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Home My WebLink About20181052.tiffGreeley City of Greeley Director of Finance P.O. Box 1928 Greeley, CO 80632-1928 Account Number 063-770388-01 Service 2770 E 18TH ST Location Meter ID Date Curr Read Date Prey Read Usage 94524348A 04/03 587 03/03 587 0 CONSUMPTION HISTORY 5 4 3 2 1 (Usage in thousand gallons) M J JASON Used h' DJFMA Statement of Account for Utility Service(s) THIS BILL SHOWS A PREVIOUS AMOUNT DUE. PLEASE REMIT AT EARLIEST CONVENIENCE. IF PYMT HAS BEEN MADE, THANK YOU. RESIDENTIAL WATER Used Rate Residential Water Base Charge Bal Fwd RESIDENTIAL WATER $14.11 0 9.92 Amount $0.00 $14.11 $51.78 CURRENT CHARGES $14.11 TOTAL DUE ON 04/23117 $65.89 WATER CONSERVATIONMESSASES BILLING MESSAGES THE WATER CONSERVATION PROGRAM OFFERS FREE AUDITS. WINTER IS THE TIME TO GET AN INDOOR AUDIT OR SIGN UP FOR A SPRINKLER SYSTEM AUDIT NEXT SUMMER. SIGN UP AT GREELEYGOV.COM/AUDITS OR CALL 970-336-4229 QUESTIONS? CALL YESENIA 970-350-9720 ****SEWER CEILING WILL BE SET FROM YOUR JAN TO FEB USAGE"*** TO PAY YOUR BILL ONLINE WITH NO FEES, GO TO WWW.GREELEYGOV.COM/UT1LITYBILL PARA PAGAR SU FACTURA SIN CARGOS, VAYA A: WVVW.GREELEYGOV.COM/UTILITYBILL DETACH AT PERFORATION AND RETURN WITH YOUR REMITTANCE Account Number Service Location Due Date Amount Due Amount Enclosed 063-770388-01 2770 E 18TH ST 04123117 $65.89 Greeley City of Greeley Director of Finance P.O. Box 1928 Greeley, CO 80632-1928 KEMPEMA KYLE 2770 E 18TH ST GREELEY CO 80631 19063-770388010000065895 Scanning Cover Sheet for Septic Permits Permit # Permit Type: Situs Street Address Situs City, State, Zip G19919006 Health / Residential/ Statement of Existing 2770 E 18TH ST Sec/TownlRange: 11 -05N -65W Parcel # (12 digits) 096111000034-R3376086 Owner Full Name: ELLICOTT DAVID Owner Address: 2770 E 18TH ST GREELEY,C0 80631 Contact Name: Contact Address: Application Status: Finaled Application Date: 03/11/1996 Owner Phone #: 000 0000000 Contact Phone# Information above has been Verified in Accela by emDloyee noted below X Processed by: Date October 10, 2008 Report ID: EHS00024v003 Page 1 of 1 Print Date -Time: 10/10/2008 12:48:16PM 9 HSP106P INDIVIDUAL SEW - GE DISPOSAL SYSTEM PERMIT NO. G-919006 WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICES 1517 16TH AVENUE COURT. GREELEY. CO 606'31 353-0635 EXT.2225 NEW PERMIT OWNER ELLICOTT. DAVID ADDRESS 2770 E 18TH ST PH (000) 000-0000 GREELEY CO 60631 ADDRESS OF PROPOSED SYSTEM 2770 E. 18TH STREET GREELEY CO 80631 LEGAL DESCRIPTION OF SITE: SW4 SW4 SEC 11 TWP 5 RNG 65 SUBDIVISION: LOT O BLOCK 0 FILING 0 USE TYPE: RESIDENTIAL LOAN 006-91/074.95 SERVICES: PERSONS 2 BATHROOMS 2.00 LOT SIZE 5.00 ACRES BEDROOMS 3 BASEMENT PLUMBING NO WATER SUPPLY GRELY APPLICATION FEE $0.00 RECD BY CINDY SALAZAR DATE 01/23191 SIGNED BY OLA FAE BRUG DATE 01/23/91 PERCOLATION RATE 0.0 MIN PER INCH LIMITING ZONE 0 FEET SOIL TYPE SUITABLE PERCENT GROUND SLOPE 0% DIRECTION REQUIRES ENGINEER DESIGN NO IN 100 YEAR FLOOD PLAIN ZONE NO FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON -SITE SOIL PERCOLATION DATA THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED: SEPTIC TANK 1000 GALLONS. ABSORPTION TRENCH SQ. FT. OR ABSORPTION BED SO. FT. IN ADDITION. THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND 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 DISPOSAL SYSTEM. WES POTTER, X• -STAFF 01/23/91 ENVIRONMENTAL SPECIALIST DATE 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. SYSTEM INSTALLER UNKNOWN SYSTEM ENGINEER TYPE OF SYSTEM INSTALLED TANK FINAL