HomeMy WebLinkAbout20170836.tiffAccount Number
00x049-01
Description
1000 Gallons
Meter Readings
Previous Present
4505
Water Minimum Charge
Water Usage Charge
CST Surcharge
Multiple Unit Surcharge
4571
Readings Dates
Usage Read Code Previous Current
66 Actual 10/18/2016 11/21/2016
$16.50
$75.98
$0.00
$3.50
Previous Balance
Payment Received
$94.44
($100.00)
Total Current Charges $95.98
$90.42
Total Due
Please include a current phone number for our records.
Water
Consurrption
188
144 rig y�S
4
12U
:,.1..
96
tift
72 W;IC
48 •;2 5276♦
24 ." $4° . •y;
'D J FM AMJ JASON
N
CUSTOMER
Crabbe & Bernal
SERVICE ADDRESS
23462 County Rd 55
ACCOUNT NUMBER
000049-01
AMOUNT DUE
$90.42
B1LUNG DATE
11/30/16
DUE DATE.
12/10/16
ANNUAL ALLOCATION YID USAGE
300 _
CENTRAL WELD COUNTY WATER DISTRICT
2235 2nd Avenue
Greeley, CO 80631
970-352-1284
0
Weld County Environmental Health Services Department
1555 N. 17th Avenue
Greeley, CO 80631
Phone: (970) 304-6415
Fax: (970) 304-6411
Web: weldhealth.org
Septic Statement of Existing
Application Number: SE -1300002
App Type: Health\ResidentiallStatement of Existinglna
DON BUXMAN
1711 35 AVCT
KERSEY, CO 80644
Owner Name: GILBERT JAMES BERNAL
Parcel#: 105303000035-R0006090
Legal Deco: PT NW4SW4 3-4-64 LOT A REC EXEMPT RE -1214 (.23R)
Site Address: 23466 CR 55
KERSEY, CO 80644
Additional Info:
Status: Recorded
Applied: 01/31/2013
Work Description:
HOUSE
App Specific Info:
Basement Plumbing
.Full Bathrooms
Location Description
Number of Bedrooms
Number of Persons
Public Water Supply
Public Water Supply Utility
'Septic Tank Size
'Tank Material
No
2
23466 CR 55 KERSEY
3
2
Yes
CWCWD
750
CONCRETE
Report ID: EHS00029v005 Page 1 of 1
Print Date - Time: 3/12/2013 12:51:21 PM
WATER SUPPLY - PUBLIC
PRIVATE YES/
WELL/CISTERN#
WELD COUNTY DEPARTMENT OF PUBLIC
HEALTH AND ENVIRONMENT
1555 N,17T" AVENUE
GREELEY, COLORADO 80631
PHONE: (970) 3044415
FAX: (970) 304.6411
SE # ( 30 000 o{
ORG PERMIT #
REPAIR # / 3 oa0c2 q
LOAN #
ISDS #
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
(PLEASE FILL OUT IN BLACK INK ONLY)
PARCEL# J V J i� � � (j '} '7
PROPERTYOWNER T.,., s
MAILING ADDRESS
DESCRIPTION OF BUILDING (ex
SITE/LOCATION ADDRESS
PHONE NO. ( 701739-alo6
City
obile/modular home, shop, office)
geld
State Zip
Ca
City State
LEGAL DESCRIPTION PT N14 ,'1'y PT,Sk'SECTION 3 TOWNSHIPRANGE 6
SUBDIVISION LOT BLOCK FILING
CENCUS TRACT
LOT SIZE/ACRES
COMMERCIAL YES / ;O RESIDENTIAL ( NO
NUMBER OF PF SON , BASEMENT PLUMBING YES f NO
BED ROOMS j BATHROOMS FULL_ 3/4_ _.._ 1/2
1Oz 7; a 0, ,
WELL YES l CISTERN YES I )
NO
NAME
SYSTEM SIZE: §eptic tank material is constructed of Con !• c eand has 2_g -O gallons capacity.
FIFA: Trench cntiiare feet nw Rea fix: YEAR INSTALLED.
...1 - ���. ..• v squat £ .%
You are required to draw a diagram of the system on the reverse side of this form In black uik 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 of ground identified by the above legal descarip6on and further
states that the system is 's no a good working order and to the hest of his/her knowledgsi'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 taw.
