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Home My WebLink About20230487.tiff. wA�zs-rs; RECEIVED TYPE OR PRINT IN BLACK INK COPY OF ACCEPTED STATEMENT MAILED ON REQUEST. COLORADO DIVISION OF WATER RESOURCES OCT 2 5 f98 818 Centennial Bldg., 1313 Sherman St. TER RFSOURas SIAM WI Denver, Colorado 8021336ltl STATE OF COLORADO " AFFIDAVIT SS_ COUNTY OF Weld STATEMENT OF BENEFICIAL USE OF GROUND WATER AMENDMENT OF EXISTING RECORD x - LATE REGISTRATION PERMIT NUMBER THE AFF1ANT(S) ale Sasaki whose mailing address is 1871 WCR 77 Coy Brighton 4STATc) rnpi 152851 County _NFL LOCATION OF WELL Weld Twp. 1 of the NE N Any IN OR SI Y, sec,.un 30 6 Qµ LE OR WI being duly sworn upon oath, deposes and says that he (they) is (are) the owner(s) of the well described hereon; the well is located as described above, at distances of 945 feet from the North section line and _145 feet from the I.,ORr, OR SOvT4) East section line; water from this well was first applied to a beneficial use for the purpose(s) described herein on the 1.5._ (CAST OR W[7-,) day of Mjarcb , 19 57 ; the maximum sustained pumping rate of the well is 1 5 gallons per minute, the pumping rate claimed hereby is 1 5 gallons per minute; the total depth of the welt is 40 feet; the average annual amount of water to be diverted is 1 acre-feet; for which claim is hereby made for Domestic purpose(s); the legal description of the land on which the water from this well is used is Part of the NE 1/4 NF 114 Sect. 30 Twp_ 1 N Rng- 66 W of which acres are irrigated and which is illustrated on the map on the reverse side of this form; that this well was completed in complionce with tie permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he (they) has (hay ad the staj rents made hereon; knows the content thereof; and that the same ore true of his (their) knowledge. (COMPLETE REVERSE SIDE OF THIS FORM) Signature(s) Subscribed ao swo B p to before t�e.on this day of �-R-�-�� , 1988 - r. My, Commission Expire My Comm ission•explres; . Alba .12 1991 .oT&J PUNLIC ACCEPTED FOR FILING BY HE STATE ENGINEER OF COLORADO PURSUANT TO THE FOLLOWING CONDITIONS: ISSUANCE OF THIS PERNII DOES NOT cQIfEER_A_PCREED WA�ER_RL IJ1 l IN ACCORDANCE WITH CRS 37-92-602(5) FOR HISTORIC USE AS INDICATED BELOW AND DESCRIBED IN CRS 37-92-602(1)(b). 2) A WELL PRODUCING I5 GPM OR LESS AND USED FOR ORDINARY HOUSEHOLD PURPOSES INSIDE THREE SINGLE FAMILY DWELLING(S) FIRE PROTECTION, THE WATERING OF DOMESTIC ANIMALS AND POULTRY, AND THE IRRIGATION OF NOT WORE THAN 10,000 SQUARE FEET OF HOME GARDENS AND LAWNS. . Ioht/B8 Nov 031988 ' a. DATE STA F R WJR AIS: • THIS FORM MUST BE SUBMITTED WITHIN 60 DAYS OF COMPLETION OF THE WORK DESCRIBED HERE- ON. TYPE OR PRINT IN BLACK INK. WELL OWNER ADDRESS 1821 DATE COMPLETED COLORADO DIVISION OF WATER RESOURCES 1313 Sherman Street - Room 818 Denver, Colorado 80203 WELL COMPLETION AND PUMP INSTALLATION REPORT PERMIT NUMBER (,52851.- / ? /- 41- 1ve Saaahi. RECE%V I3 SEP 0 6 en wog gessires mom vita NE Y. of the NE '/. of Sec, 30 WO 27 Bn/.g.hton, Co. 8060/ T.1 N R. 66 0cfo6en 26L WELL LOG ,1988 From To Type and Color of Material Water Loc. Use a TOTAL DEPTH 39' dditional pages necessary to complete log. HOLE DIAMETER in. from _ _ in. from _ in from DRILLING METHOD CASING RECORD: Size _ & kind Size & kind Size & kind to to to ft ft ft. 6 P.M. Plain Casing Size & kind _ Size & kind _ Size & kind _ GROUTING RECORD from from from Perforated Casing from from from to ft. to ft. to ft. to ft. to ft. to ft. Material Intervals Placement Method GRAVEL PACK: Size Interval TEST DATA Date Tested , 19 — Static Water Level Prior to Test ft. Type of Test Pump Length of Test Sustained Yield (Metered) Final Pumping Water Level PUMP INSTALLATION REPORT Pump Make Type Powered by 'Pump Serial No. 59frruag' Subme t4L6Le e.LeciALcLf f 2g6 88 HP /12 hp Motor Serial No. H-88 bate I nstal lea ri p rt L.L 26, /989 Pump Intake Depth 30' Remarks WELL. TEST DATA WITH PERMANENT PUMP Date Tested ApALI 26, 1989 r Static Water Level Prior to Test 20 Length of Test 1 wo(2/ Sustained yield Metered)FL/teen/ /5i Hours GPM Pumping Water Level 22' Remarks 3 WATER > C TABLE v w 1 J CONE OF DEPRESSION CONTRACTORS STATEMENT The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or pump installation described hereon; that he has read the statement made hereon; knows the content thereof, and that the same is true of his own knowledge. State of Colorado, County of Wad Subscribed and sworn to before me this 9 day of August My Commission expires: Novemben 2 Notary Public 19 92 License No. SS , 191=12._. 