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Home My WebLink About20194355.tiff Scanning Cover Sheet for Septic Permits Permit # SP-0600034 Permit Type: Health/Residential/New Situs Street Address 16136 CR 18 Situs City, State, Zip Sec/Town/Range: 26-02N-66W Application Status: Finaled Application Date: 02/0312006 Parcel # (12 digits) 130926200003-R3183104 Owner Full Name: NASH PATRICIA Owner Address: 212 S MCKINLEY FORT LUPTON,CO 80621 Owner Phone #: 303-655-1512 Contact Name: WILLIAMS MISTY L Contact Address: 212 S MCKINLEY FORT LUPTON,CO,80621 Contact Phone# 303-857-2255 Information above has been Verified in Accela by employee noted below x SCGOOm April 25, 2008 Processed by: Date Report ID: EHS00024v003 Page 1 of 1 Print Date-Time:4/25/2008 10:32:17AM WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, CO 80631 PHONE(970)304-6415 FAX(970) 304-6411 Finaled Permit#: SP-0600034 Sec/Twn/Rng: 26-02-66 Status: ISSUED Owner: NASH PATRICIA Applied: 02/03/2006 Applicant: WILLIAMS MISTY L • Issued: 02/151 0 w Permit Type: RNEW C=Commercial,R=Residential+NEW,REPair,VauLT Finaled: 513 O Parcel#: 1309-26-2-00-003 Location: 16136 WCR 18 Legal Description: Installer: P,i • Description: HOUSE Commercial: N Residential:Y Acres: 82• #of Persons: 2 Basement Plumbing: N #of Bedrooms: 3 Bathrooms -Full: 2 3/4: 0 1/2: 0 Water Public: Y Water Source: ARISTOCAT WATER Water Private: Y Cistern: N Well: N Well Permit#: Percolation Rate: 52.8 Limiting Zone: 8 ft 0 in Description: %Ground Slope: 0 Dir: Soil Suitable: (Y/N) Y Engineer Design Required: (YIN) N In 100 Year Flood Plain: (Y/N) N Minimum Installation Chambers* Septic Tank: 1000 gallons Absorption Trench: 1431 square feet • or Absorption Bed: 1860 square feet Actual Installation • Septic Tank: k6) gallons Absorption Trench: )Lt35 square feet `ka Absorption Bed: square feet • Design Type: 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 and non refundable, 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 was contingent upon the final inspection of the completed system by the Weld County Department of Public Health and Environment. x ) 1 Entiro al Health Specialist Date Form:S FINAL / , - • , r I\ v.1,0-e- 1 S qi fi i0 I 1 � 1 1 c-,), ra``m . - ,4E r,; r LO l . 4-"`• f. • FOR OFFICE'USE ONLY ISDS APPLICATION FLOW SHEET Owner: ekin't.AA Permit#.Sfo Le a Qpat--( Location: IL. r-N LC�� Legal Description: ipZa.4 Dl( Date By Comments Parcel Number Received SK-- Information Form Complete S Authorization Form Received Map Drawing Received L �� Flood Plain? Yes/No Site Inspection Date Engineer Design? Yes/No Date Engineer Design Received Customer Notified? Yes/No Date Staff Approval Sent --- Date Staff Approval Rec'd Perc Data Entered in Computer . 0(Prn5 Date of BOH Approval Eng Approval Letter Sent (Letter, Permit, BOH Review) Date of Final Inspection P.'.•c4 429ID Eng Final Inspection Letter Rec'd Variances Needed?Yes/No . Sent Variance Staff Approval 1 w Rec'd Variance Staff Approval Variance BOH Approval Variance BOH Approval Sent (Variance, BOH Review) Additional Comments: • M:lenvprolsepticllowsheet.500.wpd • • WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, COLORADO 80631 PHONE(970) 304-6415 FAX(970)304-6411 Permit#: SP-O6O0034 Sec/Twn/Rng: 26-02-66 PERMIT Owner: NASH PATRICIA Applied:02/03/2006 Applicant: WILLIAMS MISTY L Permit Type: KNEW C Commercial,R=Residential + NEW,REPair,VauLT Parcel#: 1309-26-2-00-003 Location: 16136 WCR 18 Legal Desc: Description: HOUSE Commercial: N Residential:Y Acres: 82 #of Persons: 2 Basement Plumbing: N #of Bedrooms: 3 Bathrooms-Full: 2 3/4: 0 1/2: 0 Water Public: Y Water Source: ARISTOCAT WATER Water Private: Y Cistern: N Well: N Well Permit Number: Percolation Rate •S Limiting Zone'> ft —in Description — %Ground Slope --- Direction Soil Suitable(Y/N) yEngineer Design Required(Y/N) k(, In 100 Year Flood Plain(Y/N) • From the application information supplied and the on-slte soil percolation data the following minimum installation specifications are required: Septic Tank r c gallons, Absorption Trench /445 sq ft or Absorption Bed I O sq ft Chambers: Infiltrator or Rancor Standard or Hi-Capacity,EQ36 or BioDiffuser Trench LbG Bed [,o Infiltrator Quick4 Trench -73 Bed /0.7 Hancor Narrow(15in)Envirochamber Trench CeS Bed /9, In addition,this permit is subject to the following additional terms and conditions: Civ{�i sticZ-7� JA�..