A 3/- /3
DATE O III
SI NATURE
Subscri ed and sworn to before me this day of
k 1 Mrs irr r.n ,/:
I i' 11L1 It
Witness my hand wad official seal.
AJa6 rct
DATE TA` t\' PUBLIC
STATEMENT OF EXISTING INSPECTION REVIEWED BYA
ENVIRONMENTAL HEALTH SPECIALIST DATE
, 20
•
Mil SHAW
G0NZALES •
MY C0MM+SS;C,l ExPi
exx ire ir,J• li O'Q
Al �.1 rA
r
L
fto _
WIDc.
COLORADO
5E -c q)23
LOAN APPROVAL
CLOSING DATE: Unknown
FAX FEE ($2.00): N/A
NEW LOAN
TO WHOM IT KAY CONCERN: Review and inspection report
disposal system for an existing dwelling:
SEND TO: N/A
--gz.aiZ3
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: 199-92/441
DATE RECEIVED: 06(22/92
FEE $60.00: 06/22(92
regarding water and the sewage
PICK-UP: Richard Sitzman •KcComb'-Realt
FAX TO:
REALTOR WO.: Not Available
OWNER NO.: 2646731 (H)
OWNER NO.: N/A (W)
FAX NO.: N/A
INFORMATION: Address:
Legal: PT: N2 PT: SW4
Subdivision: N/A
Property Owner: Mercier, Thelma
Tank Pumped on: 06/20/92 By:
2346. wCR 55, Kersey, Colorado 80644 Age of Septic:Unknown
SEC: 03 TWN: 04 N RNG: 64 W
LOT:_ 000 BLK; 000 FLG:.000
Original Owner: Dones, Dan
Owen's Sanitation Licensed: Yes
PERMIT ON RECORD: Name: Mercier, Thelma Permit No.: G-929121 S.O.E.: Yes
Bathrooms: 1 3/4 Bedrooms: 2 Total Acres: 9.7 Date of Final Inspection: N/A
Water Supply: Central Weld Well Permit No.: Not Available
Tank Capacity: 1000 gallons Field Size: 480 square feet
INSPECTION FINDINGS: Date of Inspection: June 25, 1992
Soil Conditions: Dry_ Saturated XXX Snow-covered
Residence: Occupied XXX Vacant
Sewage Disposal System: Satisfactory Other See comments _
Bacteriological Water Test: Acceptable XXX Other _
COMMENTS: The tank that was pumped was for an abandoned septic system. Owen's Sanitation
pumped the correct tank on the day of inspection. A pumping receipt was never received in
this office. The absorption field is 31X. undersized according to current regulations.
DATE: 03/08/93
tal 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 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 (S.O.E.) relies on information the property owner
provides, under oath, indicating current status of the system and representing_ t9 the best
of -his/her knowledge the system is not failing to function properly.
l'�
.SP$C IST'S INSTRUCTYONS:;
NEED: 1.
2.
3.
LOAD APPROVAL
CLOSING DATE,
MAIL OR `FICK-UP
r NEW LOAN/OR RE -FINANCE
Request No: , _y
Date Received: ^.• -- „
Date Forwarded:
Fee Paid: TAO' Date:
TO WHOM IT MAY CONCERN: Review and inspection report regarding water and the sewage
disposal system for an existing dwelling:
SEND TO:
`-j ice?'r re
PHONE #
INFORMATION: Address ? �A +i [j
Legal: PT }.• , PT:SWJ 4 , Sec 03 , TO-i , Rj _W, Age of House
Subdivision Lot , BIk , Filing
Property Owner i p - t' Original Owner —Jan Jr , . , . -
Tank Pumped on By''-
DEPARTMENTAL RECORD SEARCH: Permit t'.'" .../41 Name
. r
Bathrooms I ' 'i' t Bedrooms J -- Total Acreage • .
