HomeMy WebLinkAbout20181733.tiffNORTH WELD COUNTY WATER DISTRICT
P.O. BOX 56
32825 CR 39
LUCERNE, COLORADO 80646
PHONE (970) 356-3020 • FAX (970) 395-0997 • E-MAIL: water@nwcwd.org
Board of Directors: Charles Achziger, Gene Stifle, Robert Arnbrecht, Todd Bean, Gary Simpson
Manager: Rick Pickard
ACCOUNT NUMBER
NAME AND SERVICE ADDRESS
BILLING PERIOD
ANNETTE J. & SEAN JAEHN
425004
20767 CR 66
11/20/2017
- 12/18/2017
GREELEY , CO 80631
20
Water Class
P (KGal)
70 % of 1.000 Acre Foot
228
Transferred Water
0
Allocation Adjustment
0
10
Less YTD Usage
8
Remaining Water Allocation
220
Plant Investment Class
70 % of 1.000 Acre Foot
228
Less YTD Usage
8
Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oc[ Nov Dec Remaining PI Allocation
220
Prey. Read Curr. Read Usage
Unit
Amount
Previous Balance
65.65
12/09/2017 Payment -
- 65.65
12/14/2017 Payment -
- 24.40
12/18/2017 Standard - Full 1594 1598 4
kgal
19.20
Current Amount
19.20
Total Credit
-5.20
You are currently paying this account with on-line
banking - no return envelope will be sent.
NORTH WELD COUNTY WATER DISTRICT
P.D. BOX 56
32825 CR 39
LUCERNE, COLORADO B0646
PHONE (970) 356-3020 • FAX (970) 395-0997
DETACH HERE
E-MAIL: water@nwcwd.org
Any payment received after the 15th of
the month may not show on this billing.
Please note that all accounts are due by
the 15th of the month.
Return this stub with your payment
Thank you.
ACCOUNT NUMBER
SERVICE ADDRESS
AMOUNT DUE BY: 01'15'201B
AMOUNT PAID
425004
20767 CR
GREELEY ,
66
CO
80631
CREDIT
ANNETTE J. & SEAN P. JAEHN
20767 CR 66
GREELEY , CO 80631
NORTH WELD COUNTY WATER DISTRICT
P.O. BOX 56
LUCERNE, COLORADO 80646
00042500400042500400000-520
Scanning Cover Sheet
for
Septic Permits
Permit #
Permit Type:
G19949019
Health / Residential / Statement of Existing
Situs Street Address 20767 CR 66
Situs City, State, Zip
Sec/Town/Range: 21 -06N -65W
Parcel # {12 digits} 080321000048-80328694
Owner Full Name:
Owner Address:
Contact Name:
Contact Address:
ARNOLD HELEN
PO BOX 626
TABERNASH,CC 80478
Application Status: Finaled
Application. Date: 03/11/1996
Owner Phone #: 303 0000000
Contact Phone#
Information above has been Verified in Accela by employee noted below
cm
x
August 08, 2008
Processed by: Date
Report ID: EHS00024v003 Page 1 of 1
Print Date -Time' 8/8/2008 2:36:50PM
11-i1):I:tJ:i:T)7. JAI._ SEWAGE
No. G-949019
OWNER (::,!•![.;ti.[a.. HELEN
WELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SERVICES
a;t::;E..::.;
l.5:1.7 :16TH AVENUE C[:sL.I:1'T.. [:aki:E:;:l...i:::`r'„ C€:?
Z;53-0635 EXT.2?P5
• ADDRESS PO BOX 626
.T r^ pll::l ilr''r;':r!••!
CO S047,,T
#:T
I kl::: W !;:' I: !:;t ]; T.
