HomeMy WebLinkAbout20193553.tiffMeter Readings
Account Number Description Previous Present
000960-01 1000 Gallons 1627 1630
Read Dates
Usage Read Code Previous Present
3 Actual 01/18/2019 02/21/2019
Previous Balance
Payment — Credit Card
Water Minimum Charge
Water Usage Charge
CBT Surcharge
$18.15
—S18.15
S16.50
S1.65
S0.00
Please w•te account number on all payments and correspondence.
"cu may pay your bill at www.cwcwd.com
Water
F M A M J J A SONDJ F
Total Current Charges $18.15
Total Amount Due $18.15
Customer
Curtis F & Celeste Hurd
Service Address
4505 Cour y Rd 13
Billing Date
02/25/2019
Due Date
03/15/2019
Account Number
000960-01
Amount Due
$18.15
Annual Allocation
YTD Usage
300
11
Central Weld County Water District
2235 2nd Avenue
Greeley, CO 80631
970-352-1284
Meter Readings
Read Dates
Account Number Description Previous Present Usage Read Code Previous Present
001635-01 1000 Gallons 905 907 2 Actual 01/18/2019 02/21/2019
Previous Balance
Payment - Credit Card
Water Minimum Charge
Water Usage Charge
CBT Surcharge
$16.50
-$16.50
$16.50
$0.00
$0.00
Total Current Charges $16.50
Total Amount Due $16.50
Pease write account number or all payments and correspondence.
You may pay your bill at www.cwcwd.com
Water
/12/1
35
D J F
F MAMJ JASON
Customer
Curtis F & Celeste G Hurd Jr
Service Address
4525 Colorado Blvd
Billing Date
02125/2019
Due Date
03/15/2019
Account Number
001635-01
Amount Due
$16.50
Annual Allocation
YTD Usage
300 28
Central Weld County Water District
2235 2nd Avenue
Greeley, CO 80631
970-352-1284
Processed by:
Scanning Cover Sheet
for
Septic Permits
Permit #
Permit Type:
Situs Street Address
Situs City, State, Zip
G19840173
Health I EHS History / EHS Conversion History
4535 CR 13
Sec/Town/Range: 12-01 N -68W
Parcel # (12 digits) 146712100033-R5718586
Owner Full Name: HURD CURTIS JR
Owner Address: 4535 WCR 13
ERIE,CO 80516
Contact Name:
___ .._Contact Address:
Application Status: Finaled
Application Date: 03/11/1996
Owner Phone #: 303 8334717
Contact Phone#
Information above has been Verified in Accela by employee noted below
January 05, 2009
Date
Report ID: EHS00024v003 Page 1 of 1
Print Date -Time: 1/5/2009 9:24:20AM
(. r\GIiIN,k11.,•i_AI_'l.'I....l.CAN ; I,,I„IPY....ihJci"ID wcHD I AY , 1984
54.
H>16 -11.1P
:I:NDIV:I:I)LJAL.. SEWAGE oIs1::OSAI... SYSTEM PERMIT NO. (:x.._84017
OWNER 1-li1 I), (::L.JI: I :I:ia' ,.Jr,.,
WE::I...I) COUNTY TYY HEALTH DEPARTMENT
1
ENVIRONMENTAL HEALTH SERVICES
1516 HOS'P:1:TFlI... ROAD, GfkI:_1..:I_.IE:Y, CO 80631
353-0540 EXT. 270
NEW PERMIT
ADDRESS 4535 WCR 13 'PH ( 303 ) 833-4717
E:.i:.LE=. CO 80516 '
AlI)I)l:d::S,S' OF PROPOSED SYSTEM E...M 4535 WGF';i .:7
ERIE CO 80516
LEGAL DESCRIPTION OF SITE: .':i i::. ^t SE;, (., 1 2 ' 'T' lhi F'` i R I`J Lr 68
SUBDIVISION: LOT 0 BLOCK 0 FILING {•)
USE TYPE:
RESIDENTIAL yBATHROOMS
SERVICES:. PERSONS 1{A1("(�'�(.lO1'I.S' 1.00 LOT SIZE 40..0() ACRES
BEDROOMS 2 BASEMENT PLUMBING N(:; NO WATER SUPPLY I LJi I.E._
APPLICATION FEE $()r ; S)
F�EC' I) BY !ANGEL.., MAR 1
DATE:: 1 • /04/84
SIGNED BY CUR T :l: S F. I I L1 R D , J R .
