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Home My WebLink About20141118.tiff Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970)304-6415 Fax:(970)304-6411 Web:www.co.weldhealth.org Septic Permit Application Application Number: SP-1300113 App Type: Health\Residential\New\Septic GRADY WEICHEL 22460 CR 22 HUDSON,CO 80642 Owner Name: WEICHEL GORDON Parcel#: 130714000002-O9520413 Legal Desc: LEASEHOLD INT SENW 14 2N 65W WEICHEL 22-14 Site Address: 22460 CR 22 HUDSON,CO 80642 App Specific Info: 1/2 Bathrooms 0 3/4 Bathrooms 0 Basement Plumbing No Full Bathrooms 1 Location Description 22460 CR 22 HUDSON CO 80642 Number of Bedrooms 0 Number of Persons 2 Parcel Acres 80 Private Water Supply Well Public Water Supply No TERMS AND CONDITIONS A permit fee,as set by separate ordiance of the Board of Weld County Commissioners,shall be required of applicants for new individual sewage disposal systems(ISDS),payable at time of application.Permit fees am non-refundable;permit applications are non-transferable.If both a building permit and an ISDS are issued for the same property and construction is not commenced prior to the expiration date of the building permit,the ISDS permit shall expire at the same time as the building permit.If an ISDS permit is issued for a property that does not require a building permit,the ISDS permit shall expire one year after its issuance if construction on the septic system has not commenced.Any change in plans or specifications after the permit has been issued invalidates the permit unless approval is secured from the Health Officer or his/her designated agent Expired permits can be renewed by payment of the permit fee only it A.There has been no change in Inc plans and spedlcations of the proposed system as set out in the original application or such change is reviewed and approved by a Division Representative. B.The surrounding land,its use or zoning has not changed so-as-to cause the original application not to be acceptable under these regulations. NOTICE The completeness of this application is conditional upon further mandatory and additional tests and reports as may be required by the Weld County Department of Public Health end Environment(WCDPHE).The issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under article 10 title 25,CRS as amended.The applicant certfies that the proposed system will not be located within 400 feet of a community sewage system.The undersigned certifies that all statements made,information and reports submitted herewith are,or will be,represented to be true and correct to the best of his/her knowledge and are designed to be relied on by the WCDPHE for evaluation for purposes of issuing the permit applied for herein.Applicant further understands that falsification or misrepresentation may result in the denial of the application or revocation of any permit granted,and in legal action or perjury as provided by law. 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OwnerlApplicarit Date Report ID: EHS00056v003 Page 1 of 1 Print Date Time: 5/22/2013 1:36:51 PM Weld County Environmental Health Services Department �\186t 1555 N. 17th Avenue ��- Greeley,CO 80631 Phone:(970)304-6415 Fax: (970)304-6411 - RECEIPT May 22,2013 Application Number: SP-1300113 App Type: Health\Residential\New\Septic Owner Name: WEICHEL GORDON 22762 CR 22 HUDSON,CO 80642 Site Address: 22460 CR 22 HUDSON,CO 80642 Rcpt# Pmt Type Pmt Method Ref# Pmt Date Amount Cashier Comments EHS-1300204 Paid Check 1831 05/22/2013 $750.00 SCERRILLO Total Payments: - $750.00 Report ID: EHS00054v002 Page 1 of 1 Print Date Time: 5/22/2013 1:35:59RM e30aoa ' ' ` ' APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM No. ) 0 - • • WELD COUNTY HEALTH DEPARTMENT New '‘Q R 6,(0 ENVIRONMENTAL HEALTH SERVICES 1516 Hospital Road, Greeley, CO 80631 Repair —! - . 