PH C303) C:'3 ; 000 —o000
ADDRESS OF PROPOSED SYSTEM 20767 W[.;!: 66
GREELEY CO 00631
LEGAL T7F:.;l::f;:1:1: T;I:[:Tt•I [.Ti.: SITE F,:' ;Sl:::fd ',.SEl.; 21 TGJF=' 6 RHO L.}5
:il.I,F D I.'v:l::E:f:il••!;t 'LOT T 0 BLOCK 0 1:.,:1:l...:l:l'G _ r)
1.1#iSE:'. T-YF'I::: ;. RESIDENTIAL
':;E:::E: vICE:::::S;, PERSONS 2 BATHROOMS i:11'i 1.7b i...[:1't' #:ti 3.P{1:1l4::
BEDROOMS 4 BASEMENT l=.l...[.IMi::: J:I\Ic. I'tc WATER SUPPLY HW€ l..JT)
11:'E'1...1:(:::AT:l:1:1N FEE W)..0;)
I:;1:::E:: ' D BY_ - (:':i:1 Ii) ( f'iAl...i` 2AR
DATE 01/21/94
('TONED BY ANDREW ARNOLD ..-- Af,al::.FI-T.
OFiTE 01,--LA/T4
E'I :RCOL.. `, 1 :1:[::'I L RATE r;s..{) E'I:iii PLR :I:N€:Eii LIMITING -ZONE 0 !`••i:'::1:::•T
;at;b:l:l... TYPEli SUITABLE l''F::L;,(..:i:1x!f oIII,lNX) ':}L..4:ii'I::. 0;1;;' k).EE;L:[.;"T":E.(.1H
1:;:1:::E:}I.IT!'•kE::; INtIlHELR 1}i::::[[:,N AO IN :I.(1') YEAR FLOOD PLAIN 1['a1•li;;; NO
I: I (il'Y THE APPLICATION f II C:iF;I`irYr :I liNl SUPPLIED AND THE If:f: Oh —SITE `T[:1:i:t... PERCOLATION DATA
t
THE IE: €: (:TL i [:Iw ; I..IC 1'I:i: •ti: l•'IL.11'! SF: l:::I ::I: F::I: E_:r"G r-:[ i ii-•I1:S ARE REQUIRED
I RE::D
SEPTIC TANK. Iii<. I.0:){)',) GALLONS. ABSOR4ION TRENCH H .A.,1” I:: T ,.
OR
ABSORPTION BED SO. .. FT.
:III ADDITION, THIS PERMIT' IS SUBJECT TO III I f)I I...(:JI1J I I IC:; ADDITIONAL TERMS AHD
[: i:N•fI) J: •'f' 1. E:1P:
T•I-•f #:S PERMIT I'i•• IS GRANTED T -1:11I:: (:1F4Wl:I...-t T[:1 ALLOW f:sr:i!`dTpE ll:; T :I: [:1N TO COMMENCE. II'II'li:::l •I[::T:.. •I• -His PEWIT
tv I "r
MAY i•:i(::tl:;; €3I..L;F'I:N1:IT) i-) Wu 1JI:::1...E) ( C l.Ji1'i'`( HEALTH J:'I:::?::' 'rl:;;•TN1:::1•I•T• FOR RF.:r''i;: {: N(0 ::tl::.I
1:=•['I! ill IN THE WELD Xi COUNTY 1:hI}7 :1. 11: I7i..Sr=til Z)1: f:S1::`1:i4:Sr°il... ; r S I€::I'•I E:E::4':il.lE..r"'ir•:i: t:1M#:k INCLUDING
I=:•Al:f...l.lE:;I::: '•I'[;i MET s±ll•I`i "fEI !*k ok C:r(:11-II):!: r 7.(U I :I'L'l1't;i`3i:::1' CF-II:::PI 1)1•,I 1)E.1I:i•II: f 1.::NI:'HE r,l r' ('I; I i:i I(I
APPROVAL. fl••l!::: r #:`r#:iU W:E [:1I:,. .T.l..I E f:; F'I;.Li:I:'T• l}[]I::.',•'3 NOT (:;[:ilwl;'+`T':C'T l.i r 1::• r,i'.:.�.MI''iF ° (I [:Iht B Y` ..f.l..11:::
DEPARTMENT c:rj:': ITS 1::a°li:'l...f,1`sE:.l;::l:; uE I._:I: 't:Eaa:i_.:I: ! `'s` FOR 'fl••IE:: FAILURE c r INADEQUACY OF THE
SEWAGE DISPOSAL SYSTEM.