Tank Capacity L, :11U gals. Field Size L.IL6O ft. Water Supply :.ir4. i r i
Date of Final Inspections
INSPECTION COMMENTS: Date of Inspection
Soil Conditions: Dry Saturated
,Residence: Occupied ' 1 Vacant
FINDINGS:
COMMENTS:
DATE:
Sewage Disposal System:
a•cte ie'v tai Water Test: Accept blew— Other
.96/112
Snow-covered
Satisfactory Other
.1,ukt
CNATURL :
irLio
u mA.trot rL En ironmental Heal h ppecialist
0 G.�re.�.�- ��
)either the County of Weld nor any of its agents or employees u dertake 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 Ot snow cover and high soil saturation may be of questionable value to potentia
buyers due to adverse conditions. Water sample reports reflect the bacteriological quali
of the water supply at the time the sample was taken.
q
4/1
WELD COUNTY WEALTH pE>; ARTMENT
ENVIRONMENTAL PR6TECTION SERVICES
1517 16th Avenue Court
Greeley, Colorado 80631
(303) 353--0635
WeldCa tll;y Health Department REPAIR •
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
(PLEASE FILL OUT IN BLACK INK ONLY) Z g ' b I
OWNER OF RECORD:Las Lt. w I t i PHONE: 431iNi-
MAILING ADDRESS: t -1 Io 1sJ 5- \ C i Co S.01.. Li Li
City ' State Zip
SITE ADDRESS: 7- { - L - S <=4). SI Cato
tate Zip
ct' A Ct � e I -�' ' City S
1_c 114
LEGAL DESCRIPTION: PT: 1- PT: S lu Li SECTION: 3- TOWNSHIP: LA RANGE : Li
SUBDIVISION: LOT:_ BLOCK:
I,.Iru,l
NUMBER OF PEOPLEt_ l BEDROOMS: 2.- BATHROOMS: 1- -IN
RESIDENTIAL / COMMERCIAL BASEMENT PLUMBING: Y
FILING:
WATER SUPPLY: e -
LOT SIZE: 9.-1 acres
SYSTEM SIZE: Tank is constructed 'of CCtelor and has 1C300 gallons capacity
(material)
FIELD: Bed or Trench ,O square feet. DATE SYSTEM INSTALLED:�_
You are required to draw a diagram of the system on the reverse side of this form in
black ink vniv 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 of ground
identified by the above legal description and further states that the system is in good
working order and to the best of blather 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.
- 2 Z - 4 'Z —TinS
Date
Subscribed and mesworn to before me this day of
/t.
by re. GC,
Witness my hand and official seal.
Date
STATEMENT OF EXISTING REVIEWED BY:
er
,(1 , 1992,
My commission expires; MyCommissicilla rresJah 23,1995
1,64V-7 � 4r -
Notary Pub
Environmental Protection Specialist
C
N
I
0
4
GAS 6
S
. SPE CI)L .IST' S INSTRUCTIONS :
NEED: 1.
2.
3,
LOAN APPROVAL
CLOSING DATE
MAIL OR PICK-UP
{
r NEW LOAN J'Ol .RE -FINANCE
Request No:
Date Received: !: - ,
Date Forwarded:
Fee Paid: 1 ' -' Date: it t
TO WHOM IT MAY CONCERN: Review and inspection report regarding water and the sewage
disposal system for an existing dwelling:
SEND TO: ` 1�a
• H /1'a v' PHONE LI
INFORMATION: Address } -} - ±.( t.( •J [} Rj f;
—
Legal: PT ,t'..')., PT3v...141, Sec 04 , ToLr , R( 4- W, Age of House
Subdivision , Lot , Blk , Filing
Property Owner i v, ,)t,.. -1G,_, (a•'. C •^ l t '' Original Owner . ' . r1 •, ,r. ,
Tank Pumped on ! - ...C. e. -1/,.;.,,. By RI '-'2At- i. :''u VU. i 44 • `- -' . .
DEPARTMENTAL RECORD SEARCH: Permit ',' , ;.;f Name
f•
Bathrooms f --=,'- Bedrooms & Total Acreage
Tank Capacity . •: C.1U gals. Field Size W O sq . ft. Water Supply ::4-,. ! , i
Date of Final Inspection a
INSPECTION COMMENTS: Date of Inspection (j.
