HomeMy WebLinkAbout20162661.tiffDirectors:
Bill Szmyd, President
Bob Acker
Larry Brandt
Peter Bridgman
Paul Bukowski
Kathy Gallivan -Grist
Ed Martens
Little Thompson Water District
March 21, 2016
District &Ltn:12er:
James C Hibbard
835 E Highway 56
Berthoud, CO 80513
P 970.532.2096
F 970.532-3734
Patrick Chandler
3380 CR 38
Mead, CO 80542
Dear Mr. Chandler:
This letter is in response to your request for a commitment for water service for the proposed
accessory dwelling, located at 3380 County Road 38.
The District provides water service within its service area as defined by the District. The
provision of water service by extension of existing water lines of the District to the above property and
the installation of taps for lots is done under the terms of the Rules and Regulations of the District
established by the Board of the District from time to time. You may obtain a copy of the Rules and
Regulations from the District. This letter outlines the provisions of the Rules and Regulations; however
this letter does not change any provisions of the Rules and Regulations. The Board of the District may
alter and amend the Rules and Regulations at any time, and the provisions of this letter are subject to
alteration and amendment based on changes in the Rules and Regulations of the District.
We currently serve the existing residence through tap # 674 and have an 8" diameter water line
located along WCR 38. We will continue to provide service to the above property and proposed
Accessory dwelling subject to the rules and regulations of the District. Please note that if the property
is divided and each residence is on a separate parcel, they would require separate taps.
YOU ARE HEREBY ADVISED THAT THE RULES, REGULATIONS AND TARIFFS
OF THE DISTRICT ARE SUBJECT TO CHANGE WITHOUT NOTICE; AND THIS
LETTER IS ISSUED WITH THE SPECIFIC LIMITATION THAT THE DISTRICT MAY
CHANGE THE RULES, REGULATIONS AND TARIFFS APPLICABLE TO THE ABOVE
PROPERTY AT ANY TIME WITHOUT NOTICE TO YOU OR ANY PERSON.
If you have questions, please contact me.
Regards,
Michael T. Cook PE
District Engineer
SO'
SO LOGIC
March 10, 2016
Chandler Construction LLC
1601 Sumner Street
Longmont, Colorado 80501
Attn: Mr. Patrick Chandler
Re: Existing On -Site Wastewater Treatment System (OWTS) Augmentation
Proposed Auxiliary Residence
3380 County Road, Mead, Weld County, Colorado
Soilogic Project # 16-1058
Mr. Chandler:
Soilogic, Inc. (Soilogic) personnel have completed the site evaluation and augmentation
design for the existing On -Site Wastewater Treatment System (OWTS) located at the
above reference address. We understand the Soil Treatment Area (STA) will treat
effluent generated by the existing site -residence and a proposed auxiliary residence to be
constructed on the above referenced lot. According to Weld County Health Department
criteria, and discussion with the client, we understand the existing system will need to be
increased in size to accommodate septic effluent generated by two (2) additional
bedrooms associated with the auxiliary residence. Results of the completed site
evaluation, proposed layout diagram and sizing calculations are included with this report.
On March 4, 2016, Soilogic personnel visited the project site in an attempt to establish
the location of the existing STA and to observe existing site features. The exact location
of the STA could not be established at that time. The approximate location of the
existing STA was estimated based on site vegetation and by the use of aerial photography
and the Repair Application Permit Number G-890299 documents available from the
Weld County Health Department. At the time of our site visit the ground surface in the
approximate area of the existing STA was observed to be moderately vegetated in grasses
with an approximate three -percent slope downward to the southwest.
Based on our review of the repair permit referenced above, we understand the existing
STA was originally sized for a 5 -bedroom residence and consists of a 1320 square foot
bed with plan dimensions measuring approximately 22 -feet in width and 60 -feet in
Soilogic, Inc.