E: M
PAM SMITH 0I;21/4
ENVIRONMENTAL SPECIALIST DATE
THIS l::`E1:;1''€:I:'T' IS Nt:1.1. TRANSFERABLE i'1m...E l rr1I1I) SH'ir'hI..I... Bi:::[:.(,1€`ll:.:: VOID :t:I"• SYSTEM CONSTRUCTION HAS
i`111 -T COMMENCED II !I:::NI I::.1) WITHIN ONE '-rl:::(I (.:}f I T s T..:;s:]I 1r yN[:.:1::., BEFORE I: .I`; Sf:;E-1:3 l--iG €'' :I: Ns''tl_ APPROVAL 'F;ft)r•"•AL., OF
'THIS PERMIT I1:€:.r. .T.E.II::: Ea.II::lL..T' t:(:lI.JII fY HEALTH rc I DEPARTMENT Rk::.l:'::1 ; ,1i:::::i r F -1I::: I:.......... ...ci IMPOSE ADDI—
TIONAL T'I:::E':M;:; AND CONDITIONS REQUIRED TO MEET CUR ELI::T.•I1€...,:-:0-:I:CIi••E:ti [.11.1 A (. of••!I:]; I1.I:i.N Jin
:3IS.. FINAL F'l:t:4I``I:I'IT APPROVAL IS [:;.:ll'i'r:I:Ncii:::NI1 UPON -T1••II::: FINAL :E:fI;:`sl''`.i..•I:r:)hl r::il:. Ti••€E:: {r[:Fi l•••-
,_ - • t:
..,
. } r T-f:::N 1,i'( THE WEED E;[:1E J!•.i.T .`i I Il:; ,•'tl_.T! I .Csl::a=W;;..E I"ii :: E,l E ,.
,:s `F f:7 I l I'1 INSTALLER i iI ..i ..I::.l'', UNKNOWN
SYSTEM ENGINEER
.''I€" €-_ or N ).. ( I I::.l'I .i. IiiL. I AE...I i:: i) TANK
FINAL L`NF'll... INSPECTION DATE 01/21/ 94
d
APPROVAL RAM SMITH
ENVIRONMENTAL SPECIALIST
THE ;I::S::ryl.Itll•IE:: E c:!r.. THIS PERMIT DOES NOT IMPLY COMPLIANCE t''r1•ICI::: 4il:i:'TI••i OTHER STATE, COUNTY
(II:: I...E:1r:::r71._ €'.:I::'i}it_!E_ r°i'f(:11;''( aR BUILDING 11(1111!;F::!'11::E-I I ., NOR iI:;: `.•31 Ir'7iI..L.. • :I T• r'1[:',]• f'['1 E".;li::R'T:I:1=.••r' THAT
T
THE E 3I.Ji :TI::: f:; -f SYSTEM w:u,..1.. OPERATE IN I:I :t1YIF •1,.. a: Ai•Ii:::I=:: WITH ! ! APPLICABLE PL:I: E.:r'§I-sl-.F:: STATE, (LIIu!`.I-r-•.r- "CHI
LOCAL REGULATIONS ADOPTED !''I:::RSUrlN l.. .T'{:1 ARTICLE 10, 'i :[:•d'1..E: 25,, (:Lt;;:S :I.9•:i';:, AS AMENDED,
PEE:.;43I:::1::`•T' FOR THE PURPOSE [:1;:SIE: OF ESTABLISHING FINAL APPROVAL OF AN INSTALLED S'r :: l i:::N I Uk
.I.SIJANC;E:: [:1H (i LOCAL (_Tl_CI_IF'flhl(:;Y I' 1;:RI'•I-i-! F='[,€f,faE.JAN1 TE] I_,i•:r5 IU7ti} 25 -10 —III :I. r2) ,
CiR,I; E;i.1: F• AL..----r:p •I.. €...:I:[::,:'sl- i l I (::, J1:: t'-- E!:IT; l.lry }1Jk: i•.l:i;}•• •1:::1•'E ;S i'"k:'A`r•„ 19#:'l
COLORADO
DEPARTMENT OF HEALTH
. t517 - 16 AVENUE COURT
GREELEY, COLORADO 80631
ADMINISTRATION 1303) 353-0586
HEALTH PROTECTION (303) 353-0635
COMMUNITY HEALTH (303) 353-0639
February 25, 1994
Helen Arnold
c/o Ted Carlson
918 13th Street
Greeley, Colorado 80631
Dear Mr. Carlson:
On February 16. 1994, an evaluation of the existing individual septic disposal
system at 20767 Weld County Road 66, Colorado; Section 21. Township 06 North,
Range 65 West. was conducted by Pam Smith.