DATE::. 10/04/84
PERCOLATION RATE 37.6 M I N I : I::. I'4 INCH €. I"I WATER TABLE DEPTH 80 FEET.
S P SUITABLE PERCENT GROUND) SLOPE ::_' DIRECTION
SOIL TYPEis
REQUIRES ENGINEER DESIGN N(1
FROM (:isi THE APPLICATION INFORMATION SUPPLIED AND THE ON —SITE is(:)]:I... PERCOLATION DATA
r1
THE FOLLOWING ,M:I:N1:WiL.JiM :l:N.S'TAL..l_.AT:L.C)Nr E:'EcIF]:cl1 i :i.ON, ARE i::I:::O(.J:I:RED:
E:::F''T:iC TANK i000 GALLON: , ABSORPTION .TRENCH 550 SQ. FT
ABSORPTION BE::I) 7i 4 ,S'( . FT.
IN FaDt):I:'T':I:(:)N, T'FiI S ' F'E::RMIT IS S'l.JI;',.JIE:ci TO THE FOLLOWING AI)I):I:'T-IC)NA1... TERMS AND
CONDITIONS:
THIS PERMIT IS (.,RANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT
BEREv(:JKE::I) 'OR •s'usF'E::NI)F_I) BY THE WELT) COUNTYHEE: AI...TI"I DEPARTMENT ro REASONS SET
FORTH IN THE WELD COUNTY :I:NDIVI!)L.JAI_. SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDING
FAILURE T(1 iM1:..1:::-T ANY TERM OR CONDITION IMPOSED L THEREON DURING TEMPORARY OF; FINAL
APPROVAL. THE ISSUANCE 01'' THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE
DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR INADEQUACY OF THE
S'I:::UJA€:;1::: DISPOSAL SYSTEM.
PAUL..S'ON, MARY 10/29/04
ENVIRONMENTAL SPECIALIST DATE
THIS PERMIT IS NOT 'T'RANSF'i:RABI..,E..: AND SHALL BECOME V(:1:1:D IF SYSTEM CONSTRUCTION HAS
N€:1'T' COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF
THIS PERMIT THE WEE_.!) COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI—
TIONAL TERME AND CONDITIONS REQUIRED TO MIE:I:;:T (:1L.JI: REGULATIONS ON Fl CONTINUING BA—
SIS. F':I:NAI... PERMIT AlF'RC1'vr"AI... IS CONTINGENT UPON 7111::: F'':I:NAE... INSPECTION T':I:C)N OF THE COM—
PLETED SYSTEM lM BY ..(.HIE::: WI..:I...I) COUNTY HEALTH DEPARTMENT.
SYSTEM INSTALLER 'r F':I:NAI.., INSPECTION DATE
NPs
SYSTEM ENGINEER ...................... ............................ APPROVAL _� ....... .
"I' Y i EE OF SYSTEM INSTALLEDITAngks,, I::: N 1i :I:1 C)' . 'i ; NIAL SPECIALIST
THE ISSUANCE (:1F THIS PERMIT DOES NOT :I:NiF'I...Y COMPLIANCE WITH OTHER STATE, COUNTY
OR L..00A1_. REGULATORY OR I11_l:[LDING RI::LLJIREMiE:N'i'S, NOR SHALL IT ACT TO CERTIFY THAT
THE SUBJECT SYSTEM W:I:I._E... OPERATE IN COMPLIANCE WITH APPI._1:(:;F1:C+1...1::: STATE, COUNTY Y AND
I...C)CAll_. REGULATIONS ADOPTED EI) F`I:_F;s'L,.I r T TO ARTICLE 10, TITLE "` CRS i`r' '3, AS AMENDED,EXCEPTFORTHEPURPOSE OFlE:ST'iAiI:tl_.:I:S1-1:I:Nc FINAL APPROVAL.. OF " AN INSTALLED SYSTEM FOR
FSS'l.JA\C;l::: OF A I...(:lC;Al... OCCUPANCY PERMIT PURSUANT TO CRS 1973 25-10-111 (2).
65-
tr
H. St a
- _ _y rusi. sir.
WELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SERVICES
1516 Hospital Road, Greeley, CO 80631
353-0540 EXT. 270
OWNR E"' N �" �' a �• ADDRESS 41--(15.- err) .u.