3050 67th Avenue, Suite 200 • Greeley, CO 80634 • (970) 535-6144
P.O. Box 1121 • Hayden, CO 81639 • (970) 276-2087
Existing On -Site Wastewater Treatment System (OWTS) Augmentation
Proposed Auxiliary Residence
3380 County Road, Mead, Weld County, Colorado
Soilogic Project # 16-1058
2
length. At this time we understand the residence has been remodeled to a 4 -bedroom
home. We understand there is an existing 1000 gallon septic tank servicing the existing
residence that will be allowed to remain in place according to the Weld County Health
Department.
An average percolation rate of 20 minutes per inch was established for the near surface
site soils according to the Weld County Health Department Permit Number G-890299. In
accordance with Weld County Health Department design criteria and using a design
percolation rate of 20 minutes per inch and corresponding Long -Term Acceptance Rate
(LTAR) value of 0.60 gpd/sf, a two bedroom auxiliary residence utilizing a gravity fed
rock and pipe system in a bed configuration would require a minimum STA of 600
square feet with a minimum septic tank capacity of 1,000 gallons.
We understand the existing Soil Treatment Area (STA) was constructed with a plan area
of approximately 1320 square feet. Under current Weld County Health Department
septic design regulations the existing 4 -bedroom residence would require 1050 square
feet of STA assuming a gravity fed rock and pipe system in a bed configuration. With
the addition of an auxiliary residence requiring 600 square feet of STA, the combined
STA for the existing and proposed residences of 1650 square feet can be calculated. We
recommend expanding the existing STA 6 -feet in width and 60 -feet in length (360 square
feet) with the addition of a single lateral in order to promote equal distribution of effluent
throughout the field. An overall STA of 1680 square feet would result with this
expansion meeting Weld County requirements.
We recommend the infiltrative surface be established at a depth matching the existing
STA infiltrative surface. The additional lateral should consist of a 4" diameter perforated
pipe tied into the existing manifold or distribution box. A new distribution box may need
to be installed as part of system augmentation. The distribution zone should consist of
/" to 2 ''A" diameter clean, washed, graded distribution aggregate placed at least 2" above
the top of pipe to at least 6" below the bottom of pipe. The perforated PVC pipe should
be placed running down the approximate center of the added 6 -foot wide distribution
aggregate zone.
Existing On -Site Wastewater Treatment System (OWTS) Augmentation
Proposed Auxiliary Residence
3380 County Road, Mead, Weld County, Colorado
Soilogic Project # 16-1058
3
We recommend the top of the newly installed septic tank be established a minimum of
12 -inches below finished site grade. We understand Weld County Health Department
regulations require the top of the septic tank to be buried no deeper than 4 -feet below
grade. Some septic tank manufacturers specify the top of the tank to be established no
more than 2 -feet below grade.
Care should be taken at the time of system installation to ensure Weld County
requirements concerning minimum required separation distances between system
components and site features and amenities are maintained. A minimum 10 -foot setback
is required between the STA and property lines. Offset distances are shown in their
approximate location on the proposed layout diagram. If the bed addition will not fit on
the south side of the existing field due to proximity to the property line, the bed addition
will need to be completed on the north side of the existing field.
The owner should realize an OWTS is different from public sewer service and assume the
responsibility for maintenance of the OWTS. The system is relatively maintenance free
although periodic pumping of the septic tanks will be required. Water use must be
monitored so toilets and other fixtures are not allowed to continuously run. A freely
running toilet can consume in excess of 1,000 gallons per day. An excess 1,000 GPD can
flood and irreparably harm the onsite septic system. In addition, toxic or chemically
treated pool and or spa water and plastic and other non -biodegradable materials should
not be introduced into the OWTS.
Sprinkler systems should not be installed or allowed to irrigate over the absorption bed
area. In addition, livestock should not be allowed to graze over the absorption field and
the field should not be subjected to vehicle traffic. We recommend the surface of the
absorption field area be seeded after installation using a dry -land seed which does not
require irrigation water. In addition, the absorption bed area should be mowed to
maintain vegetation in the range of 6 to 12 inches in height.