7/5 FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM must be an original copy on both sides and signed. WHITE AND GREEN copies must be filed with the State Engineer. PINK COPY is for the Owner and YELLOW COPY is for the Driller. THIS FORM MUST 9E SUBMITTED WITHIN 6Q DAYS OF COMPLETION OF THE WORK DESCRIBED HERE- ON:TYPE OR PRINT IN BLACK INK. WELL OWNER Joe Sasaki ,A,f9; COLORADO DIVISION OF WATER RESOURCES 1313 Sherman Street - Room 818 Denver, Colorado 80203 WELL COMPLETION AND PUMP INSTALLATION REPORT ,Q PERMIT NUMBER NE /. of the NE ADDRESS 1821 WCR 27 Brighton, Co. DATE COMPLETED 1Q-26 WELL LOG From To Type and Color of Material Water Loc. /A-3-Ov RECEIVED DEC 0 11988 WM eiGitirit ODM. Y of Sec. 30 T. _ 1 N ,R. 6i6 W fi 19 88 HOLE DIAMETER 7 7/8 in. from a to 39 ft. in. from to ft. 0 1 36 37 38 1 36 37 88 39 Top Soil Coarse sand & pea gravel Rusted orange clay Brown sand stone Shale TOTAL DEPTH -I 9 Use additional pages necessary to complete log. x 1 in. from to ft. DRILLING METHOD Rotary CASING RECORD: Plain Casing P.M. Size S— & kind PVC from +1 to 19 ft. Size & kind Size & kind from to ft. from to ft Perforated Casing Size _5__ & kind pVC from 19 to 39 ft. Size _ & kind from to ft. Size & kind from _ to ft. GROUTING RECORD Material CemRn.t Intervals 0-10 Placement Method Poured GRAVEL PACK: Size 3/8 Interval _La_ 19 TEST DATA Date Tested ? fi — 2 6 , 19 8_a_ Static Water Level Prior to Test4:L$ — = ft. Type of Test Pump Fla f 1 r3 Length of Test 2 Hrs Sustained Yield (Metered) 15 Final Pumping Water Level 20 rs PUMP INSTALLATION REPORT 4 �LI'i�r. Pump Make L hint i n s t.1 1 pry by R _ R Type Powered by f6` HP ''ump Serial No. Motor Serial No. Date Instal leo Pump Intake Depth Remarks WELL TEST DATA WITH PERMANENT PUMP Date Tested Mot tested by Static Water Level Prior to Test Length of Test Hours Sustained yield (Metered) GPM •Pumping Water Level - Remarks CONE OF DEPRESSION CONTRACTORS STATEMENT The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or pump installation described hereon; that he has read -the statement made hereon; knows the content thereof, and that the same is true o- his own knowledge. ;SIgnatu,re-- f -� '=C�!/- License No. F3 5 7 State of Crit'otltdo, County of Weld SS SuPscrib6gd and sworn to betore me this play o , 19 0. My, Commission Expires .i1ry_Corra x44 expires: ti Ppl. 2 991 A ., 19 Notary Publj FORM TO BE MADE OUT IWOUADRUPLICATE: WHITE FORM must be an original copy an both sides and signed. WHITE AND GREEN copies must be filed with the State Engineer. PINK COPY is for the Owner and YELLOW COPY is for the Driller- MWRJ•s,Rov. 76 Application must be complete where OCT 2 5 ig88 ) A PERMIT TO USE GROUND WATER applicable. Type or (x ) A PERMIT TO CONSTRUCT A WELL 1.0—.,5_88 print in BLACK IBA!! Rif IRAx ) A PERMIT TO INSTALL A PUMP r,l ,? ..r, INK. No overstrikes IfAZE . ENOINRIR or erasures unles$ 001.0, (x ) REPLACEMENT FOR NO. T.atr+ rc.g L 1RLk:, initialed. ( I OTHER TM WATER COURT CASE NO. COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 RECEIVED PERMIT APPLICATION FORM (1) APPLICANT - mailing address NAME ,Toe_ Sasaki STREET 1 821 WCR 27 CITY Brighton, Co. 80601 (state) (Zip) TELEPHONE NO. Q59-0018 (2) LOCATION OF PROPOSED WELL County Weld NE Y. of the NE '/4, Section 30 Twp. 1 N Rng. 66 fN,Sf 1E.Wf 6 P.M. (3) WATER USE AND WELL DATA Proposed maximum pumping rate (gpm) 1 5 Average annual amount of ground water to be appropriated (acre-feet): 1 Number of acres to be irrigated: Less than_ Proposed total depth (feet) : 4 0 ' Aquifer ground water is to be obtained from: Gravel Owner's well designation GROUND WATER TO BE USED FOR: ( ) HOUSEHOLD USE ONLY • no irrigation (0) x) DOMESTIC (11 ( ) INDUSTRIAL (51 ) LIVESTOCK (2) ( ) IRRIGATION (6) ( ) COMMERCIAL (4) ( ) MUNICIPAL (8) ) OTHER (9) DETAIL THE USE ON BACK IN (11) (4) DRILLER Name $ >Y R j1elj 1'11mp tut - Street i45 16th St. P.O. Box 577 City (Stato (ZIp) Telephone No. 3 5 3- 3 1 1 8 Lic. No. 8 5 7 tilt 2:13 J 60.00 Pi3fl21 60.00 CHEQUE 613.00 n on c.. FOR OFFICE USE ONLY: DO NOTTi4}JRITE IN THIS COLUMN ,L 1. 9A3364[ Receipt No. 93(09-0 --P / Basin _ Dist. QONDITIONS OF APPROVAL This well shall be used in such a way as to cause no material injury to existing water rights. The - issuance of the permit does not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested water right from seeking relief in a civil court action. ISSUANCE OF THIS PERMIT DOES NOT CONFER -A -DECREED TER-RIGIHT` 3) APPROVED PURSUANT TO CRS 37-92-602(3)(c) FOR THE RELOCATION OF EXISTING WELL PERMIT NO. 1i XN1J PLU(THE EXISTING WELL MUST BE 1liBANDONED ACCORDING TO THE RULES AND REGULATIONS FOR WATER WELL CONSTRUCTION AND PUMP INSTALLATION CONTRACTORS WITHIN NINETY (90) DAYS OF COMPLETION OF THE NEW WELL, THE ENCLOSED AFFIDAVIT FORM MUST BE COMPLETED AND SUBMITTED AFFIRMING THAT THE OLD WELL WAS PLUGGED AND ABANDONED. "41b-2) THE USE OF GROUND WATER FROM THIS WELL IS LIMITED TO ORDINARY HOUSEHOLD PURPOSES INSIDE THREE SINGLE FAMILY DWELLINGS TUE WATERING OF DOMESTIC ANIMALS, AND THE IRRIGATION OF NOT MORE THAN 10,000 SQUARE FEET OF HOME GARDENS AND LAWNS. 3) THE DEPTH OF THIS WELL SHALL NOT EXCEED 40 FEET OR THE BASE OF THE SOUTH PLATTE RIVER ALLUVIUM, WHICHEVER COMES FIRST. --- }3 • to13f `f� APPLICATION APPROVED PERMIT NUMBER " 85.Hk / 4"5 DATE ISSUED EXPIRATION DATE N0V 0 3.1994 BY I.D. 1 NOV 0 3 1988 INEER) cOU (5) THE LOCATION OF THE PROPOSED WELL and the area on which the water will be used must be indicated on the diagram below. Use the CENTER SECTION (1 section, 640 acres) for the well location. !4-- - SMILE, 5280 FEET -- —�1 + + + ± + ! T + f NOR rH� T 4 NORTH SECTION LINE -1 I 1 l x I 4 I I J I I m 1 w m a z r_ + + -4- + —4- + + -- +, ± — + --- —f-- ' -- +' — 4 — The scale of the digram is 2 inches = 1 mile ,Each small square represents 40 acres. ' i'' 1 • WATER'EQUWALEN7S TABLE fRounded Figured An 06e -toot covers 1 acts of land 1 foot deep t• 1•ctytiio foot per fecund (cfs) . . 