water Supply Utility Repair Reason Type Septic Permit Expiration Date Waive Fees Waive Fees Comment Year installed 0 0 07/24/2007 Yes No 2 15607 CAROLINE AVE, FORT LUPTON 3 2 1 Yes Aristocrat Ranchettes Repair for Upgrade No ENS Pere Test (Site): Engineer Design Required Engineer Evaluation Received Engineer Job Number Engineer Letter Received Ground Slope In 100 Year Flood Plain Limiting Zone Feet Limiting Zone Inches Limiting Zone Qualifier Percolation Rate Qualifier Percolation Rate Value Slope Direction Soil Description Soil Type Suitable Variance Required No No No No 8 0 Greater Than Equal To 5 Yes No Crystal Reports Viewer Page 1 oft 4 4r NI / 1 Main Report Permit # Permit Type: Situs Street Address di z00% • euclno sts Scanning Cover Sheet for Septic Permits SP -0701103 I Health / Residential I Repair 15607 CAROLINE AVE Situs City, State, Zip FORT LUPTON, CO , 80621 Sec/Town/Range: Parcel # (12 digits) Owner Full Name: Owner Address: Contact Name: Contact Address: 27 -02N -66W Application Status 130927114009-80140389 LOCKWOOD BYRON & ROSE 5347 E 118TH PLACE THORNTON,CO 84233 5347 E 118TH PLACE THORNTON,CO,80233 Application Date: Owner Phone #: Contact Phone# Information above has been Verified in Accela by employee noted bel April 17, 2008 http://crystalsrvr/businessobjects/enterprise115/InfoView/Report/report view dhtml.aspx?... 4/17/2008 4§1,,Det Wilk COLORADO Minimum Installation: Absorption Bed Absorption Trench Additional Terms and Conditions Bedt� o� \ Bed O tion Bed Option 3 Chamber Option 1 Chamber Option 2 Chamber Option 3 Septic Tank Size Trench Option 1 Trench Option 2 Trench Option 3 Septic Permit m Final S. Weld County Environmental Healthervices Department 1555 N.'17th. Avenue Greeley, CO 80631 Phone: (970) 3046415 Fax: (970) 304-6411 www.co.weld.co.us 155 YES 1000 Actual Installation: Septic Tank: Design Type: gallons Absorption Trench: L,-1 sq ft Absorption Bed : sq ft Chamber Model 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 appravat of installed system for issuance of a local occupancy permit persuant to CRS 1973 25-10-111 (2). This permit Is nontransferable and non-refundable. The Weld County Department of Public Health and Evnironment reserves the right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval was contingent upon th final ins Ion of the completed system by the Weld County Department of Public Health and Environment. x 42f1V1 Environmental Health Specialistte 'irtikra) kniotqD yL r 1)0- foilhasiz„ t SP 0'l G1I.403 15 (009 Carof.irue AV& • • / e1' .J• .q. 7/ Swiftkc map U INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICES 1516 HOSPITAL ROAD. GREELEY. CO 80631 353-•0635 EXT .222 5 OWNER JENNINGS. ED ADDRESS OF PROPOSED SYSTEM LEGAL DESCRIPTION OF SITE: SUBDIVISION: ARISTOCRAT USE TYPE: RESIDENTIAL.., SERVICES: PERSONS 2 BATHROOMS 2.00 LOT SIZE BEDROOMS 2 BASEMENT PLUMBING NO WATER APPLICATION FEE $150.00 1EC' D BY RECEPTIONIST AID DATE 03/13/89 r 4o rer� o Is Form I NO. G-890041 CO 80134 NEW PERMIT PH (303) 844-488• RNG 66 BLOCK 22 FILING 0 1.00 ACRES SUPPLY ARIST SIGNED BY ED, JENNINGS DATE 03/43/89 PERCOLATION RATE ( !I.() IN PER INCH LIMITING ZONE 8 FEET SOIL TYPE SUITABL, PERCENT GROUND'SLOPE 2% DIRECTION W ,REQUIRES ENGINEER DESIGN NO FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON -SITE SOIL PERCOLATION DATA THE FOLLOWING MINIMUM INSTALLATION SPECI 'CATIONS ARE REQUIRED: SEPTIC TANK UU0 GA ■ '. ABSORPTION TRENCH 250 SQ. ABSORPTION BED 330 ( . FT. IN ADDITION. THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND CONDITIONS: 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 ISSUANCES 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. ..t_ c. 1v zctl,‘yr,. 