INSPECTION DATE 01/23/91 APPROVAL WES POTTER, X --STAFF ENVIRONMENTAL SPECIALIST 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 104 TITLE 25, CRS 197-3. AS AMENDED. EXCEPT FOR THE F'URF'OSE 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: Cr. PY-WCHD WCHD-EHS MAY. 1984 Orin; .COUN'ZY HEALTH DEPARTMENT 'EXV4RONMEMTAL PROTECTION SERVICES 1317 16th Avenue Court ` Greeley. Colorado x0631 (303)353-0635 Weld County Health Department SOE.S LOAN 1 O 7 -? ISDS I REPAIR 0 PERMIT I T /.0p016 STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN BLACK INK ONLY) . OWNER OF RECORD; D A- ) ' d9. E\ PHONE: S 3 - —4-00 MAILING ADDRESS : --2--1--:.0 C . 1 Es ` re_e-Ec 'a so 4.3+ City State Zip SITE ADDRESS: 2,-1-1 O G . \ $ s - - C, rt`, I � S O to "3-J City State Zip LEGAL DESCRIPTION: PT: Sw4-{ PT: S�ZU SECTION: t 1 TOWNSHIP:()1; 5 RANGE: to_ SUBDIVISION: Pt Pr NUMBER OF PEOPLE: BATHROOMS: 12, LOT:_ BLOCK: — FILING: LOT SIZE: .1P/ BEDROOMS: COMMERCIAL BASEMENT'PLUMBING: Yes No WATER SUPPLY: CO (LGE+-y SYSTEM SIZE: Tank is constructed of C-Ik Yr and has 1 Oda gallons capacity � (material) YIELD: Bed �sq . f t . or Trench '_ NVW sq . ft. DATE SYSTEM INSTALLED: ca +ulc+xr.. J Ton are required CO 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 is in fact installed. as described. and exists at this time on the parcel o€ ground identified by the above legal description and further states that the system is in good working order and to the best of his/her 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. S Date Subs�f ed_r;:drI i •to bY Owner before me this 9' day of I . 199_[1. Mitnes's;my h*nd•ada of f icial seal. 5 - Date STATEMENT OF EXISTING REVIEWED BY: My cission expires: 446 Environmental Protection Specialist .E.74pHr CV. kkele 4. 61.0 , . • • 'eV +fr f �A 1 BLACK INK ONLY! N W. 8 S '- a "Le re • 9/— M000 oa 6' 41 { STATEMENT OF.ERISTINC SEPTIC SYSTEM (PLEASE FILL OUT IN INS) oWN' R of RECORD_ �1.► w �s-- 1..� a e_ 8r L73 Phone 2-'57/ MAILING;ADDRESS: CIAg as3ss` Lae 'C4› Co /WO S3 Cicy Scats Zip SITE ADDRESS: _ 69770 L`` / S ,,•e / 1e /o - -- ere 6 3 l City State Zip LEGAL Df:SCRIPTION:. PT 5 J'1 PT set! 54 Section ! / Township S Range bs- 4.1 SUBDIVISION. + LOT BLOCK FILING NUMBER. OF PEOPLE: 7 Bedrooms: J Bathrooms; rooms 14accr supply Z Q 6-ree /ey RESIDENTIAL OR COMMERCIAL: eCe+t �'a. % Lot Size: Acres SYSTE4-SIZE: Tank is Constructed of FIELD: Bed C or Trench (material) and h ss .-.7 O gals capacity sq. ft. Dace System Installed: 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 dwelling_ The undersigned property owner hereby certifies that the above described septic system is in fact installed,- as described. and exists at this time on ehe 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 his/her knowledge is not failing.to function properly. I further understand that any falsification or• misrepresentation bay result in revocation of any permit granted based 'upon this information hereby submitted and in. legal action for perjury as provided by law_ - - Date Subscribed and sworn to be ore me chi by ,_ • , ' E Witness ay hilid'and official seal. • Date .STATEMENT OF EXISTING REVIEWED BY otary Public Hy c ission expires • Envir.onmentai ?rot ction Specialist Dace•, f f.J .; V 'a \ jA viev60 0 W S 15tH COLORADO LOAN APPROVAL 6,ctiqobcf Request No: Date Received: _ Date Forwarded: Fee Paid: $50.00 Date: 3/26/90 Pt-Cr-el i.4,p 3-a-2 40 DEPARTMENT OF HEALTH 1516 HOSPITAL ROAD GREELEY, COLORADO 80631 ADMINISTRATION (303) 353-0586 HEALTH PROTECTION (303) 353-0635 COMMUNITY HEALTH (303) 