449'getlons per minute (gpn' l A family of 5 Will require approximately 1 acre-foot of water'p'er veer. 1 acre-foot . 43,560 cubic feet ... 325.900 gallons. 1,000 ppm Dumped continuously for one day produces 4.42 acre•feet. (6) THE WELL MUST BE LOCATED BELQW by distances from section lines. 850 ft. from North ';;ec. line 115 (north or south) ft. from _East sec. line LOT BLOCK (east or West) FILING • SUBDIVISION (7) TRACT ON WHICH WELL WILL BE - LOCATED Owner: Same as 1 No. of acres 40 . Wilt this be the only well on this tract? yes (8) PROPOSED CASING PROGRAM Plain Casing 5" in. from +1 ft. to 20 ft _ in. from ft. to €t. Perforated casing S" in from 20 ft. to 40 ft. in. from ft. to_ ft, i (9) FOR REPLACEMENT WELLS givedistance and direction from old well and plans for plugging it: 1 0.0' _IQ.xtheast 1 1•r 1.1 (10) %ANDI:ON,WHICH GROUND WATEFtWIL( 8E j) ED: •,, 1f Owner(s) Same as 1 ''l• • . •I ;r Legal description: NE 1/4 . NE 1/4 Sec . 30 TWN 1 N Rng fi6111 fi PM No. of acres: 4 0 (11),DETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of disposal system to be used. ' I i + :. ' it • Domestic • ;12) OTHER WAT. R FLIGHT$ used on this land, including wells. Give Registration and Water Court Case Numbers. Type or right Used for (purpose) Description of land on which used (13) THE APPLICA (SC %%Tlj j (S) THAT THE INFORMATION SET FORTH HEREON IS TO THE ST OF HIS KNOWLEDGE. ►GN M�aNAf5J ti Use additional sheets of paper if more space is required. Scanning Cover Sheet for Septic Permits Permit # Permit Type: Situs Street Address Situs City, State, Zip G19900015 Health / EHS History / EHS Conversion History 1821 CR 27 Sec/Town/Range: 30 -01N -66W Parcel # (12 digits) 147130100103-R3351705 Owner Full Name: Owner Address: Contact Name: Contact Address: SASAKI FARMS 1821 WCR 27 BRIGHTON,CO 80601 Application Status: Finaled Application Date: 03/11/1996 Owner Phone #: 303 6590018 Contact Phone# Information above has been Verified in Accela by employee noted below X Processed by: October 28, 2008 Date Report ID: EHS00024v003 Print Date -Time: 10/28/2008 11:55:58AM Page 1 of 1 .,j "�. ....�.� i� . t:i l''• 1,.1, ...i,}Ui i! - lAI(: 'rF..:.I..1"'-.'• .Y OWNER E :`'fl, 'i iii', ,i: FARMS. INDIVIDUAL WAGE -DIEP0EAL SYSTEM• PERMIT WELD ',COUNTY HEALTH DEPARTMENT ENVIRONMENTAL- HEALTH •EERVICEE 1 ..: i ;' i i(5 i • i" i AVENUE COURT, •i.•; I'';1::. i::. E.,. F::. 'r CO 80631 353-06'35 EXT.:2225 NO. G-900015 REPAIR PERMIT APDRESE 1821 WCR 27 PH (30 3) 659-0018 BRIGHTON Cd• 8060i ADDRESS , . .. .1 :...... . !.11.. PROPOSED' ? C:. f''1 , ;:3 .:i: '! KR i"'. 27 , BRIGHTON SITE:;._'::. L:r !•'! ... i.' 1:: . ! I" I !" i s. !..14`••. t.J P• EUBDIVISI0N CO B0601 LOT i:;BL0CK- 0 .FILING 0 t i,', ... TYPE: REEIDENCIAL : ,.. , 1 ' i:.' : -: ( 1 = :: .€ !..: '' i . i s LOT SIZE F • 0 '' i. +.l:: ,.r!...iti. v .!.,.:::.:�. �� 1...'t::rl..:I•.,.o- :.: BATHROOMS Jc.{,1..; i...4..: ,':• '.::.E::. !f? .: ACRES.' ...,.. ! H.. I c I BASEMENT L, .. PLUMBING ! •i B I. N G t {::s WATER , SUPPLY i.. !.-. I:::,k:....:t..11,., ...rE:.;l::.!lL..11? i...•...} •::::�� 'I::`1...1<' i�'t-�!'il... APPLICATION FEE $100,00 I'=:!::. BY 'RECEPTIONIST I 'i ... I .' ,'.! .. I.:r f':I I::..' BY JOE ,.Y r i :::• i i K. . DATE 02/07/90 DATE.02/07/90 PERCOLATION , i...1. , C 1.I . -' •i .!. 0 N RATE. - I j MIN N ,::, ,... !..- .: , ••:: FEET .. , { • .. .;.: t : :.. .; i !':!' I. , !..i LIMITING ZONE SOIL TYPE SUITABLE PERCENT G i .' i::1 U ND • I i •1 !::: 0% DIRECTION 1';I::.Ql..}.I.RI::::.. I::.i=-'.(.:r:Ni::::::R DESIGN NO FROM THE APPLICATION .1.r•.,its{'i;:;;!"#!':t..•.I:0N SUPPLIED AND THE ON -SITE .OIL PERCOLATION i;tt::.. THE FOLLOWING MINIMUM INSTALLATION Sr''i::.4....i.!".l..L.,r-'!! i.i. H,': ARE REQUIRED: ABSORPTION 0. :O'N TRENCH _5Lit :. I: i . SEPTIC TANK 1000 -GALLONS, (�I?:.�,:Y!..!I":.:' { .<.;'t ::!.., ' ABSORPTION BED 570 EQ. FT. IN ADDITION; CCII THIS PERMIT :I:,'' ;''I.►:t':,. ii::: I. T. Ti::: •i•F"ii..: FOLLOWING ADDITIONAL i',E Rt'`!,`'; AND GRANTED TEMPORARILY • �•( .. i I 11 I CONSTRUCTION lI. 't C:::T ("iN ••i COMMENCE. THIS PERMIT t ! I .F.::PERMIT .. • . , , , : � 4�: 1 :: I I::. I''! •! f.1 "..° r' : -... ' "C ;.:! . i.: i:. • .. � i'�` .... .... i t.: ... i''i i ... I k h•! ? BE <... REVOKED OR ; SUSPENDED BY THE L:: WELD COUNTY HEALTH DEPARTMENT FOR I t REASONS ,.:• 1::. . FORTH IN THE WELD COUNTY INDIVIDUAL. t '..r`I:. •'!::(1.ji::ti"1�: DISPOSAL .i;.''i ii�;r.'i`•;lG .. 1'•. 1 .. s .i. .: .. j'�i ... SEWAGE .. .; ! ,'a ! ::.I-'4 REGULATIONS .. 4`-...... FAILURE { ., v i::' .:' •�,i •�' i' _: ••i •. i 1 ' I: ' i - i IMPOSED •! I ,... I t -DURING i' i:;, FINAL ! ( i MEET !... i::. i ANY. ; ! ' , i.:. I'�` f'. !.1 i''•� L.: !.: i 1 •, l...l. �...J 1'-t .I. P'i : ,.J ,::� ?::. �: I"'i i:.. I`';1::. , ,) I''•. � J ! , I.. ,', I`•:i i.., L.. APPROVAL, THE .L,::,`:•I,!s.:!I':I(::::C c:C::. ..i.H:C:,°: PERMIT DC::!i:.:Y I`':'<..i..i. C.:C)'•:,.i F•:I: •i•(i•-t I::: i t,:::`...I ,•:ir:''. :CCN1 .....HE• DEPARTMENT I,"'� ! I.1I::.i`': ! 5•.' i. ! i''.... t ...:: ':' ! LIABILITY : .... t... !