3. DR-aq zc_ ALICE RINEBOLD 03/16/89 C•Gvvvp •.;) Tri.1 ENVIRONMENTAL SPECIALIST DATE THIS PERMIT IS NOT TRANSFERABLE 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 ADDI-- FIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA— SIS. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE COM— PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT. SYSTEM INSTALLER ,. �. FINAL INSPECTI: ADDRESS 12502 N 1ST PARKER 15607 CAROLINE AVENUE FORT LUF'TON CO B0621 SEC 26 TWP 2 LOT 5 .SYSTEM ENGINEER .._...%`�..._... _._._...__wAPPRO AL TYPE OF SYSTEM I NS.T..ALLED .��,.—.4i;er.-.�, T Ej.`-per ENVIRONMENTAL SPECIALIST 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 1 973 . AS AMENDED, EXCEPT FOR THE PURPOSE OF ESTABLISHING FINAL APPROVAL OF AN INSTALLED SYSTEM FOR ISSUANCE OF A LOCAL. OCCUPANCY PERMIT PURSUANT TO CRS 1973 .5--10--iii (2). ORIGI14AL.•-APP1 Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 www.co.weld.co. us Septic Permit m Application Number: SP -0701103 App Type: Health\ResidentiallRepairlSeptic Applicant Name: BYRON/ROSE LOCKWOOD Owner Name: Parcel #: Legal Desc: Site Address: 5347 E 118TH PLACE THORNTON, CO 80233 LOCKWOOD BYRON & ROSE 130927114009 • 15607 CAROLINE AVE FORT LUPTON, CO 80621 ep it Fa,/ 303-y52 Applied: 07/24/2007 Expires: 07/23/2008 App Specific Info: Additional Terms and Conditions Basement Plumbing Chamber Option 1 Chamber Option 2 Chamber Option 3 Engineer Design Required Ground Slope In 100 Year Flood Plain Limiting Zone Feet Limiting Zone Inches Location Description Number of Bedrooms. Number of Persons Percolation Rate Value Private Water Supply Public Water Supply Septic Tank Size Septic Tank Size Slope Direction Soil Type Suitable No 15607 CAROLINE AVE, FORT LUPTON 3 2 Yes 44 hiDe ,, -f Weld County Environmental Health Services Departrttent 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 www.co.weld.co.us Septic Permit - Repair Percolation Rate Limiting Zone 78' ft in Description % Ground Slope Direction Engineering Design Required (Y/N) kin Soil Suitable (Y/N) In 100 Year Flood Plain (YIN) From the application information supplied and the on -site soil percolation data the following min'µnun Installation specifications are required: 191 -AX Septic Tank ( P94O gallons Absorption Trench (sg-r sq ft or -Absorption Bed sq ft Chambers: Hancor Standard or Hi -Capacity, EQ36 or BioDiffuser Infiltrator Quick4 Hancor Narrow (15in) Envirochamber Ina ttion, this permit Is subject to the following additional terms and conditions:Oh. ,Prvnu, # /g er/a ql , pV)%d u 7b a u 155 Trench Bed Trench Bed Trench Bed 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 therm 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 o hires ono year from the annllcation date. x EnvXronmental Health S ' ecialist Date Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 www.co.weld,co.us Septic Permit Applicati Application Number: SP -0701103 App Type: Health\ResidentiallRepair\Septic Applicant Name: BYRON/ROSE LOCKWOOD Owner Name: Parcel #: Legal Desc: Site Address: App Specific Info: 5347 E 118TH PLACE THORNTON, CO 80233 LOCKWOOD BYRON & ROSE 130927114009 15607 CAROLINE AVE FORT LUPTON, CO '80621 n 112 Bathrooms 314 Bathrooms Basement Plumbing Full Bathrooms Location Description Number of Bedrooms Number of Persons Parcel Acres Private Water Supply Public Water Supply Yes Public Water Supply Utility Aristocrat Ranchettes 0 0 No 2 15607 CAROLINE AVE, FORT LUPTON 3 2 1 TERMS AND CONDITIONS A permit fee, as set by separate ordiance 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 non-refundable; permit applications are non -transferable. If both a building permit and an 15O5 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 Public Health and Environment (WCDPHE). 