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Home My WebLink About20222862.tiffScanning Cover Sheet for Septic Permits Permit # Permit Type: SE -0701062 Health / Residential / Statement of Existing Situs Street Address 7050 ELM ST Situs City, State, Zip LONGMONT. DE . 80504 SecITown/Range: 08 -02N -67W Parcel # (12 digits) 131108302001-R5377186 Application Status: Recorded Application Date: 10/2212007 Owner Full Name: SANDOVAL RICKY B & KATHLEEEN A Owner Address: 7050 ELM ST LONGMONT,CO 80504 Owner Phone #: 303-833-0543 Contact Name: 2D ENTERPRISES LLC Contact Address: PO BOX 504 FT LUPTON,CO,80621 Contact Phone# 303-857-4981 Information above has been Verified in Accela by employee noted below X April 16, 2010 Processed by: Date Report ID: EHS00024v003 Page 1 of 1 Print Date -Time: 4/16/2010 2:07:02PM Application Number: App Type: Applicant Name: Owner Name: Parcel #: Legal Desc: Site Address: Additional Info: 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 Statement of Existing Septic Permit SE -0701062 Health\ResidentiallStatement of Existinglna STEVE DICKINSON 2D ENTERPRISES LLC PO BOX 504 FT LUPTON, CO 80621 SANDOVAL RICKY B 8 KATHLEEEN A 131108302001-R5377186 EH -9 L9 ENCHANTED HILLS %7050 ELM ST% SITUS: 7050 ELM ST WELD 80504 7050 ELM ST LONGMONT, DE 80504 Status: Recorded Applied: 10/22/2007 Work Description: HOUSE App Specific Info: 1/2 Bathrooms 3/4 Bathrooms Absorption Bed Size Absorption Trench Size Basement Plumbing Full Bathrooms Location Description Number of Bedrooms Number of Persons Private Water Supply Public Water Supply Septic Tank Size Tank Material Year Installed 0 1 UNKNOWN UNKNOWN No 1 7050 ELM STREET, LONGMONT 3 2 Yes UNKNOWN BLOCK UNKN • otts:rm WI!Dc COLORADO Weld County EnvironmenUl Health Services -Deo ant; nt 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 www. co. weld.co.us Statement of Existing Septic Permit NOTICE The property owner/agent has certified by Notary Seal that the above described septic system is in fact installed as described, and exits at this time on the parcel identified above by the parcel number and/or legal description, and further states that the system IS 11S NOT in good working order and to the best of his/her knowledge IS / IS NOT failing to function property. The property owner/agent further understands that any fallcation 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 sytem IS / IS NOT failing to function property. 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. X Environmental Health Specialist Date P vvtLU I:UUN i Y DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17n' AVENUE GREELEY, COLORADO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411 SQE# 09 01004 ? ORG PERMIT # REPAIR # LOAN # ISDS STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN BLACK INK ONLY) PARCEL NO. /37/0g,36000 O2X / �J r _U 4�/ PROPERTY OWNER e, GJ�y .3 ,z4,41 6 gkanisfaONE NO. (3031 0.33 6-5-4 3 MAILING ADDRESS 7o_c0 .%r 5t la,,,k 19004 City State Zip DESCRIPTION OF BUILDING (ex. house, mobile/modular home, shop, office)/ Led SITE/LOCATION ADDRESS L/111 S. La 7 ificm, City LEGAL DESCRIPTION PT PT SECTION S TOWNSHIP Z SUBDIVISION r.G `� 11e#el C c LOT 9 BLOCK CENCUS TRACT LOT SIZE/ACRES 2. 3 -,S COMMERCIAL YES NUMBER OF PERSONS 2 - BEDROOMS WATER SUPPLY - PUBLIC PRIVATE RESIDENTIAL �!`� NO BASEMENT PLU ING BATHROOMS - FULL NO NAME C WELL YES O CISTERN YE _630_5 -o4 - State Zip RANGE 67 FILING SYSTEM SIZE: Septic tank material is constructed of .1] /a64 and has 7 gallons ca acity. FIELD: Trench 7 square feet or Bed ? square feet YEAR INSTALLED You are required to draw a diagram of the system on the reverse side of this form in black ink oniv, 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 i s not n good working order and to the best of hislher knowledg i n ' 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 a provided by law. _ /O/z z/o-7 DATE OWNER SIGNATURE /�, Subscribed and sworn to_before me this a 2. lay of L1f? By .1.