353-0639 040-90 3/26/90 3/211190_ TO WHOM IT MAY CONCERN: Review and inspection report regarding water and- the sewage disposal system for an existing dwelling: SEND TO:, Pick -nn PHONE # 352-897L INFORMATION: Address 3915 B Street, Greeley, Colorado 80634 Legal: PT •NE4, PT , Sec 02 , T..115...9 R 66 W, Subdivision Johnson , Lot 15 , 51k , Filing_ _1 Property Owner 18RUG ; MELVIN & OLA Original Owner Cook. Don - Tank Pumped on Ma chr 26, 1990_ By Slim's Sacir.Ar.i fi Sery ee bEPARTMENTAL RECORD SEARCH: Permit # Bathrooms - - . - 2 . ,. - -Bedrooms - -- 4--. • -. --. Tank Capacity 1,500gals. Field Size sq. ft. Water Supply _ Gxseley Date of Final Inspection Age of House 1972 None on File Name . Total .Acreage 1 -- INSPECTION COMMENTS: Date of Inspection March 27, 1990 Soil Conditions: Dry I Saturated Residence: Occupied Vacant X Snow-covered FINDINGS: Sewage Disposal System: Satisfactory X Other Bacteriological Water Test: Acceptable X Other COMMENTS: Statement of Existing was recommended. DATE: March 28. 1990 SIGNATURE: Director, Envirtion Services 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 property in connection with either its examioation of the property or in the report. This inspection was conducted solely for the purpose of detecting health hazards observable at the time 'of inspection, and' does not constitute a warranty that the system is without flaw or that it will continue to function in the future. Inspection requested during periods•of snow cover and high soil saturation may be of questionable value to potential buyers due to adverse conditions. Water sample reports reflect the bacteriological quality of the water supply' at the time the sample was taken. INSPECTION DATE: 3 - r2 - Q'4 AREA IV SPECIALIST'S INSTRUCTIONS: NEED: 1. 2. 3 - LOAN Af I`P0VAI. CLOSING DATE MAIL OR •` ICK 3 -?a-94 OR RE -FINANCE Request No: Date Received: 3 - - 96 Date Forwarded: Fee Paid:1{O, dQ _ Date: 3 -,26 - 90 �,• TU WHOM iT MAY CONCEFY: Review ard inspection report regarding water and the •dis asst system for an existing dwelling: _� ,.PSEND TO: o c Y u p • At Li/ INFORMATION: Address Legal: PT Al/7Y_, PT Subdivision _ i 11J?so,PI Property Owner Jai* Pum-ped on T.c 12 sewage PHONE # ?S 8.97/ 1411 , Sec 0 , Tom, R'��W, Age of Septic /7222 Lot / , Blk , Filing Original Owner _ /al t4- n/n ClopClop r ?: By5/1,N:5_ DEPARTMENTAL RECORD SEARCH: Permit I Name Bathrooms `2 _____UkteFj_LECS j Bedrooms g Total Acreage • I Tank Capacity • gals. Field • Sizesq. ft. 'Water Supply_ � yr Date of Final Inspection. Ar _ __ INSPECTION CEMENTS: Date of inspection 3/21.7b0 Soil. Conditions: .Dry. ,/ • Saturated Snow-covered Residence: ,Occupied _ _ Vacant i/ _ FINDINGS: Sewage Disposal System.: Satisfactory Other _ Bacteriological Water Test: Acceptable wee Other Cc'i•- ENTS : 5, O. E DATE: S ICNATURE: 1 i.ealth Specialist ',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 property in connection with either its eyamination of,the property or in the report. This Inspection was conducted solely for the purpose of detecting health hazards observable at the time of -inspection, and does not constitute a warranty that the system is without flaw car that it will continue to function in the future. Inspection requested during periods of snow cover and high soil saturation may be of questionable value to potential bnvers.drse to adverse conditions. Water sample reports reflect the bacteriological quality of the water supply at the tine the sample was taken. 