The existing individual septic disposal system is of sufficient size and capacity
to adequately handle the proposed load. A copy of the evaluation has been
forwarded to the Department of Planning Services to release your Recorded
Exemption.
If we can be of any further assistance, please contact our office at 353-0635.
Sincerely.
Siplid&
Pam Smith
Environmental Protection Specialist
PS/cs-093
Enclosure (3)
•
.;fz.; ;� _ y�V••'^ �'y�"�a, ytl.V' ,rr—�,r�tii.�{��, ..
• a ,
INDIVIDUAL SEWAGE
DISPOSAL SYSTEM EVALUATION RECEIVED BY: '`j
Weld County Health Department
-J/
OWNER:
MAILING ADDRESS:
SITE ADDRESS:
REQUEST NO:
DATE RECEIVED:
PHONE:_ /r rl!J r — 1p...1/Ay 1/co—t., 7-072V
CITY
STATE
CITY
ZIP
STATE ZIP
LEGAL DESCRIPTION: PT: = <2 PT: c'rr V SEC: / TWN: (ra N RNG:p
FLG:
RESIDENTIAL COMMERCIAL TOTAL ACRES: 4, (574 -
SUBDIVISION;
WATER SUPPLY:
i1)( jc1 I
LOT:
PERMIT ON RECORD: Name:
System System Size: Tank)000 gallons
Percolation Rate: 5E),12
Engineer Design: Y
Trench:
minutes per inch
Percent Ground Slope:
�p��,,, Permit No.; c".%/?0,/9' S.O.E.:
UN
ML square feet Bed: �Z, , square feet
Soil Type:qiiiti6IC
Direction:
tic s. stem ' dentif d abo' - IS 1 S + of su nt size t accodat
terat - s) indica
CURRENT FLOW
Description: / r) t, C e
Persons:
Bedrooms:
Bathrooms: _ /, 73
Basement Plumbing:
The existin
acc
Neither the County of Weld 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 propertyor in the report.
elow to t ructure ) s ed by •pis s tem.
ADDITIONS
PROPOSED TOTAL
Description: Description:
system s RE IRED to hav the 101
iterations to the structure(s) served:
I rr . G Lo V5(i Y j • �A
A
alters '*ns rn•'e to
s
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 systems is not failing to
function properly.
c)''
211991
WELD CD: HEALTH DEPT.
OLIVER OF RECORD:
HAILINQ ADDRESS:
SITE ADDRESS
STATEMENT OF .EXISTING SEPTIC SYSTEM
(PLEASE FILL OUT IN INK)
Helen Arnold ','boat:
Box 626, Tabernash, CO 80478
City
20767 Weld County Road 66, Greeley, CO 80631
Sc•a tc Lilo
LEGAL flf;SCRL₹'TION:: PT E1/2
PT SE1/4
Section
City Scatc lip
2,1
Tounshi p 6 k;eitl;c 65
SUBDIVISION LOT BLOCK rzLruc
NW bE2.OF PEOPLE: Bedrooms: 4 Bathrooms: 1,3/4 'Water Supply North Weld/Well
RESIDENTIAL OR C6MMERCLAL: Residential Lot Sixc: 4.0 +1- Acres
SYSTEit•SIZE= Tank is Constructed of ' .Concrete And h:s 1,000 gals capacic}•
(ln:YCeri.A )
FIELD: Bed 720 +/: or Trench
sq. fc_ Dare System Installed: 1955 +f -
You are required to draw a diagram of the system on the reverse side of this
form and indicate position, length, width, and distance from the' duelling -
The -undersigned property owner hereby certifies that the above described septic
system is in fact installed as described, end exisct at this time on the
parcel of ground identified by the above legal description. and further states.
