HomeMy WebLinkAbout20194581.tiffMeter Readings Read Dates
Account Number Description Previous Present Usage Read Code Previous Present
000006-01 1000 Gallons 3287 3294 7 Actual 12/17/2018 01/22/2019
Previous Balance
Payment — Check
Water Minimum Charge
Water Usage Charge
CBT Surcharge
Multiple Unit Surcharge
$23.30
—$23.30
$16.50
$8.25
$0.00
$3.50
Please write account number on all payments and correspondence.
You may pay your bill at www.cwcwd.cam
Water;
J F MAMJ
8
J A SONDJ
Total Current Charges $28.25
Total Amount Due $28.25
Customer
David & Cynthia Stark
Service Address
25311 County Rd 49
•
Billing Date
01/28/2019
Due Date
02/15/2019
Account Numbo r
,,
000006-01
Amount Due
$28.25
Annual Allocation
YTD Usage
300
15
Central Weld County Water District
2235 2nd Avenue
Greeley, CO 80631
970-352-1284
Scanning Cover Sheet
for
Septic Permits
Permit #
G19880193
Permit Type: Health / EHS History 1 EHS Conversion History
Situs Street Address 25311 CR 49
Situs City, State, Zip
Sec/Town/Range: 25 -05N -65W Application Status: Finated
Application Date: 03/11/1996
Parcel # X12 digits)
Owner Full Name:
Owner Address:
Contact Name:
Contact Address:
096125000039-R3922286
FEDERAL LAND BANK
127 22ND ST
GREELEY,CQ 80631
Owner Phone #: 303 3563943
Contact Phone#
Information above has been Verified in Accela bir employee noted below
Processed by:
December 05, 2008
Date
Report ID: EHS00024v003 Page 1 of 1
Print Date -Time: 12/5/2008 9:43:47AM
I- I E 1'.:. 1 0 r.`I F:'
INDIVIDUAL, SEWAGE DISPOSAL 'r ,`.= T E M I"'' !::: f 4M 1: i 'M
D, G-880193
bJ H; !, I} COUNTY I i IE: ' L1 1 1 T! EP AI5' T i`i l : T,l
ENVIRONMENTAL HEALTH i1 SERVICES
1 i 6 HOSPITAL ROAD, (v!';:!:: 1:::1.1:?'( , CO F10r.'f:T !'
OWNER I'I.E DI1iRAT I ANIY7 BANK ADDRESS i2 ':.N:I'.1 ET PH CZ03)
R!Ei:IEE:I..F::Y CO t3�gry�31
ADDRESS '.S' OF��:: kM'!�I,411:' 1:� SYSTEM 21!151 1 bilk 49..
LEGAL 1)!i: S I:: I ::I: i I I N OF SITE, NE4 ;, i 4 ,`.:' I'=: i:; ;:',:x TWP - ) i{ 65
S! Jr1I?:I:t'T:s':I:CIN: I..(:1'I' (•? BLOCK 0 FILING 0
USE TYPE: E::: RESIDENTIAL
R IE R11:1"(:;I::: : PERSONS H BATHRDOMS 4,00 I_ H I SIZE .50 ACRE
DI::l7Ri:i1::;i`1S I::r`i':1:i+! T FI..IlI1:•;':I:N(:r YIr:> I I r'i F: R SUPPLY
APPLICATION FEE x! 1100,00
DATE 09/15/2a
S L(:M EE:BYi : F F:: i I :{7 I i I.:: I S
DATE 09/15/02
REPAIR :IR PERMIT
I'T
is:'I:I; lSi:r!_i'I:I:(:iN RATE 20,0 MIN PER :E:N(:FI
LIMITING ,:,Cull:: ti3 I I.i.l..