Existing On -Site Wastewater Treatment System (OWTS) Augmentation
Proposed Auxiliary Residence
3380 County Road, Mead, Weld County, Colorado
Soilogic Project # 16-1058
4
We appreciate the opportunity to be of service to you on this project. If you have any
questions concerning the enclosed information or if we can be of further service to you in
any way, please do not hesitate to contact us.
Very Truly Yours,
Soilogic, Inc. Reviewed by:
Josh Schmidt
Engineering Technician
Wolf von Carlowitz, P.E.
Principal Engineer
MARCH 2016
PROJECT #16-1058
PROPOSED LAYOUT
DIAGRAM
SO LOGIC
;b.
APPROXIMATE
LOCATION OF EXISTING
SOIL TREATMENT
AREA (gip)
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1
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INSTALL ONE•.1,
d-I&LYLPERF0.0•V('. DISTRIS11T1OIYT-IGB
AND CQIJNECT TO
D-BOMOR MANIFOLD
M
PROPOSED ADDITIQQN
TO, EXISTING STA.
AW SOUAR -
jBa"KET X in. Fri
t
EXISTING
4 -BEDROOM
RESIDENCE
APPROXIMATE
'� •
LOCAIIDN OF !"�I%, �.
EXISTING 10007441
SEPTICT
>y .
x�.
,
.,A,, �._`
'N w LJ'
Tg IN To EXISTING
• E FLUENT LINE
•" PROPOSED
AUXILIARY -
RESIDENCE
•rr
,..
r'
ttr
-NW
DENOTES DIRECTION OF SLOPE
AND APPROXIMATE GRADE
•
'71 PROPOSED 1000 GALLON
SEPTICrAtD 2 -CHAMBER) LOCATE
MINIMUM ;NOM RESIDENCE
+WNyERTOUT(EL=100.0)
T'►OP OF TANK ESTABLISHED
"} 7 T2.` BELOW FINISHED , -
'1.1% ARE GRADE MINIMUM • —
ryti •
4
—
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c
a• 40'
SCALE 1" = 40'
N
PROPOSED AUXILIARY RESIDENCE
3380 COUNTY ROAD 38, MEAD, WELD COUNTY, COLORADO
PROPOSED AUXILIARY RESIDENCE
3380 COUNTY ROAD 38, MEAD, WELD COUNTY, COLORADO
Sollogic Project # 16-1058
March 2016
SITE EVALUATION SUMMARY AND DESIGN CALCULATIONS
ON -SITE WASTEWATER TREATMENT SYSTEM (OWTS)
Soilogic Personnel Information
Wolf von Carlowitz, P.E.
3050 67th Avenue, Suite 200 - Greeley, Colorado 80634
970.535.6144 - Wolf@Soilogic.com
Date of Site Visit - (3/4/2016)
Existing Septic System Design Calculations (Per Permit G-890299)
Existing 4 Bedroom House, Q = 525 gpd
Percolation Rate = 20 mpi and LTAR = 0.60 g/d/sf
A = Q/LTAR = 525 / 0.60 = 875 sf
Size Adjustment = 875 sf * 1.2 (Gravity) = 1050 sf
Proposed Addition to the Soil Treatment Area
Proposed Auxilary House, Q = 300 gpd
Percolation Rate = 20 mpi and LTAR = 0.60 g/d/sf
A = Q/LTAR = 300 / 0.60 = 500 sf
Size Adjustment = 500 sf * 1.2 (Gravity) = 600 sf
Existing Soil Treament Area (STA) = 1320 sf
1050 sf (Exisitng) + 600 sf (Proposed) = 1650 sf (Required STA)
1650 sf - 1320 sf = 330 sf additional STA required
Soilogic proposes adding an area approximately 6 -feet in width and 60 -feet in length to the exisitng STA,
for a total of 360 additional square feet
Alternative configurations could be considered.