�a� Oe•� W Z� ,N 3,, • 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 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 disposal system. This nermit 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 -- x � j5•oCa Farm:S_PERMITN Ediironmental Health Specialist Date WELD COUNTY DEPARTMENT OF PUBLIC HEALTH&ENVIRONMENT - 1555 NORTH 17TH AVENUE, GREELEY,CO 80631 PHONE: (970)304-6415 FAX: (970) 304-6411 WEBSITE: WWW.CO.WELD.CO.US Copy Reprinted on 02-03-2006 at 11:41:07 APPLICATION/RECEIPT Initials: SG Permit Number: SP-0600034 Receipt Number: HAP-06036 02-03-2006 Amount: $470.00 Payment Method: Check Notation: 1159 Owner Name: NASH PATRICIA Applicant Name: WILLIAMS MISTY L Parcel Number: 130926200003 . Location: 16136 WCR 18 Account Code Description Amount - 2560-41400-4221-4203 New Septic Permit $470.00 2560-41400-4221-4203 Repair Septic Permit $0.00 2560-41400-4221-4203 Vault Permit $0.00 _ 2560-41400-4221-4203 Variance Request $0.00 Description: HOUSE Commercial: (Y/N) N Residential: (Y/N) Y Acres: 82 Number of Persons: 2 Basement Plumbing: (Y/N) N Number of Bedrooms:• 3 Bathrooms: Full - 2 3/4: 0 1/2: 0 Water Public: (Y/N) Y Water Supply ARISTOCAT WATER . Water Private: (YIN) Y Cistern: (Y/N)N Well: (Y/N) N Well Permit Number: TERMS AND CONDITIONS A permit fee,as set by separate ordinance 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:remit apolcatlans are namtransferable.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(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 certifies 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 of perjury as provided by law. da-\1\619 Owner/Ap nt Date Form:RT HAPP SeVLLDCaLI i...,7r, .. • SEPTIC INFORMATION FORM \\ To obtain an I.S.D.S. permit, one must file an"application for Individual Sewage I Disposal System"at the Weld County Environmental Health Services office and 11 O 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 COLORADO' provided on the septic information form. PARCEL NO.: 1W51 n to a ()p n( ) 3 (12 DIGIT NUMBER) CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650 PROPERTY OWNER .,-k-v-;r _; a 4 . A/04.. k... MAILING ADDRESS: I a �:V.2i n J,P ' CITY 62141,41DAST C[) ZIP eashaj HOME PHONE: 3(13 loES5 -1 Sl WORK PHONE D3 AX APPLICANT NAME: 1 " •" 'n h('' k_ I Ik 1 S7 W 11..k j,4 14t c MAILING ADDRESS: a, S. o t n CITY ST ZIP .Solo � 1l.?� }Z '�� -�� j,c�ion �� W HOME PHONE: en) tias - Ir--1 A, WORK PHONE AX ( ) f5s,- a a55 ca,3O8-.;@.57 LOa f•[ ,-/ LEGAL DESCRIPTION PT PT SEC We, TWN a// RNG to to W ACRES S SUBDIVISION LOT BLOCK FILING DESCRIPTION OF BUILDING(EX: HOUSE,MOBILE HOME,MODULAR,SHOP,OFFICE) tiol _`-(a SITE ADDRESS )(el ail, wC . lcj , ror4- IA:43+OA , (D far 62 a-I DIRECTIONS TO SITE J-1& .( 9 -I® ( )0,1q M LE 1-) POrw►P d-c. }'y�r'1Gie 9I- l 8 /0 NEW PERMIT REPAIR PERMIT VAULT PERMIT 400 $400 $ 150 IF OBTAINING A REPAIR PERMIT, PLEASE LIST PREVIOUS OWNERS OF THE PROPERTY: FLOOD PLAIN YES /NO CENSUS TRACT t -a? RESIDENTIAL YE /NO COMMERICAL YES / el NUMBER OF PERSONS a. BASEMENT PLUMBING YES /CgiP NUMBER OF BEDROOMS BATHROOMS: FULL . 