- )' ri + : ! ! : �: ITE. EMPLOYEES • 1 I I''I i.. i. ,:: i:; I"• i- i.i i'�. THE !::. FAILURE 1:: i'� INADEQUACY 4::: !". THE .. SEWAGE DISPOSAL :> t ,.: i 1;..1''1 ,; --1;<- -A-a 4_ ► 3 9 0 C opnr .... ...... C::NV:i:P1::!i: j:j;:: i:.'s A SPEC i:AL.a:,::..,. 02/07/90 DATE ! 3 i::: ....t. .,• tie ,,. S .,' i:: l [ ;., ... E...... ...J ,. 'VOID ! ! ...:., PERMIT ! .L,.; NOT i ,,, i!•.,.: i.. ,':64i.!._ _. AND SHALL f�li...:... BECOME �tl..l.L i..' .I. I" SYSTEM CONSTRUCTION i..:AS NOT COMMENCED !-,!I-'.. I: WITHIN 'I ONE YEAR ISSUANCE ':1'::' I..i 1!..'!..• II! :i i, !:..!.. .Ii i..'�.. . , ! ...... 1 , i ! i... , , ... !...... ...i. , ! .I. 1''•. ... ,:... I ... I`: ..J .i. i ,. .t. ,:Y ,.Y .., . t ! .: 1... :. !. L ... ...:..... .±.:� ,.. ....1. I' ...r I .c " !! S t... APPROVAL. ... . . PERMIT , , i, { 11. HEALTH DEPARTMENT .. I. . E.. ..1. .1... ;., E... RIGHT i 1 ••' s•1.1: 7.: F... ' :.: ...... �r �� Y TO !'`';''1.7:`•'ADDI— TI0NAL i e!.t:.: t' ::.:'.F I.t. t I -i,�. •?,,...t...:... COUNTY I ( !' ::.f`i ... 1 '! ''�!I''•. ! i:•I .. il,. I :.Yi::.i''. t::.,'} THE ''•'... , I i .. r ::. - .. .. ••l.' REQUIRED i.. REGULATIONS i..' 1 BA— SIS, L.. I'•. I ! ,.. AND 1 r.: CONDITIONS { MEET OUR �: .. I ••: i••. CONTINUING. FINAL PERMIT r-'il'!I''i";3..1b'ftl... IS CONTINGENT UPON THE i":i:;''•;j::!ii:N;':.T''Et.: I .1.1.7i -,r L.7i.. "I'I..II::. I_l.fM....- P L i i`:.:! EYETEM BY THE I WELD COUNTY HEALTH 7.? i::: i::'.i: i i'' Ti''+I::: I`; i SYSTEM INSTALLER' INSr SYSTEM ! I::.1; ENGINEER _ APPROVAL TYPE OF SYSTEM INSTALLED I.. O7 *j77 .... • ENVIR0NMENAL SPEC _i#::' ISSUANCE ! ! OF THIS 1. • PERMIT ;li•'I{...,;. 1.,.1. IMPLY COMPLIANCE .:,1..., ... WITH ..... STATE, :i'•L,._ C(:iL i...4. 4;!.... .L ,.r,.,,.JP•illl.:c:. ,.,.:.:J./l..l._.; 1�.I .L!''i!''....'i tt ..i"li'.L.:i::. i.l.Ii"I +_�I'I'ii::.1'': �:!;", L".: ... • OR LOCAL REGULATORY i.. x. ..7.1.,... 1.I. N1., i''•:1:' !ltI , I !:; t.. I' 4"•111 i N!..7I"•. 'SHALL ACT 1.. ..1 . THAT JF. .. .:., ..: ::... ,,...:. :.: , .. .i. 1 i..: .i. ..11.7 CERTIFY �• {. I�., THE (::' SUBJECT SYSTEM OPERATE r !:..., :•• !::. ! : i , .... , C: i:'. i .. 1 -COUNTY y ('I I) I ,:: !,._,1 iii. ::, ':' '�'. i.f' IE.:'i.,. .L i—t 1''};. .;. WITH i..i I"'i i�'I"'I ..L 1.: i�!s:�i... L.. STATE, i':•1 ! 1: i—t1+1l:• ,,. i ! !;; . I t. i.: ,.; ! WILL .. r i t••= ! . I'`•. , '..J 3 : LOCAL .;i:: i 1 I, '.:: ! I'!'f 1!'.' ADOPTED 1 %''1'I::'(.! , i 1... i ..i.'i ARTICLE ..'! ....r. .iI 1. ' E : ti, AMENDED,. f�.,........s, ..,.. i,,.: s•s... t:i• �, !....,, I�'i:::i�'t;:::k.=i��s. �4 s•_si_,..4..a:i.�i...l::: 'i :. , TITLE L..i: ::....;, •;':;'s'�:i; i'�i,.� EXCEPT FOR s'. THE i 1::. PURPOSE .OF I::.::; ! A ;_,1,., !.:`':• I":.i. ! C ti a• FINAL APPROVAL .OF AN .L t v ::≥. F A i_. l... t...1.? :::: 'T i 1:.. ? ! FOR R .i.,.:•,.:taAi'•.!.::... OF A LOCAL OCCUPANCY PERMIT PURSUANT TO CRS 197... ......: 'i ., 'I (2), AI 4\ 61, j..) E j.: 1I !. t.. OWNER ,.;`FiSi"i;`'-. J. t:_ f::l)",t'!,:ir ADDREES• OF PROPOSED LEGAL !,o-- t! b:' I SUBDIVISIO USE. TYPE: .+•� :.•,..•.:+'•i .. 'f, •I•<:'c>r:=. tar:•,.. .w 3 V .,. ? l.! !"i i... ,. !... '•r.? I..i i:i i._ .L' .1. v.:; E S.? :.i !..i t... ,:i I• ,..f ) .:. t't . ;' ,.:. 7 `•. t V! .I.. } i-'f !..� :. t,y .... .. .• i !i i ENVIRONMENTAL HEALTH EERVICEE .I • 6 HOSPITAL ROAD, GREELEY, Q0 i ::;!`.'! :y,y , BRIGHTON CO DW.)01 STEM 1821 WCR 27 t:1 i:. I i.:r . , ..i t ;I OF SITE: j•'. j::. s a. c i:: N ) .). n FLREUNS BEDROOMS CO 80601 SEC 30 1. i:t :' 1 RNG i:i:i AIR PE IT PH (303). 65970018 0 FILING ..? !;ti-; ) t..il'';Ut..El ;,.: 2,0Q 1 t I ! S]/ ;41:; CiEI:1 :if,t'ti;: ,: APPLICATION FEE $100,00 REC'D BY RECEPTIONIST r' ID DATE 02/07/90 SI;NED BY JOE SASAKI. DATE 02/07/90 .'._7 !'..' , ' t N RAIL. r MIN PER i...LIMITING ZONE' _ 'FEET SOIL i T t t ,) .t:+t:`t' :i•..IIG!.'Q),!;•t.•(rf REQUIRES ENGINEER DESI;N FROM , I - i ._.. ... r..:::,1 .,. .;.: +' t::' AND N— i' .3 . ..t'3 t ''':'i: r -::t; ..i.. I'.i !•, }1 :...... APPLICATION ) .)..tte .!.+.-;[ !.J Pti"if'� ) .L+..7t'': .:>�[.i)"'t''L...f.t...�:i F',:._ THE ON —SITE t�;::. ..•�.:.:.... i:..,'.t:!:i_ i''-! :.Lt..11•: ) THE FOLLOWING N, MINIMUM iit i N ... ., I : f.., i v., '. .... ..i .t. .. . . ,:t,..:-_�t...l...t...t�,:i.l.!tcr .:. :..'.f::i!...:...f�•ii.t.E..,. .::I'`C:.l.=.,.I".Li..:.ii ....�1•.,.> i)!:)::. t''�!::.iat.t.)"�Y.:.x., I::. I ) .). E..: TANK (1..4)O V i:r i i L..:._ !.: ! '; ,.:• ; f.a : ! g i. ! , ! _ ... UN ) i'!: I::. N l..• ..F 4 i.;! iOR . 7•'ila,:'Orlt`'' t .t.E.+tai 17}::.d:° 59O . THIS ,M1 ! 1•', `:):;;.));:.f..'.... TO t)'E:I"t.LLt...t (:It'`G ADDITIONAL ERMS AND . IN ADDITIO ............ DOIA THIS .+!.: I:,+m : . .:I::" t -t :: I: , t .: . f.. , .�. :..,i... I PERMIT ` }.:rltf•!r ; t::.'.' . !::.1'jl-'[.1)'tf�il'': a.:...`i ) !.! f-il...)...f.iti...`..�t:,:"7�1�:)..1i:;��i•a.,.�!`: . t::i t..:t...!I"i!"!E::.?`.:!..:!::.:. ��j�j..i.[.,:; 'iii.:j 1' t.f '.. REVOKED it:' L. f''; OR y`i [ 3t::'•:!'i}t:: t! E-; y: WELD I5 t :t i) II',i i HEALTH DI..: '-a •• (•,t7 ).:' IL,' i•rE. '.3 I(', '. :'t:. I ::. , ... !... . ::.......: . .... :.: t.. , ,:....::> r ,... t ..!: i....., :.. THE : !... �•:• L:. L..:.: .....? ..? , :. `s s •I I::. F�i )__ : ! , ..... �i )�!? ) i , L.. , , , .. , . ,._. .,, I ,..t..! tE I. ,;. ,..._-.t .! .Y. INDIVIDUAL `, }-I :;:t. '•!