Soil Conditions: Dry Saturated _
,Residence: Occupied y Vacant
FINDINGS:
COMMENTS:
DATE:
Snow-covered
Sewage Disposal System: Satisfactory Other
B cte iclocal Water Test: Accept b1e — Other kJ 1003 Saw
CNATURE:
dr
dam'pti «Q % b2,44 "5tur42
aeon ,ivi ! hn ironmental health Specialist
Neither the County of Weld nor any of its agents or employees u dertake 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 high soil saturation may be of questionable value to potentia
buyers due to adverse conditions. Water sample reports reflect the bacteriological quali jr'
of the water supply at the time the sample was taken. �-? G
f
WELD COUNTY HEALTH DEgARm NT
ENVIR MENIAL PROTECTION SERVICES
1517 16th Avenue Court
Greeley, Colorado 80631
(303)353-0635
vGela county Health Depnrtmdr
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
(PLEASE FILL OUT IN BLACK INK ONLY)
OWNER OF RECORD; \ LIB w t+
PHONE:
MAILING ADDRESS: - % tofa, J
City
• State
SITE ADDRESS: ' C_ P- S LC 5- 'Co.
Lest A , f �-,, t� tb� ` I0 3-(53-3- REty2L State
LEGAL DESCRIPTION: PT; IQ 2- PT: Sl.0 L1 SECTION: TOWNSHIP: L4
SUBDIVISION: LOT: BLOCK:
' l �frurl
NUMBER OF PEOPLE: 1 BEDROOMS: Z BATHROOMS: l - '3Iy
RESIDENTIAL / COMMERCIAL BASEMENT PLUMBING: Y
Zip
Zip
RANGE:
FILING:
WATER SUPPLY: LADEEkcii.
cr
LOT SIZE: 9.-7 acres
SYSTEM SIZE; Tank is constructed of CE11/4-tmiLlr and has l OO gallons capacity
(material) t�wk�,oc�r
or Trench LA 'go square feet. DATE SYSTEM INSTALLED:
FIELD: Bed
You are required to draw a diagram of the system on the reverse aide 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 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.
Cp-- 2_ Z -S2,
CI�� L._ 4 w. l` �1 -c► - _ -
Date caner
Subscribed and sworn to before me 'this 4Z _
by /2,./e-ba4 s�I.(
Witness my hand and official seal.
day of g{/1E--
, 1992,
My commission expires AMY Commission Wes 1995
6- - - 2— LOA \ i'
Date Notary Pub isL-
STATEMENT of EXISTING REVIEWED BY:
Environmental Protection Specialist
'
SPECIAlLg`nS LNSTRUCTIONS:
NEED:
2.
3.
LOAN APPROVAL
CLOSING DATE
MAIL DR PICK-UP I% -D-
-
HEW LOAN. OR RE -FINANCE
Request No:
nate Recei••ed _ „ - f: ,.
Date Forwarded:
Fee Paid: , ) =' Date: f . {
TO WHOM IT MAY CONCERN: Review and inspection report regarding water and the sewage
disposal system for an existing dwelling:
SEND TO: 1t. Li
PHONE #
INFORMATION: Address ;17.L-1462 .✓- LAX R. ! sus -r,�,. -rr,,;',. �f -1
Legal: PT j" , PI.A S- , Sec 63 , To-, R(....,9 W, Age 'o€ Rouse
Subdivision Lot , Blk , Filing
Property Owner 1 (0.40, ni-P f 0_ i 'r Original Owner IJK,g,
Tank Pumped on ' :40 -`id4 By (. l tvv. �Ca..Y1.L1(1.1 .ice
DEPARTMENTAL RECORD SEARCH: Permit #• .2';'''',' 2:Z Name At e, r; x i
-f ), r .,,,/,
Bathrooms Bedrooms 4 Total. Acreage Y- i
Tank Capacity gals. Field Sizezff,, sq. ft. Water Supplyef'D
Date of Final nspection
INSPECTION COMMENTS: Date of Inspection le q '
Soil Conditions: Dry 4 Saturated Snow-covered. _
Residence: Occupied ( Vacant -
FINDINGS: Sewage Disposal System: Satisfactory )r Other
Bacteriological Water Test: Acceptable r Other
COMMENTS:
DATE: 61941q,2 SIGNATURE:
Environmental Health 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 eider its
examination of the property or in the report.
