HomeMy WebLinkAbout20194568.tiffTOWN OF JOHNSTOWN
450 S. PARISH AVE.
P.O. BOX 869
JOHNSTOWN, CO 86534
,ACCOI,INT rite -5874664 puE_DATE
984.451.01 DUE BY 10TH
METER READING
PREV'iOU.$ C,IRREN1 USED 02O8/2015
1.585 1.565 2,050 AMOUNT
RECEVED 117 725 CR
Water
MAR 2 9 2016
Town of Johnstown
NEW UTILITY BILL FORMAT COMING SOON!
Easter to read with more information for customers.
CURRENT E. JOR
17.77 17.7+
•.
•
HSP106F' INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
WELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HE::AiLTH SERVICES
1516 HOSPITAL_ ROAD. GREEELEEY , CO 806:11
353••-0635 EXT.2 25
NO. G-099026
NEW PERMIT
OWNER SLOAN, OLIVE I. ADDRESS 1201 W. PARK AVE. PH (303) 587-491E
JOHNSTOWN CO 00534
ADDRESS OF PROPOSED SYSTEM 23165 WCR 413
JOHNSTOWN CO 80534
LEGAL DESCRIPTION OF SITE: SE4 SEC i TWF' 4 RNG 60
SUBDIVISION : LOT 0 BLOCK 0 FILING 0
USE TYPE: RESIDENTIAL LOAN APPROVAL 052-89
SERVICES: PERSONS i BATHROOMS 1.00 LOT SIZE 1.22 ACRES
BEDROOMS 2 BASEMENT PLUMBING ND WATER SUPPLY f=WEL.L..
APPLICATION FEE $0.00
RIE:c'D BY RECEPTIONIST AID
DATE 03/21/89
SIGNED BY OLIVE I. SLOAN
DATE 03/21 /09
PERCOLATION RATE 0.0 MIN PER INCH LIMITING ZONE 0 FEET
SOIL.. TYPE: SUITABLE PERCENT GROUND .I 01' 1. 0/ DIRECTION
REQUIRES ENGINEER DESIGN NO
FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON -SITE ,SOIL. PERCOLATION DATA
THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED:
SEPTIC TANI< 1000 GALLONS, ADSORPTION TRENCH SQ. FT.
OR
ADSORPTION BED SQ. FT.
IN ADDITION. THIS PERMIT IS SUBJECT TO THE FOI...I...OW:LNG AIDDIT]:ONAL TERMS AND
CONDITIONS:
THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT
MAY BE: REVOKED OR SUSPENDED BY THE WILD COUNTY HEALTH DEPARTMENT FOR REASONS SET
FORTH I IN THE WELD COUNTY INDIVIDUAL. SEWAGE DISPOSAL OSAL 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 O1= THE:
SEWAGE DISPOSAL_ SYSTEM.
X STAFF
ENVIRONMENTAL._ SPECIALIST
03/21 /09
DATE
THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS
NOT COMMENCED WITHIN ONE: YEAR OF ITS ISSUANCE. BETORE: ISSUING FINAL_ AF'F'ROVAL.. OF -
THIS I- FRill1 THE WELD COUNTY HEALTH DEP'ARTME=N'TRESERVES THE RIGHT TO IMF'OSIF. ADDI-
TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA-
SIS. FINAL._ F'FSM:i:T APPROVAL 1.3 CONTINGENT UPON THE FINAL INSPE'CTION OF THE COM-
PLETED SYSTEM BY TI'1E WELD COUNTY HEALTH DEPARTMENT.
SYSTEM INSTALLER UNKNOWN
SYSTEM ENGINEER
TYPE OF SYSTEM INSTALLED TANI<
FINAL INSPECTION DATE: 03/21/09
APPROVAL X STAFF
ENVIRONMENTAL SPECIALIST
THE ISSUANCE OF TI-IIS PERMIT DOES NOT IMPLY COMPLIANCE: WITH OTHER STATE. COUNTY
OR LOCAL REGULATORY OR BUILDING REQUIREMENTS. NOR SHALL IT AC'T' TO CERTIFY THAT
THE SUBJECT SYSTEM WILL OPERATE IN COMPLIANCE WITH APPLICABLE STATE, COUNTY AND
LOCAL REGULATIONS ADOPTED F'ERSiJANT 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 25-10-111 (2),
r1G4Tr;1' IAI --APPI TrANT r'I'iIDV.-I,Ir n
mrwn-rwv MAY 400A
STATEMENT OF EXISTING SEPTIC SYSTEM
(PLEASE FILL OUT IN INK)
OWNER OF RECORD: ()I/YE 1 S'l/I#- /
Phone: ,7-/I
MAILING ADDRESS: Q _ L /J A S�,-
City State Zip
SITE ADDRESS.