:'!:1DU TYPE SUITADLE PERCENT (G!'41.11.1,1D SLOPE N DIRECTION
I I:::+.'1U:1:I.!:::,S' IE:N(:r:!:Nh:1:;:!s DESIGN iJ(:1
I FL .. I O.., , �..., SUPPLIED ..:L1T:r r`rrN:6 THE ON —SITE t'C11:1. F E:kii::1::11.. UT:IlCiN :0i`, I rl
{)rI !III;: fll::'I::'I.:I:LwI`ITTf,Ii�! I:�,f��1IT°ir1'far:il! JI::'I�"I
T'HI.�. F'"UI.'I +_IIsH,iU N_IN.N I.Jr1 .I.N,� T Hl.l...i1 f .IUi ;a1• EIE:CY n i':1 ON ARC Ii:IE:OIJ:I:ItE::I):
EPTIC TANK 1250 Fur11.l.-.1:11d,S', ADSORPTION IFIIi:E!(1I•'! 1254 SO, FT,
(:1H:
AC, (:1(kF' T':I:0N 01::0 12 ,N'G ., I' •'f
N r11:)di 1 .,1, :1 i:1,J , THY. PERMIT 11 "i' :I:,.. EUBJECT TO THE : FOLLOWING ADLI.FIJINAL TERMTERMs Hill
CONDITIONS:
CF•!.I:.> PERMIT :1: .S' GRANTED TEMPORARILY TD ALLOW (:',C1'N!El'IiITE:'r]:(JN TO !f:f:1NIIMI:i:idC::I:.:, `fI•i1:p:' PERMIT
MAY BE REVOKED OR SUSPENDED BY THE IHI I.:t-7 i:;i:1UC T 1• HEALTH DEPARTMENT FOR Rli (I,C'CI1
I•l .. . .( :;Tz'!"'H,sr;I SYSTEM FiI:::0(0 H)' IUU;' :1:U!::I 1.1I'IN(:;
I r,1 F� -'f I� I !: �l T I -I IE: WELD COUNTY J: !vl :0 ]: '�,r` �. ,(71J f�l L..SEWAGE T
�:l;I 1„11tI.. TO ! I::I::I ANY I I::.I':1", (.JFti i::.('t1`�iry1. T I:UN IMPOSED 'I"i-Il: I?I::!N UUI I�i(:T TEME (:1k'IRY u4; Fl ENitI
" . � ;' D l f ; (a N ; i :I: "i I I T FE: ASSUMPTION ,'i ;:> 1 J MI i.., �.T.:I: O i''' 1. ; i THE
!:(:
r�F ! hal.�v'rl! THE 'I::a,.�1.11-1i'd(�',F:: OF •TII�!� 4 PERMIT DOES i'�!i_' ..
-DEPARTMENT 1, I . .I, I ,:EMPLOYEES I .r !" • I.. f. r7 t� .I.1...: h i "•r I I ! I�. T. I I !EE: FAILURE (:1 i :I: i` I A 111:E: (x111 A (' `r- (:1 F ' T ! T I::
SEWAGE DISPOSAL SYS1EM,
TC 8bb°e, Ip—s—$8C
LAO oil? lo- 5-��
ICJ Iii: ,S' PUTTER
ENV T1='L(IN(1[:Ei'Ti-lI 7F''UCTI:A.:1.51'
r7Y/i:` c(:1L:I
I)FIlI:::
THIS F'E!LHI:l:'i I, .S NO7 ti Di.l::: AND 5'1111.1 :1111::('i:IMF:: VO T :1: F S Y',S-1' IE' M CONSTRUCTION HAS
. CDNMEC i I/ J. T- 111. I 0 N l..: „YEAR or ...• :!; ,.i J , U I' ] P I i:: C , T:� 1:: !•- �:3 IN C' °.:' U N E I • :I; N rI L, A ' I' I�,' Ci T;' r' I I (: r
THIS 111,111 101 NII i I HEALTH r
'I' Ir,�Yi"•.I-r�:'-"' .�-f.-y� ;.,Lyxre�,I,l'_,I,11f1f I.'�=rl..,y I DEPARTMENT ..� ..,.. .., ,::1.. r7I7:{7 :I. •.
1. . , i . i � ,.,. i , �.. :.. , . a: � � ' e • J. I , L l 1 1 Y i., 1 •. I I J . _ r ) ( � I •
i J°ll•'t`,! I Fyl. !1..h ,'I::� THE I:4•I•!-I'i• }'lI IMPOSE
... . r � li� . i' RE ET T i:i i.i i';: l:v i..+ L. A 1 :i. L }'`.i ,., UN O 4.. l ! i9 1 L N l l .L f'! lrr 4:, fi .
PERMIT 1 a,1''F''i 1J1 r':,1.