�-, 4-�i� f .K d11 Witness m baa and official seal. com one it �_a r � cam, /o /1 „2--/ 6 7 IA AI DATE N ARY PUB �* r --..;7- STATEMENT OF EXISTING INSPECTED & REVIEWED BY r / f-- q ENVIRONMENTAL HEALTH SPECIALIST DATE , 2007 ch., 6+. Scanning Cover Sheet for Septic Permits Permit # Permit Type: SP -0701172 Health / Residential / Repair Situs Street Address 7050 ELM ST Situs City, State, Zip WELD, CO , 80504 Sec/Town/Range: 08 -02N -67W Parcel # (12 digits) 131108302001-R5377186 Owner Full Name: SANDOVAL RICKY B & Owner Address: 7050 ELM ST LONGMONT,CO 80504 Contact Name: Contact Address: 2D ENTERPRISES LLC PO BOX 504 FORT LUPTON,CO,80621 Application Status: Finaled Application Date: 10/22/2007 Owner Phone #: Contact Phone# 303-857-4981 information above has been Verified in Accela by employee noted below x Lk c o Processed by: March 12, 2008 Date Report ID: EHS00024v002 Print Date -Time: 3/12/2008 2:48:06PM Page 1 of 1 Application Number: App Type: Applicant Name: Weld County Environmental Health Services Department 1555 N. 17th Avenue Septic Permit - Final SP -0701172 HealthlResidentiallRepairlVauit STEVE DICKINSON 2D ENTERPRISES LLC PO BOX 504 FORT LUPTON, CO 80621 Owner Name: SANDOVAL RICKY B & Parcel #: 131108302001-R5377186 Legal Desc: EH -9 L9 ENCHANTED HILLS %7050 ELM Site Address: 7050 ELM ST WELD, CO 80504 Greeley, CO 80631 Phone: (970) 304-6415 Finaled Fax: (970) 304-6411 www.co.weld.co.us Status: Ready to Final Applied: 10/22/2007 Issued: 10/22q007 Finaled: {0 f .1/09 ST% SITUS: 7050 ELM ST WELD 80504 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 1 10/22/2007 No 1 7050 ELM STREET, LONGMONT 3 2 2.3 Yes CWCWD Repair for Failure No EHS 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 COLORADO Minimum Installation: Septic Permit - Final Weld County Environmental Health Services'Dspartfnent 1555 N.% 17th Av,enue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 www.co.weld.co.us Absorption Bed Absorption Trench Additional Terms and Conditions Bed Option 1 Bed Option 2 Bed Option 3 Chamber Option 1 Chamber Option 2 Chamber Option 3 Septic Tank Size Trench Option 1 Trench Option 2 Trench Option 3 PERMIT IS TO REPLACE TANK & LINES TO & FROM TANK PLUS (POTENTIALLY) THE DISTRIBUTION BOX. 1000 Actual Installation: Septic Tank: I ocao Design Type: gallons Absorption Trench: 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 approval of installed system for issuance of a local occupancy permit persuant to CRS 1973 25-10-111 (2). Thls permit is non -transferable 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 the final inspection of the completed system by the Weld County Department of Public Health and Environment. x Env ,O.3;'04 I Health Specialist Date SP o7d1inZ \ti Of+g� l 'I 050 £gym s+ VS" ViiDc Weld County Environmental Health Services` Deparfrnertt • 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 Map baGic � I � +MNW_CO.VYeid.CO.U5 COLORADO Septic Permit - Repair Percolation Rate tj /1\ -Limiting Zone ///it in Description Ground Slope rS /A--- Direction Soil Suitable (Y/N) Engineering Design Required (YIN) In 100 Year Flood Plain (YIN) From the application information supplied and the on -site soil percolation data the following minimum installation specifications are required: Septic Tank t 6 L 1 gallons Absorption Trench P J/P- sq ft or Absorption Bed sq ft Chambers: Hancor Standard or Hi -Capacity, EQ36 or BioDiffuser Trench Infiltrator Quick4 Trench .7—,---- Hancor Narrow (15in) Envirochamber Trench Bed In addition, this permit is subject to the following additional terms and conditions: •' 11t tr I S -n AE' PukC E l- 1 & o w\ FL\ e•J P L t i kvrt. N-1fii;�lv.