i
SO LOGIC
HSP106t' •
INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT NO. G-890299
WELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SERVICES
1546 HOSPITAL ROAD, GREELEY, CO 80631
353-0635 EXT'.2225
REPAIR PERMIT
OWNER MC I.NNIS, LARRY ADDRESS 3380 WCR 38 PH (303) 535-4777
PLATTEVILLE CO 80655
ADDRESS OF PROPOSED SYSTEM 3380 WCR 38
PLATTEVILLE CO 80651
LEGAL DESCRIPTION OF SITE: NW4 SEC 3 TWP 3 RNG 68
SUBDIVISION: HIGHLAND ESTATES LOT 0 BLOCK 0 FILING 0
USE TYPE: RESIDENTIAL S.O.E. 899125
SERVICES: PERSONS 5 BATHROOMS 3.00 LOT SIZE 2.05 ACRES
BEDRTICHS 4 BASEMENT PLUMBING YES WATER SUPPLY LTHMP
APPLICATION FEE $100.00
REC'D BY RECEPTIONIST AID
DATE. 41/30/89
SIGNED BY REGGIE KAMAKELE/AGENT
DATE 11/30/89
PERCOLATION RATE 0.0 MIN PER INCH LIMITING ZONE 0 FEET
SOIL TYPE UNSUITABLE • PERCENT GROUND SLOPE 0% DIRECTION
REQUIRES ENGINEER DESIGN '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 836 SQ; FT.
OR /3ao i -
ABSORPTION BED 1128 SQ. 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.
K t d�a a va aaAA p� WES POTTER 11 30/89
ra---aa-8961
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 �(/--_APPROVALFINAL JC�
SYSTEM ENGINEERAIAT aZI�it
ei
TYPE OF SYSTEM INST i_LED
ENVIRONMENTAL SPECIALIST DATE
TAL 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 10, TITLE 25, CRS 1973, AS AMENDED,
EXCEPT FOR THE PURPOSE OF ESTABLISHING FINAL APPROVAL OF AN INSTALLED SYSTEM FOR
ISSUANCE OF A LOCAL OCCUPANCY PERMIT PURSUANT TO CRS 1973 25-10-111 (2).
• a.
4.
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"HSP10$P .
INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
WELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SERVICES
1516 HOSPITAL ROAD, GREELEY, CO 80631
353-0635 EXT.2225
NO. G-890299
REPAIR PERMIT
IWNER MC INNIS, LARRY ADDRESS 3380 WCR 38 PH (303) 535-477
PLATTEVILLE CO 80651
rDDRESS OF PROPOSED SYSTEM 3380 WCR 38
PLATTEVILLE CO 80651
.EGAL DESCRIPTION OF SITE: NW4 SEC 3 TWP 3 RNG 68
UBDIVISION: HIGHLAND ESTATES LOT 0 BLOCK 0 FILING 0
ISE TYPE: RESIDENTIAL S.O.E. 899125
ERVICES.: PERSONS 5 BATHROOMS 3.00 . LOT SIZE 2.05 ACRES
BEDROOMS 4 BASEMENT PLUMBING YES WATER SUPPLY LTHMP
iPPLICATION FEE $100.00
EC'D BY RECEPTIONIST AID
DATE 11/30/89
SIGNED BY REGGIE KAMAKELE/AGENT
DATE 11/30/89
ERCOLATION RATE _/0.,Q MIN PER INCH LIMITING ZONE FEET
'OIL TYPE PERCENT GROUND SLOPE __X DIRECTION ___
EQUTRES ENGINEER DESIGN _
ROM THE APPLICATION INFORMATION SUPPLIED AND THE ON -SITE SOIL PERCOLATION DATA
HE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED:
SEPTIC TANK (Qo o GALLONS, ABSORPTION TRENCH C36_ SQ. FT. �rconentence
ExFSra. �6?'i f
ABSORPTION BED 1[? SQ. FT. I°4 5
N ADDITION, THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND
OND I T I ONS':
HIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT
AY BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SET
ORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDING
AILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPORARY OR FINAL
PPROVAL. THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE
EPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR INADEQUACY OF THE
EWAGE DISPOSAL SYSTEM.
