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Home My WebLink About20193959.tiffORIGINAL PERMIT APPLICANT(S) BROKEN ARROW INVESTMENTS LLC AUTHORIZED AGENT J Et T CONSULTING INC (YORK, J.C.) PERMIT TO EXPOSE WATER IN A PIT APPROVED WELL LOCATION Water Division: 1 Water District: 3 Designated Basin: NIA Management District: N/A County: WELD Parcel Name: N/A Physical Address: NIA SW 1/4 NE 1/4 Section 4 Township 5-0 N Range 85-0 W Sixth P.M- UTM COORDINATES (Meters, Zone:13, NAD83) Easting: 528357.0 Northing: 4475536.0 ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL 1) This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of this permit does not ensure 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. 2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in accordance with Rule 18, 3) Approved pursuant to CRS 37-90-137 (2) and (11) for for the construction and operation of a well (gravel pit pond) in accordance with the temporary substitute water supply plan approved by the State Engineer on August 1, 2018, for the Derr Pit, Division of Reclamation, Mining Et Safety Permit Number M-2008-017. The well (pond) shall not be operated unless it is included in a substitute water supply plan approved by the State Engineer ora plan for augmentation approved by the Water Court. The water supply plan for this pit is currently valid through July 31, 2019, and if it is not extended or if a court decree is not entered fora plan for augmentation, diversion of ground water from this well must cease immediately. 4) The use of ground water from this well, in addition to dewatering and evaporation, is limited to water lost with the mined product and dust control. No other use of water is allowed unless a permit therefor is approved. 5) The total surface area of exposed ground water at the site is limited to a maximum of 31.85 acres, and may not exceed the amount covered under a water court approved plan for augmentation or substitute water supply plan approved by the State Engineer, 6) The annual amount of ground water to be appropriated for operational purposes (water lost with the mined product and dust control) shall not exceed 9.41 acre-feet or the amount covered under a water court approved plan for augmentation or substitute water supply plan approved by the State Engineer. 7) The owner shall mark the well (gravel pit pond) in a conspicuous location with well permit number(s) and court case number(s) as appropriate. The owner shall take necessary means and precautions to preserve these markings. 8) A totalizing flow meter must be installed so as to measure any pumping from this gravel pit pond and maintained in good working order. Permanent records of all diversions from the gravel pit pond, tonage of mined product, and the surface area of ground water exposure shall be maintained by the well owner (recorded at least annually) and submitted to the Division Engineer upon request. 9) Pursuant to Rule 9.33 of the Water Well Construction Rules, ground water ponds and gravel pit wells are exempt from the minimum well construction and location standards except for contamination considerations as stated in the Rule. The owner shall take necessary means and precautions to prevent contaminants from entering the ground water pond or gravel pit well. 10) Pursuant to Rule 17.1.5 of the Water Well Construction Rules, the owner shall submit, after initiation of construction, site plan and crass section drawings showing the extent of intended excavation, the maximum depth of the pit or pond, the initial static water level, and the date of initial ground water exposure to the atmosphere. 