€`hat the System is in good working order and co the best. of his/her knowledge is not
failing -to function properly_
X further understand that any falsification or, misrepresentation hay result in
revocation of any permit granted based `upon this information hereby submitted
and ia•legal action for perjury as provided by law.
February 23, 1994
Date
80149/4.- 447Aitid&-ef-P-1-414
h�
subscribed and sworn to before me this s73 day of
by ff lLj J. rpd i e6;
Witness my band. and ,official se41.
t Dazs:
.STA'T'EMENT-oF'ExISrING REVIEWED BY
pj
Hy commission expires
• `"f�/d' � �LV7
Notary Pu>> c
/9 / 51
avironmencei :':6CCCC1o[1 SpcciaLi. c PaCl_•.
Permit #
Permit Type:
Scanning Cover Sheet
for
Septic Permits
6/9940408
Health / EHS History I EHS Conversion History
Situs Street Address 20767 CR 66
Situs City, State, Zip
,
SeclTownlRange: 21 -06N -65W Application Status: Ffnaled
Application Date: 03/11/1996
Parcel # (12 digits) 080321000048-80328694
Owner Full Name: WILLIAMS KENNETH/BARBARA
Owner Address: 20767 WCR 66
GREELEY,GO 80631
Contact Name:
Contact Address:
Owner Phone #: 303 3562496
Contact Phone#
Information above has been Verified in Accela by employee noted below
X
P.-•--dby:
August 14, 2008
Date
Report ID: EHS00024v003 Page 1 of 1
Print Date -Time: 8/14/2008 8:56:11AM
I••E #cal' .1040 . ,
:I:MD:kviDUAL. SEWAGE: A).1:;3I"'(:):JAL. SYSTEM PERMIT N(:)., 0-9 40408
WELD COUNTY HEALTH DEPARTMENT
I:N'_;4:I=[:31•41Y11:-N•T•`F4.., HEALTH SERVICES _
15171.o T E"1 AVENUE . COURT , (:;REI:•:L„L:Y M co 80651
353-0635 i:xr`..22d 5
C)tJNr k 4,J:I:4...L._:I.AIYI#ia„ ICE: NNE1I-I/ AF4D 1RA ADDRESS 20/6/ WCR 66
CaFaELEL..EY CO 00631
nT)); l a S OF PROPOSED ED SYSTEM 2076/ WCR 66s
{aI'• I:l;::l...EY CO H06:"s:l
I...I::(aAL.,, X)I'r'f:y(:;Fti:CF'l :1:01 I (:)E-' `:i:l:'r'1:-g ;: E4 ':3i:C 21. r iii 6 i i ic3
#:ODDI:V:ISIONN LOT () tiI.foGK 0 1=I:1.,.:1NQ o
usi: 'r`YI=='k:,: RI_::siDE:.Nr':Ef5I... I•i(:1(.I#:3F:'/I IF:f"'I._ hC1": 'rANIC Oh11...Y/t949O:19
s:xlc:r v.i: C:ECS „ 1::'I-.Iwsoh1S 6 BA'Tl••4R{:Z(:MIS 1./5 L..O1 Ss:1:1;1'r.: 4.00 Aci,: i s
T:al :r)F (:)(:)4''l a 4 BA#:iEIYII:::N TPLUMPING :1:NG YES WATER NWCWi)
REPAIR PERMIT
APPLICATION FEE $125.00
I' 1:::(:'. ' 1) BY CINDY SAL,,AZA1
DATE 08/11/74
F''E'"I ( ?0;3) 356-2496
SIGNED BY BARBARA ti., WILLIAMS
DATE 08/11,/94
PERCOLATION OL.,AT :(:)N RATE 30.0 {} lira i 4'i:::l; INCH l -k LIMITING ZONE 8 FEET
SO:E:I,.. TYPE SUITABLE L..Ei: PERCENT CE'r N T GROUND SLOPE 0 DIRECTION
REQUIRES QUIRES ENGINEER DESIGN NO :1:14 :E,{)0 YEAR FLOOD PLAIN ZONE: NO
FROM THE APPLICATION INFORMATION ON SUPPLIED AND THE ON -SITE i:!(:I:I:I... PERCOLATION DATA
THE IIL FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE F l;:ol.I:I:F4I;_D
SEPTIC TANK 1250 GALLONSABSORPTION TRENCH SO F T ..