,�:Iz:'. FINAL '"' - !lr.' ! 1 UPON "'!IL;' r' (i4!AI_. :':I'1,::'P!ii;l'T:I:i:1r"! OF TI"I I: I;(:I(~1
FX1.11::'1' F:I) SYSTEM :BY THE E WELD COUNTY I••1El 'H I :OI:::F'FiRTMI".'1`{T' ,
EM:I: N 'T (� I. I.I:� R. ��. h er� 6�6,'�. °lF INAL1 ►
SY3ILM Li: N I: N i::: I.i: F /DA igg
TYPE OF INYTLE.T; , 1f E.b. 11kuNIILNIAL sPEIIALIsT
.. . ... ,. ` :: I 1 ...._ ... F, (III I A N E l IJ :1 I I I OTHER STATE, (1 {:1 U N "!''r
I �' l 1::: ISSUANCE ('I F' I � I'•I :i. �.� I" !": ! ; I f I: f' T, f i iE:: ,S' i`�i (:r I IMPLY (:: L:i ' .�; ...: "
I Ir'..,., ....: .... �N .... " .. `1°' ��s I !r',I.I,...1...1 .. III .,.. TO IIE:I !':1 F 'I THAT
1. r� (!L,���L. I•�' ,J r_. r�l f l..I r� �� !��} I'!' BUILDING 1 I' I:.. F,, I��;11- [:, I,l �I I•,_ L:� 1, F: I� i , ri
THE .l l::f::'1' 1 r COUNTY ll l�l l)
,, I`I•1�� L>J ! 1•, _ >�� T I:,. I, i`�! t., L.I'•n'I . I r•rP�TL.1::. APPLICABLE frlfl:..
I 1 1 REGULATIONS A1,i1..11 1 I::,.(1 P11„EliANI '1-+:.:I i"N 1 .E.1.:Il 1. 2'5, (:;I';r:; ! ?;:. , il,Eti r•`IIYlE::h'!IlE.E:1) ,
E X i:; i::' 1 T F 0 R T ! I I::' PURPOSE OF I:I S 1 1::111._ :!: � y l l li l ii I.::I:1N N , APPROVAL OF (21N INrj'ef:',1{J..E.Ds is S' I I,:: N 11;111:
:I,F,sUUiUC`IE: UI: r 1., :'inns. (:i(::f:1Ul:'ANC-'i PERM -I:1 I:UI:EI.1r1N1 CI::I CRS 19'T,, 115..11 {=,— 1 i i Cn:`7 ,
,' IN'il:l:`w1i)(JphiI,. SEWAGE D:1:SI:'C1,:rrtr1. SYETFM PERMIT
WELD COUNTY HEALTH DEPARTMENT
T
ENVIRONMENTAL III:FiL1II SERVICES
1516 HOSPITAL ROAD, , L-i i I- F F:'T , CO 00631
353-063'S E:X'1'., 22'.2`'
OWNER E:'i_S}F:k(I... L(;ND EANI< ADDRESS 12?' 22ND El
(;IkEEEI_I:Y
ADDRFEs OF PROPOSED sY\ rEEI'i 25311 WI;Ik 49
f y l:k 1-. IE L,. {.E `( CO 00631
LEGAL DESCRIPTION OF ;S:I:'1' E::: N1 4 SJ 4 SEC 2's rWI:.' " RN
SUBDIVISION: LOT 4)
l J r l :: l -'Y I' I_:: RESIDENTIAL
SERVICES: PERSONS #:i BATHROOMS TIHIR:ktili:lMS 4.00 l..(:1'I' SIZE
BEDROOMS r 6 BASEMENT r PLUMBING YE::1 L.lA1"E:i:k
t,1''PI..:I(::ATi:(JN FEE :Is10S),{•)4}
l IE: C ' D BY . E: s POTTER
DATE 09/15/00
CO 0063i
a
BLOCK 0:) FILING k•)
NO, G-0001?3
REPAIR PERMIT
I:''I.'I (,h.)) 356...?i943
9,,15•) ACRES
SUPPLY CWCWI)
SIGNED BY ROBERT D I:i'k1:EE'';s
DATE 09/15/09
F'f";T";coL,A C' J:cm i:kri T'EE ......,... MIN PER INCH LIMITING - (1NE:4, _ FEET
son. TYPE PERCENT RCI:EN'T' GROUND sI_Oi'I' r: DIRECTION
REQUIRES E.NGf.I.NNli::-E_Imo. DESIGN ...MO
FROM III APPLICATION I'.I.(]U INFORMATION SUPPLIED AND 'V'I"ii': ON -;:']:TI:: SOIL PE:::R(::(:'I..r'H i'.uN DATA
rl'll:. FOLLOWING MINIMUM INSTALLATION ,Si='I:C::1:1•:'J:CAT:IClN ;' r•`1RL:: RisOU:CRI 1) :
SEPTIC T'N1r41, i•x (:KAl..l_.(1N.4' , TR{:::P•.(::E•I as71,SQ
OR
a 100 b ram, ire. aIi,1,`:kl: ri:(:1c! BED SG, FT.