11) The boundaries of the gravel pit pond shall be more than 600 feet from any existing well, completed in the same aquifer, that is not owned by the applicant, excluding well permit nos. 223887 and 223885-A, which were the subject of case no. 185E07 (vacated). Printed 49-11-2499 For questions about this permit call 343-8bb-3569 or go to www-water-state-co-us Pate 1 of 2 WELL PERMIT NUMBER 82868-F RECEIPT NUMBER 3686683 NJ::,TE: µvii.. , 11.J. 75 as:D-C ';,i p I._uv.l C, SAR:''.FI CRUtKER Exp:r.i Dr L'L7.C; 2020 k" ...: 1' L _:., 1 ,.u44.1; :: k: .,., : L''.'F..'t _.... F:, " - - - Scanning Cover Sheet for Septic Permits Permit # Permit Type: 619940549 Health / EHS History / EHS Conversion History ,Situs Street Address 960 E C STS Situs City, State, Zip Sec/Town/Range: 04 -05N -65W Parcel # (12 digits) 096104000067-R0063795 Application Status: Finaled Application Date: 03/11/1996 Owner Full Name: NOFFSINGER MANUFACTURING Owner Address: 500 6TH AVE GREELEY,CO 80631 Owner Phone #: 303 3520463 Contact Name: Contact Address: Contact Phone# Information above has been Verified in Accela by employee noted below August 08, 2008 Report ID: EHS00024v003 Page 1 of 1 Print Date -Time: 8/8/2008 10: 32: 55AM r H_'P1O6P INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT NO. G--940549 WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICES 1517 16TH AVENUE COURT, GREELEY. CO 80631 353—.0635 EXT.2225 :EF'AIR PERMIT D'+)N•ER NCF=SINEEF: MANUFACTURING ADDRESS 500 6TH AVE PH (3:303', 352—P)463 GREELEY CO 80631 ADDRESS OF PROPOSED SYSTEM 960 E C ST. GREELEY CO 50631 LE = --L DESCRIPTION OF SITE: N2 SEC 4 TWP 5 RNG 65 SUEDi°dISION: LOT 0 BLOCK 0 FILING 0 'J5 . TYPE: RESIDEN-"IAL HOUSE SERVICES: ='=R3CNS w BATHROOMS 1.00 LOT SIZE 97.00 ACRES BEDROO1S .3 BASEMENT PLUMBING NO WATER SUPPLY NWCWD APPLICATION FEE $240.00 REC'D BY CHAD YOUNG DATE 11/23/94 SIGNED BY JAMES D. PICKETT DATE 11/23/94 PERCOLATION RATE 6.8 MIN PER INCH LIMITING ZONE S FEET SOIL TYPE SUITABLE PERCENT GROUND SLOPE GX DIRECTION REQUIRES ENGINEER DESIGN NO IN 100 YEAR FLOOD PLAIN ZONE NO FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON --SITE SOIL PERCOLATION DATA 'HE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED: SEPTIC TANK 1000 GALLONS, ABSORPTION TRENCH 495 SC. FT. OR ABSORPTION BED 645 SQ. FT. IN ADDITION, THIS PER' ;T IS SU JECT TO THE FOLLOWING ADDI-'"IONAL TERMS AND CONDITIONS: 51,50e,a-tiovig9 - C1tZ1� !HIS PERMIT IS 3RA'VTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS F'ERMIT "Al, BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SE - FORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTENREGULATIONS INCLUDING r-.AILU'RE 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 %IF LIABILITY FOR TAE FAILURE OR INADEQUACY OF THE SEWA E DISPOSAL SYSTEM. PAN SMITH 1/750/9 ENVIRONMENTAL SPECIALIST DATE THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS NOT CDM1,'ENCEO WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF THIS PEF:MIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RI_ -'T TO IMPOSE ADDI- TIONAL ".-ERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA - SIB. FINAL FERMI' APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE COM- PLETED SYSTEM BY THE WELD] COUNTY HEALTH DEPARTMENT. SYSTEM INSTALLEEF, 1'� letaW4 ... FINAL IN .CT" ,�' r DATE (_ SYSTEM ENGINEER APPROVAL I ( L.� !! C "YPE OF SYSTEM INSTALLED CKEP-- ENVIRONMEN T AL SPECIP`.LIS THE ISSUANCE OF THIS PERMIT DOES NOT IMPLY COMPLIANCE WITH OTHER STATE COUNTY OR LOCAL REGULATORY OR BUILDING REC'UIREMENTS, NOR SHALL IT ALT TO CERTIFY TI -:AT THE SUBJEOT SYSTEM WILL OPERATE IN COMPLIANCE WITH APPLICABLE STATE, COUNTY AND OOP. i:E3ULATIOP.S ADOPTED FERSUANT TO ARTICLE 10. TITLE 25, CRS 1973, AS MENDS' EXC'=PE FOR THE PURPOSE OF ESTABLISHING FINAL APPROVAL OF AN INSTALLED SVS"EM F'I:H. ISSUANCE OF A LOCAL CCCUP'`.N.'CY PERMIT PURSUANT TO CRS 1973 25--10-111 (2). WEs - ~S 14,0 .r�'' , r 30 u IU NAL-AF`' F'_L1CAN F r 1 1 { CUt Y--WLH.) W(.HD-L-HS MAI, 1,i,U4 Y HSP 3.46P INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICES 1517 16TH AVENUE COURT, GREELEY, CO 80631 353-0635 EXT.2225 OWNER NOFFSINGER MANUFACTURING ADDRESS 500 6TH AVE GREELEY CO 80631 NO. G-940549 REPAIR PERMIT PH (303) 352-046 ADDRESS OF PROPOSED SYSTEM 960 E C ST. GREELEY CO 80631 LEGAL DESCRIPTION OF SITE: N2 SEC 4 TWP 5 RHO 65 SUBDIVISION: LOT 0 BLOCK 0 FILING 0 USE TYPE: RESIDENTIAL HOUSE SERVICES: PERSONS 4 BATHROOMS 1.00 LOT SIZE 97.00 ACRES BEDROOMS 3 BASEMENT PLUMBING NO WATER SUPPLY NWCWD APPLICATION FEE $240.00 REC ' I) BY CHAD YOUNG DATE 11/23/94 SIGNED BY .DAMES D. PICKETT DATE 11/23/94 PERCOLATION 'ATE4...... MIN PER INCH LIMITING ZONE ��_ FEET SOIL TYPE �(, PERCENT GROUND SLOPE _ DIRECTION ___ REQUIRES ENGINEER DESIGN �,Q _._» IN 100 YEW FLOOD PLAIN ZONE _ FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON -SITE SOIL PERCOLATION DATA THE FOLLOWING MINIMUM I STALLATION SPECIFICATIONS ARE REQIII ED: SEPTIC TANK GALLONS, ABSORPTION TRENCH SQ. FT. ,,,,rr�� OR :Y ABSORPTION BED 9T7 SQ. FT. IN ADDITION, SanoWUBJEWeniftgrINC -.rXT OVAL TERMS -ND CONDITIONS: �` THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT MAY BE REVOKED OR SUSPENDED BY THE WELD 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 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 DISPOpAL SOTEM. (IL ti ENVIRONMENTAL SPECIALIST D TE THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI- TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA- SIS. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE COM- PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT. S - • WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICES SITE EVt' UATION Oarner UUUAiiff_7(f y •l. r'[ Application No ' Sipe CND �J Data 3d1g4 Sub PT I� Z S L TRIT Lot Block Filing PERCOLATION TEST DATA:Start Time • Hole No. Hole Depth H2O Remain • (O min. t ' min. W' min., min. mitt. min. m•ine min. min. min. inch I (IA \ TO 2 7P \ & o LS�4 ego ,Q9 ,2 S. 3, I. 3 21 ,_JIMEMP aDrs i ip 1 tAi i4 5 r 6 L\ All measuremen�s in .)mm unless otherwise * + Add H2O 8EnvironmentalEnvironmentalHealthth Specialist- indicated. Total - - Averag Rate •�� PLOT PLAN eisle SOIL PROFILE • dry clvrE. 6rowK. trawtAtdr .brw.r...ij y � eopittk (ulose • se et n HS0.106P' . APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM NO. G-940549 WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICES . 1517 16TH AVENUE COURT, GREELEY, CO 80631 353-0635 EXT..2225 REPAIR APPLICATION OWNER NOFFSINGER MANUFACTURING ADDRESS 500 6TH AVE PH (303) 352µO463 GREELEY CO 80631 ADDRESS OF PROPOSED SYSTEM 960 E C ST. GREELEY CO 80631 LEGAL DESCRIPTION OF SITE: N2 SEC 4 TWP 5 RNG 65 SUBDIVISION: LOT 0 BLOCK 0 FILING 0 USE TYPE: RESIDENTIAL HOUSE SERVICES: PERSONS 4 BATHROOMS 1.00 LOT SIZE 97.00 ACRES BEDROOMS 3 BASEMENT PLUMBING NO WATER SUPPLY NWCWD APPLICANT ACKNOWLEDGES THAT THE COMPLETENESS OF THIS AP'P'LICATION 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 25p CRS 1973 AS AMENDED. THE APPLICANT CERTIFIES THAT THE PROPOSED SYSTEM WILL NOT BE LOCATED WITHIN 400 FEET OF A COMMUNITY SEWAGE SYSTEM. THE UNDERSIGNED HEREBY CERTIFIES THAT ALL STATEMENTS MADE;, INFORMATION AND REPORTS SUBMITTED HEREWITH AND REQUIRED TO BE SUBMITTED BY THE APPLICANT ARE,'OR WILL BE, REPRESENTED TO BE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE 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 UNDER- STAND 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 WO. LAW. APPLICATION FEE $240.00 RECD BY CHAD YOUNG DATE 11/23/94 11/23/94 DATE ORIGINAL -APPLICANT; COPY-WCHD 1J^'•1D-• EHS MAY, 198a • '•-r. REQUEST NO: 0 49 _ '14 - INDIVIDUAL SEWAGE DATE RECEIVED: ION /14 DISPOSAL SYSTEM EVALUATION RECEIVED BY: (// f Weld County Health Department OWNER: `i i g . L.. ,u' 7 ,,,,.J/ortz.4, 4, LL MAILING ADDRESS: 5 -CO tp .« PHONE: SITE ADDRESS: q 10 d F LEGAL DESCRIPTION: PT: SUBDIVISION: PT: WATER SUPPLY: 71 tr. IA FEE $70.00: Igp U/fri/Rk DATE INSPECTED: Itha/gs# ( cr6,31 CITY STATE ZIP cf. (10 CCtr,8 I CI STATE ZIP SEC: (714- NM: Cod N RNG: LOT: (5 BLK: FLG: IESIDENT) / COMMERCIAL TOTAL ACRES :A 4..Gt.l,a., PERMIT ON RECORD: Name: 711t .rr1lr .,rt ermit No.:"f 1 q ((ci- ( S.O.E.: •System Size: Tank:I ' ' gallons Trench: square feet Bed: - square feet Percolation Rath minutes'per inch Soil Type: Engineer Design: Y Percent Ground Slope: Direction: The septic system identified above-Iri of sufficient size to accommodate themiggoxed the structure(s) served by this system. CURRENT FLOW Description: -�+i]� Persons: Bedrooms: 3 Bathrooms: + Basement Plumbing: Alt) ADDITIONS Description: PROPOSED TOTAL Description: The existing septic system is RECOMMENDED to have the following �alteratiops made to a r = - structure(s) served: Stilk I& i TIC-�!f P� "1114d 1121041- dam. .6cW ut-itA) tC �-14 . Ac,,Lcixtkt. acrn�.cF 44.0 tr},ou. a,u,> dtfem.kcuei Neither the County -of Wed 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 or in the report. This inspection was conducted for the purpose of determining compliance with current regulations and for detecting health hazards observable at the time of inspection. This does not constitute a warranty that the system is without flaw or that it will continue to function in the future. Inspections requested during periods of snow cover and high soil saturation may be of questionable value to potential buyers due to adverse conditions. Evaluations based on Statements of Existing (S.O.E.) relies on information the property owner provides, under oath, indicating current status of the system and representing to the best of his/her knowledge the syst is not failing to fl (11/14iniAVit function properly. •1 Scanning Cover Sheet for Septic Permits Permit # Permit Type: Situs Street Address Situs City, State, Zip G19949164 Health / Residential / Statement of Existing 960 ECSTgi SeclTown/Range: 04 -05N -65W Parcel # (12 digits) Owner Full Name: Owner Address: Contact Name: Contact Address: 096104000067-R0063795 Application Status: Finaled Application Date: 03/11/1996 NOFFSINGER MANUFACTURING 500 6TH AVE GREELEY,CO 80631 Owner Phone #: 303 3520463 Contact Phone# Information above has been Verified in Accela by employee noted below August 12, 2008 Processed by: Date Report ID: EHS00024v003 Page 1 of 1 Print Date -Time: 8/12/2008 1:27:32PM INDIVIDUAL •::J::.lrl—i,:l::. J_s'..SPi.:c..:•1... SYSTEM PERMIT -•!.?.. T:7....9'r'y:.c:J..., ENVIRONMENTAL j::I .4.i ICOUNTY I !HEALTH 11DEPARTMENT 1::.I'•1�.1.t.L',t.Tl`I;Y;;::.1'l i iF'11... HEALTH I•'l ;:Jl'::.f''.V.I.!..:I::.::} 1517 16TH AVENUE COURT, GREELEY, CO t.7 80631 353-0635 EXT.2-225 NEW PERMIT OWNER �yr� s l.: . s.{ 1' i- I 1 .. ,- MANUFACTURING ADDRESS , If , - : ;— AVE i .'iii ;i 32-0463 . f..,, f:-,...,.F•,E.:1:::1�': �:I ) �: l i-�s',�F:. PH t; .. ADDRESS :.'; S €.71.. PROPOSED s .:i f i::.t''i ';'170 1::. C. {:;..I. GREELEY CO 80631 LEGAL DESCRIPTION OF SITE 1: N2 ,::'t .::. 4.: 4 i 4J,"' •J RHO ti:Jt SUBDIVISION '. LOT J BLOCK >. FILING (1 USE I _r ., .. ,: RESIDENTIAL .,.SI3'::i U`-:..-.r,....r, 1..-r1 .,. ..c,... ;..- PERSONS .., r'+:'a Ir'-- :-5 BATHROOMS .. y.., ;.. If., SIZE 97.0 ,� - r ,. {L. 1-- , : Ir..j1Y 1 'I 00 r.l.. {, r Y E 4 ,.: i::. •'-, .1. 4...I::. ,., .. ;" F::. ":-:.'•!.. 'i;:J .c.. .!'.: f : :', ,.+1.., ,•... ... :, .: ,: LOT ;.?.,. .;.. .:.,: 1"1 .: fit:.. i:: BEDROOMS 3 BASEMENT + PLUMBING I"-I(:i WATER 1..:F:: SUPPLY Y NWf:::W:f:} APPLICATION FEE i:.: $0.00 Ri: C ' I:} BY r':!:'.-'-NI)>i' {: A!...Fi:f.:AR DATE 10/18/94 SIGNED BY S Al, 111. i1". P't I i"1 DATE 10/18/94 PERCOLATION 3.. Y1 •i' LIMITING ",1. .. ATE 0.0 IN PER HCH E 0 SOIL TYPE SUITABLE PERCEHI GROUND SLOPE 0% DIRECTION I•i;ft::t:TU-T:I:R1':.,.. ENGINEER DESIGN L'4.. IN 100 YEAR FLOOD :1:..1"'1.1.1'' ZONE /''1.. FROM '-s'I..li::: APPLICATION INFORMATION SUPPLIED AND THE ON —SITE SOIL PERCOLATION of --J: T•i,, .. :. FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED SEPTIC TANK :1.000 Gi:`71...!-..1.iNS ABSORPTION i::r..l .I:l- N TRENCH 400 SO. ET. OR ABSORPTION BFfl SO. FT. :I:1''! ADDITION, 1i••i:: 5 PERMIT :1:::.i `:IJI:{k:l:::(:.l..l. ..i.f:1 11..1!.:: FOLLOWING ADDITIONAL TERMS i=:i'.I': THIS IS PERMIT .I.!.. GRANTED TEMPORARILY Tr ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT 1 :..v.: •c l::: }..i1...11 -. SUSPENDED .. .11.... ... - 1 tv.., DEPARTMENT sE .., r.., F., 1r1�-'11 .c•.1::. i',1::.•,rf::il;:L:..4, f.71�4 a:'s--��` THE WELD COUNTY '�� HEALTH .)1:::1�'F-iI �T-I E:a'•'I-T' FOR !=��!:::.`s;:.i.:Il'•E..J SET FORTH R 1'-1 IN THE WELD COUNTY Y INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDING FAILURE TO MEET ANY TERM ..:R CONDITION IMPOSED THEREON DURING TEMPORARY , FINAL APPROVAL. T . .. ..-:ra:., r'iNi..:. OF .. ..E .. :J FERMI { DOEs • t.7 I CONSTITUTE ASSUMPTION BY THE DEPARTMENT E:"i- ' r'•1:' 1' EMPLOYEES ..F... 4.11 F......71 THE INADEQUACY =Ii;.t _!i:.. THE I:....I" 1..1E", , l Ir..., 1 i ,.:!', ITS :.r t:..l 11•''L..Ea i'1::.L:....: 5,71•' LIABILITY FOR i 1'•11... I'- t -'[.!.I i 11'41:' (-31"> .:-!`1s--F.:!::..... ••1 .-'r [.. E" i ₹'";:::. SEWAGE f ' y .:'i. 7'::; 1'-11..- SYSTEM. PAM SMITH ENVIRONMENTAL SPECIALIST 10/18/90 DATE THIS PERMIT '1 ..! 1 TRANSFERABLE 1..; ,F !.} SHALL BECOME .. ...4 IF SYSTEMCONSTRUCTION i.