_.,_ .. !.. ,: t.,:.3 .: .Ei 1'i ; I • ): •11")... -.I','! A.3s.. ;.? i -. - ) ) .L t -. THE : L.. 1.::...:... a, i..: t.. i..) ; •c , .!. i j �., .l. :. z::.? : ! :... ,::• )::. t.':) i-i !., :... � i E:.! �:: r�i .... .'.: i ,' . .... e't : I, t, Y t i .:.. :. 'i:1 t' ,:> ! '. ,.: t: J .,:.,...... MEET .: 3 CONDITION ND., ..f. f. :+O ;'[.: :t THEREON i;:.. N DURING f.. TEMPORARY )''!.t .. FAILURE f ;.' �'t:...f::. i ANY TERM •.l)"; ,.:,.:I•.:.: F. .....lt': IMPOSED , ,:)...,,)::.i.1t•. .., s)'�:.).,i'-.,., ) :..J, ....f:a)":'f 'OR ;:...) NA. APPROVAL,. THE E I ,:: !.t A i f i..: ):I. OF , H . ,:t ' : !... R M I ) DOES I::. i_ , ..: i.? ! •. +.. , .t. U ..) .... ASSUMPTION BY ) '! t::. DEPARTMENT ,.. r', .,+.'f' :•r' i::' N i i.; ITS • , I.. , i , , i FOR t .:. •t :... .t: ,... t r', ) •. , ) !._ t'.: !..: i , .,. ) ,.: I::. i', : :...:.! S )::. )::. �.': ,.: ) LIABILITY t..; a :... �. f • •`i� ' t.. �', .. j": � :. • j.a . ,....:? ,... OR r', INADEQUACY l.: THE i::. SEWAGE DISPOSAL SYSTEM, r ) a-�—qo 1)C-- Q—UVWID 1±TS PERNIT IS NOT TRANSFERABLE Y ; SHALL BECillE VOID IF E Y ,.. ,::. 1't ...... ,.. R U t..: ) .). !.. HAS NOT ! COMMENCED WITHIN c.: ! •; :... YEAR OF ', { `•: '1' ; , +, ) A 1-.::. , BEFORE ISSUING ETNA_ APPROVAL OF .:.,.: PERMIT THE ,i.:' WELD !....•'U:''1 3 'f-i"IC..At... t :"t .,Ji::.PAt'!: t !'!:.!•; i t.; ).. .;!I::.i';V:•: THE RIGHT ,. .t. !'IPi tS)^ f.a'• :.!.... , I i:.! Li,' I C. i.: r -r:.., AND ; I !' f !.. f..i I t. t t t3 `..i f•,i.,... s•,i i ..: j,l!.., BA— SIS. , ...'..?,,:,!... !,._!'.;!,.; f—iE'Etl ,.,l.lj`:El.'.). ) .LE..!!''•�:::� :,j::.t.:;F.'.).)'!:..x.! ) !.� i''))::.)::. ) E..i)..'L': )'!:)::.[:rt..:. :: .,...+!`'?,:. t..� Ea CONTINUING .1.,:,.1 FINAL PERMIT E•• 1 APPROVAL t E , : i 1 ) t:!f:i:s I ; e • I '!• f tN i)_ I .. .. :q.... ;' .t., :, ,:.,. ! L.. t'•., :.1. t ,,, ,')'!: ..: :''f•F ... ..,.`; CONTINGENT ..F )' ..... ):::. I".1. ..... .t. ,'j ,3� ... ... .. _,.. ... 7"t::. ... ,. i t t'• tJ SYSTEM BY • 4•I..)!::. ELD I::.OJ7''.!..l..,I•, HEALTH t"i DEPARTMENT, - ENVIRONMENTAL E €.! ••! .... t: # : (••I i _ t!i f.: H trs .... 1::. t•'t .a MAY! 'i ::x APP i.: { i t I i.. % t''+f i" O {'!. INDIVIDUAL SEWAGE o .[. ,:. , ' t. J ,':• A [_. ,.r `{ :.. t ':•.... . WELD COUNTY HEALTH DEFARTMENT ENVIRONMENTAL;..?E..,it...al.. EERVICEE 1516 HOEPITAL ROAD; GREELEY, CO 80631 Er•• G-900015 .JAIR APPLICATION ADDHES 121 WUN 2( PH ) 659-0018 BRIGHTON CO 80601 ADDRESS OF PROPOSED I F:. i't 1821 [:':{ (.: [•'•, 27 BRIGHTON BEDROOMS 3 BATHROOMS �... ... ..., ... ,.::--. !" i t i i •.. 2,00 ; i• ' ; # 't (.: ' BASEMENT PLUMBING YEE WATER i::•, ?..:Pi't...`f ''w':.!...#... {-!! E E....,. U i`•:f I •; ( AUKNUIALLD6E I i' i I 1 i" i::. UUMFLEIENE '; ::; OF L. H I ,.: APPLICATION IS CONDITIONAL i t # FURTHER MANDATORY ..:.:{`.! ;:.-..E.,,.i........t..{`.J:,{ T{::':,--{-; :-.1{•t..,, ::{..{i:.�....' :.. 'ti��!Y BL��'.s::.{;#;..�.I.�''•°:::.i. BY THE... E WELD �. #...D COUNTY HEALTH DEPARTMENT TO BE MADE , : tt {, FURNISHED BY THE :.. APPLICANT OR BY -THE ,. E.. ) f i 1!,I;:,{ i.. . A- ? • ![::. r:: {.,_ ; r.:. N • # j ._{ [[., ::,#,..1:+'!::.�.': OF -THE :. .. ..O; i {..{,... ..•{..j{:: !•, : i :•dE...E....:. „ [ ! ,.I c..#•-##.... hl !.. # , #, ��tE:.. . i h .. I•:: I• 'i .. .� I:.. d `E�...[..{i•-i�.i...!`•. _I•• ...• :.[• i #......:i':y.•I•..:.:,'• . A±-+°;., !H!... .E.,.:•:.: %J! -:1°;t..: f::. {.Ji.. [H{::. PERPERMii IS ,•l.JB,.:t::.l..: { 10 ,........r!"I ! !:_! a! L:'; AND CONDITIONS AS D[".t::.:'''E?.' NECESSARY TO INSURE COMPLIANCE WITH :: tL,t:','• AND {";{::.!:r:.;y..{^I { .,.R.!t++[,.+; ,,._EOP[ E:.:i, i {i+.tDt::.`'. ARTICLE .1 0, {.. t -: . .E : t cAMENDED,- '[..[E {.: E.: ? AN i '['[::': ..t ! ' {! ° "it .: TITLE : [....... ::.. ..: ! ..: t •, :.: ;• f ..`i , {-•... .... APPLICANT t .......... -:i . ..: t..., �. .�. ...... THAT THE [':: :.. [-' .. ,.''1::. ..: -{ 3 E.. fi WILL NOT i.! E.. ' # v '• ++ : ! . '{ ; WITHIN 400 -FEET E... COMMUNITY —SEWAGE SYSTEM, -THE '''b....•,:- - #:{':i::. ! f st.. E''I".7.' - ! -{:' I'•` !" ! t., '1..{i-i. i ALE SATEMENS MADE, .i.{: . i''{`f:-t ' .1.± n# AND {._i':OI i , +f,i t:5. (( ,.. #,, ;..! AND :'7.E. e t E# t:'' , #_!': 't[ ,,' ,'Y t t{.� [ .;:{.. t�{#•'-' WILL �.:�[::. ,.: # .!. E :....,: [ E ,... i' -. i...::' .v. t , � , , : , :: ''�: °:..... ..: .L ['':",::..#: ..: [.:. .. .. .. ...... ... E E i... #"i 1 � F ' #..... .: {"# t''? [ ... !. .. l!•. .. ... ... , .. #, { Y It i { t BE -TRUE i:"I+E7; ! .i.�i..e[:�'::.i.,.. .:..{ THE '±..iE...,..,. i. KNOWLEDGE J, !!AW" . ,,E -•::E AND i::i:� [.: F, ANt :I::.!"�'•.i::.�•[....e.....,.: s ... .. CORRECT �i ... �:... BEET E_3t:.. MY i;t`'''-.. i_.f ...,... .•, :.. ...E...t......... AND • _..,KE t_j,.. i i !t • 17 T-i I" RELIED I. : UN J:{ , "'I'• WELD ;E :i' ..j..: ' i ...E t i.'J # E. [ {.• G E... ,.:.,. c:rt♦!... :.: ! ... ...... I' .:... .... .. :. J.:E UN .r ! [ i.... :.. ....: .. .. si`' i '{ ,...�'i L.. 1 !"1 �.l t::. i''{.i#t't t+'t {::.: .I. '. - #::. 'd {•�#!... 1.. 1•�I ! .t. t E. -f :,-:: +:t,.. FUN : {..!{ t ., t { .;`{.. I {i.. # t'E �+.!t .=E.. s.: [:. , j ; { AFFLIED __ •[• [' { j !.. {. i. HEREIN, . (al... ,.,# 1 : 't:: 1 UNDER— STAND s : ,_. ::• k'•i I , #... J ['-: ..! [ •. ...:...... .::� ... , ISSUING ,.r t...!, s -...: i ' #,... E ...E -•. , .,. r .. i............ , ..1,', 1". I::.. , i::........ ... .. #.;_ { I..i...... THAT 4'•I I++{ { E i..: E... :.:•.I.! .t. !.: i.:# I l l.i t\! t -I i"•: I"t .-. ,: i'4 [:..t' H [::.SI::. N {:'# i .#. t.11\! MAY N C:. ,:r Uf.:. t IN 1H€::. DENIAL ..J #" Ii";!::. ,E:, , ,r,.......t : U# REVOCATION • ±•: .: PERMIT GRANTED ... :°#_'{-E UPONAPPLICATION-AND ,:.t ;.. s.. #...:. {..: , # ? .[.:.I ! `t t..: E . ! •, #... � ,.: t..: t`: [ .t. #..: t •� {..: t i..t ±•+d Y !' ' �:.. s �. t"t .[. E l:r s , r , ; -: , ,...:.: J; i #'•:'± ,:-� ,...:.: ..: E L_! !'••: SAID ....�:-E IN LEGAL ACTION #::' L..t R t"` i::. R ,. {...E• {.,.'-1' AE. t::= [', f..t f i..is i::. 1.-s BY LAW. y.,i...:. "-E - BY - RECEPTIONIST AD. DATE .. ,....NT SIGNATURE DATE Scanning Cover Sheet for Septic Permits Permit # Permit Type: Situs Street Address Situs City, State, Zip G19900018 Health / EHS History / EHS Conversion History 1821 CR 27 Sec/Town/Range: 30-01 N -66W Parcel # (12 digits) Owner Full Name: Owner Address: Contact Name: Contact Address: 147130100103-R3351705 SASAKI TOM & JOE 1821 WCR 27 BRIGHTON,CO 80601 Application Status: Finaled Application Date: 03/11/1996 Owner Phone #: 303 6591967 Contact Phone# Information above has been Verified in Accela by employee noted below X _ Process y October 28, 2008 b: Date Report ID: EHS00024v003 Page 1 of'1 Print Date -Time: 10/28/2008 11:58:27AM .INDIVIDUAL 1, r:. 1:t::. DISPDEAL SYSTEM PERMIT NO: G-900018 WELJ -COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH EERVICEE 1517 16TH AVENUE .: !. ; E.) ! i, i r . 1:. ± `: !::.1:.. L.. E '!' CO i 80631 6n6-066 Ex1,2225 NEW PERMIT ADDRESE'1821 WCR 27 PH (303) 659-1967 BRIGHTON CO o0601 ADDRESS OF PROPOSED SYSTEM 182J WCR 27 °:f EtI.i.:r3"1 i UN c:c: ' :J=. i?0'j •1.,. E:::::: f 'I i... ;) E::. C:: Fi•' :E E::' 'r . O OF F 3?:E: T i:::: ' N1:::4' t'.: • :, E G. :.: {; --i' W (-, RNG 66 SUBDIVISION: .. LOT T 0 BLOCK 0 FILING 1..1::;k:. TYPE: RESIDENTIAL .l:ARi•'•:.l.l.;i{ TYPE.. L.ij"!l i;;.'i.-....#. ;•"'1.k:llR ,.:E:.i•;,., l,1.E:::': • !••E::.R„sl..:t'.,:. ::.i•.,i,•i','.i:.1RO•.;,±''i::. .......•?.; LOT ,..:E:::E:: .:?'::?.,'::?i.; f::,•..;Ri::.,. i f t" • 1•' 7.:' i•,. l.J':. � i-'i ,`.';' �`; 1:J r'1;:::1: M E: N PLUMBING i '11:'::3.1`•' l:i 1'' O WATER r'I ••j I:. R � ' LJ P E... Y 1'' G',l E' E 1 APPLICATION .. :!> 150,00 BY 3:3.33•• I'• F:. , 1) :E: f -t i'+{ i'-i 1:.. DATE 02/22/90 SIGNED. BY JOE. E::.. 3 A ,:S i•-! E•. I DATE 1... 02/22/90 PERCOLATION- 6,1 I'{ ... {•- PER. INCH LIMITING :`.. '..J 5'' 1... x.:) i" 1... 1... ! SOIL TYPE „ t.! { 1 r.:{ I: i !... ,::. .. 1.. i.,• i .. i'. ! GROUND ELOPE OZ DIRECTION REQUIRES !;.1''i:::E:1 E:::i:::Ft ) E:::,..°:1:G N .;i:: FRt.l{'? THE APPLICATION INFORMATION i .E.L.J;•: ;:`...1F::i::.i....E.E::.l, .:.,!:1: THE 1.Ji''')....,:::.1. ! t.:. .;,:•'i.1.i... PERCOLATION DATA 1.. Y-3:) i I„{; +1 '1•'!' INN ..I I .. I t•; t 1 i 3: 1 :,,:,,. REQUIRED: 1... ..t 11",#... ..:1........•!'�!.x.!'•.ls i"I.{.{''•-..L1't,.:i't .i.1'>!,: ! f•�it...i...!'•'t , .t. ,.1t'`,•,.. i:..,.,.1.i' ..(.•,: ..1,J!'•;:.: (••i4'-.1.:. .:E:.1;•L:.Li•';E:.1.: '! 1 I SEPTIC .,.,..: TANK 1250 1::!^!,...,...i..,N:.:: ABSORPTION .LOi•s TRENCH "! ..iti:'t=:; ,.. 1'...,. OR ABEORPTION BED— 760 SQ, FT; ..N ADDITION, { ! N, THIS : PERMIT ', �,` tt::'1'. I!.1 FOLLOWING i.., ,D .. Ij..lNj.. ..f..:.t;=MyE ;,1t.� , t x:..: .,. �.. 1 ... ,.: 1::. t , I t .. 1 .t. ,.: ,.. 1.! .•.._ ..r :.... - i .THE E::. i" 1.. ... l... i.: =;-J .!. 1`: { t.a i..'t..E. , .: ! � i E... t...: •. f 1 ,:; ... -CONDITIONS: THIS PERMIT IS GRANTED TEMPORARILY I !..F` c: .. i... t..1 E i >... O I'•i S i F? I. a.: ! ;I; 1: j N TO COMMENCE ,. THIS PERMIT MAY:BE j..1.: ..'II','!::_':.'•,1'1'D':�'1', ".,t '1'1..!j::• WELD j......,1!-;', :+,!::.,::,F..,.1 :.T O REASONS SET I' I f••3 ! J:f ::. REVOKED ?.. 1. #.....1 ..1 ! , SUSPENDED. , t... I .... 1..... .1. ,i THE ,... . ,1 ... ....... ..: �..... I t . 1 i"i 1::. i•'i i... 1 I"I DEPARTMENT I t-•i ! •. � 1 1 #::. E :: FOR � E°•: 1 , ,... i•�? ,:'r 1.: , : ,.: ,.r ,... 1 FORTH .I.1 ; i : t 1::. WELD COUNTY 'INDIVIDUAL. SEWAGE :t..? .E. S '' i..1,'.'> f ?t E... E"' ;:=..1.1::.1''1 R E::.1.•s 3 1 i,.. } .3...:. 1..I I'+E {'' .E. f' i j'. E l iD .E. 1'•E 1.x , I =..'.'r::, '' , - .i r "', :'!:. I- '3 i .I :.I i,. t -, ,.,.; "i1., IN AL F•'I.1. E...1 `i ; E::. 1 t.1 1'`l 1::.1::.1 i.i i`i '!� : !....1', t t �. � i''•. •..;1J 1''•1) :I. 1 .I.1.1 I •: .I. I''t E' �.. � :::• L.. !_! ! #" L:. #'': E:_ •..J ! -< ' 1.? +..! I'i .#. !'+! •.x ! E:. i"11'' �.J I l i'$�';.` -?` 1.! t ': !" .E. r: I::i L APPROVAL THE t E::, I ,:; ,':.i. i. i::i 1''a 1.: E:. 1..11" THIS PERMIT DOES NOT 1 1.:1.11 I EI .I. 11.1..1 t.,. f:a ,:; ,::• 1 eM {'` f .i. E.j ('.1 F; ..(, THE 1..i E::. DEPARTMENT 1.11''•. IT,:: EMPLOYEES or E,:' 1111133, FOR i . ••i • I• -E E:: F A3: i...+a 1"..1::: 1:.1 l. 1'- A1) E:. Q t! ••t C 'i 1.13" THE SEWAGE DISPOSALEYETEM, Comp WE,:} POTTER 02/22/90 'ENVIRONMENTAL •, 1.. t-:. !.:.{. , I E 1' ' 1 • DATE THIS PERMII t '•, Lilt ' R ,.. .AND , ..li+ BECOME 1_;1..1 VOID SYSTEM - I...:l! 1` 3 i(...... .j.i,! HAS :.,. ,.. I t •. f•'t 1''t •- !::. , '•. � 't A"' ..1::. . !'•. .1. ; t ••! . 1::. .. .. f'•.: `• ( i ; ... .. f .1... t `•. 