ADDRESS OF PROPOSED SYSTEM • 41.35-- t.cuc X- /3 ,
LEGAL DESCRIPTION OF SITE: PT- %✓ il� 3,' S /.2 , T__/____, R 67
SUBDIVISION LOT ; BLOCK , FILING
USE TYPE: RESIDENTIAL V' tioh1 ie I-I-asT- INSTITUTION
COMMERCIAL OTHER _
SERVICES:_ PERSONS_ - ` BATHROOMS_ LOT SIZF
BEDROOMS =. r - BASEMENT' PLUMBING r -- WATER' SUPPLY•} 14./e -/-/:• '-
TYPE OF SEWAGE DISPOSAL REQUESTED: . -1-' rc._ • ci L Oc0'.7 r -re D /Q
Co.„)
New
Repair
BP
PHONE S3 -' 1'
Applicant acknowledges that. the completeness of this application is 'conditional upon further mandatory and additional 'tests
and reports as may be required by.the Weld County Health Department to be made and furnished by the applicant or by the
Weld County Health Department for purposes of the evaluation of the application; and 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 1973,'as amended. The applicant certifies that the proposed system will not be located within 400 feet of a corn=
munity sewage system. The undersigned hereby certifies that all statements made, information and reports submitted here-
with and required to be submitted by the applicant are, or will be, repi'esented to be true and correct to the best of my.knowl-
edge and belief, and are designed to be relied on by the Weld County Health Department in evaluating the same for purposes
of issuing the permit applied tor herein. I further understand that any falsification or misrepresentation may result in the denial. --
of the.: application or revocation of any permit granted based upon said application and In legal action for perjury as provided by law..
.. Application fee / oO D
'Ree'd-by `1`Zlr - r (4----r,--"t.14 Datei'0 - -` --u _
OwnerlAgent Signature -Da a 't
- *,*,*•*-474,4—*. *.*'e *.w:--
v
FOR DEPT. = :` PERCOLATION. RATE 73:1 • - WATER :TABLE -DEPTH -7' 1-
- USE ONLY = : SOIL TYPE PERCENT GROUND SLOPE c NG.
•.. • ,• REQUIRES-ENGINE'ERDESIGN ( ) YES•
w'+r w * w w :'w :* a e ;w'r,t * * • w eww -w _• a w • w; e, * :'e -w:.• R • -s, -w * • *' • * e.e:.e- ::-:w: a t -'.s `w w w :.* •w e..•
• " -INDIVIDUAL:SEWAGE DISPOSAL SYSTEM PERMIT. -
,froin the aPplication intorniatiOn-IsupPlied and the On -site SOH percolation data, the folloWlng specifi-
•
cations are required: _ s--= .•
:+
or is .
SEPTIC TANK 1.c � GALLONS, ABSORPTION TRENCH S C� SQ FT i urf '1`
ABSORPTION BED -'1 l `- - - .. ... SQ. FT. ..- -'
f
In addition; this Permit is. subject to the following additional terms and conditions:
1 ‘7,4„1 C�� . f�.p y ,. �, .*-^r�r Lv +{. • t iA. ra►nt O F
This. Permit is granted temporarily, to allow construction to commence. This ,Permit may be revoked or_suspended�bythe Weld
County Health Department for reasons"set forth in the Weld County Individual Sewage Disposal System Reguiations,'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.fhe failure or inadequacy of the sewage disposal system.
t\t\ vjE. _ _._ D nvironmental Specialistate;
• This Permit is not -transferrable and shall become void If system'construation has.•not-cornmenoed..wlthin�.oneyear_of.its 1 seance.
.Before issuing: final: approval of this Permit the Weld County Health .Department reserves the right to Impose.` additional -term_ s
'and conditions *lilted to meet our regulations on a continuing basis. Final Permit approval Is'contingent upon the final in-
• spection of.the completed system by the Weld County Health Department.: ' , v: 4,. �, ;
J.
. SYSTEM CONTRACTOR FINAL INSPECTION
SYSTEM ENGINEER APPROVAL'
..'_Environmental Specialist ---...ti:-- Date
The issuance.of this Permit does not imply compliance with other state, county or local regulatory or building requirements,
nor shall it aat to certify that the subject- system will operate In compliance, with applicable state, county and local regulations
adopted pursuant to.Article:10, T itle.25, CRS 1973, as amended, except for the purposes of establishing final approval of an .
installed system for. issuance of a -local occupancy"permit pursuant to.CRS 1973 25-10-111(2).