IN ADDITION, THIS PERMIT :I:,i SUBJECT TO THE FOLLOWING ADDELT.tlltlrll... TERMS ni'=1:O
THIS PERMIT IS (:GRAN'cE:X} TEMPORARILY 'I"(:1 ALLOW CONSTRUCTION r0 i r:)NI•IENCL:.: TI -II I:'I:::RMJ:1"
MAY ICE- REVOKED OR SUSPENDED BY THE IAII:;:1.1J (:'UUi`•! i HEALTH i DEPARTMENT FOR REASONS SET
FORTH 1:N THE WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL AAI_ SYSTEM REGULATIONS INCLUDING
FAILURE TO MEET ANY TERM OR CONDITION IMPOSED D THEREON DURING TEMPORARY OR f:''.I:NlA-IL...
APPROVAL, RO X11.. THE ISSUANCE OI:. THIE PERMIT DOES NO i r_iosr _I:'t,1 f I ASMHTLJO U i' 7i It
DEPARTMENT OR :C'T',. EMPLOYEES S III I I OEa01.:L'li1,s''`s (H
SEWAGE DISPOSAL SYSTEM,
CONDITIONS:
rc •#ra BoL et- IS -82 '--
e 4-ig-08
LIABILITY FOR '.I.il..
l:,.I,t, • I Ip4i'ii::I . I I,i
T'H:C,S' PERMIT IE NOT TRANSFERABLE AND `'' _ VOID IF SYSTEM C(:iN,il roUCr I:CJN! HAS
sI�IFlI..I... BECOME �t_�
NiCT COMMENCED W:I:1 EIJ;N ONE YEAR OF ITS ISSUANCE, BEFORE :I:Ik 'LII N(:; FINAL APPROVAL OF
THIS II! MI r THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO :I'MI'(:l ;h ADDI-
TIONAL Hk'i•5;:' AND CONDITIONS 01 RI 91:';I;::D TO MEET 13111 REGULATIONS (:1N A CONTINUING I'n
EIS, FINAL I'I":I PERMIT APPROVAL IS ,I CE•!'TJ:NI?I NiI UPON CHE FINAL :INSSI::'IE:(:; 1.'I:CI0 UI:" Tiff CIJO
F'!_r.::1r:::i:1 SY.S`rE_i''i t'r T'LIII: WELD COUNTY HEALTH OE::i='AIkri"II=Nf ,
OI('T(:; INriL-r1PPl.,ICANT , I::(11-'Y'._Wi.;T-Ir)
I I I) 1i: I. I: r` A V , .f9 I3 4
9
4
4.9
IL
CaH
p -r
IJ
icSe-au
Scanning Cover Sheet
for
Septic Permits
Permit #
Permit Type:
SP -0900174
Health / Residential / Repair
Situs Street Address 25311 CR 49
Situs City, State, Zip
GREELEY. CO .80631
Sec/Town/Range: 25 -05N -65W Application Status: Fineled
Application Date: 11/13/2009
Parcel # (12 digits) 096125000039-R3922266
Owner Full Name:
Owner Address:
Contact Name:
Contact Address:
STARK DAVID C & CYNTHIA A
25311 CR 49
GREELEY,CO 80631
25311 CR 49
GREELEY,CO,80631
Owner Phone #: 970-353-3313
Contact Phone# 970-353-3313
Information above has been Verified in Accela by employee noted below
March 18, 2010
Processed by: Date
Report ID: EHS00024v003 Page 1 of 1
Print Date -Time: 3/16/2010 8:20:02AM
Septic Permit - Final
Application Number: SP -0900174
App Type: HealthlResidentiallRepair\Minor
Applicant' Name: CYNTHIA A STARK
25311 CR 49
GREELEY, CO 80631
Owner Name: STARK DAVID C & CYNTHIA A
Parcel #: 096125000039-R3922286
Legal Desc: 12834A PT E2 25 5 65 BEG AT PT ON E LN SEC 3870'5 OF NE COR W560' N575' N46D41'E 298.34'
E342.93' 5779.6T TO BEG (9.51A) (.5R) SITUS: 25311 49 CR WELD 80631
Site Address: 25311 CR 49
GREELEY, CO 80631
*M41t ret1► Environmental Ilealet Services department
1555 N, 17th Avenue
Greeley, CO 80631
Phone: (970) 304-6415
Fax: (970) 304-6411
wwvv.co.weld,co.us
Einaled
Status: Reedy to Finai
Applied: 11/13/2009
Issued:
Finaled:
A S ecific 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
11/13/2009
No
0
25311 CR 49, GREELEY
1
1
9.5
Yes
CWCWD
No
1988
EHS Pere Tent (ajte):
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
Septic Permit - Final
Minimum Installation:
Absorption Bed
Absorption Trench
Additional Terms and Conditions
Bed Option 1 'Bed Option 2
