HomeMy WebLinkAbout20150040.tiff NORTH` NORTH WELD COUNTY WATER DISTRI
WELD MO1 P.O. BOX 56
COUNTY 32825 CR 39
WATER. LUCERNE, COLORADO 80646
DISTRICT PHONE(970)356-3020 • FAX(970)395-0997 • E-MAIL:water@
ACCOUNT NUMBER SERVICE ADDRESS AMOUNT DUE BY
37046 NORTHWEST DRIVE
1195003 WINDSOR , CO 80550 $ 24
VICKI S. SWENSON Anypaymentreceii
16705 RI ST CANYON ROAD not
BELLVUE , CO 80512 Please note that all
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ACCOUNT NUMBER NAME AND SERVICE ADDRESS BILLINI
VICKI SWENSON
1195003 37046 NORTHWEST DRIVE 07/24/2014
WINDSOR , CO 80550
Prey.Read Cum.Reed Usage
Previous Balance
08/14/2014 Payment - Electronic
08/22/2014 Standard - Full 170 178 8 k
Current Amount
Total Amount Due
You are currently paying this account with on-lin
banking - no return envelope will be sent.
District E-Newsletters enroll at www.nwcwd.org
Water Surcharge Rate Effective 11/01/2014
$2/Kgal
Water Class
70 % of 1.000 Acre Foot
Transferred Water
Allocation Adjustment
15 Less YTD Usage
Remaining Water Allocation
Plant Investment Class
77° MR
" WELD COUNTY HEALTH DEPARTMENT # 2/_9 3
1555 17th Ave. No. 9s .
Greeley, Colorado •
Application for Permit to Install, Construct, Alter or Repair Individual Sewage Disposal System.
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a' / PiZnert. 0 7
Address of Site � ��tr
Mailing Addres
General Information Septic �T/an
1. Living units / 1. Liquid Capacity %I)"-3 Gallons
2. No. of Bedrooms �� 2. Dimensions L D
3. No. of Baths a 3. Material
4. Basement Drain 4. Type Inlet
5. Automatic Dishwas Type Outlet
6. Garbage Disposal
7. Automatic Laund Secondary Treatment
8. Size of Lot ! ��
9. Type of Soil Field Bed 6
10. Percolation Test —
At �� 1. No.of distribution lines
11. Water Supply2. Trench: Width Length
12. Lot Grade
13. Water Table Depth 3. Type Filler Material
14. Other 4. Depth of Filler Material
5. Gravel Size
6. Type Tile
7. Depth of Cover -
8. Other
The Permit is to remain in full force and effect for six (6) months from date, until revoked for non-compliance.
This system will be constructed in accordance with the above specifications and regulations governing non-
municipal sewage disposal systems, in accordance with Regulation No. .1 of the Weld County Health De-
partment.
Date: //' IL ' 7 APPlican
The plans and specifications as shown are approved, pending paymei of pe• e.
Sanitarian:
Date:
The above system inspected an found to comply with the plan and description.
Installed by Da
oG Sanitarian:
PERMIT FEE $ �� JJ/��/
Received by ` wX�1/' Date /I /[ -- 71
Please use reverse side r Plot Plan o use separate sheet of paper.
,., Tor
HGP106P INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
WELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SERVICES -
1517 16TH AVENUE COURT. GREELEY. CO 80631
357-0635 EXT.2225
04lNEF: GARBOR. P. 3 7 RE low ft t
00C>t:u
ADDRESS OF PROPOSED SYSTEM PENDING
00000
LEGAL DESCRIPTION OF SITE: SW4 SEC 29 TWP 7 RNG 67
SUBDIVISION: NORTHWEST ESTATES LOT 14 BLOCK 0 FIL
USE TYPE: RESIDENTIAL HOUSE, DUPLEX
SERVICES: PERSONS 1 BATHROOMb 2.x+0 LOT SIZE 1.44 ACRES
BEDROOMS 5 BASEMENT PLUMBING YES WATER SUPPLY NWCWI
APPLICATION FEE *240.00
REC'D BY CINDY SALAZAR SIGNED BY GERHARDT BRUNNEF
DATE 06/01/95 DATE 06/01/95
PERCOLATION RATE MIN PER INCH LIMITING ZONE _ FEET
SOIL TYPE PERCENT GROUND SLOPE ! DIRECTION
REQUIRES ENGINEER DESIGN i ` IN 100 YEAR FLOOD PLAIN Z1
FROM .THE APPLICATION INFORMATION SUPPLIED AND THE ON-SITE SOIL PEP
THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED:
SEPTIC TANK GALLONS. ABSORPTION TRENCH SQ.
OR
ABSORPTION BED SQ.
IN ADDITION. THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TER
CONDITIONS:
THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMME
MAY BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMEN'
FORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULA
FAILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMP
APPROVAL. THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUME
DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR INADEi
SEWAGE DISPOSAL SYSTEM.