}' i-iiE nti UTlCl' i2C'(. )i.L uo.,c--() ZS c ti1\t<1. AL.An3LJc APPIL). 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 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 failure or inadequacy of the sewage disposal system. nil p�rtnit� non -transferable and non-refun ble. 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 xpires onvear from the application date. x Environmen)at'H Date th Specialist Application Number: App Type: Applicant Name: Owner Name: Parcel #: Legal Desc: Site Address: 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 - Repair SP -0701172 HealthlResidentiallRepair\Vault STEVE DICKINSON 2D ENTERPRISES LLC PO BOX 504 FORT LUPTON, CO 80621 SANDOVAL RICKY B & 131108302001-R5377186 EH -9 L9 ENCHANTED HILLS %7050 ELM 7050 ELM ST WELD, CO 80504 Applied: 10/2212007 Expires: 10/21/2008 ST% SITUS: 7050 ELM ST WELD 80504 EHS Application Documents: Authorization Form Authorization Form Signed By Date Authorization Form Signed Map SOE System Diagram Percolation Holes Flagged Pumping Receipt (For Loans and ISDS) Date Pumped (For Loans and ISDS) Yes RICK B & KATHLEEN A SANDOVAL 10/22/2007 Yes Yes No No EHS Septic General: Location Description Repair Reason Type Associated Building Permit Associated Building Permit Number Application Date Septic Permit Expiration Date Waive Fees Waive Fees Comment Number of Persons Number of Bedrooms Basement Plumbing Full Bathrooms 3/4 Bathrooms 1/2 Bathrooms Public Water Supply Public Water Supply Utility Other Water Supply Utility Private Water Supply Private Water Supply Permit Reference Number Parcel Acres Year Installed 7050 ELM STREET, LONGMONT Repair for Failure 10/22/2007 No 2 3 No 1 1 0 Yes CWCWD 2.3 EHS Pere Test (Site): Percolation Rate Qualifier Percolation Rate Value fttit'n W1`PG •q. •1 Weld County Environmental Health Services ibepartmerit 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 www.co.weld.co.us Septic Permit - Repair Limiting Zone Qualifier Limiting Zone Feet Limiting Zone Inches Soil Description Ground Slope Slope Direction Soil Type Suitable In 100 Year Flood Plain Engineer Evaluation Received Engineer Job Number Engineer Design Required Engineer Letter Received Variance Required EHS Septic Install (Site): Septic Tank Size Absorption Trench Absorption Bed Chamber Option 1 Trench Option 1 Bed Option 1 Chamber Option 2 Trench Option 2 Bed Option 2 Chamber Option 3 Trench Option 3 Bed Option 3 Additional Terms and Conditions EHS Septic Actual (Final): Septic Tank Size Absorption Trench Specification Absorption Bed Specification Chamber Model Number of Chambers Additonal Terms and Conditions Design Type Lift Station Lift. Station Size Tank Anchored Water Reduction stavl IhDc COLORADO Percolation Rate 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 - Repair Limiting Zone Olt in Description Ground Slope Ai /A-- Direction Soil Suitable (YIN) Engineering Design Required (YIN) In 100 Year Flood Plain (YIN) From the application information supplied and the on -site soil percolation data the following minimum installation specifications are required:Septic Tank 1 trt0 gallons Absorption Trench a/A-- sq ft or Absorption Bed sq ft Chambers: Hancor Standard or Hi -Capacity, EQ36 or BioDiffuser Trench Infiltrator Quick4 Trench Hancor Narrow (151n) Envirochamber Trench In &c additio , this permit is subject to the following additional terms and conditions: iivf lktr is Tin Rt Puk.e. TA/4K t � rid ;• .o u I Pt,tA c ( eo Te NAfi LuJ riAc is 11--I (7 a o rt ,y 0)0)f. AU_ vtll�`i�D e u i c 19. kLM-iO�\1c A•PQLk/ 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 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 failure or inadequacy of the sewage disposal system. pit 