Bed Option 3
Bed Option 4 '
Chamber Option 1
Chamber Option 2
Chamber Option 3
Chamber Option 4
Septic Tank Size
Trench Option 1
Trench Option 2
Trench Option 3
Trench Option 4
Actual Installation:
ltttlttl
1555,N. nth Avenue
Greeley, CO 130631
Phone: (970) 304-6415
Fax: (970) 304-6411
www.co.weld.co.us
CONNECTING ADDITIONAL HOME TO EXISTING SEPTIC
SYSTEM FOR MEDICAL HARDSHIP.
97.6( •.- r
Septic Tank: gallons Absorption Trench: sq ft
Absorption Bed : sq ft
Design Type: 37--2.-'-J'2r Chamber Model
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).
This permit Is non -transferable an 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
cialist Date
Environmental Health S
s erai
,)5311 1
t h 4P 974 ;sfi'^$--
f •4`�
�Iln r qj D°G Ib„1
riefi 4
FOR OFFICE' USE ONLY
ISDS APPLICATION FLOW SHEET
Owner.
%dc a
Location: _ 11 C
Date
B
Permit #:
Og
Legal Description; as" s- 105
Comments
Parcel Number Received
hdoth15tlon Form Complete
Authorization Form Received
Map Droving Received
Flood Plain? YeelNo
U
Site Inepec tlon Date
i I ell
Engineer Design? Yes/No
/
Date Engineer Design Received
Customer Notified? Yes/No
Date Staff Approval Sent
Date Staff Approval Rec.d
Pero Data Entered in Computer
• '
tot--
Date of BOH Approval
frq Approval Letter Sent
(Latter, Permit, BOH Review)
Date of Find Inspection
Eng Final Inspection Letter Read
Varlsnaea Needed? Yee1Na
Sent Vwiance Staff Approval
Read Variance Staff Approval
Variance B0H Approval
Variance B0H Approval Sent
(Variance, BOH Review)
— -
A idltanal Comments: cQ1. ( I —
— 4 °
HAE'4VIRONMF TALHEALTHSERVICES'SFFT1C1J WSHEET
WUDc
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
Application Number: SP -0900174
App Type: HealthlResidentiallRepair\Minor
Applicant Name: CYNTHIA A STARK
Owner Name:
Parcel #:
Legal Desc:
Site Address:
Applied: 11/13/2009
Expires: 11/13/2010
25311 CR 49
GREELEY, CO 80631
STARK DAVID C & CYNTHIA A
096125000039-R3922286
12834A PT E2 25 5 65 BEG AT PT ON E LN SEC 3870'S OF NE COR W560' N575' N46D41'E
298.34' E342.93' S779.67' TO BEG (9.51A) (.5R) S1TUS: 25311 49 CR WELD 80631
25311 CR 49
GREELEY, CO 80631
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
NOT NEEDED
Yes
No
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
25311 CR 49, GREELEY
11/13/2009
No
1
1
No
0
1
0
Yes
CWCWD
9.5
Report ID: EHS00028v004 Page 1 of 2
Print Date - Time: 11/13/2009 1:47:27PM
r r$
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
Year Installed 1988
Percolation Rate Limiting Zone —ft in Description
% Ground Slope _— 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 r.gallons Absorption Trench
sq ft
or Absorption Bed sq ft
Chambers: Standard BioDiffuser Trench Bed
Infiltrator Quick4 Standard or Hi Capacity Trench __ _ _ Bed
Biodiffuser Arc 36 Standard or Hi Capacity Trench Bed
Infiltrator Quick4 EQ36 Trench Bed
All Weld County ISDS regulations apply. In addition, this permit is subject to the following additional terms and
canfilons: s • - _
-c—t A) L.)1 --ii . •u.A -TO 1S k1C ` .. f: C_ - - ,S
r-ta +r -t- ,
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. 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 expires one year from the application date.