5-
Original•Applicant; Copy-WCHD WCHD-EHS February, 1981
/54
S ITf5,r.-VALUATiON Owner
App lfr'c'at=n No. [�?j�Sice
x.41 s ,rzNa
LJC 11— )
Dace. 1 Q (0 %s Sub_ 10'or Lot_
Block
/2-r1 RJR
Filing
•PERCOLATION TEST DATA:
Start Timei(,LS
Hole
No. .
Hole
Depth
inch
H2O
Remain,1�5iaaS'
inch
46
min•
‘175`t'
`� 1
min.
y
,1'S
min.
\V
1�'55Z`,
rain.
Lb 5-
1 �
min.
min.
min.•
min.
clin.
min.
inch
I
5,...
l
Cj
1 Qp
1 its
-1 os
1?1s
bTI
'ii 1i
4 kil
logo"
b Q
I A
(0. sl
4-5A
al_
aio-k
a
aL
2
3-' tko
O
Cats
kois
wet'
ka 'a-
( S
IDS'16-
k)-(1,
G °ll
c 2k
a r, A
Qq `
a-i
ab
0
7
Z
,�
ILg
-13,5
Noll
1ST
1\
\\ A
1*
%
5
1,s
Iz
--II-O
kocks
oc-t11-
,42ott
toplit
0.--7.00
3 *
X91`1
6-i,
1
a.
6
1.
(
0V
b�
1
X43?≥,
'17 2
1v
1 Z.d
`I oSo
I Lk
-I'LL,
1406f
I3a is
+L
110
1(j �
I S
19
All measurements in .uma unless otherwise
* - add H2O'41,h,p
1 L t d 5 v- r `.\- O TnU•...it.- C.Qt*►—'6
nv ronmental Health SlecialistP\
indicated.
\S
1 . ft.} ... 44 ,
\
61-D +A
v". +
Total
a5. (o
Average Rate
3.1ak0�
k xa.c2z:,
<wv-c
PLOT PLAN
a
4 v.--.1-
dor
y•
I
Depth
inches
SOIL PROFILE
'Description
o - ac,''stAeA�- �---
D c�
4.
ThHIGH PLAINS ENGINEERING & DESIGN, LLC
555 MAIN STREET, P.O BOX 1077. HUDSON, CO 80642 • PHONE: 303-857-9280 • FAX: 303-857-9238
March 26, 2019
Integrity CDL Academy, LLC
Attn: Bonnie Babcock
4525 Colorado Boulevard
Dacono, CO 80514
RE: Certification of the existing septic system for the existing residential/commercial
building located at 4525 Colorado Boulevard, Weld County, CO.
Job #19-8757
To Whom It May Concern:
The original 2 bedroom mobile home septic system was constructed with Weld County
septic permit #G-19840173. The septic system was constructed with a 1000 -gallon
septic tank and 3 trenches 100 feet long for a total of 900 sq. ft. The 1000 -gallon septic
tank was certified by Septic Surgeon on March 22, 2019. Please reference the attached
System Cleaners Checklist and sketch.
The proposed use will be for a CDL training office with a maximum of 10 visitors on every
other Monday, and up to 4 full time office employees. They do not have a dish washer or
clothes washer and never use the shower.
Design Flow:
4FTE@15GPD =60GPD
10 VISITORS @ 5 GPD = 50 GPD (every other Monday)
TOTAL FLOW = 110 GPD
The original OWTS was designed for a 2 bedroom home 4 300 gpd which Weld County
Health Department required 550 sq. ft. STA but the STA that was installed is 900 sq. ft.
After reviewing the existing septic records with a reported percolation rate of 37.60 minutes
per inch, we have determined that the size of the existing STA will be adequate for
proposed use for the CDL training facility at the above described site. The existing STA size
will be adequate for the new design flow of 110 GPD.
Disclaimer: The existing septic system is 35 years old. High Plains Engineering & Design,
LLC has not inspected the piping and STA chambers and have no knowledge of how well this
system has been maintained or pumped or used in general. We make no certification or
warranty for how long the system will continue to function properly. The owner and/or
renter should follow the following O & M strategies to prolong the life of the system.