OR
ABSORPTION 1<:+I:l.D :?(e n FT.
:I:I•I ADD:I:'T:coi1,, ni:I:S PERMIT IS 4l,,E TE:cr TO THE. FOLLOWING ADD:1:T':I:OPAL., TERMS AND
(: (:lNI):k:T':1:oi s
'r'l••I:C.:; PERMIT MIT IS GRANTED TEMPORARILY Iti:1:I...Y TO ALLOW CONSTRUCTION TO (:ommEm[:',1:::„ THIS S PERMIT
MAY BE:: REVOKED DR SUSPENDED .NDED BY THE WI:i:L..D COUNTY HEALTH T H DEPARTMENT FOR REASONS S SET
FORTH :I:ICI THE WELD COUNTY INDIVIDUAL SEWAGE T):1:4:3P(:i::3AL.. SYSTEM REGULATIONS INCLUDING
FAILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPORARY OR FINAL
APPROVAL. . T1"IF, ISSUANCE (:)I"' THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE
DEPARTMENT (DR ITS EMPLOYEES OF. LIABILITY FOR THE FAILURE DR INADEQUACY OF THE
SEWAGE z):[SPOSAl... SYSTEM.
IMAM SMITH
ENVIRONMENTAL SPECIALIST
Cw:CAI...:1: ST
DATE
00/11/94
THIS PERMIT T 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 I THE WELD COUNTY HEALTH DEPARTMENT RESERVES t TFII:. RIGHT 11' TO 1111'(:I#SE" ADDI-
TIONAL -TERMS AND CONDITIONS REQUIRED T(:) MEET OUR REGULATIONS ON A CONTINUING BA-
SIS. E':I:NAl... PERMIT APPROVAL IS CONTINGENT UPON THE 1=':I:NAI... INSPECTION OF THE COM-
PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT.
SYSTEM INSTALLER' . ........... .
SYSTEM ENGINEER
T YI"'E OF SYSTEM I:_M INSTALLED
AI.._I...L.D
tut, t
61h- FINAL 1
APPROVAL
DATE
l:hlV:I:1 CI1�IM6i'TAI... SPECIALIST
THE ISSUANCE OE TI"I,I:s PERMIT DOES NOT IMPLY COMPLIANCE WITH OTHER STATE COUNTY
OR LOCAL REGULATORY OR BUILDING REQUIREMENTS, PIC)R i3FHAL..i... IT ACT TO CERTIFY r THAT
THE ;i`UBOEC T' SYSTEM W:1:I..,L,. OPERATE E:: :1:1 1 COMPLIANCE WITH APPLICABLE STATE., COUNTY AND
LOCAL REGULATIONS ADOPTED TIC:I) I::'f: RSUAl*I`T' TO ART:lCl...i:;: ;i.0„ TITLE L.E: :� 5, CRS 1973, AS AMENDED,
EXCEPT FOR TI••IE PURPOSE OF ESTABLISHING FINAL APPROVAL OF AN INSTALLED STAL..L.ED SYSTEM FOR
ISSUANCE OF A LOCAL OCCUPANCY Y PERMIT PURSUANT TO (:.RS 1973 25-10-111 (2).
con. p (:s(:: PY••••W(:rIAD
' i:r1 IO.,..l=:F•Is MAY, 1904
Zd
4g -k
°Alt
WO)
r
w
E.4SI•' 1.06F'
JhEi}1V3:I}I.IAE... SEWAGE DISPOSAL SYSTEM F'E I'IT'T NO.. 0-94040
WELD COUNTY HEALTH DEPARTMENT
ENV:LRONMENTAL. HEALTH SERVICES
1517 16TH AVENUE COURT, (:l1YC-_:EI...J Y, CO 80631.