1-C- 1° Saitatr ) 1 -30-89 be
tank'
ENVI liNMENTAL SPECIALIST U V:
HIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS
or COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF
HIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI-
IONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA -
IS. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE COM--
LETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT.
T
INSPECTION DATE: 6- Ai' -90 AREA
SPEGIAEISTWINSTI1UCTIONS:
.Y
NEED: 1. 4/
2. icUJAntal
3.
LOAN AITFOVAL
1
CLOSING DATE (e.3o
MAIL OR(FICK-UP)
OR RE -FINANCE
Request No: /0i -ft
Date Received: b-ia -
Date Forwarded:
Fee Paid:SS0.00 Date: G-2Z-fi
TO WHOM IT MAY CONCERN: Review and inspection report regarding water and the sewage
disposal system for an existing dwelling:
SEND TO: Re MAX
4tl'x: Onto? CPHONE 77a'3$o0
O
INFORMATION: Address 33$0 WLR 38)-74IlaAtOlIkt,
Legal: PT 06.4, PT , Sec 3 T3 , Raw, Age of Riptic /coo IR 1 yr QrpO
Subdivision NAg ktaaJ ES -la 4ri-airwo` )Lot 3 , Blk , Filing
Property Owner MtTnnis Uteri N-KOrfjio. Original Owner Sq,,,,,e
Tank Pumped on Slit /2 -ken BY Aahtc Sa.t,i,�a �i ew r✓: _
DEPARTMENTAL RECORD SEARCH: tPermit #Ciaty1q Name PRI In1r lS iiIrrif
Bathrooms Bedrooms Sr Total Acredge Q
Tank Capacity /,ypfj gals. Field Size jy sq. ft. 'Water Supply GTHAnt
Date of Final Inspection /a�a,/,per
INSPECTION COMMENTS: Date of Inspection Z./flzeig,ei
Soil Conditions: Dry ✓ ...Saturated __ . Snow—covered
Residence: Occupied .ter Vacant
FINDINGS: Sewage Disposal System: Satisfactory A../Other
Bacteriological Water Test: Acceptable Other
CODIENTS:
DATE: /s ypt." SIGNATURE:
Environmental Health Specialist
Neither the County of Weld nor any of its agents or employees undertake or assume any
liability to the cwner of the above property, to.any purchaser of the above property or to
ar.y lending agency making a loan on the above property in connection with either its
eracination 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 nr 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.
i9
vit
WECYc
COLORADO
LOAN APPROVAL
szoVni
6-3-9 -20
C1-gqo a`79
DEPARTMENT OF HEALTH
1516 HOSPITAL ROAD
GREELEY. COLORADO 80631
ADMINISTRATION (303) 353-0586
HEALTH PROTECTION (303) 353.0635
COMMUNITY HEALTH (303) gsq•e38
Request No: 107-90
Date Received: 6-26-90
Date Forwarded:_ 6-29-90
Fee Paid: $50.00 Date: 6-27-90
TO WHOM IT MAY CONCERN:. Review and inspection report regarding water and the -sewage
disposal system for an existing dwelling:
I
SEND TO: PICK-UP Attn: Carol Cizek ; PHONE 1 772-3800
INFORMATION: Address 3380 WCR 38, Platteville, Colorado
Legal: PT NW4i. PT-' , Sec 03 , T 03 , R 68 W. Age of Septic Repaired 12-21 R9
Subdivision Highland Estates , Lot 003 . B1k , Filing
Property Owner MCINNIS, LARRY A KORINA Original Owner Same
Tank Pumped on 12-08-88 By Bob's Sanitation Service
-,-DEPARTMENTAL RECORD SEARCH: Permit #G-890299 Dal‘ McInnis, Larry
Bathrooms- 3 Bedrooms 5 . Total Acreage 2
Tank Capacity 1000 gals. Field Size 1320 sq. ft. Water Supply Little Thompson
Date of Final Inspection December 21, 1989
•
INSPECTION COMMENTS: Date of Inspectiod . June 28, 1990
Soil Conditions: Dry X Saturated '
Residence: Occupied X Vacant
FINDINGS: Sewage Disposal System: Satisfactory X
Bacteriological Water Test: Acceptable R
COMMENTS:
Snow-covered
Other _
Othet
DATE: June 29.4990 SIGNATURE: Wei leet`
Directdr, EnvirentM Protection Services
Neither the County of Weld- nor any of its agegts 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 futute. 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.