OPERATION AND MAINTENANCE:
The owner must realize an OWTS is considerably different from public sewer services. The
owner must be aware of and assume the responsibility for continued maintenance of the
system. The system is relatively maintenance free, but the owner must have the septic
tank pumped. We recommend the septic tank be pumped at the end of the 1st year of use
to monitor sludge buildup and then at a minimum of every 2 years or as required by the
governing agency. Effluent filter and screened vaults, as applicable, are to be cleaned at
1
the time of pumping or as needed. There are also daily considerations, such as not putting
plastic or other non -biodegradable material down the sewage disposal system. Also, water
use must be carefully monitored so toilets are not allowed to run when seals malfunction.
To illustrate the point, a running toilet may consume in excess of 1000 gallons per day if
allowed to run which could flood and irreparably harm the system.
We also caution against installation of water softener. The high levels of salt from the
backwash of a water softener is detrimental to all on -site sewage disposal systems and a
separate drywell should be constructed for the backwash waste if a water softener is
installed. No landscaping or plastic can be used over the disposal field which will reduce
evapotranspiration from the disposal field. Chemically treated water from a swimming pool
or spas should not be introduced into the OWTS. Livestock and vehicular traffic must be
fenced out from the absorption field area.
Please call this office if you have any questions or concerns.
Sincerely,
Todd M. Schroeder, PE 33548
Attachments: System Cleaner CheckList and Sketch, Existing Records
Copy: Governing Health Department, file
This report was prepared for the exclusive use of our client and is not intended for any other purpose. Our report is based on
the information made available to us at this time. Should additional information become available, we reserve the right to
determine the impact, if any, of the new information on our opinions and conclusions, and to revise our opinions and
conclusions if necessary and warranted by the discovery of additional information.
Compank Name:
Customer Name:
Wbkl County HeIth Dept
Syn Cns Checklist
(6,t - c. rd
Address of Pumping: L/5"..)-
Pcmping Date: _) -
:. Tank Size- /(.7CC Gallons Pumped; /G'LC
Cr( v/4/ &.;q4—..4,
Phone number:
F/1/
Y. Lift Station: Yes No X/ if ties. functioning: Yes No
Pump Alarm: Yes N(c 24 if ‘es. functioning: Yes No
Excessi' e water running hack into tank from field? Yes No
If>es. estimate in gallons:
4 Liquid level in tank oNer inlet line? Yes No
lank Construction check one
Concrete (7e. Metal Brick _ Plastic or Fiberglass _
Cesspool or Seepage Pit Other
!,. Tank Construction Obsen ed: One Compartment Two Compartment
inletoutiet tees and, or baffles in good condi€ion? Yes No
8. Filter on outlet cleaned and inspected i if applicable)? Yes No
Access to clean -out lids within 8 inches of grade.'
inlet: Yes .J No Outlet: Yes f,No
W. 20 mi. plastic replaced and sealed o‘ er tank lid i flood plain onl` i' Yes
i i . Tank structurail} sound and water tight:' Yes No
12. Access lids structurally sound and water tight? Yes (XNe__
13. Ohs ious cracks. leaks obsen ed? Yes No 1-
if.es. explain area:
14. Other conditions noted u hich mat affect proper functioning of system?
�c�Sf6.0.7 S rlt.Az/
12
Reason for Service:
Maintenance Real Estate Sale
36) d?'/ -/975
x
.6'4/rcr rti
Emergenc} Backup Other
)0) g ) `r- /975
GYrlei
LLB
N
M1
Scanning Cover Sheet
for
Septic Permits
Permit #
Permit Type:
Situs Street Address
Situs City, State, Zip
G19840173
Health / EHS History / EHS Conversion History
4535 CR 13
Sec/Town/Range: 12-01 N -68W
Parcel # (12 digits) 146712100033-R5718586
Owner Full Name:
Owner Address:
Contact Name:
Contact Address:
HURD CURTIS JR
4535 WCR 13
ERIE,Co 80516
Application Status: Finaled
Application Date: 03/11/1996
Owner Phone #: 303 8334717
Contact Phone#
Information above has been Verified in Accela_b, employee noted below
X
Processed by:
January 05, 2009
Date
Report ID: EH500024v003
Print Date -Time, 1/5/2009 9:24:20A.1111
Page 1 of 1
' ! ' L.. is r:; r i c ! r ; f: OF' .... I,:1 C I"i J:)
4:11: J" I o -- i::, i" I ,;; MAY, 1984
:I:NI).i'V:}:!)l..Jr-"il... SEWAGE :()i:sF'or.`~ :rl... SYSTEM PERMIT NO,
..i I 1,. 1 l i�' 4.J n G-840173
:IRi E:R FiI.JI::1), E::I.IF .{ :I:SS' JR.,
iJI..:€..l:) COUNTY Y HEALTH I I)I:I:l:: r' F;..I NfI:::it..I.