11 '' 1. • 1 COLORADO LOAN APPROVAL CLOSING DATE: 06/12/95 FAX FEE ($2.00): N/A NEW LOAN TO WHOM IT MAY CONCERN: Review and inspection.report disposal system for an existing dwelling: PICK-UP: Richard Sitzman DEPARTMENT OF HEALTH 1517 18 AVENUE COURT GREELEY, COLORADO 80631 ADMINISTRATION (970) 353-0586 HEALTH PROTECTION (970) 353-0635 COMMUNITY HEALTH (970) 353-0639 FAX (970) 356-4966 REQUEST NO: 074-93/884 DATE RECEIVED: 06102/95 FEE $90.00: 06/02/95 regarding water and the sewage REALTOR NO.: 353-3200 INFORMATION: Address: 2770 East 18th Street, Greeley, CO Age of Septic: Unknown Legal: PT: SW4 PT: SW4 SEC: 11 TWN: 05. N RNG: 65 W Subdivision: N/A LOT: BLK: FLG: Property Owner: Ellicott, David Original Owner: Brug, Ola Tank Pumped on: 06/05/95 By: Owens Sanitation _ Licensed: Yes PERMIT ON RECORD: Name: Brug Bathrooms:1 Bedrooms: 3 Water Supply: Greeley Tank Capacity: 1000 gallons Ola Permit No.: G-919006 S.O.E.: Yes Total Acres: 5 Date of Final Inspection: N/A Well Permit No.: N/A Field Size: Unknown square feet INSPECTION FINDINGS: Date of Inspection: 06-06-95 Soil Conditions: Dry xxx Saturated Residence: Occupied Vacant xxx Sewage‘Disposal System: Satisfactory xxx Other • Bacteriological Water Test: Acceptable xxx Other COMMENTS: There were no visible signs of failure at the time of inspection. There is not enough information available to determine if the field is adequately sized according to current regulations. This Department recommends that the system be brought into compliance. A permit is required for any alterations made to the system. DATE: 06/09/95 SIGNATURE: blk Snow-covered Environmental Protection Specialist 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 property in, connection with either its examination of the property or in the report. This inspection was conducted solely for the purpose of detecting health hazards observable at the time of inspection, and 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_conditaons _Water sample reports reflect the bacteriological quality of the water supply at the time the sample was take. 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 system is not failing to function properly. • DATE: p SPECIALIST INSTRUCTIONS: - CLOSING DATE: G /2 - y5 REQUEST NO: O791 -75- FAX MAIL. PICCC DATE RECEIVED: ` 2 FAX FEE ($2.00): ----- RECEIV Y: FE $90.00 $105.00: (o -4?-95- N u LOAN RE -FINANCE TO WON IT MAY CONCERN: Review and inspection report regarding water and the sewage disposal system for an existing dwelling: SEND TO: PICK-UP: 4 CJ1 r.. -r. .'T FAX TO: REALTOR NO.: S 3 - 3 a,Q0 OWNER NO.: (H) OWNER NO.: (W) FAX NO.: INFORMATION: Address: g 77' g j_! `'4" c y_ r. (142 t[16,3 1 Age of Septic: ,,,,,,4 Legal: PT: s. y T: c 1,„ If SEC: // r TWN: q N RNG: 4,4r W Subdivision • •N A LOT: BLK: FLG: Property Owner `//i'ee a, Oa ..`r - Original Owner: !{7 r N * ()/a - - Tank Pumped on: By: Licensed: Y N PERMIT ON RECORD: Name: (5 r u (5) a Permit No.: Qf 7(9 176 Bathrooms: I _ Bedrooms: 3 Tdtal Acreage: Date of Final Inspection: Ad", Water Supply: r r Well Permit No.: -Tank Capacity: [ 'f gallons Field Size: (I.h.k_ square feet INSPECTION FINDINGS: Date of Inspection: If; -L - Soil Conditions: pry 3, Saturated •'Snow-covered Residence: Occupied Vacant Sewage Disposal System: Satisfactory Bacteriological Water Test: Acceptable )( Other Other io + its ( rail dKs �'1c1Lfe, `'M -n. • lc' f" � SIGNATURE: c]�4i Environmental Protection Specialist 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 property in connection with either its examination of the property or in the report. This inspection was conducted solely