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 certfies that the proposed system will not be located within 400 feel of a community sewage system. The undersigned certifies that ail statements made, information and reports submitted herewith are, or will be, represented to be true and correct to the best of his/her knowledge and are designed to be relied on by the WCDPHE for evaluation for purposes of issuing the permit applied for herein. Applicant further understands that falsification or misrepresentation may result in the dente the application or revocation of any permit granted, and in legal action or perjury as provided by law. O nerlApplicant Date • SEPTIC PERMIT 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 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. COMMERCIAL PERMIT NEW or REPAIR $600.00 VAULT PERMIT NEW or REPAIR $150.00 RESIDENTIAL ,PERMIT NEW o MINOR REPAIR PERMIT $100.00 PARCEL NO.: 13 0 9 a7114o C y (I2 DIGIT NUMBER) LEGAL DESCRIPTION: SECTION .2 4, TOWNSHIP c.Z N RANGE 6 t.0 w ACRES / SUBDIVISION ts LOT--- BLOCK_ FILING THIS INFORMATION CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650 SITE ADDRESS J sYv o 7 ear() // ;l 2 Poe_ F+ L u 1 A0 n( Q g 1 DIRECTIONS TO SITE N 8,5 C rQ / (p CRllp 3 / Cie_ 3/ /V T° ac .rro PROPERTY OWNER: ,By4a 17 aR /C o Se- /rn ko utoo cr MAILING ADDRESS: S734/-1 E I ! • N. -ACE CITY T7) 044rrdal ST e0 ZIP .go a 53 . HOME PHONE: (1 o3) 450 J ar]5" WORK PHONE (3() ) fo59 /// 419 FAX ( ) EMAIL ADDRESS: a e i 19-70 573 F S•32_. APPLICANT NAME: B> o n go3e.... e� 4.0 (kw o o cf MAILING ADDRESS: ..g3t f 7 l / g1l1PL fit'./ CITY /4 a yf vrO /ST n ZIP R 0 R-33 HOME PHONE: (3cii 3) 4/ 5b / a 7 S WORK PHONE ( ) FAX LJ EMAIL ADDRESS: DESCRIPTION OF BUILDING (EX: HOUSE, MOBILE HOME, MODULAR, SHOP, OFFICE) P70(111/ q A IF OBTAINING A REPAIR PERMIT, WHAT IS BEING REPAIRED? ,Lee C r n g F e r NUMBER OF PERSONS IN FLOOD PLAIN AREA? YES NUMBER OF BEDROOMS 3 BASEMENT PLUMBING YES BATHROOMS: FULL of 3/4 PUBLIC WATER SUPPLY PRIVATE WATER SUPPLY YES A ARE PERCOLATION HOLES MARKED FOR INSPECTION? YES/NO CENSUS TRACT NAME ahA4) hAt f ",,toosct -s WELL /CISTERN PERMIT # IS Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 www.co.weid.cO.us S Field inspection Form Application Number: ISDS-0701039 App Type: HealthlResidentialliSDSina Applicant Name: BYRON & ROSE LOCKWOOD Owner Name: Parcel #: Legal Desc: Site Address: 5347 E 118TH PLACE THORNTON, CO 80233 LOCKWOOD BYRON & ROSE 130927114009 15607 CAROLINE AVE FORT LUPTON, CO 80621 The septic system identified above IS / IS NOT of suffifient size to accomodate the proposed alteration(s) indicated below to the structure(s) served by this system. Applied: 07/02/2007 EHS ISPS Reseach: Absorption Bed Size Absorption Trench Size Engineering Design Other Public Water Supply Utility Private Water Supply Private Water Supply Permit Reference Number Public Water Supply Public Water Supply Utility Research Comments Septic Permit Recorded Septic Permit Reference Number Septic Search Septic Tank Size Year Installed 276 No Yes Aristocrat Ranchettes Yes G19890041 Yes 1250 1989 EHS 1SDS Current Flow: Current Flow 112 Bathrooms Current Flow 314 Bathrooms Current Flow Basement Plumbing Current Flow Comments Current Flow Description Current Flow Full Bathrooms Current Flow Number of Bedrooms Current Flow Number of Persons 0 0 No THERE USED TO BE A 2 BEDROOM MODULAR ON SITE. VACANT PROPERTY. 