This inspection was conducted solely for the purpose of detecting health hazards observable
at the rime of inspection, and does not constitute a warranty that the system is without
flaw nr that it will continue to function in the future. Inspection requested durin
periods of snow cover and high soil saturation may be of questionable value to potent]
buyers due to adverse conditions, (later sample reports reflect the hacteriological qua v
of the water supply at the time the sample was taken. Ca
sue» COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL. PROTECTION SERVICES
X517 16th Avenue Court
Greeley, Colorado 80631 - -
(303)333-0635Nikki lttHealth Departmeni
IMPAIR #
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
•
(PLEASE FILL OUT IN BLACK INK ONLY)
OWNER OF RECORD : C k g �- J j cj PHONE:
MAILING ADDRESS: 2 (4 ( lx -]C 4 . S •� ( Ce , g O (n
City `State Zip
SITE ADDRESS: `- 3y b-2.- L)3 c -s" i ceb g.c)(oLle L
L c. rt A tz.+e �► `� %-, ¢ w3 '-o53•-Q3. Ci -�-�e (�.t4t s e Zip
�to�tt
�
LEGAL, DESCRIPTION: PT: N 1Z_ SU'
PT: / SECTION: 3 TOWNSHIP: L4 RANGE: Co L
SUBDIVISION: LOT: BLACK: FILING:
NUMBER OF PEOPLE: 1-i BATHRoOMS: — q WATER SUPPLY: tx [�c4
I BEDROOMS: �• e��
RESIDENTIAL j COMMERCIAL BASEMENT PLUMBING: Y () LOT SIZE: Cl.:1 acres
SYSTEM SIZE: Tank is constructed of C51-ciar and has ISO[ gallons capacity
(material)
FIELD: Bed or Trench % I (, square feet. DATE SYSTEM INSTALLED: tq $.}
You 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
is 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 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.
\ ¢ LK A k C.rl _- - b C.K
Date
. ,. er Li ^a*i-Na`"
Subscribed and sworn to before me this cqa day of
by j eL
Witness
my hand and official seal.
Date
STATEMENT OF EXISTING REVIEWED BY:
My commission expires:
Notary Publ
, 1992,
My Commission &Ikea Jan. 23, 1995 =.
Environmental Protection Specialist
" L
,INDIVIDUAL SEWAGE cn:: I):1:6:S1'''(:)#;Sall., SYSTEM i PERMIT
WE::I.,.rD COUNTY I-•{I:;:f'rl...'T'F•I DEPARTMENT
ENVIRONMENTAL T'r1L HEALTH SERVICES
1517 16TH AVENUE COURT, ;, (:i(iI:::I:::I.. EY CO 80 631
35 3-0635 E::. T„2••+2
NO. G-929122
NEW PERMIT
OWNER IYIL::I' (:',:EL::R., THELMA ADDRESS 23442. (1JCR 55 F'I••I (;;r,};:T) 284-6731
KE (- a:3EY CO 80644
ADDRESS O1::' I::I:.nI:''OSE::D SYSTEM R:,;:i4,52 WCR ;;5'a
KI:::I:tf:3E Y CO 80644
l i ranl.-. DESCRIPTION OF e:3:!:'r'1::.,, II2 Sh1el c:i:::r:' .,. 'r•hui::' 'E RE -I(:: .rri
;:SLJI:3I):I:V:L::S:I:(Jhls, LOT 0 BLOCK 0 I: i:i... ND ()
USE 'T'YF:'E:: ,I RESIDENTIAL LOAN 200-92
::SI k') I:(:;L::;;S g PERSONS :l. BATHROOMS TI -II UUl 1;:'S 3.00 LOT SIZE sf ,.'1() ACRES
BEDROOMS 4 BASEMENT PLUMBING NO WATER SUPPLY (::WCWI)
APPLICATION FEE 'Is().,00
RE::C;' D BY CINDY I:aALA I:
r)11m: 06/22/92
C3:I:(:)141I:::I) BY RICHARD D. #:S:I:"(':l:l''Ir1N/r1(:aE::11'T'
DATE 06/22/92
PERCOLATION RATE 0.0 hl:l:hl I::'E::I:w INCH LIMITING ic• l.(:JNl: O FEET
.`:3(]:I.I... TYPE SUITABLE PERCENT GROUND #:31...(:)1='1::: C)='•., DIRECTION
REQUIRES ENGINEER 1)E::,:3.1:(311 l -I
FROM 1F•Al::F:'I...:I:(:rr'r:Ei:11•! INFORMATION SUPPLIED A1IT> 'ii -ii: ON —SITE SOIL PERCOLATION DATA
THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE t: i:(:I(.J:I:F L::]Dt,
SEPTIC "('f1s1i1< 1500 GALLONS, ABSORPTION TRENCH f:s:l6 fa(:I . FT.