for the purpose of detecting health hazards observable at the time of inspection, and 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_ uy_ers due to adverse conditions. Water_sample reports reflect the bacteriological quality of the water supply at the time the sample was taken. —Evaluations based on Statements of Existing (5.0.E.) relies on information the property owner provides, under oath, indicating current status of the system and representing to the best of hislher knowledge the system is not failing to function properly. INSPECTION DATE: J •- 2 L - f ( AREA SPECIALIST'S INSTRUCTIONS: NEED: 1. 2. 3. LOAN APUFOVAL CLOSING DATE MAIL OR ' CK-UP OR RE -FINANCE Request No: OO19 _f j Date Received: (51... 17g- 9I Date Forwarded: Fee Paid : j '`_ Date: CI- I$ r91 TO WHOP! IT MAY CONCERN: Review and inspection ,report regarding water and the sewage dieposal.systen for an existing dwelling: SEND TO: INFORMATION: Address 1'1'1 Legal:. PT Cry PT,Stokl, Sec T O'5 , R i,s, W. Age o 3 Septic fln.r i to Subdivision , Lot Blk Filing Yrcperty Owner_ - Original Ownertld I Tank Pumped, .on ati _ s� _ ct Byoo. '`. -z!.', o.) PHONE #3a —V111 Is. DEPARTMENTAL RECORD SEARCH: Permit--?/?RName _ Bathrooms I Bedrooms Total Acreage Ea Tank ,Capaccty gals. Field Size ttnlc sq. ft. 'Water Supply_clArg_pgaEl, Gate of Final Inspection U SPECTION CCMENTS: Date of inspection -'— aa 4 Soil Conditions: Dry Saturated . Snow—covered kesidence: Occupied _ Vacant x FINDINGS: Sewage Disposal System.: Satisfactory eteriological Water. Test:_ Acceptable /) I'S,A ern --. ,,,td ' c.. +r4 i_..14A.4,...+ Iwo als.KENTS : - .. l, -E, O h710 el ' „ct.... i- ..--.9/ c - DATE: 9I SIGNATURE: [ 7.t"lx.cv nvironmental Hearlth Specialist Other Other f �S Q fO Ii 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 property in connection with either Its eyaination of the property or in the report. This inspection was conducted solely for the purpose of detecting health hazards observable at the time of inspection, and does not constitute a warranty that the system is without flaw or that it will continue to function in the future. Inspection requested during periods of snow cover and high soil saturation may be of questionable value to potential hovers d►:e_to_adverse conditions. [later sample reports reflect the bacteriological quality_ of the water supply at the time the pample was taken. v • e f. SLIM'S SANITATION INC P 0 BOX 357 LA SALLE COLO 80645 303/284-6951 -• 303/224-3185 303/442-4915 CUSTOMER W- 0 R ! K 081334 MELVIN BRUG WELR•µGOPNTY R4 }:3.t..� .. KERSEY 352-8971 CO 80644 TANK 2 SIZE :roe NEXT SERVICE : REMARKS LOCATION = DATE: /--//-yi INSTRUCTIONS .'ST IS IN DRIVEWAY E SIDE SERVICE ORDERED: SEP SEPTIC TANK ORDER a • WORK ORDER £: 2032 DATE ORDERED: 01/11/91 , DATE WANTED 01/11/91 ORDERED BY : OLA TERMS : NET 10 DAYS P.O. NUMBER : JOB NUMBER : 2770 E 18TH STREET GREELEY_. HOSE REQ ' D . : / ROUTE : S'/ LAST SERVICE : BY : D4l'y/ DUMPED: /f OF HOUSE SERVICE PERFORMED'- BY -- DATE Ho ENTER TANK LOCATION SKETCH BELOW COLORADO LOAN APPROVAL TO WHOM IT MAY CONCERN: Review and inspection disposal system for an existing dwelling: SEND TO: PICK-UP RICHARD D. SITZMAN DEPARTMENT OF HEALTH 1517 • 16 AVENUE COURT GREELEY, COLORADO 80631 ADMINISTRATION (303) 353.0586 HEALTH PROTECTION (303) 353.0635 COMMUNITY HEALTH (303) 353.0639 REQUEST NO.: 120-92 DATE RECEIVED: 4-15-92 DATE FORWARDED: 4-17-92 FEE PAID: $ 80.00 DATE: 4-15-92 report regarding water and the sewage INFORMATION: Address: 2770 EAST 18TH STRE Legal: PT SW4 , PT SW4 , Section 11 