ENVIRONMENTAL HEALTH SERVICES
l:{_I:::::
1516 HOSPITAL ROAD, AI), GPM ...FY, CO 806'31
353-0540 EXT, 270
N IE: W PERMIT
ADDRESS 4"53 (.i(: i=: 13 I::•il (30 3) 833-471
ERIE CO 80516 :
I)I)F Iw:,SS' OF PROPOSED {;'Y `rlENi X4.`.5:E WCP13
ERIE CO 80516
.`.; J: T' I::: ,'.> i::: 4 EEC f:; 1 1 W I::� :i Ft; i`J I.r 68
... I::: CT �F J-.. DESCRIPTION f: i F=' � r
UI:+I):I V:I: S':I:ON : LOT iii :f:sI._O1::;It 0 FILING 0
J I::: TYPE: RI:::S'J:I?f:::N r:I: i...
I:: -I -;\I.1. t„E::SPERSONS 3 BATHROOMS S i :. (00 €.. C]T SIZE 40,00 ACRES
BEDROOMS n' BASEMENT PLUMBING NO WATER SUPPLY F4,11 —:LL
)F:•I'1---:I: f:;r1..1 :I: ON FEE $0.00
i:::C;'..1) BY F4r')\1'•EL, MARY,
._
DAIL 10/04/94
DATE 10/04/84
SIGNED BY fEl„ll:':T:I.i`' I::', F.IL.1FcC), :.JR.,
:'I:::I:,:f:;CII_.r'r.r [O1N RATE ;, ' 6 MIN F:'Il:I:; INCH WATER F;. T rl1:;L..I:,: DFI:: i I.i f:}
C1 :1: I.,, TYPE ,r. I I..: U J: r r'7B I... E PERCENT GROUND ELOPE t i I..: 2% DIRECTION
;;1=.:wU:I:RE::S ENGINEER DESIGN N NO
I UIN THE APPLICATION INFORMATION :I:Oi'`l SUPPLIED r1On TFII.:. ON — SITE ITI..: :.''Oa:1... PERCOLATION DATA
THE i O I-.. L.- C:' W :I: iN (:T , N :I: N J: M U i`'i INSTALLATION SPECIFICATIONS A F: E:: REQUIRED:
I::-#'' I :Ec. TANK. i 000 GALLONS, ADSORPTION TRENCH 550 0 ,SQ. FT,
.,
OR
ABSORPTION BED 714 S f , FT,
€: N ADDITION, THIS PERMIT IS , t.I I' ..J I : f: -r. .r. t:l 'r I -'I I : FOLLOWING ADDITIONAL TERMS r'•i Ni T)
:;f:iNI):I:T:LONS:
'MIS PERMIT 1 IS GRANTED E I) rE::MF'ORr'1R:TI.,.Y 10 ALLOW CON`;'-I-k'Iuf: r ION TO COMMENCE, THIS PERMIT
r
IrlY BE I;1:::V(:lKI:::I) ' f:lk SUSPENDED 1'•r• THE WI:.:I.-.1) COUNTY HEALTH DEPARTMENT FOR REASONS SET
-ORTI'-I IN THE I:iiL.,I) COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDING
AI€._1.JRI::: TO f't1:::i:::r ANY TERM OR f::Oi'Ic:i: I .I:OiN IMPOSED IHI:::F:,I::.ON DURING TEMPORARY OR FINAL
l''F''I. fa'v'ili... h THE.: ISSUANCE OF:. THIS F-'I:::I: Ml I DO1::.S Ni:' i NON:a I J:T.f.JTE:. (>isSuF'il:':r.:F.ON BY THE
DEPARTMENT OR :I:T,S E::MF:'I...ui:-.I::.S OI" I.-.:I:i-`U:I:I....I. I Y I-i::lk (FIi..: FAILURE OR INADEQUACY OF THE
E':W(1f:,I::: DISPOSAL SYSTEM,
.