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. Thls permit _ (tires • = v arfrom the annlicatlon date. /U )-/-0- Environmen Y He-'th Specialist Date l 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 Application Application Number: App Type: Applicant Name: Owner Name: Parcel #: Legal Desc: Site Address: App Specific Info: SP -0701172 HealthlResidentiallRepairWault STEVE DICKINSON 2D ENTERPRISES LLC PO BOX 504 FORT LUPTON, CO 80621 SANDOVAL RICKY B & 131108302001-R5377186 EH -9 L9 ENCHANTED HILLS %7050 ELM ST% SITUS: 7050 ELM ST WELD 80504 7050 ELM ST WELD, CO 80504 1/2 Bathrooms 3/4 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 CWCWD 0 1 No 1 7050 ELM STREET, LONGMONT 3 2 2.3 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 ISDS 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 (WCDPI-IE). 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 feet of a community sewage system. The undersigned certifies that all 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 denial of the application or revocation of any permit granted, and in legal action or perjury as provided by law. X ( ner/Applicant /007 Date 0$40:r. VIiDc October 22, 2007 Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 RECEIPT Application Number: SP -0701172 App Type: HealthlResidential\Repair\Vault Owner Name: SANDOVAL RICKY B & 7050 ELM ST LONGMONT, CO 80504 Site Address: 7050 ELM ST WELD, CO 80504 Rcpt # Pmt Type Pmt Method Ref # Pmt Date Amount Cashier EHS-0700379 Paid Check 2354 10/22/2007 $ 150.00 MSWAIN Total Payments: $ 150.00 Comments COLORADO SEPTIC INFORMATION FORM To obtain an L.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. PARCEL NO.: /; _ 1l O 830 Zap) (12 DIGIT NUMBER) 10\5 CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650 APPLICANT NAME: 2 r ill Seri LL. C 3-(--eae.b rC �wsc MAILING ADDRESS: Pa ,Q dx Sb 4 CITY L� f�.� ST 6 ZIP Sinipzt HOME PHONE: (303 )7_$j WORK PHONE (3)3) 6 3 6 2772 FAX (.03) 857 esks- PROPERTY OWNER: R LLn d Ieer \ ASisk), dovai MAILING ADDRESS:705O PinS1 CrrYLInni n+ ST �C) ZIP HOME PHONE: (-3rS3)'2 C 5y 3 WORK PHONE {3)3 ) D L'tict3 FAX L� LEGAL DESCRIPTION PT PT SEC TWN RNG 7 ACRES 213 SUBDIVISION En ciri rited LOT Ci BLOCK FILING DESCRIPTION OF BUILDING (EX: HOUSE, MOBILE HOME, MODULAR, SHOP, OFFICE) 41,.rte:, SITE ADDRESS -1050 E m 54- End', 1--r5 fLC1tiYl ~C it, .00 y 20r`-' DIRECTIONS TO SITE 35 S 4Th 4t(sic (,(, lz -+b ,b ICR ct . UX� S -I-r) LLY _ Z'4 . W Cam. 2� w +o u'Csk t 5. li�cR. _15 S -to EJ.rA sir Leif I * r.%.,(.._ ar- cth1` COIuIlViERCIAL PERMIT RESIDENTIAL PERMIT NEW or REPAIR $600.00 NEW or REPAIR $470.00 VAULT PERMIT (-� MINOR REPAIR PERMIT $100.00 NEW or REPAIR $150.00 What is being repaired? t 4e. f'r'4 ., ha,, s a. Iv 440 IF OBTAINING A REPAIR PERMIT, PLEASE LIST PREVIOUS OWNERS OF THE PROPERTY: FLOOD PLAIN YES ___() NUMBER OF PERSONS 2 - CENSUS TRACT BASEMENT PLUMBING YES NUMBER OF BEDROOMS BATHROOMS: FULL \ 3 � Y2 WATER SUPPLY: PUBLIC YES / NO NAME &A\ V14 -6-r1);\" . PRIVATE YES / ' O CISTERN YES / WELL YES / O- WELL PERMIT # w PERC HOLES MARKED FOR INSPECTION BY SPECIALIST YES / NO A/71 t 1f C t (Ajent/Applicant) located at 05V E/v,, 5 LEGAL DESCRIPTION: SEC AUTHORIZATION FORM RE: [-PERMIT APPLICATION n SALE OF PROPERTY I.S.D.S. EVALUATION f WATER SAMPLE I . $e- i t vlsc9r� represent Pt c..bC VgiiiNigen &S 1nct°for the property (owner) RNG /I Yc1, SUBDNI:SION NAME: E ,Aryftcl i ► i IS LOT BLK, I can be contacted at the following phone #'s: Home _1O- g5S7 4-981 Work 303 rr)38 27 72 - Fax # 303 957 i35 -5 - The property owner can be contacted at the following phone #'s Home3O3 $33 0543 Correspondence mailed to (only one): Work 3 4440 1og1,3 Fax # ©--Agent/Applicant 0 Property Owner DATE /0 /22/x7 OWNER'S SIGNATURE • Please Draw A Map to Your Property Si- Vfuin .66. mow- _ _40, lit -'1O 5a 13m -1-- Z2 COLORA • WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NorIn 17th Avenue, Greeley, CC 80631 ..A.