1RIGINAL-APPLICANT; COPY-WCHD WCHD-EHS MAY, 1984
r`
HSP106P APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM NO. G-89029
WELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SERVICES
1516 HOSPITAL ROAD, GREELEY, CO 80631
353-0635 EXT.2225
REPAIR APPLICATIOI
1WNER MC INNIS, LARRY ADDRESS 3380 WCR 38 PH (303) 535--47T
PLATTEVILLE. CO 80651
;DDRESS OF PROPOSED SYSTEM 3380 WCR 38
PLATTEVILLE CO $0651
-EGAL DESCRIPTION OF SITE: NW4 SEC 3 TWP 3 RNG 68
:UBDIVISION: HIGHLAND ESTATES LOT 0 BLOCK 0 FILING 0
JSE TYPE: RESIDENTIAL S.O.E. 899125
:ERVICES: PERSONS 5 BATHROOMS 3.00 LOT SIZE 2.05 ACRES.
BEDROOMS 4 BASEMENT PLUMBING YES WATER SUPPLY LTHMP
IPPLICANT ACKNOWLEDGES THAT THE COMPLETENESS OF THIS APPLICATION IS CONDITIONAL
1PON FURTHER MANDATORY AND ADDITIONAL TESTS AND REPORTS AS MAY BE REQUIRED BY THE
JELD COUNTY HEALTH DEPARTMENT TO BE MADE AND FURNISHED BY THE APPLICANT OR BY THE
JELD COUNTY HEALTH DEPARTMENT FOR PURPOSES OF THE EVALUATION OF THE APPLICATION;
IND THE ISSUANCE OF THE PERMIT IS SUBJECT TO SUCH TERMS AND CONDITIONS AS DEEMED
IECESSARY TO INSURE COMPLIANCE WITH RULES AND REGULATIONS ADOPTED UNDER ARTICLE
0, TITLE 25, CRS 1973, AS AMENDED. THE APPLICANT CERTIFIES THAT THE PROPOSED
;YSTEM WILL NOT BE LOCATED WITHIN 400 FEET OF:A COMMUNITY SEWAGE SYSTEM. THE
INDERSIGNED HEREBY CERTIFIES THAT ALL STATEMENTS MADE, INFORMATION AND REPORTS
,UBMITTED HEREWITH AND REQUIRED TO BE SUBMITTED BY THE APPLICANT ARE, OR WILL'BE,
;EPRESENTED TO BE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND
IRE DESIGNED TO BE RELIED ON BY THE WELD COUNTY HEALTH DEPARTMENT'IN EVALUATING
'HE SAME FOR PURPOSES OF ISSUING THE PERMIT APPLIED FOR HEREIN. I FURTHER UNDER-
'TAND THAT ANY FALSIFICATION OR -MISREPRESENTATION MAY RESULT IN THE DENIAL OF THE
IPPLICATION OR REVOCATION OF ANY PERMIT GRANTED BASED UPON SAID APPLICATION AND
:N'LEGAL ACTION FOR PERJURY AS PROVIDED BY LAW.
iPPLICATION FEE $100.00 (—RraGGIE KA4IAK-LE/AGENT
!EC'D BY RECEPTIONIST AID
DATE 11/30/$9
11/30/89
SIGNATURE DATE
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