ZWJi-•'•12 i G:
Ott>�:�ti E_X'T...:..r.R..:
REPAIR PERMIT
OWNER W:I:I...I...:LANS R KENNErHJT<ARi• ARA ADDRESS 20767 WCR 66 PH (30,;) ..;t16 2496
GREI~ I._k:Y CO 80601,
ADDRESS 01::' PROF OSF'D SYSTEM 20/67 WCR 66
GREELEY CO 80631
I.,.F..(aAL DLLSCI4J:1-TJON 001 S]:TE, : 1: •'. SE_4 SIC c1. TWP 6 E.11(3 6 .
SUBDIVISION. L..C T 0 BLOCK 0 FCLING 0
USE TYFV : k RESIDENTIAL HOUSE
SERVICES: PERSONS 6 BATHROOMS 1.1h LOT SIZE 4.00 ACRE::S
BEDROOMS 4 BASEMENT PLUMBING YES WATER SUPPLY NWCWD
APPLICATION FEE $>:L2ty.00
NEC'D BY CINDY SAL-AZAR
DATE 08/;1.:L/941
PERGOLA i :Lol-.E 30lA 10
v M KN PER INCH LIMITING ZONE FEETso:I:L.. TYPES t PER(::I:"INIT' GROUND SLOPE _ .ar 0:I:hl:::(.Ci'T1:(:1N _
RI: OUI:I F:W3 ;J�l(:;1NE:I:::R DESIGN 14.0 1N 100 YEAR... FLOOD F'L..A:LH ZONI.
I -ROM -T-HI::: AE'P1..,:CCAT`ION :INFORMATION SUPPLIED AND THE ON -SATE SOIL.. PE:R€::OLA'r:I.ON DATA
THE: FOLLOWING MINIMUM :u sT L-.LAT J,oN SPECII:: TEAT 1Cll'iS ARE REO I:CRED:
f3l:F''r:[C. I ANT' (:iAI...I...ON{' • ABSORPTION TRENCH SO. ET.
OR
ABSORPTION BED i SQ. FT-_
777 -
IN Ari :[T:1:ow4 ' 1;113 I •1;_RiIi T', :[r sUBJECT Tg Tla.LOWINCbAD :1 T: ONAL.. 'rERI S rtir4za
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SIGNED E'r BARBARA a. w7:1...L..iAIM
DATE 00/11/94
THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. T-I-I:ro PERMIT
MAY BE REVOKED OR SUSPENDED BY THE: WELD COUNTY I-HEA1,..'r1-I DEPARTMENT FOR REASONS SET
FORTH IN THE WELD {.:DU I'TY INDIVIDUAL SEWAGE DISPOSAL.. SYSTEM REGULATIONS INCLUDING
FAILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPORARY OR FINAL.
APPROVAL. THE ISSUANCE OF TF•I:1:o PERMIT DOES NOT CONSTITUTE: ASSUMPTION BY THE
DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR INADEQUACY OF THE
SEWAGE DISPOSAL,,. SYSTEM
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:::NV:I:I .0N11l;_N-TAE..- SPECIALIST DAT
THIS PERMIT IS NOT TRANSFERABLE AND SHALL., BECOME VOID IF SYSTEM CONSTRUCTION HAS
I•lrrr COMMENCED WITHIN ONE: YE:AR rw ITS ISSUANCE. BEFORE ISSUING FINAL.. APPROVAL 11F
THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI-
TIONAL TERMS AND CONDI'T'IONS REOUTRED TO MEET OUR REGULATIONS ON A CONFINLJSNG BA-
SIS. FINAL PERMIT APPROVAL IS CONTINGENT (JF'OH THE F:l:NAL_ INSPECTION (:1F THE COM-
PLETED SYS11111 BY THE WELD COUNTY HEALTH DEPARTMENT.