0 0 0 4,1 • I WIiDc COLORADO EHS ISDS Research Changes: Addition Comments Additions 1/2 Bathrooms 0 Additions 3/4 Bathrooms 0 Additions Basement Plumbing No Additions Description WANT TO PUT A 3 BEDROOM MODULAR ON SITE. Additions Full Bathrooms 2 Additions Number of Bedrooms 3 Additions Number of Persons 2 Proposed Basement Plumbing No Proposed Total 1/2 Bathrooms Proposed Total 3/4 Bathrooms Proposed Total Full Bathrooms 2 Proposed Total Number of Bedrooms 3 Proposed Total Number of Persons 2 .'i:, .. Weld County Environmental feaith Setvices Departritent 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304.6411 www.co.weld.co. us ISDS Field Inspection Form EHS Inspection Corrections: Approved Corrections Comment Field Area Undersized By Field Undersized By Increase Field Area To Tank Construction Tank Undersized By The existing septic system is REQUIRED / RECOMMENDED to have the following alterations made to accomodate the proposed alterations to the structure(s) served. 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 Enyironment for reasons set forth in the Weld County Individual Sewage Disposal System Regulations Including failure to meet any term or condition imposed theron during temporary or final approval. The issuance of this permit does not constitute assumption by the department or its employees of liability for the falirue or inadequacy of the sewage disposal system. 7hts permit Is non -transferable and_non-refundable. Before issuing final approval of this permit the Weld County Department of Public Health and Evniranment 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 X Environmental Health Specialist CitabtAk allacitd emu, ,c ztJ Date WeirK) cuu. 1Okek0 Mierai /*cm._ 1-494,,c* vuuk �'�'�CB,l kk"0 rAdvit9,2,Lawfum 1 • r • LISP 06-1=' INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICES 1516 HOSPITAL ROAD, GREELEY. CO 80631 353-0635 EXT.2225 OWNER JE:NNINGS. ED ADDRESS OF PROPOSED SYSTEM LEGAL DESCRIPTION OF S:[TE: SUBDIVISION: ARISTOCRAT USE TYPE: RESIDENTIAL SERVICES: PERSONS 2 BATHROOMS 2.00 BEDROOMS 2 BASEMENT PLUMBING ND WATER SUPPLY ARIST APPLICATION FEE $150.00 REC'D BY RECEPTIONIST AID DATE 03/13/89 ADDRESS 12502 N 1ST PARKER CO 80134 15647 CAROLINE AVENUE FORT LUF'TON CO 80621 SEC 26 TWP 2 RNG 66 LOT 5 BLOCK 22 FILING LOT SIZE 1.00 ACRES SIGNED BY ED. JENNINGS DATE 03/13/89 NO, G--890041 NEW PERMIT PH (303) 841-488( 0 PERCOLATION RATE 5.0 MIN PER INCH LIMITING ZONE O FEET SOIL TYPE SUITABLE PERCENT GROUND SLOPE 2X DIRECTION W REQUIRES ENGINEER DESIGN NO FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON --SITE SOIL PERCOLATION DATA THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED: SEPTIC TANK e 40 GA ■ ABSORPTION TRENCH 250 SO �� ABSORPTION TIED ,330 .11. Fr. IN ADDITION. THIS PERMIT IS SUBJECT TO THE. FOLLOWING ADDITIONAL TERMS AND CONDITIONS: / 5.6 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. '1—c • Dc,,.,v.�sL THIS PERMIT IS NOT TRANSFERABLE 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 ADDI— TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA— SIS. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL.. INSPECTION OF THE COM— PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT. ALICE RINEBOLD 03/16/89 ENVIRONMENTAL SPECIALIST DATE SYSTEM INSTALLER ..