ENVIRONMENTAL SPECIA
THIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM C
NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FIN'
THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT
TONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A
SIB. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE F:NAL INSPECTIOl
PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT.
. ' . p. S.-rf ANT o�'cIi� SE -c c x>�Cj
i WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIR
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE (970) 304-6415 FAX (970) 304-6411
Permit #: SP-0200448 Sec/Twn/Rng:29 07 67 Statt
Owner: L14 WINDSOR, LLC Appl
Applicant: GARBER WARREN Issue
Permit Type: RREP C=Commercial, R=Residential + NEW, REPair, VauLT Final
Parcel #: 0705-29-0-03-002
Location: 37042 NW DRIVE
Legal Description: 1NW-14 L14 NORTHWEST ESTATES 1ST FILING
%37042-37044-37¢46 N► 1
Installer: }�/,
Description: -X-- flf AA •
—
Commercial: N Residential:Y Acres: 1.44
# of Persons: 6 Basement Plumbing: Y
# of Bedrooms: 3 Bathrooms - Full: 3 3/4: 0 1/2: 0
Water Public: Y Water Source: NWCWD
Water Private: N Cistern: N Well: N Well Permit #:
Percolation Rate: 21.7 Limiting Zone: 8 ft 0 in Description:
% Ground Slope: 0 Dir: Soil Suitable: (Y/N) Y
Engineer Design Required: (Y/N) Y In 100 Year Flood Plain: (Y/N) N
Minimum Installation
Septic Tank: 1250 gallons Absorption Trench: 0 square feet
or Absorption Bed: 1490 square feet
Actual Installation NtSh
Septic Tank: O,0OO gallons Absorption Trench: square fel
Absorption Bed: I S SO square fe
Design Type: GA
NOTICE
The issuance of this permit does not imply compliance with other state, county or local regulatory or bt
shall it act to certify that the subject system will operate in compliance with applicable state, county am
persuant to Article 10, Title 25, CRS as amended, except for the purpose of establishing final approval
issuance of a local occupancy permit persuant to CRS 1973 25-10-111 (2).
This permit is not transferable. The Weld County Department of Public Health and Environment rest
additional terms and conditions required to meet our regulations on a continuing basis. Final permit ap
the final inspection of the completed system by the Weld County nepartment of Pun Health and Envi
WELD COUNTY ENVIRONMENT DEPARTMENT OF PUBLIC SOE;
° HEALTH ORG
1555 N. 17Th AVENUE REP,
� � GREELEY,COLORADO 80631 LOAI
PHONE: ( 4 ISDS
FAX: (970)304-6411
COLORADO STATEMENT OF EXISTING FOR SEPTIC SYST
y� (PLEASE FILL OUT IN BLACK INK ONLY)
PARCEL NO. V 1O5 %o/ Wind-5J0) o
PROPERTY OWNER L, //7 r� L G_G PHONE NO. 132'J1 7
MAILING ADDRESS /0 92 / 7/4 i,ve. / @r g /.y re ga s
City G�-
DESCRIPTION OF BUILDING (ex. house, nvv/ r mobile/modular home,shop,office)
p rs
SITE/LOCATION ADDRESS 7,I v t 2 / ol" ve /4/i .rl/(AS0 , �-? Cc
_P70 LIV City
_97 Or
LEGAL DESCRIPTION PT PT SECTION TOWNSHIP
SIUBDIVISION N,yMweC ES4ufec fi>stl/igLOT / ,V/ BLOCK / a
CENCUS TRACT LOT SIZE/ACRES I' 9 weld
Col
COMMERCIAL YES/NO RESIDENTIAL�/NO
NUMBER OF PERSONS BASEMENT PL ING YES NO
BEDROOMS BATHROOMS-FULLi 3/4 9
WATER SUPPLY-PUBLIC YES NO NAME /U0 rI-A q/e/o1
PRIVATE YES/NO WELL YES/NO CISTERN YES/NO WELL
SYSTEM SIZE: Septic tank material is constructed of and has
FIELD: Trench square feet or Bed square feet YEAR INSTA
You are required to draw a diagram of the system on the reverse side of this form in black ii
location, length,width,and distance from the dwelling.
The undersigned property owner hereby certifies that the above described septic system is it
described,and exists at this time on the parcel of ground identified by the above legal descr!'
that the system is/is not in good working order and to the best of his/her knowledge is/is not
I further understand that any falsification or misrepresentation may result in revocation of
upon this information hereby submitted and in legal action for perjury as provided by law.
/ 0 — .— 2D19,E 42,0,-,/,,t3 �
DATE OWNE IGNA
Subscribed and sworn to before me this / Sr day of Ooltob er
By Wager 3 flo�P
Witness my hand and official seal. My cAmmissiog spires C i M ' S
rU
N\
._ - _ sp 6�L^Oa4F�
1
\ Da_Servev\. 4-
\./0
Se pit-.CL Sy5&-ems for 3 044 Ncr} ku:es+ hr. )
L I�{� v S\-- F 15 . PJo a 11,w es ES J-es
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