1"I F�l..S NOT COMMENCED !.;1 .y.... ,1 ..) . , YEAR. j.. i.. .,:.�..., .. `•;1 1 :: ''.!' . I.. BEFORE +.1 I ', ... ,T 1 1': 1.: f ...1. 1 1••i .E. 1', 1.71'@ E:. ! i::. f�•1 ! •. ..1. .l. ,.. ,...., ! ! ! .... !...., 1•:il::.1'• ... i •'. i::. .E. ,`.p` ....J .i. i � 1.:. i• .;; t'-i i�•::... APPROVAL OF l (.. THE E WELD COUNTY ,•! . tT E =i,'E: i'H R TOTHIS PERMITDEPARTMENT I1"!Pt:i;:'(::. ADDI— TIONAL TERME -:.111! CONDITIONS ....!:?1! ,.., .�.I' :t::'!':'" OUR REGULATIONS i ..',.., .,x.11 .t. .i.. :.. REQUIRED ...{.1'x.1::.1) MEET 1 .� ..: 1' -. ON.A CONTINUING i .#. 4 . •..? :,. !'+ ,.:. BAT ''' 1 `' FINAL AL... I''E::.3'+:1'�1.E. 3 APPROVAL CONTINGENT #ai::'ja.�) THE-.FINAL .f.!..1 1:: 3 i 3,:•1 • '-,.;<°�:7:. 3 i.j..3 I I'' ..*!:: ...1,:'.... , Il.... , .E, ., t,... .,.rF 1:.1.;1.1....1. IE1,... 1.: ...tt. 1: , 1" I ,.'.• ,.: 1 1::.1'`1 BY 3 1!•'1L WELD -1.: 1.1 U N 1 , HE. A L.. i !'"E I:' E::. P !A E'; 11°1 E::. N I : t::' is t . 1 : y ,.. !.; FINAL N .,1... i r S ..f.1.;. ,:• :.: ! ...... .1.1`<,.: i••,!._L..,...,: -/ n-L,K:.'�'� ___`"'''R!v!;L9, .E •.,:: !::...: a .E.1.1�-'. �i_ ill', cs..<if .._.. i,-.. SYSTEM I ('.Itti ;•`,' 1 I::"1j 3:�:,i'• 1 ( ,1i':7i:.tif...: 1 ••=!:.i..,...r:1 ;..i. .— TYPEi :.:.t`. ,,.. ! ,( ............ L..I-,d.--::f.1Y-.: .....If'�i:... ,.;1..1.:.•..,.1,1....1.,::, „ APPROVAL THE .,.:.;,.:t.!!!!`+',.:I::. 1.1' t.1'..:.; 1''::.1;1'1.1.1 1:..;1:..,.: !''•?1..i a.1''II"....! ..:x.11"1i::'...I!:j!•:1ti::. i!.I:E...l. 1......E..#1:::1'°` :..?A1.. ...1,!I,,;i'l)...,r. -. , , t , D .� ,.I f.. 1., E. .t 1 .,1,....Y E',1..'. NOR ..,i .. .. .. CERTIFY 1.7 'S LOCAL '-. ,... is .I (.a 1 1.1 P, f !_ ! , 1'.• .: .....1 � .. i ..:•r :.::. 1:., ,.1 .i. " :.1 E :.. , !: � i', 1. 1'ti SHALL IT ' i i J ..#. .1 1.1 � :1::.1"; I .1, i'. `•t. THAT THESUBJECT ;:::,,..:.y..... !,.i• :'[;' '"1_• 1 :+.i COMPLIANCE i..1 :P1 ,'j''+.::; ...:"i., COUNTY I3t SYSTEM x.; 1 1::.1', ....1...1... OPERATE .1 . ( . ... re r.. i { ! : f !"` .....i.. :. ...I::. STATE,. . 1 . 1::. r AND LOCAL 1 1.'1.11.,.1•! .1.1_I!''+I'• ADOPTED 3.`t" #"•:ER.if:'.•,I:.l..j. ...I 3 t'`:lE:•'.'3 .I.1..:f...I::.- 1'' , TITLE LE:: 25,:CRS : CR,:k j973, A:::: (7!1`!1::.1`)1.13::.1.% , EXCEPT FOR THE PURPOSE 1FESTABLISHING i.: '. :.: • APPROVAL t" ?�:'! ... i? ,,INSTALLED r;:1•-1!.. f��!: !,�., • I,. •' AN E",,' ,,T;:::i"t FOR 1 j≥.. (..t LOCAL OCCUPANCY.. 1 . 1;i ..,i ... .,1 I : ...�. .Y.1_1 . .. i, ISSUANCE ' I::: t i i'. 11: ,: ., t 1'�:. l., i•�. ,.. : ,.. 25-10-111 (2), 18 5/ I ry 0 .+t5 INDIVIDUAL a:•±... !:;l (..±+.:r'... !.i I S Pj..J ,:}i•:±1... SYSTEM , EM: NO, G -90001B NIE'...D COUNTY HEALTH D:PARTMENT 11.( 16IH AVENUE COUHI, .i S I ft'-.!I...I. :.:, i:.,.:S.. }. ? TOM .:+: JOE !•'S i.!J.: E', i::. '` `: 1821 4ti l.: i''•. ':! BRIGHTON CO 80601 ADDRS j,i.: ±•?i:;'71•"..t.. ..c' - ,..i.. M !; Yi I,li''S:'' .. BRIHTON CO S0601 • .. ,.. a , , , t :5 ±,.: s ... (... L.. �' L.. ,.:• [.: a ', .t. i" i .1. t.! ; `! [.J 1-• �`; .I. ! i::. � :`�, �::.:i:. !'*� �::. EEC [.: ..':' t:.i ..l I:. , ' • -{ I"-: i`:' < < f:Y'::Y x: I 1 1•{ J_i .I. V .!. ,:; F. I..J i'•! : • 1... I:l •i t;! BLOCK FILING ,:i t.!::r,::. TYPE: t ... ,RESIDENTIAL x.+Ai-:1"•:a.[.:I', TYPE 1 ,... HOUSE —LABOR ,:; 1' , •. „ .,. ± • '. , `• PERSONS 10 BATHROOMS 2,00 LOT SIZE 60,00 ACRES BEDROOMS 4 BASEMENT PLUMBING NO WATER SUPPLY-PWELL NEW PERMIT APPLICATION FEE $1DATE 02/22/90 50,00 SIGNED BY JOE:SASAKI RATE N t.. i., {LIMITING + . ..I..i IZONE O , I ,... FEET i»..1 PERCOLATION ....hit._ i'! .I. PER , INCH `, [.: {"i i....?. I', .l. .t. I'•-. [.: ......;1'": L:. I'• ,...:... F :'I 1 ; t . 1::'•...PE.RCL.Ni F;.:O t.i. i..±..:'E D DIRECTION REQUIRES ENGINEER. DESIGN J70._ FROM t '..If.. APPLICATION ••- I 1' ,! INFORMATION SUPPLIED .j'( ' ' i' {.... !, .. PERCOLATION :•: ...±. . : ± ::... ±• :: L.: ±. !.: t•'I : .:. L.! I •: i':± P••..:1 THE ..J P', ....I. { I::. ,.: [.J .I. i... DATA : (��F THE E t.. 7. i 1 =.! [!:.. - 3 l.� MINIMUM INSTALLATION ,.. , '` E [. I i" SPECIFICATIONS A ••I .l. [. ± 1'•F ,'. ARE ... REQUIRED: ., t... i,..'. F''-. L : - -. !< : .. pry. ::; ±::. ).. E .!. S..: I i-•! , '� s ; /�..�� i .:: '• : (., ` J', � i"l :i: ,.:• [..:.. i .I. 1_J I `c 1 i'': i... i`'? i.: "1 �O (J OR IN ADDITa0N,... :' ..:..,.,.', ; , ;''I(..., ....(... .r. E. .E FOLLOWING. E.;J ADDITIONAL i Eli , .. ,.% i•' L.. i . PERMIT .,. � i � ..:': ':.. z-: ;. i::..: 'I � ± THE i::: s : i... 7.... .. s :. I'!: t�I , AND 1HIS i'`I::.F;,1:' . I IS ± A(`J i LJ.I i I::.('tI....I :f-)RIi_.Y IU (::II...I...[.JN [.;U(';::':: I kO[.: I .[.l :l I l... [.:[.li'INI::.Ni,.;i::.., II! .. '{..'..•;1 ;.I ± L; SUSPENDED I••tI• WELD -"i-'±ii:•.I..i.. HEALTH i..i DEPARTMENT ±::. ..i .-: I°ti�iY ::.:i... I'�,,...;�;,:i'',I::.:.: :.Jt•. sI I.•:l• ,...,�..,,F....,: BY J „L:. :!-:i.:.€...:.: COUNTY ';� ::,..., i:..: I I, FOR .REASONS '.E..t. I..1,1 iLI ,:{ WELD COUNTY [i`J 1.1! '� iti''L.. , II`';1-: Ei.i. ,Ii ..'.i I.,-.i-.I#i ..i.(. ' .., . t ....I. , •-. THE ,... '-,� .... ,... J.: !.: _..... � I ± ... •... .. '',� .. `..... , :':: �:...!: i .... {::. ... :: I•' !.: ,::' i� j I... ,.: ±... �'? . , I.... r ,. ... i•:; ..I ..... � ±'� :':: INCLUDING FAILURE I ; I l:.�'.. "i ,: E:. E.. r.::'•E''� I'. 11. I i �EDI .