i'rll.11...;sON, MARY-- 10/29/84
/84
ENVIRONMENTAL SPECIALIST DATE::
THIS PERMIT IS R! f:i I TRANSFERABLE (1 F'N t) SHALL BECOME VOID IF :i Y ,:>' -1- f :: iii CONSTRUCTION HAS
.l f:. T. COMMENCED WITHIN f : i N i:: YEAR OF ITS
S ISSUANCE h t }:.: F: O R1_: ISSUING FINAL APPROVAL OF
THIS PERMIT T F'} I = WELD COUNTY HEALTH DEPARTMENT Ft I:E a I:: R V i:: E .1 I -s' E:- RIGHT TO O IMPOSE ADDI—
TIONAL TERMS' ciN1? CONDITIONS REQUIRED TO NiI..:I::_T OUR: REGULATIONS LJ cY':€ONS ON rl CONTINUING 11rl"'-
-. ., COUNTYI ...DEPARTMENT. IN THE F::I:i'+IAi-.. INSPECTION :i:ON toE:. THE I Oi1—
..a .. I-=:I:iv,rll... PERMIT APPROVAL C::> CONTINGENT l.11::'f:
:'L.-i.E r I_:I) �'YS' I I:::M I• Y THE LJIfE€....f� HEALTH 11 I
iYSTi:_1•'i INS'TOI...L-.I..:I - : FINAL INSPECTIONDOTE
Y ; I- i::- i1 ENGINEER — -......-..._....................................... APPROVAL
TYPE OF EYSTEM INSTALLED ENVIRO
i,1 l r::•i I-.. ; =• F'!:- i:::l: r i._ :I: S , I.
THE ISSUANCE l: OF THIS PERMIT DOES NO i :Is1PL..`r COMPLIANCE W:1:TL'I OT-I-1I..:I':. ,EE1'OVE, COUNTY
R LOCAL REGULATORY (:II'i BUILDING F, I:::fi11:I:} I MI:::NI S, (`'OI SHALL :I i i1I:d.I. TO CERTIFY THAT
IIIE SU(1 Ii .:.i
:,''r :. i f:::i'ri Iil L L f:lf'I.:I,A 1 r.. TNI 1i1-? I .i:A•,,...: '1 APPLICABLE S1
i:Y I E, COUNTY AND
DcAL.. R I::.L.=LJI_i'i ; I IP..E\ ADO/ f i " '.,1 PER NT TO
(i; i0 !: 'i;�''
i.:L..r'! I_`uL. III 13 1
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•
WELD COUNTY HEALTH DEPARTMENT
`" : ENVIRONMENTAL HEALTH SERVICES
1516 Hospital Road, Greeley, CO 80631
353-0540 EXT. 270 BP
OWNER.,� ' ci ADDRESS 4:76 PHONE :.r i" 7
ADDRESS OF PROPOSED SYSTEM 453 S LA) R / 3 p G,
LEGAL DESCRIPTION OF SITE: PT-5Z%V //C S / ,
SUBDIVISION LOT , BLOCK , FILING
USE TYPE: J -+n r7- INSTITUTION
COMMERCIAL OTHER____-.
SERVICES: - PERSONS BATHROOMS / LOT SIZE
BEDROOMS BASEMENT PLUMBING WATER SUPPLY -'I Q 1>✓
TYPE OF SEWAGE DISPOSAL REQUESTED: — ,7-/ 1 c_ .c.1 Z Qc C P .1 r n /i
Applicant acknowledges thatthe completeness of this application is conditional upon further mandatory and additional tests
and reports as may be required by the Weld County Health Department to be made and furnished by the applicant or by the
Weld County Health Department for purposes of the evaluation of the application; and 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 1973, as amended. The applicant certifies that the proposed system will not be located within 400 feet of a com-
munity sewage system. The undersigned hereby certifies that all statements made, information and reports submitted here-
with and required to be submitted by the applicant are, or will be, represented to be true and correct lo the best of my. knowl- _
edge and belief, and are designed to be relied on by the Weld County Health Department In evaluating the same for purposes
of issuing the permit applied for herein. I further understand that any falsification or misrepresentation may result in the denial
of the application or revocation of any permit granted based upon said application and In legal action for perjury as provided by law.