(31:
ADSORPTION BED SQ.. FT.
IN i"rrl):I:'T'7:(JN;, THIS PERMIT 13 f:`sL.JI•:3wiE:C`.'T ... THE FOLLOWING ADDITIONAL TERMS AND
(: O 111) :I: T:C (:1116:3 ;,
r'I•'I:(:6:Y PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION T(:) COMMENCE. •T'I•'1:I:6;3 PERMIT
MAY BE REVOKED OR SUSPENDED BY THE WI:::I...D COUNTY HEALTH DEPARTMENT FOR REASONS SET
FORTH IN THE WELD COUNTY :IND:I:V:I:DIJAI... SEWAGE I):E.:SF'OtA1... SYSTEM REGULATIONS INCLUDING
I:'A:lLURE::, TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPORARY AR`'( OR I:'':II'1AI...
APPROVAL. THE :E:::36:SIJr511(:;E:: (:JF:- •rl•-I:I:;iS PERMIT r)(:JE:6a NOT CONSTITUTE ASSUMPTION I:+1' 'T'1 -•n:
DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR INADEQUACY CY OF THE
SE:::Wr^GE:. r):F-i:i1::'(:l{:irll... SYSTEM.
F''A1 i SMITH C)fps/A'2/'• 2
ENVIRONMENTAL Iii(:hl Tr11... 631::'I:::(:;:I:i-il...:(:6:S'T' DATE
THIS PERMIT IS 11(:IT• TRANSFERABLE r111I) SHALL BECOME VOID :I:I::' SYSTEM (:',(:11w163'r'RIJ(.:'r'1:(:1ikl HAS
NOT COMMENCED I) WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE (:JRE::: :I:::3::41.1:I:1lt:i FINAL APPROVAL OF
THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT TITIE::hN'T' RESERVES THE 1:';:I:(i71•J'r' TO IMPOSE ADDI—
TIONAL TERNS AND CONDITIONS REQUIRED QU.k:F4l:;:I) TO MEET OUR REGULATIONS :E(:)1tiI6:S UN A CONTINUING BA—
SIS. FINAL fl.,. PERMIT r1F:'I::'ROV(11... IS CONTINGENT IJI'C111 •rI"IE:: I":r1-IAI... INSPECTION OF THE COM—
PLETED E::'r'E:::T? SYSTEM BY 'r'I"II::: WE::L..I) COUNTY HEALTH DEPARTMENT.
SYSTEM :IYI INSTALLER UNKNOWN
SYSTEM E::11(:3:1:11E::I..:R
TYPE C)E:'' SYSTEM INSTALLED TANK
F:':1:HA1... INSPECTION DATE C)6/22/92
APPROVAL V Arl... PAM SMITH
(:::hIV.I.R(JNME::1•I'r'r11... SPECIALIST
:C.r l..:l:d:3'T
THE ISSUANCE or THIS PERMIT :O(:)E::S NOT IMPLY COMPLIANCE W]:"('E•.I OTHER STATE, COUNTY
NT'Y
OR LOCAL REGULATORY OR BUILDING REQUIREMENTS, ME::N't NOR SHALL IT ACT TO CERTIFY THAT
I
THE SUBJECT SYSTEM W:I:I..,L.. OPERATE :1:11 COMPLIANCE WITH APPLICABLE 6:S'Tr•i'rI:::, COUNTY AND
I...(:J(::AL... REGULATIONS ADOPTED F:'I:::R6:SLJr;l41'T TO ARTICLE :LC)., 'r:I:'rl.,E:: 25, CRS :I.ei'73, x16:5 AMENDED,
EXCEPT T FOR ('1..11::: PURPOSE OF: ESTABLISHING FINAL APPROVAL OF AI'•! INSTALLED LI.: SYSTEM FOR
ISSUANCE OF A LOCAL OCCUPANCY I::I:::E:'.ITI:I:'T' PURSUANT TO CRS :I-9'l;:r 25-10-111 (2).