•,vv.r.vireldhealth.org Application Number: Owner Name: Site Address: App Type: Septic Permit - Final SP -2200064 RENNER ABBY 7050 ELM STREET LONGMONT, CO HealthlResidentiallNew OWTS\Septic CODY GARDNER A PERFECT FLUSH 4333 FLACON DRIVE FORT LUPTON, CO 80621 Parcel Number: 131108302001-R5377186 Legal Desc: EH -9 L9 ENCHANTED HILLS Work Description: NEW SHOP EHS SEPTIC GENERAL Application Date Manual Expiration Date Entry Number of Bedrooms Number of Persons Parcel Acres Public Water Supply Public Water Supply Utility Septic Permit Expiration Date EHS SEPTIC ACTUAL (FINAL) Septic Tank Size, gallons Absorption Bed, sqft Chamber Model Number of Chambers Installed Design Type 02/25/2022 CHECKED 2 1 2.60 Yes CWCWD 10/23/2022 1060 432 Quick4 Plus Standard 36 Chambers -Bed NOTICE Application Status: Red Tagged Applied Date: 2/25/2022 Issued Date: Finaled Date: 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 failrue 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 Evnironment 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. Alex Clemments June 22, 2022 Environmental Health Specialist Date H ealth Administration Vital Records Tele. 870-304-8410 Fax. 970-304-84t2 Public Health & Environmental Health Clinical Services Services Tale: 570 -3O4 -F420 Tele: 977,304-0415 Fax: 970-344-8418 Fax: 970-304-€411 Communication, Education & Planning Tele: 970-304-C470 Fax: 570-304-0452 Emergency Preparedness & Response Tele: 970-304Z470 Fax: 970-304-6452 PubHe Health wJR-26-77 THIS FORM MUST BE SUBMITTED WITHIN 60 DAYS OP COMPLETION OF THE WORK DESCRIBED HERE- ON. TYPE OR PRINT IN BLACK INK. WELL OWNE COLORADO DIVISION OF WATER RESOURCES 1313 Sherman Street - Room 818 Denver, Colorado 80203 WELL COMPLETION AND PUMP INSTALLATION REPORT PERMIT NUMBER L & L i) 4/ 1 ADDRESS" Q k O 4,1-C711,4/ -�� L O4t taut , L-� `.�.c%cG/ DATE COMPLETED L IV- ,191r1 WELL LOG From To Type and Color of Material �r li e c, co (,NAne 1O t S4-Sc TOTAL DEPTH `0 6 Use -additional pages necessary to complete log, Water Loc. 1/4 of the T..-2 _ , R. RECEIVED SEP 1 51981 WATER RES011RCO IrATE EMMER w. 3 L / �% of Sec. HOLE DIAMETER 7 in. from 6 to I / o ft. in. from to ft. 6 in. from to ft. DRILLING METHO (L* A. • . CASING RECORD: Plain Casing Size C & kind pJr4'\Cfrom CI 0 Size & kind from Size & kind from Perforated Casing Size S & kind g'1 L..4 hC from h 6 Size & kind from Size & kind from PM. to 1715 ft. to ft. to ft. to /el 15' ft. to ft. to ft. GROUTING RECORD Material Gp Intervals ' f4 t q_ e- Placement Method GRAVEL PACK: Size, -,34f Interval 9- L 4-P' / iJ 6 TEST DATA Date Tested z 1L Static Water Level Prior to Test Type of Test Pump Length of Test lf" ,19x1 ft. Sustained Yield (Metered) Final Pumping Water Level /0 P 7V1/4 PUMP INSTALLATION REPORT Pump Make Type Powered by HP I Pump Serial No. M�-w Motor Serial No. Date lnstallea 1` c> Pump Intake Depth 9 d Remarks q '1D or WELL TEST DATA WITH PERMANENT PUMP Date Tested ?.AIL 1; t-4 J Static Water Level Prior to Test ) ' Length of Test Hours Sustained yield (Metered) GPM Pumping Water Level `'C5 Remarks WATER 'TABLE r 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. Signature State of Colorado, County of Subscribed and sworn to betore me this %d day of My Commission expi Notary Public License No. SS , 19(L. / , 19 F/ 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. _ _ OIRJ-5•Re'v. 76 Application must be complete where applicable. Type or print in BLACK INK. No overstrikes or erasures unless initialed. COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 PERMIT APPLICATION FORM ( 1A PERMIT TO USE GROUND WATER ( ) A PERMIT TO CONSTRUCT A WELL FOR: ( ) A PERMIT TO INSTALL A PUMP (X1 REPLACEMENT FOR NO d / t-3 7 ( ) OTHER WATER COURT CASE NO. RECL, 4' MAR 101981 rfitr CUt0. (1) APPLICANT - mailing address NAME 4' Li- / 41 4, gd5 72. 