City State Zip
LEGAL DESCRIPTION: PT .51-61.,OrPT Section - Township 4/ Range
SUBDIVISION LOT If]' BLOCK ,VA- FILING _
GL%
NUMBER OF PEOPLE: / Bedrooms: al Bathrooms: / Water Supply -art/01 1teti t
RESIDENTIAL OR COMMERCIAL: _'I1LSFQeN f ,grL- Lot Size: .,/,,,,1„2„2_, Acres
SYSTEM :SIZE: Tank is Constructed of cloact-cid_, and has /MO gals capacity
material)
Nkda /4/3'Z8
FIELD: ed or Trench sq. ft. Date System Installed:
Youare required to draw a diagram of the system on the reverse side of this
form and indicate position, length, width, and distance from the dwelling.
The undersigbed property owner hereby certifies that the above described septic
system is in fact installed, as described, and exists at this time on the
parcel of ground identified by the above legal description and further states
that the system is in good working order and to the best of his/her knowledge is not
failing to function properly.
I further understand that any falsification or misrepresentation may result in
revocation of any permit granted based upon this information hereby submitted
and in legal action for perjury as provided by law.
i61J Vyc-r;"
\
Owner
Subscribed -and sworn to before me this 4 I day of
19
fC'
Witne"es my hand and official seal. My commission expires
Date
Notary Public
cAkt
I 1r 1
i I L � •' h •4 ~~
FINDINGS:
CcTa_ENTS:
DATE: Z�
r SPECIALIST'S INSTRUCTIONS:
-a�
NEED: 1.
2. a d, L,
3. A e (546 AtiaLc ,
U 1
LOAN APPROVAL
CLOSING DATE 3 -3/
MAIL OR PICA
NEW LOAN OR RE -FINANCE N e W
Request No: r16',2
Date Received:
Date Forwarded:
Fee Paid:, .f0 OO Date: 3? -k9'
TO WHOM IT MAY CONCERN: Review and inspection report regarding water and. the sewage
disposal system for an existing dwelling:
SEND TO: A i It1Are. Rey 1'li4.
R 11 fir, ICI+ 1
O
PHONE // S7 -44 I
INFORMATION: Address (2. ) p 5- Wc-le. 1 j , Jphrk5-i•owIl
Legal: PT .a4 , PT , Sec r.0 , T 64 , R teR W, Age of House ,/ Mr c_
Subdivision , Lot Blk , Filing /
Frcperty Owner__ . lnke " n1iv e, Original Owner
Tank Pumped on / - /4/..',e. e By e 4- _I cc,i2;7/47 Bilk,
DEPARTMENTAL RECORD SEARCH: Permit # 2990a6 Name ,.1,aQ n l vo... I. , & t t` ii t t7
- Bathrooms k Bedrooms a Total Acreage I,
Tank Capacity gals. Field Size sq. ft. Water Supply ,.i niShRU.1fV
Date of Final Inspection
Sq ,D
INSPECTION CCLMENTS: Deter oi` Inspection
Soil Conditions: Dry Saturated
Residence: Occupied Vacant y
Sewage Disposal System: Satisfactory X Other
Bacteriological Water. Test: Acceptable Other
SIGNATURE:
Snow —cove red
Environmental Health Specialist
Neither the County of l-Teld nor any of its agents or employees undertake or assume any
liability to the owner of the above property, to any purchaser of the above property or to
any lending agency making a loan on the above property in connection with either its
examination of the property or in the report.
This inspection was conducted solely for the purpose of detecting health hazards observable
at the time of inspection, and does not constitute a warranty that the system is without
flaw or that it will continue to function in the future. Inspection requested during
periods of snow cover and high soil saturation may be of questionable value to potential
huyers due to adverse conditions, Vater sample reports reflect the bacteriological quality
of the water supply at the time the sample was taken.
Jun Jul
�`ri.,tulittlptrr . CROOKS, RICHARD
Johnstown
TOWN OF JOHNSTOWN
450 S, Parish Ave.
P.O. Box 609
Johnstown, CO 80534
970-587-4664
Monday - Friday
8,00am - 5:00pm
Drop Box Available
(See reverse for location)
11 23165 WCR 13
980.051.01
Customers now have the option to pay utility bills online through
i
I
•
Visit townofjohnstown.com for more information.
Town Offices will be closed on July 4th in observance of Independence Day.
Previous
5/19/2019
1833
IiiI.iI'I.I••ij•••
I
AugSep Oct Nov Dec Jan Feb Mar Apr May Jun
METER READING
Current Days Usage/Gallons
6/19/2019 31
1840
Water
Surcharge
Total Current Charges
Previous Balance
Payment Received
Balance Forward
Total Amount Due
27.30
0.00
7000
35.18
15.00
50.18
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