-, ,1 ±••. I i..;±.. i;=i.. 3 DURING ±.. y:q!_I ;;_'i' R •, .:. ;... !.:: , L_ , 1 L. I:.. I , ,1 :. ' i ... I•'. ('i [.. , � L: ,.: i ::.:.!. i a. I:. � `• a. e' i (• ..: i::. J3 : , ::... ; , ... [.J (�-: .: �.. J [�; :: [`:� �:: I ,.... ... , . , . J I•!: . -1 L.. c'' THE ;.. ISSUANCE ! :' ('t i::' THIS , ,. PERMIT •E..t E.• 1.: ;1 E CONSTITUTE ASSUMPTION „ ; •';' APPROVAL, ; , , :... .E. ,.:- ,.; ,. (-'i, �, •..: 1:.. _! I i"i , :r DOEE !'''; I ... THE - DEPARTMENT r,.,' ± !'`,' I 1 :vit::LIABILITY t..I ..E, (..E:• INADEQUACY ±1- ,.., I •. ITS i... ('; I' :.....J 'i' :.1::. �`s l.. , FOR i'. THE FAILURE •... F'•: .t. t'•. {• t :.: l:....,, ... f �'± [.: -'� ,.: I ' '' i.. 1::. TC_- V •eo-cl.p a=aa-qo NV IJ•-;jI::'N , CAL.. 366............ 1:::I:E::'i ...:i::.:..i. DATE I-- PERMIT ,,± : ? ::, •. ; .' :• j;: ; t I VOID (..I I I... CONSTRUCTION ± , :.±. ,., .I. ,:; NOT I : I ; ±�•, t'-, ;.: , ,... ±�:' .::± J:{ L.. F i��± t'•. J.: I -I i�•, ,... ,... BECOME ...:.,..: i .,.1'• SYSTEM 1..I A :' ...;. COMMENCED E'•dCE'(; I,.I ... 'i'I•.,i ONE YEAR OF ITS.ISSUANCE- i;.'-.,(-• •j-;t:.....O...,.... ISSUING ,I APPROVAL (.•E•:: ' E F-{.. ,_, ?,.. .!•±:1 THE - WELD .COUNTY DEPARTMENT ±.: .I•.+i3 t.?... I I : i..,:••:•':`i.: AUDI i ... , .1. ,.: 1 , ... i i i (... RESERVES , THE i. [:r I [.. IMPOSE ': I... i::l J.:� ..: . ..i..:...ii ^.; t ,,:, ±...i... i-.± ' REQUIRED . I ±i:� :.r'.., ...ii_ `•:1 CONTINUING .. , .1.[.!,•;F• ::... ::...:.: t,,, i..;i•-.�±.! l..:l.J1':?!.! :. .i.[.Jiz:.; F';i::.L;.'±.:J: 1- t,.,,..:.. ......:': ..1...'... �-E i .....;i';:- LIf, ('�F ..:[.JI'': E i,E,:,.I l.(',E•r E.ig;,.. ,.:.1` FINAL t`.Ir.:;t .. ..., I. ! , APPROVAL CONTINGENT ; ti.., .. I ..fH .. FINAL 'I: `E'••:`I•? O E E.: '{::E.... .,.::. ,:, ,... i i...I-., E : , {-t 1' : ,.l..Jtit(-;;... 1.,:; UPON i.JI`�. ... I" .:.: ... I`•.:.: .::.1.: I .Li..:l`•. [.: ! 1"l:... L.:L.!., F: t::: I ' ! \ •' v .. ,: I..n.. N , ., I • , ..... I ' _ HEALTH . : E. ±::. �: :.: ± ,.; I ... i I (: ! I I :... r.,:, Y:. L...: ! . E ! !..! E -'t I' ° DEPARTMENT,. J CHD HACHD—EHE MAY, i984 .. .,. i.;r 'j "i "t E 'i't # E i SEWAGE DISPOSAL i 's' #:. 'WEL. COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, '...R t::. i::. 3... #: YCO. 80631 i } BRIGHTON CO 80601 NEW, APPI. WI #-s t: ;r . t... ,.. Is # ::. ..?t' i.?,:: #::. r.:' ::? i ,:? # #::. #'#. } C:`:::. f L+i ;.: i': : - • BRIGHTON CO 8060) SUBDIVISION:. • • LOT 0 BLOCK 0' FILING •UEE TYPE: RESIDENTIAL BARRICK TYPE HOUEE —LABOR SERV:CEE: pERsoNs 10 BATHROOME -2,00 LOT SIZE 60,00 ':; }.. i} c:c: 4:` .4. BASEMENT PLUMBING Nt•'# . WATER t}}'•:E-':L € ,fi:"+ i .. .,; a.: -:.#E : t•t,' THAT .E.€ ....,€ �'IF: 'P...APPLICATION APPLICANT ,:.:t•:E".•..:.... ..•: .:#:.:.� .. # t , t : } +-;.I1: t...}... �'•!.'. :� .. E f"t.i.,� ..CONDITIONAL } F r "#N i' FURTHER �, .,.., F, E .. . } '" e.;12:#'! ADDITIONAL. .#.}.1, s'' '} }:# # } . I.. t #1.;. REQUIRED -BY -THE ,.: •..:,-. ..:.. # i.....1 •. 1••. ..:.! # ,.: # AND E"'i :.. .,: .,. .}. _..!#'•:!-'#..., i... :::.'.., ,.. !"'':, .:.. !", I:... ... # ,. €^#.:; MAY `€ .:+i::. :.3 ... ! is COUNTY .- HEALTH DEPARTMENTT;.? BE MADE . 1 . FURNISHED BY T t"# ::. . i . a. ;: (I.. } • . OR •'By,,THE WELD 1 COUNTY Es}.. f_; E E}.. ;.! ;;:.}•, . . ,:'}� -"' F f €!.,# -.i : ..i €_' "HE::. ..E};, f..# ,.}E... ,. f.., ..i.., f' N t ....:...... E : _....: •i ... ..:. s : } t :..:: • FOR , :.: . ' .> I::... .. , THE t i... ... ' €"i t ': .i. E... ..: f.. THE APPLICATION . -'-.N i:..t'. ISSUANCE :}: -. i•.4, i'.. THE .. }i .�T ...,-..i. .,f;j..-H n O�li.i .t .#T AND THE tE:. s. :: .; =..! ..t,-...,.: f OF 1 , :}- PERMIT :'i f . I'.: :.. TO f #..j ;, AND t: [. +..f F.i,. ...; !..'f..'f•:�,f..(1 :: E f..: i..: !...:.: ;•, ;�: � •: •. r ..:.:... .:.... ' :'+ ': E... ..: CONDITIONS ...: .,. ... '1 .... '... is _. PE ..::... ..... ..... ..: , ::.. - 4 }., ... COMPLIANCE ,'t E i' ! F. j i ! # REGULATIONS F t..+ 'E' i'', } t' I'` ,-. i:.. E..: !::.:a :.-#.a !": # E: i.? .. !'': : c.:s,t... .... , t"! RULE ... ,.. AND ... 'ADOPTED •t '..!t- , L.. !.: ._,`-: �.: ..., _ : i ... ..:t ... '-.: [J ##... L. •:::. ..}, E... #`. ,::• !?7Z, .... AMENDED, '.#'H::. APPLICANT ..: #::. R#..#.. .,. .._ THAT fi'Ei... PROPOSED D EYETM WILL NOT BE LOCATE WITHIN.400 FEET. OF •A ,COMMONITY SEkAGE UNDERSIGNED HEREBY #..: !..... , s. i" . I::. E THAT ALL , }. ..... ,..:. !'4 t , MAD., I1'•:, ..#1..,:1"LA! ... ..:1•; AND REPO.. ,.:" E ! E• } € E.. , } f}..}., -:..WITH AND REQUIRED ..;..t BE EJP,MITTED By THE APPLICANT ';•N.'; ARE';" -s;:;' !.1. B :-. 1...t .... :.: t.... t :... :.; TO BE -TRUE #^SN-,! CO!''-.R:...CORR:CT TO f.: E-. BEST. OF -MY KNOWLEDGE AND BELIEF, i��i �'. .f.? # i E!.. : TO ::-• RELIED !"# #..#i.: ',f E•• i COUNTY , •- :ALTH DEPARTMENT ,.. 1 ..S.. ':.i+.. THE SAME FOR .:: }. = f ..: - }.. , . ...E 1.: L! .RMIT , FOR HEREIN, FURTHER is '"i'°..##:'' . UNDER. : i.: ":I } THAT .., },: : I....., : t # s. i } i ! i OR IEREPRESENTATION IIIMAY.4ZE.EULT .f' i'-:THEDE.NI.(q.:ii • .. ! ............ : ...... 3 . 0R REVOCATION OF ANY :. `•: s'# .. i ... ?: ! # : 1 1::. J. BASED UPON SAID . ,.PL...... # € s. _... (':? 1 :.. IN LEGAL roACTION .. 1 #.,. PERJURY fi i ,, PROVIDED W. APPLICATION . ........ IC 1 :.. s.! ., }.:ii:'' 02/72190 UL —AP Hello