__ - _________FINAL INSPECTr D4TE SYSTEM ENGINEER __.�` 2_.____. ... ._.APPRO AL _ � �.4f_ ___ _. TYPE OF SYSTEM INSTALLEDr�L'rSPEC �,_ ��..-�!�-�--c- �. ENVIRONMENTAL SPECIALIST 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 1973. AS AMENDED. EXCEPT FOR THE PURPOSE OF ESTABLISHING FINAL APPROVAL OF AN INSTALLED SYSTEM FOR ISSUANCE OF A LOCAL OCCUPANCY PERMIT PURSUANT TO CRS 1973 25 -10 -iii (2), P4Qp • V1 9J •1: 1 •i . . 11 • • 1 • ISDS NO: DATE RECEIVED: RECEIVED BY: FEE: INDIVIDUAL SEWAGE DISPOSAL SYSTEM EVALUATION SITE ADDRESS OR LOCATION: f S (: O 7 a r o I r n', o PARCEL NO:- 13 CA Qtin q009 9 THIS CAN BE OBTAINED FROM THE ASSESOR'S OFFICE AT (970) 353-3845 EXT 3650 OWNER: ByRnn Rosia, LoGkcoaocL PHONE: f 303 4/3 /a7S- MAILING ADDRESS: 531/7 C 1 t S t& PI Cl z, 71 l-49 3 3 CITY STATE ZIP APPLICANT NAME: APPLICANT ADDRESS: '1534 7 F in g po a 3 3 (IF DIFFERENT FROM OWNER) CITY STATE ZIP PHONE: ALT #: 970 -- 593 - X53 a. FAX: LEGAL DESCRIPTION: PT: PT: SEC: eZD TWN: oZ N RNG: (4)10 w /IN srae.A/ ' I Ficketfe3 SUBDIVISION: LOT: BLK: .FLG: WATER SOURCE: Jxabiedackik, a� ACRES: / ORIGINAL OWNER OF SEPTIC SYSTEM: PERMIT NO: SOE: YES / NO DESCRIPTION OF STRUCTURE . • CURRENT FLOW: ADDITIONS: PROPOSED TOTAL: • Vgco M - DESCRIPTION: f ipciuIo/ mo tA(ar'' PERSONS: BEDROOMS: BATHROOMS: BASEMENT PLUMBING: 5 a a 3 a • N D 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. V/04/2007 16:22 ' 3034272522 LEONARD 17u1 bs .B0d'Z 9s 49t1h1 .ARTS SRMITMTIOM . ,,; ... :its 970-1B5-8321 PACE 02/02 p.1 I-2 People: every 9•a yews. In Account with Art's Sanitation Service Arthur C. Beierie/Bradky A. Betel& 10373 Weld County Rd. 28, I Iat evaIs, Ccfarada 80051 Pretpt, DepeutiaDte Service Hwy Day rx ept Sat irday Metro: (303) 6S9-2335 klntte`'1llet (970) 785-63333 70925-7 Septic Tanks -- Grease Traps-- Lift Stations Holding Tanks •- Electronic Locator price end Sepilc Minim : 4-Z People: !very 2 yews. 1-7 People: Every year. 7+ People: Ow)! 4 eowithal n !rµun.. Scrvlceata : yd Record# Name: jg 05.c /4' l -of k Luez" _ Corny. (-.irk Bong Aare= /5 407 fog ed rf..J City, Staten Zfp: t� : / t r 34,0A JabAddrets: Date: ?- P11oaP aunt SO0241 ek . Crrwsr7lep,_,__, Malden_ Holdlrefek,,,,.•_ Wm TsekSiur )1r7_Ga lonswcdloaCquolty )'l GallOllakftwad t3andlagr % c2 I ocouprao K Trek Com n: i~ontte • Flmpc_ Metal_ Odor StretwtailySotted 8t WentTrgpte Ye , No _ Cocopartmortd SAM Iietn Ulm 000&_ aOulu; . .. Minim' Ouluod., Bads^ Miss*_ LERPoop Falxdoolawl( .^_ No�� %.......xa WorVelittimb Nimrodi Below _ - • Abets • SeElls Mara Heavy: Y195 _ Drain F7dd Roosiuy 13uk: Yes Ho How Much Any Other Prvblews Obeernd: !i_l0 Remo ierSernitrnMeiaa:asaoo Rol EsteteSala F] sletwstcyt8atkup Olhoi Cast: S -313‘ -; 40 4dd1[to taLSeratee: t 1 snow call E 4 respectipfls ry e: NAWT 1 Smtdud i I made t I I 084istrAbot �s Apo Rota 1 tAemer Semi= laluagsFplie bards oars mak epprecds tote rocasifln afsooas ]ids 1 $coo Equipmemlapre P in rime: Credit Terms I zitia , frr►Yl��e,�Fiar s �/fc Tatad Cart: $ j 1. el 5 $ S Au =Tim shall be duo 30 daysbeta dam of aavisxt Any =sum dnauo3D days Past Dm xiltbe'Antd a late ho oftwenty daller:025A. Any mains 90 day. Pest Due Will beturned arcr to aoenedion service sad llweeeze:um-Ai bareepretsibly lb( all coats incurred in the caliottica of the Past D Signature: X Damage Waiver AM srrdtralon Bervfcri =wet qo rerpoasiisWiy The gismo= Inside aRlba curb w prepetltr lies *bare damsgs=ay =us to • .00 .00 .00• .00 ,00 .00 stigt- £ECeaeal C/ r &dowelat tksDatrtemersalambwJratitsidealiecrossttontdyate}ofrearesood>fbavc. Signature: X Hello