X
Env
nmen aith Specialist
Date
Report ID: EHS00028v004 Page 2 of 2
Print Date - Time: 11/13/2009 1:47:27PM
ietd c �urriy Environment* r leetl r a arttr�erxt
1555 N. 17th Avenue
Greeley, CO 80631
Phone: (970) 304-6415
Fax: (970) 304-6411
www.co.weld.cous
Septic Permit Application
Application Number: SP -O900174
App Type: Health\ResidentiallRepair\Minor
Applicant Name: CYNTHIA A STARK
Owner Name:
Parcel #:
Legal Desc:
Site Address:
App Specific Info:
25311 CR 49
GREELEY, CO 80631
STARK DAVID C & CYNTHIA A
096125000039-R3922286
12834A PT E2 25 5 65 BEG AT PT ON E LN SEC 3870'S OF NE COR W560' N575' N46D41'E
298.34' E342.93' S779.67' TO BEG (9.51A) (.5R) SITUS: 25311 49 CR WELD 80631
25311 CR 49
GREELEY, CO 80631
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
Public Water Supply Utility
0
1
No
0
25311 CR 49, GREELEY
1
1
9.5
Yes
CWCWD
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 far 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 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.
O ne Applicant 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 SVKDRE1 $5'Q, Dj
VAULT PERMIT
NEW or REPAIR $8 c2,5O.00)
RESIDENTIAL PERMIT
NEW or REPAIR $1,N7cro 7155, co
MINOR REPAIR PERMIT
$100.00
PARCEL NO.:
C 23 3-°1
LEGAL DESCRIPTION SECTION 3,5 TOWNSHIP RANGE (p5 ACRES "1 •
BLOCK FILING
SUBDIVISION LOT
(12 DIGIT NUMBER)
THIS INFORMATION CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650
SITE ADDRESS, 1 "1 J- 1�� C„ E (.2_3i
DIRECTIONS TO SITE
PROPERTY OWNER:
MAILING ADDRESS:
2111 C 12 -
HOME PHONE: (.C10) '2'713
EMAIL ADDRESS: -v „C, 0 Ai 6, R-4 P • Aif
APPLICANT NAME:
MAILING ADDRESS: _
HOME PHONE: ( )
EMAIL ADDRESS
DESCRIPTION OF BUILDING (EX: HOUSE, MOBILE HOME, MODULAR, SHOP, OFFICE) Pf. L I , Q D L.
H I F} V`4 rn S1(,
CITY G1 k c. L ST CO ZIP ;6(0_31
Ip WORK PHONE h - I sic")` D ! ( FAX (61-76) 3G-3- qq/q
ST ZIP
FAX ( )
IF OBTAINING A REPAIR PERMIT, WHAT IS BEING REPAIRED?
NUMBER OF PERSONS '2 -
NUMBER OF BEDROOMS
BASEMENT PLUMBING
5
/NO
BATHROOMS: FULL 2. N 2 .4
PUBLIC WATER SUPPLY
PRIVATE WATER SUPPLY YES /INO
IN FLOOD PLAIN AREA? YES / O'
a nus+ he
Ns PERCOLATION HOLES MARKED
FOR INSPECTION? giMli
CENSUS TRACT
NAME -DMI i lD t (1 S.:CA ?lc
WELL /CISTERN PERMIT #
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