Subdivision N/A Property Owner:HERMAN, ROGER & LUCILLE Tank Pumped on: 1-11-91 ET, GREELEY, CO , Township 05 North, Range 65 West , Lot 000 , Block 000 , Filing 000 Original Owner: BRUG, OLA By: SLIM'S SANITATION PHONE NO.: 353-8918 HOME ALTERNATE: 333-3200 OFFICE 80631 Age of Septic: 1960 DEPARTMENTAL RECORD SEARCH: Permit No.: G-919006 Name: DRUG, OLA Bathrooms: 1 Bedrooms: 3 Total Acreage: 5 Tank Capacity: 500 gallons Field Size:UNKNOWN square feet Water Supply: GREELEY Date of Final Inspection: NOT APPLICABLE INSPECTION CANTS: Date of Inspection: 4-16-92 Soil Conditions: Dry^� Saturated XXX Residence: Occupied XXX Vacant FINDINGS: C0[II ENTS : Snow-covered Sewage Disposal System: Satisfactory XXX Other Bacteriological Water Test: Acceptable XXX Other RECOMMEND A 1,000 GALLONS TANK FOR A THREE (3) BEDROOM HOUSE ACCORDING TO CURRENT REGULATIONS. ANY FUTURE BUILDING PERMITS WILL REQUIRE A SEPTIC PERMIT AND BRINGING ENTIRE SYSTEM INTO CONFORMITY WITH CURRENT REGULATIONS. DATE: APRIL 17, 1992 SIGNATURE: 4'L ent1 Protection Specialist 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 property in connection with either its examination of the property or in the report. This inspection was conducted solely for the purpose of detecting health hazards observable at the time of inspection, and does not constitute a warranty that the system is without flaw or that it will continue to function in the future. Inspection requested during periods of snow cover and-highsoil saturation may be tf questionable value to potential buyers due to adverse conditions. Water sample reports reflect the bacteriological quality of the water supply at the time the sample was taken. ';',SPECIALIST'S INSTRUCTIONS: NEED: 1. 2. 3. LOAN APPROVAL CLOSING DATE '' MAIL OR PICK --UP .NEW LOAN OR RE -FINANCE Request No: Date Received: &rf.•'r Date Forwarded: Fee Paid: A' zi. 19.O Date: cf TO WHOM IT MAY CONCERN: Review and inspection report regarding water and the sewage disposal system for an existing dwelling: SEND T0: �1, h{ 1 !' .11r� V ('a `_� , INFORMATION: Address 0 72 ! e Legal: PT 9,-4/, PT 1Cr. L Sec // , T 7 , R e -4-1W, Age of House Subdivision Property Owner Tank Pumped on /w Fr ., 7/' r 1N; rJn•Y ;.r. r.r PHONE # r: S-943/ , Lot 31k , Filing vfeo r 'i//€Original_Owne€ '3r t,ra `'p.,/ tByr f c' DEPARTMENTAL RECORD SEARCH: Permit # c0 9(OH Name /(a it ___ Bathrooms I Bedrooms 3 Total Acreage •I Tank Capacity d gals. Field Size vk . sq . ft. Water Supply ,.7-' . •.• ,- f +F Date of Final Inspection 5,0,f, f , f/ Z- '1/ INSPECTION COMMENTS: Date of Inspection V/1/(6. &Z Soil Conditions: Dry Saturated %,...0 Residence: Occupied Vacant FINDINGS: Sewage Disposal System: Satisfactory / Other, Bacteriological Water Test: Acceptabl Other Snow -cove red CO!-. ENTS:f`�_.i..1...�__� DATE: / I NATURE : ral 'Health Specialist !either the County of Weld nor any of its agents or employees undertake or assume any liabill:y 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 in connection with either its examination of the property or in the report. This inspection was conducted solely for the purpose of detecting health hazards observable at the time of inspection, and does not constitute a warranty that the system is without flaw or that it will continue to function in the future. Inspection requested during periods of snow cover and high soil saturation may be of questionable value to potential buyers due to adverse conditions. Water sample reports reflect the bacteri.,logical quality of the water supply at the time the sample was taken. Hello