Application lee / G-43
- _-Owner/A Owner/Agent Signature :� Date
Recd by -1-1—IO2-4-). c,.),--1 v Dake_/D S 4 9 __
* * * * * * * * •r •- • •* i.,• * * * * • *•r • * r * *'* *'*`• •-a' *.• • **. * * * * r r • * * *,*'• * •
FOR DEPTPERCOLATION RATE_ 41 -I,00--WATER TABLE: DEPTH-
U5E ONLY SOIL TYPE c -5, -....r. ---z sc,L,A PERCENT GROUND SLOPF c.
RESIDENTIAL 1� rrioki 1P
_- ' REQUIRES ENGINEERDESIGN ( ) YES No ` i '
* 4,* r..*: r_* * *.*-:*=a *, -a:* *N*i*-*'*'.*'* a:, -r * •' * w. * * w a - _ _ _ _ _ _ -�.
INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
From the application information -supplied and the on -site soil percolation data, the following -minimum installation specifi-
cations are required: . - = •.'
SEPTIC TANK \ GALLONS, ABSORPTION TRENCH 5 f SQ. FT. 7«^fr`
or -s.
ABSORPTION BED -1 ii- - - SO. -FT.: •
in addition, this Permit is.subject to the following additional terms and conditions: ;
New
Repair
r - r
1 _
This Permit is granted temporarily to allow construction to commence. This Permit may be revoked or.suspend_ by theWeld
County Health Department for reasons -set forth in the Weld County Individual Sewage Disposal System Regulations, including:
- failure to meet any term or condition imposed thereon duringtemporary 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_sysfern.
ynvlronmental Specialist ._-
This Permit is not transferrable and shall become void if system` construction has: not cotnrriencedwwithin one year of Its is tuance.
Before issuing final approval of this Permit the Weld County Health Department reserves the right to Impose additional terms
and conditions required to meet our regulations on a continuing basis. Final Permit approval Is:contin genkuponthe tin* in-
spection of the completed system •by the Weld County Health Department.;
SYSTEM CONT,FIACTOR FINAL INSPECTION
SYSTEM ENGINEER APPROVAL_
;.Environmental Specialist Date.
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 slate, county and local regulations
adopted pursuant to Article 10, Title 25, CRS 1973, as amended, except for the purposes of establishing final approval of an
installed system for issuance of a local occupancy permit pursuant to CRS 1973 25.10-111 (2). -,-`
Original -Applicant; Copy-WCHD WCHD--EHS February, 1981
/5‘
Owner C &*tS
[T`E=VALUATION
a p 1 i'a
No.osscfsicc_
Sub
:0 ph
Lot
Block
/2-T j R K,g
Filing _
ER.COLATION TEST DATA:
Start
tole
lo.
Hole
Depth
i'"i
H70
Re�ainli�,oa�
inch
4.a
min.
d
,\+
min.
`o
,r`A'S
min.,
VD
i\''S.
min.
to,.gig
,Z'
min.
min.
min. -
min.
min.
min.
inch `
I
`1
O
14-5
171s `ts
It
oc \_l
`-T
I
1O
45A
al_
a o/ 4
a•
aLt
2
._
i,
4
1 C0
.,
o
t.2 iS
I.��i
QDkcj
[D4 5
‘,07-'
(S`
iD �-
to scr
to S
_ l�-i L
G a�`7
?k
a7 A
94,
�-
ae
0
iq 1 i
1�
\
1 7
t*
is
4
1t
1 5
- 1
`� ? `
411
1l
1 us
1
`t'xp
`_-
� ��o
3 *O,I,,*
1
a--
6
ISO
v
b1
"t1.
-\K-31,,,
-
'1(,
I?
1040
(ZI
-11-1
`1'F(
I 6 1C
_'112
q--2.--yk LOA 1 74 IS
_ 19
1 measurements in .mm unless otherwise
- �
add H2O /
- , t 0,"'e 1-kt.r -\ ' .. CQcu-
Environmental Health Specialist
a
indicated.
A,p 1S �
A]L ? -A-'-9 `{.Q• ✓\..
\ r j.. ` o l Cadclz,
Total
G1a14,6
Average Race
7
31.b6
PLOT PLAN
i
Lss-
i7-a-
Depth
inches
0 -
SOIL PROFILE
'Description
ctrtic
Fe.- QAT
Y\o A t.'o
Hello