0 eu STREET 10-5-0 ELM T arT6/ V �LGS CITY 4D° 90-1im/�^ e,l1 tOe. / / (State) (Zip) TELEPHONE NO. 57 33/I (2) LOCATION OF PROPOSED WELL County 1,4) % of the 5 w 1/4, Section K Twp. _ Rng. 6 r7 a P M. SN,S) I E,W) (3) WATER USE AND WELL DATA. Proposed maximum pumping rate (gpm) Average annual amount of ground water to be appropriated (acre-feet): Number of acres to be irrigated: /5 Proposed total depth (feet): / G b Aquifer ground water is to be obtained from: A1 -1 - Owner's well designation GROUND WATER TO BE USED FOR: ( ) HOUSEHOLD USE ONLY ( !Q DOMESTIC (1) ( ) LIVESTOCK (2) ( ) COMMERCIAL (4) • no irrigation (0) ( ) INDUSTRIAL (5) ( ) IRRIGATION (6) ( ) MUNICIPAL (8) ( ) OTHER (9) DETAIL THE USE ON BACK IN (1 1) (4) DRILLER Name Street T.L.Arr V4 L.e.y wet was p,0. /3 X /q() evA 5/ City pi/477-1_6 C E 0/0 (State) (zip) ry Telephone No ` Lic. No. 9) FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN Receipt No. Basin Dist. CONDITIONS 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. APPROVED AS A REPLACEMENT OF WELL NO.59 Z • THE OUSTING WELL MUST BE PLUGGED AND ABANDONED ACCORDING TO THE REVISED AND AMENDED RULES AND REGULATIONS FOR WATER WELL ANJ PUMP INSTALLATION CONTRACTORS. THE ENCLOSED AFFIDAVIT MUST B. SUBMITTED WITHIN SIXTY (60) DAYS AFTER THE CONSTRUCTION OF THE NEW WELL, AFFIRMING THAT WELL NO„99'37 WAS PLUGGED AND ABANDONED TEE MUtICIPAt OR COUNTY GOVERNMENT SIL&LL BE CONSULTED ` EN LOCATING THIS WELL, AND THEIR REGULATIONS SHALL BE COMPLIED V'ITLJ APPLICATION APPROVED PERMIT NUMBER 5 t 33l + A DATE ISSUED MAR 23 1981 1 ilON DATE M R 2 3 EXP d As BY l.D. COUNTY (� (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. + - -j- - -F- - - -- -4- ---- - --- I NORTH+ T I w 2 2 O w w w ••4-- ------ 1 MILE, 5280 FEET NORTH SECTION LINE I I I - + - -_ + j - --__--A- - - I I I UTH SECTION LINE m + n a N m n 0 2 r 2 m The scale of the diagram is 2 inches =1 mile Each small square represents 40 acres. - —}— (6) THE WELL MUST BE LOCATED 'BELOW by distances from section lines. i 14a 175 ft. from ft. from So arA (north or south) L/ .S (east or west) sec. line sec. line LOT i BLOCK FILING # SUBDIVISION .6—AfLALA 41 -E -1L (7) TRACT ON WHICH WELL WILL BE LOCATED Owner: • eat, 57"`L 0 ti." No, of acres mCc 7 the only well on this tract? Will this be (8) PROPOSED CASING PROGRAM �lyiE Casing rin. from 4 ft. to 90 ft. - in. from ft. to ft. Perforated casing in. from _ft. to /0D ft. in. from ft. to ft. WATER EQUIVALENTS TABLE (Rounded Figures) An acre-foot covers 1 acre of land 1 foot deep 1 cubic foot per second (cfsl ... 449 gallons per minute Igpm) A family of 5 will require approximately 1 acre-foot of water per year. 1 acre-foot - .. 43,560 cubic feet ... 325,900 gallons. 1,000 gpm pumped continuously for one day produces 4.42 acre-feet. (9) FOR REPLACEMENT WELLS give distance and direction from old well and plans for plugging it: d S% dLD LLrq- 4/13 -12-12.t a f 7 A 4,l"�3o y/ crI) GL p.P Q r., , 46S `�— (10) LAND ON WHICH GROUND WATER WILL BE USED: Owner(s): e a ST.L, GIJ Legal description• .5s7f 41E — No. of acres: sc r 7 (11) DETAILED DESCRIPTION of the use of ground water: Household use system to be used. p a 4 STi • — 44,/ rTA 44 w n/ and domestic wells must indicate type of disposal .S,it> T , c - 74-A< b- L .4 ,',,1, x s7714( , (12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers. Type or right Ira Al Used for (purpose) Description of land on which used (13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE. SIC ATUHE Of APPLJCANTISI Use additional sheets of paper if more space is required. SPY CENTRAL WELD