(:)R:l(a:l:lde"rl..•...e`rh'I::'I...:I:C;(11•I-T' II c 4jl::. (....Wc;I..II) WC:F4Iy---E::F-1 NAY, „ :1.ti'24
COLORADO
5E- 9Zq z5
LOAN APPROVAL
CLOSING DATE: Unknown
FAX FEE ($2.00): N/A
NEW LOAN
TO WHOM IT MAY CONCERN: Review and inspection report
disposal system for an existing dwelling:
SEND TO: N/A
DEPARTMENT OF HEALTH
1517 - 16 AVENUE COURT
GREELEY, COLORADO 8O631
ADMINISTRATION (303) 353-0586
HEALTH PROTECTION (303) 353-0635
COMMUNITY HEALTH (303) 353-0639
REQUEST NO: 199-92/441
DATE RECEIVED: 06/22/92
FEE $80.00: 06/22/92
regarding water and the sewage
PICK-UP: Richard Sitzman=,.McComb,Realt
FAX TO:
REALTOR NO.: Not Available
OWNER NO.: 284-6731 (H)
OWNER NO.: N/A (W)
FAX NO.: N/A
INFORMATION; Address: -2346S.WCR 55, Kerse ,
Legal: PT: N2 PT: SW4 SEC: 03
Subdivision: N/A
Property Owner: Mercier, Thelma
Tank Pumped on: O6/2O/92 By: Owen's Sanitation Licensed: yes_
Colorado 80644 Age of Septic:Unknown
TWN: 04 N RNG: 64 W
LOT: 000 BLX: 000 FLG: 000
Original Owner: Danes, Dan
PERMIT ON RECORD: Name: Mercier, Thelma Permit No.: G-929122- S.O.E.: Yes
Bathrooms: 1 3/4 Bedrooms: 2 Total Acres: 9.7 Date of Final Inspection: N/A
Water Supply: Central Weld Well Permit No.: Not Available
Tank Capacity: 1000 gallons Field Size: 480 square feet
INSPECTION FINDINGS: Date of Inspection: June 25, 1992
Soil Conditions: Dry Saturated XXX Snow-covered
Residence: Occupied XXX Vacant
Sewage Disposal System: Satisfactory Other See comments
Bacteriological Water Test: Acceptable XXX Other
COMMENTS: The tank that was pumped was for an abandoned septic system. Owen's Sanitation
pumped the correct tank on the day of inspection. A pumping receipt was never received in
this office. The absorption field is 3l7 undersized accordingto current regulations.
Environmental Protection Specialist
DATE: O3/O8/93 SIGNATURE:
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 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 (S.O.E.) relies on information the property owner
provides, under oath, indicating current status of the system and representing to the best
of hisfher knowledge the system is not Failing to function properly.
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COLORADO
TO WHOM IT MAY CONCERN: Review
disposal system for an existing
SEND TO: PICK-UP RICH SITZMAN
LOAN APPROVAL
and inspection
dwelling:
-ctzc1Z.Z
DEPARTMENT OF HEALTH
REQUEST NO.:
DATE RECEIVED:
DATE FORWARDED:
FEE PAID: $
1517 - 16 AVENUE COURT
GREELEY, COLORADO 80631
ADMINISTRATION (303) 353.0586
HEALTH PROTECTION (303) 353.0635
COMMUNITY HEALTH (303) 353.0639
200-92/E1299
6-22-92
06/29/92
80.00 DATE: 6-22-92
report regarding water and the sewage
INFORMATION: Address: 23462 WCR 55,
Legal: PT N2 , PT SW4 , .Section
Subdivision
Property Owner: MERCIER, THELMA
Tank Pumped on: 6-20-92
PHONE NO.: 284-6731
ALTERNATE:
KERSEY, CO 80644 Age of Septic: 1984
03 , Township 04 North, Range 64 West
N/A 'Lot -000 , : -Black-- 000 ," Filing ' 000
Original Owner: UNKNOWN
By: OWEN'S SANITATION
DEPARTMENTAL RECORD SEARCH: Permit No.: G-929122 Name: MERCIER, THELMA _.