€JI :C c I I'IAL••-AP F .-:[ CAN'T' pp COPY••••WCI••ID W€:I••ID•••-EHS MAY. 1.984
V
MSP106R Al L_ICAlION FOR JNDI:VIT)1.JAL.. SEWAGE DISPOSAL SYSTEM NO.. C7"-940400
WEI,..ID COUNTY HEALTH DEPARTMENT
ENVI:RONMENTAL.. HEALTH SERVICES
1.5.1.7 16TH AVENUE COURT, GRE:C.:L..EY, CO S0631
353-0635 2.22..
REPAIR APPLICATION
OWNER WILLIAMS, KENNETH/BARBARA ADDRESS 2.0767 WCR 66 PH (303) 356-2496
GREE L..EY CO 80631
ADDRESS OF PROPOSED SYSTEM 20767 WC:R 66
GFEE:ELEY CO 8063:L
LEGAL DI:t,TR:I:F•I [UN OF SITE: EA' SE: r4 $L-(.; 21 TWI 6 RNG 65.E
SUBDIVISION:: LOT 0 BLOCK 0 FILING 0
USE TYPE:, RESIDENTIAL HOUSE
SERVICEsg PERSONS 6 BATHROOMS J.25 LOT SIZE 4.00 ACRES
BEDROOMS 4 BASEMENT E:N T PLUMBING YES WATER SUPPLY NWCWD
APPLICANT ACKNOWLEDGES THAT THE COMPLETENESS OF THIS APF•L.ICAT7:i:IN IS CONDITIONAL..
UPON FURTHER MANDATORY AND ADDITIONAL TESTS AND REPORTS AS MAY BE REQUIRED UIRED BY THE
WELD COUNTY HEALTH DEPARTMENT TO BE MADE AND FURNISHED BY THE APPLICANT OF BY 'fl•4:
WELD COUNTY HEALTH DEPARTMENT i=OR PURPOSES OF THE EVALUATION OF- THE APPLICATION;
AND THE ISSUANCE OF THE PERMIT T IS SUBJECT TO SUCH TERMS F:M `> 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 40{) FEET OF A COMMUNITY SEWAGE SYS'T'EM. THE
UNDERSIGNED HEREBY CERTIFIES THAT AL..L- STATEMENTS MADE, INFORMATION AND REPORTS
SUBMITTED HEREWITH AND REQUIRED TO z:ci::: SUBMITTED ED BY THE APPLICANT ARE, OR WILL BE,
REPRESENTED TO DE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND
ARE DESIGNED TO BE RELIED ON BY THE WEI...I) COUNTY HEALTH DEPARTMENT IN EVALUATING
THE TAME FOR PURPOSES OF :,SLUING THE PERMIT APPLIED FOR HEREIN.. I FURTHER UNDER—
STAND,THAT ANY FALSIFICATION OR MISREPRESENTATION MAY RESULT IN THE DEMN:I:AL.. OF:. THE
APPLICATION OR REVOCATION OF ANY PERMIT GRANTED BASED UPON SAID APPLICATION AND
IN LEGAL.. ACTION FOR F•ERaLJRY AS PROVIDED BY LAW.
APPLICATION FEY $:L2.00 BARBARA J. W:I:L..L..:LAMS
REY':C; ' 0 BY CANDY SAI...AZAR �Cx.
DATE 087:C 1/914
_ . ,........_.._.. _... .-_ _.,...... 08/11/94 .
C3WNE;:R/AC;ENT E J:GI-.EA'T'uRE HATE
ORIGINAL—AF'•PL:CcAN'r COPY.•-WcI••II> WCHI)'-•F_I1S MAY;. 1904
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