COUNTY WATER DIS April 05, 2022 Kyle Schwartz & Abigail Renner 7050 Elm St Enchanted Hills Longmont, CO 80504 RE: Additional Water Service a 7050 Elm St Enchanted Hills Dear Mr. Schwartz & Mrs. Renner, This letter is in response to your request to serve an additional dwelling on the property described as follows: EH -9 L9 ENCHANTED HILLS Parcel: 13110 3 02001 One water tap may serve a second residence providing that there is only one owner involved and one specific parcel of property. This property is currently being served by tap 286. The existing tap has a 300,000 gallon annual water allotment. The tap holder can be provided with additional water through the existing tap if the District has water available. If the annual water allotment for the tap is exceeded, a CRT surcharge will be assessed on all additional water usage. The CBT surcharge is currently $7.00 per thousand gallons. The surcharge rate is reviewed annually by the Board of Directors for all District customers. The tap holder should also expect to pay a multiple unit surcharge of $7.00, which will be added to the monthly bill. The following restrictions apply: 1. Water service which involves two or more residences on the same water tap generally means that both pressures and flows are inadequate during the periods of peak usage. The District's responsibility ends at the customer's side of the meter yoke in the meter pit and poor pressures or flows attributed to the second residences are the responsibility of the customer. . Once a customer's water service has been designated as having an additional residence involved and a multiple unit surcharge has been assessed to the account, the charge will remain on the account indefinitely, regardless of whether the additional residences are occupied or not. In the event that the additional residence has been removed from the property, or the water service line has been permanently disconnected to the additional residence, the customer may request that the dwelling unit charge be removed from their account. This request must be in writing, stating the circumstances involved, and will be addressed by the Board at the next regular scheduled meeting. The customer will then be advised of the Board's decision in writing. In the event that the parcel of property involving additional residences is sold, so that the "one owner - one property" rule is violated, a second water tap will have to be purchased to serve the additional residence. 2235 2nd Avenue • Greeley, Colorado 80631 • Phone (970) 352-1284 • Fax (970) 353-5865 Stan Linker, District Manager eiVre CENTRAL WELD COUNTY WATER DISTRICT April 05, 2022 Kyle Schwartz & Abigail Renner 7050 Elm St Enchanted Hills Longmont, CO 80504 RE: Additional Water Service @ 7050 Elm St Enchanted Hills Dear Mr. Schwartz & Mrs. Renner, This letter is in response to your request to serve an additional dwelling on the property described as follows: 4 EH -9 L9 ENCHANTED HILLS Parcel: 131108302001 One water tap may serve a second residence providing that there is only one owner involved and one specific parcel of property. This property is currently being served by tap 286. The existing tap has a 300,000 gallon annual water allotment. The tap holder can be provided with additional water through the existing tap if the District has water available. If the annual water allotment for the tap is exceeded, a CBT surcharge will be assessed on all additional water usage. The CBT surcharge is currently $7.00 per thousand gallons. The surcharge rate is reviewed annually by the Board of Directors for all District customers. The tap holder should also expect to pay a multiple unit surcharge of $7.00, which will be added to the monthly bill. The following restrictions apply: 1. Water service which involves two or more residences on the same water tap generally means that both pressures and flows are inadequate during the periods of peak usage. The District's responsibility ends at the customer's side of the meter yoke in the meter pit and poor pressures or flows attributed to the second residences are the responsibility of the customer. 