•;..f;:? ''f 5.1 I COMMENCED WITHIN ONE YEAR OF ITS ,:. ISSUANCE. .,. .... ... sL':. ISSUING FINAL APPROVAL .. THIS I''E:::Ri'I:i:.t. -.I.I..II::: WELD COUNTY HEALTH DEPARTMENT F;I::::}1:::F;1'aE:::::; ".f'1•.II RIGHT TO IMPOSE 'f:1'::?I:.: ADDI— TIONAL 1. TERMS . .. .. .. REGULATIONS -. .... � CONTINUING BA— SIS. -- 1•'11'` AND CONDITIONS s s • ;'� •-• -' '• -- 5 i�l::.l::. OUR .. ', � .L..f'i f � �s'.':.. OH :s 1'° i .1.'- `'I t:! FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION I:::i:::-T I(:1;''l OF THE COM— PLETED SYSTEM S T-IEM BY .1..!..li::: IJ.IE:::!...I) COUNTY HEALTH DEPARTMENT. SYSTEM INSTALLER UNKNOWN sYsIEN ENGINEER TYPE PI::. ,.!1" SYSTEM INSTALLED TANK ENVIRONMENTAL SPECIALIST FINAL INSPECTION DATE 10/10/94 ':>r.., APPROVAL PAM SMITH •.r .�.�.- 1... ;:., :.. THIS PERMIT .. DOES NOT IMPLY COMPLIANCE F•. i -.,1... WITH f OTHER •- ISSUANCE !. -• 1 f•'..F.is 1.. 1:.. •',IY .!. I i34.7F::.•::� 1`1'_.� I ..:'Fr' .... r' i.:i.?1':;''1-...1,r't=t..:F:'. ;!., .r. F : , l.7 I '1 r::.R STATE,- COUNTY OR ...[.!!... F -'I1... ",.::.l:a .. ...i-•I ' t 7 -'; Y 1.7R BUILDING REQUIREMENTS, I'•sl. SHALL ...E ACT _7 CERTIFY THAT THE r.. SYSTEM -1:. WILL OPERATE :: 1•" COUNTY 11.!.i'\: +, WITH APPLICABLE ,.� ....•[.+ ,..• .-. s'COMPLIANCE _ .. I i STATE, s -s c:. ,. t.: t_t1�-i 1 i AND { REGULATIONS A1,7 i 1} -"4:'J;,: 'I f{'; 0 i .t„ , , AS AMENDED. LOCAL ADOPTED 1 ....... ---r .....s-'. -i 1 1 4.. r -It', I ........:... .L .:., .I. f ..-... ,..... ..:1":;:: .,- 1 rl i'•::J i"i 'li::.'-:.. s::.:.. EXCEPT 1...;.. ... PURPOSE F.., F., ESTABLISHING ...,,•.. : 1: APPROVAL .. 1.., f, i.F IF....... i t....,'. Jr.....r.,...i. I.:.;.�_��, E .ci -f'1 1 FOR R THE E" UR1" f.1 ::Y;:1: f: F 1::. .::r f ABL. I`. S.. ING FINAL Ni' 11... i•1r" r• I': ..: ':CAF... O 1-'11`1 INSTALLED I A1..,Ltn D SYSTEM ..:' 1 E l FOR IR ISSUANCE '..71'• F'-1 LOCAL OCCUPANCY PERMIT PURSUANT TO 1.::>,.. 1973 25-10-111 (- .7 . •.)` '- i..t_.r-.I'1f ........ i.y l.. 1.. t..•I"i a ii 1 ,1.. i ....iti C.:l"IAA WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL PROTECTION SERVICES 1517 16th Avenue Court Greeley, Colorado 80631 (303)353-0635 Veld County Health Department SOE. 8491(4 LOAN 0 IsDs I (D j 9,4. REPAIR* Po[IT 4 STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN BLACK INK ONLY) OWNER OF RECORD: rN S;flier"' 1i!cz.nl rL0"r? rC,p . PtioNE: o � 3 MAILING ADDRESS: r3) SITE ADDRESS: LEGAL DESCRIPTION: PT: SUBDIVISION: PT: Cit Stae Zip cify State SECTION: lit TOWNSMIP:. iV RANGE:66-1c) LOT:__ BLOCK: FILING:,,___ NUMBER OF PEOPLE: BATHROOMS: 1 LOT SIZE:„BEDROOMS: RESIDENTIAL or Ce Q1ER6I . BASEMENT PLUMBING: Alma '74.L WATER SUPPLY: 07011 SYSTEM SIZE: Tank is constructed of CO+*o and has J, n • gallons capacity (material) O FIELD: Bed �� sq. ft. or Trench + sq . f t . DATE SYSTEM INSTALLED: lcipr- Tan are required to.draw a diagram. of the system on the reverse side of this form in black ink only and. indicate location, length, width, and distance from the dwelling. The undersigned property owner hereby certifies that the above described septic system i$ 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 hislher 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. De e I99. Subscribed and sworn to before me this day of Vet eirMr96 Bonded Witneaa"•tsy^h nd ind official seal.P NOTARY PUBLIC AGENCY Ply crromissioa expires: Date,. Notary Public STATEKENT or EXISTING REVIEWED ay: Environmental Protection Specialist r l-4u"se .. . L. Hello