3/a 1/2 WATER SUPPLY: PUBLIC • ES NO NAME (AI-k% S`-\-I C ((-4- 1A)0_4-ex-- PRIVATE (Y NO CISTERN YES WELL YES/NO WELL PERMIT# PERC HOLES MARKED FOR INSPECTION BY SPECIALIST E NO • DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 N. 17"' Avenue Greeley, CO 8O631 WEBSITE: www.co.weld.co.us - ADMINISTRATION: (970) 304-6410 FAX: (970) 304-6412 PUBLIC HEALTH EDUCATION & NURSING: (970) 304-6420 FAX: (970) 304-6416 ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415 COLORADO FAX: (970) 304-6411 AUTHORIZATION FORM RE: 7f PERMIT APPLICATION n LS.D,.S. EVALUATION n SALE OF PROPERTY n WATER SAMPLE • I hi -r-L4 1115 represent i( .b. getfor the property (Agent/Applicant ++__ (Owner) located at 1 1pl-t o LOOK IS, Po v-+ 4-0 A t 0.D So LEGAL DESCRIPTION: SEC 3.6 WN RNG SUBDNISION NAME: LOT BLK I can be contacted at the following phone#'s: Home 3O3-4? - 161a. Work a08- e57 - Fax# The property owner can be contacted at the following phone #'s Home 303 — )3J . Work X03 - aCv 8- 5, Fax# Correspondence mailed to (only one): I Agent/Applicant [] Property Owner DATE -?,- OWNER'S SIGNATURE ,, L PLEASE DRAW A MAP TO YOUR PROPERTY. . • ?r; I X. \ 4 /6/36, WCk is • • Weld County Health Department 2/1/2006 Percolation Test and Soils Data • High Plains Engineering 'N.i 735 Denver Avenue • Fort Lupton CO 80021 I11 Phone 303-857-9280 • Fax 3O3-857-9238 L_- FILE.NO..06-4942 J Property Address 18136 WCR 18 Legal Description WELD COUNTY, CO Property Owner Info Name MIKE NASH Street 16136 WCR 18 City, State,Zip FORT LUPTON, CO 80621 Phone 303-809-4482 ,a._ ratwn -.- Ili- r_ <'Goundwater Smeared Su :s-. Encountered at (GREATER THAN 8 Meet Removed: YES Sand or Gravel Added: NO Estimated cleptfi to maximum seasonal water table if not Date and Time 1/30/2008 date encountered in profile: Presoak Water Added: 11:00 time Amount of Presoak Is area believed to•be subject to Water Added: 15 allons seasonal fluctuations which could Date and Time result in a seasonal water table within Percolation T• - 1/31/2006 date 8'of surface?. Started: 11:00 time ._... f i I.•.. _$IopeMDeterrntruttion"in ArppontMia; Did Water Remain in Hole After the Overnight 396 Swelling Period? to the WEST direction Hole.1 YES Hole 2 YES • Hole 3 YES Encountered @ 'GREATER THAN 8 Ifeet Hole.4 YES Hole 5 YES Estimated depth if not encountered in Hole if, YES profile: •Percolation s 'r .. • •Percolation; _ Measurement] Sln), , Rate;.(rilsn)in) Hole 1 36 50.00 Type of Bedrock: Hole 2 36 41.67 Hole 3 36 50.00 Hole 4 36 62.50 Is bedrock fractured or weathered? Hole 5 36 62.50 Hole 8 36 50.00 Is bedrock believed to be permeable Average 52.8 (perc rate<60 mien)? • Y. - • Weld County Health Department 2/1/2006 Percolation Test and Soils Data Rile Hole Information(cont) - Note: Soils must be classified using unified system ASTM D2487 . . Profile Hole:Log • 0 Il �- 2 m c �3 SANDY SILT(SM) a 4 ----5 - 7 II8 r ---10 • itification. - I certify that the above information is correct and complete to the best of my knowledge and that all tests were performed in the accordance with the provisions of Weld County Health Department individual sewage disposal regulations by myself or under my supervision. o;.c',Q High Plains Engineering Signature i c3 c %.6... 735 735 Denver Avenue :a a 73! i Ft. Lupton, CO 80621 r+l 07l^R 6.t: , c� 303-857-9280 Date 1t4�aim. : • r 5ITE MAP 1G136 WCR 18 WELD COUNTY, CO TO WCR 3 I WCR 18 n rn • • • • TELEPHONE • a POLE d-4014-1- 38' EXISTING STEEL HOUSE SITED • LEGEND All locations shown above are based on specific information •—Percolation Test Hole furnished by others or estimates made in the field by High Plains Engineering personnel. The locations, distances, X-Percolation Profile Hole directions, etc. are not the result of a property survey but are approximations and are not warranted to be exact. It is Ls,—Soil Profile Hole the owner/builder's responsibility to define property - boundaries and ensure all onsite improvements are Located *X—Fence within the platted site and out of inappropriate easements. All distances are to be verfied prior to excavation. Hello