2. Once a customer's water service has been designated as having an additional residence involved and a multiple unit surcharge has been assessed to the account, the charge will remain on the account indefinitely, regardless of whether the additional residences are occupied or not. In the event that the additional residence has been removed from the property, or the water service line has been permanently disconnected to the additional residence, the customer may request that the dwelling unit charge be removed from their account. This request must be in writing, stating the circumstances involved, and will be addressed by the Board at the next regular scheduled meeting. The customer will then be advised of the Board's decision in writing. 3. In the event that the parcel of property involving additional residences is sold, so that the "one owner - one property" rule is violated, a second water tap will have to be purchased to serve the additional residence. 2235 2.nd Avenue • Greeley, Colorado 80631 • Phone (970) 352-1284 i Fax (970) 353-5865 Stan Linker, District Manager ellre CENTRAL WELD COUNTY WATER DISTRICT 4. A water tap installation is for a specific parcel of property and a customer will not be permitted to extend a service line from one parcel or property to another parcel to provide additional water service. For your records, Tap 286 water usage was 238,000 gallons during the 2021 water year, 258,000 gallons during the 2020 water year, 194,000 gallons during the 2019 water year and 279,000 gallons during the 2018 water year. if, you exceed 300,000 gallons usage in a water year, you should expect to pay a surcharge for any additional water. If you want to consider an upsize of the existing meter to better accommodate water needs for the property, a water study to determine the cost of a larger meter can be requested by submitting appropriate documents and fees to our office. If a landowner is negotiating an annexation to a City or Town, the terms of this letter become null and void and water service shall be obtained through the City or Town. If annexation is not being considered, this letter expires 120 days from date of issue, unlessextended in writing by the District. The District will not notify, by separate letter, any prospective landowners of cost increases. The District has the right to review the annual allotment and compare it to actual usage to determine if additional raw water will be purchased and transferred to the District by Tap Holder. It is your responsibility to confirm with your local Fire Protection Authority if fire flow water capacity is required for your project, if you have any questions regarding the above, please contact this office. Sincerely, CENTRAL WELD COUNTY WATER DISTRICT Stan Linker, District Manager Slide 2235 2"d Avenue • Greeley, Colorado 80631 • Phone (970) 352-1284 i Fax (970) 353-5865 Stan Linker, District Manager Thank You for Your Payment - Central Weld County Water District 3/31/2022 2:15 PM Mountain Standard Time awe Customer Name Abigail Renner Effective Date 3/31/2022 Approved 20007408 its ire . Service Letter Subtotal: Transaction Fee: Total Charged to: Visa ***** 9099 Total Amount Paid: Collection Mode: Web Payment Details Service Letter Company/Last Name: Parcel 131108302001/ Schwartz - Abigail Renner - $30,00 A Transaction Fee has been included in the total amount paid for this transaction. Arno a rlt $3O00 $30.00 $0,83 $30.83 $30.33 Hello