Bathrooms: 3 Bedrooms:
Tank Capacity: 1500 gallons Field Size: 816 square feet Water Supply: CENTRAL WELD
Date of Final Inspection: N/A
4 Total Acreage: 9.70
INSPECTION COMMENTS: Date of Inspection: 6-25-92
Soil Conditions: Dry Saturated XXX Snow-covered
Residence: Occupied XXX Vacant
FINDINGS: Sewage Disposal System; Satisfactory XXX Other
Bacteriological Water Test: Acceptable XXX Other
COMMENTS: N/A
DATE: 06/29/92 SIGNATURE:
r..JJ VIA�►'�
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. 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.
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Weld Coun EnvironnnialH�alth Servit<es Department
1555 N 17th Avenue
Greeley, CO 50631
Phone: (970) 304-6415
Fax: (970) 304-6411
Web: weldhealih org
Septic Permit - Final
Application Number: SP -1300O24
Owner Name: JAMES BERNAL
Site Address: 23466 CR 55
KERSEY, CO 80644
App Type: Health1Residential\RepairlSeptic
DON BUXMAN
Parcel #:
Legal Desc:
App Specific Info:
1711 35 AVCT
GREELEY, CO 80634
105303000035-R0006090
PT NW4SW4 3-4-64 LOT A REC EXEMPT RE -1214 (.23R)
Finaled
Application Status:
Final Pending
Applied Date:
01131/2013
Issued Date:
02/01/2013
Fineled Date
Location Description
Repair Reason Type
Application Date
Septic Permit Expiration Date
Waive Fees
Number of Persons
Number of Bedrooms
Basement Plumbing
Full Bathrooms
Public Water Supply
Public Water Supply Utility
Parcel Acres
23466 CR 55 KERSEY
Repair for Failure
01/31/2013
01/31/2014
No
2
3
No
2
Yes
CWCWD
9.7
Actual Installation:
Septic Tank: Iv.' O gallons
Design Type: G
Absorption Trench= sq ft
Absorption Bed 90 sq ft
Chamber Model (- -t, .
Chambers
NOTICE
The issuance of this permit does not imply compliance with other state, county, or local regulatory or building requireinenis, 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 earmit is /ton -transferable and non-rifundable 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 ) r 12't•t j((��.
Environmental Fi(ellRh Specialist Date
Report ID: EHS00033v006
Print Date Time. 2/6/2013 10:26:07AM
Page 1 Of 2
rh
H
Application Number: SP -1300024
Owner Name: JAMES BERNAL
Site Address: 23466 CR 55
KERSEY, CO 80644
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Report ID: EHS00033v006
Print Date Time: 2/8/2013 10:26:07AM
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c3Z) bed 7.
Page 2 of 2
ALLES TAYLOR & DUKE, LLC 36n 35TH AVE. UNIT #6
LICENSED PROFESSIONAL ENGINEERS EVANS, 80634
LICENSED PROFESSIONAL LAND SURVEYORS 970-330-0308
February 4, 2013
Mr. Trevor Jiricek
Weld County Department of Public Health & Environment
1555 North 17th Avenue
Greeley, Colorado 80631
RE: Septic System Inspection
Gilbert J. & Rande L. Bernal and Cheryl M. & William C. Crabbe
23378 WCR 55
Kersey, CO 80644
Lot "A", RE 1214
Pt SE 1/4, Sec 3, T4N, R64W, 6th P.M.
Dear Sir:
The following residential septic design for Gilbert J. & Rande L. Bernal and Cheryl M. &
William C. Crabbe is submitted for your review and approval.
1. On February 4, 2013, I preformed an inspection of the septic system, as installed at
the site. I observed that 7 rows of 7 units of Quick 4 Infiltrators, for a total of 49
units had been installed. The required number of infiltrators was 44 Quick 4
Infiltrators.
2. No lift station is required at the site.
3. A new 1000 gallon septic tank had been installed per design.
4. Four feet of replacement soils, with a percolation rate of 10 min./in., had been used
in the construction of the absorption bed.
5. No traffic shall be permitted on the new absorption field after construction.
If you have any questions, please contact me.
Respectfully submitted,
Mark Taylor
Colorado P.E. 46065
2013-018
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