353-0540 EXT. • BP i c OWNER ' ,,II r'/NS' ADDRESS .o-' ?76 2 f r.' oc /(ui' cnr, PHONE •^ •'• i ADDRESS OF PROPOSED SYSTEMa Al ,(�.t n✓1 LEGAL DESCRIPTION OF SITE: PT S% till,41S / `/ ,T T , R K- 5 • SUBDIVISION LOT , BLOCK , FILING USE TYPE: RESIDENTIAL X tuft/: a_ INSTITUTION COMMERCIAL OTHER SERVICES: PERSONS '</ BATHROOMS t LOT SIZE gr an('es BEDROOMS ? BASEMENT PLUMBING ) 10.E WATER SUPPLY / " TYPE OF SEWAGE DISPOSAL REQUESTED: "Pliin l' (7)-,. i l g;4/TA P' PA Applicant acknowledges that the completeness of this application is conditional upon further mandatory and additional tests - and reports as may be required by the Weld County Health Department to be made and furnished by the applicant or by the: Weld County Health Department for purposes of the evaluation of the application; and the issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under Article 10,t Title 25, CRS 1973, as amended.The applicant certifies that the proposed system will not be located within 400 feet of a corn-' munity sewage system. The undersigned hereby certifies that all statements made;information and reports submitted here- i with and required to be submitted by the applicant are, or will be, represented to be true and correct to the best of my knowl- ; edge and belief, and are designed to be relied on by the Weld County Health Department in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any falsification or misrepresentation may result In the denial of the application or revocation of any permit granted based upon said application and In legal/ action u for perjury as provided by law. Application fee �/�� • �J /c/nhsn — lit) A,-%// I Recd by`:-�•��`'/'•%r L/��'>-�Dated/-/c-`r3 OwnerlAgent Signature Date • * • • • • ♦ • • ♦ ♦ • • • • • * • ♦ • * • • • • • • • • • ♦ ♦ • • * • * • • • • • * • • • ♦ * • • • • 4- FOR DEPT. PERCOLATION RATE t 'r' co kte, In WATER TABLE DEPTH ' ' USE ONLY SOIL TYPF •• S:/r- 4+ �� ? 11->"--'2 PERCENT GROUND SLOPF / REQUIRES ENGINEER DESIGN( )YES( ) No ' "-Cl • INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT From the application Information supplied and the on-site soil percolation data, the following minimum installation specifi- cations are required: . SEPTIC TANK MOD `� GALLONS,ABSORPTION TRENCH � " SQ. FT. •'' ABSORPTION BED /?3 0 • or • ASQ.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 assumgion by the Department or Its employees of liability for the failure otlnedequacy of the sewage disposal system.; Environmental Specialist Date This Pen-nit is not transferrable and shall become void It system construction has not commenced within'one year of its issuance. I, Before issuing final approval of this Permit the Weld County Health Department reserves the right to impose additional terms , and conditions required to meet our regulations on a continuing basis. Final Permit approval is contingent upon the final in • - spection of the completed system by the Weld County Health Department. i SYSTEM CONTRACTOR FINAL INSPECTION ///� K 4��/ SYSTEM ENGINEER _ • APPROVAL • �� !� ✓ / I • 7 �-- Environmental pedal s to 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 pursuant to Article 10,Title 25, CRS 1973, as amended,except for the purposes 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;Copy-WC-ID WCHD—EHS February, 1981 ! c' 1 A'- 7c_ id S" Form No. OFFICE OF THE STATE ENGINEER GWS-25 COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203 (303)866-3581 EXST WELL PERMIT NUMBER 292798 - _ APPLICANT DIV. 1 WD 1 DES. BASIN MD • APPROVED WELL LOCATION WELD COUNTY SE 1/4 NW 1/4 Section 14 GORDON WEICHEL Township 2 N Range 65 W Sixth P.M. 22762 WCR 22 DISTANCES FROM SECTION LINES HUDSON, CO 80642- 2550 Ft. from North Section Line 2585 Ft. from West Section Line (303) 536-4218 UTM COORDINATES (Meters,Zone:13,NAD83) CHANGE/EXPANSION OF USE OF AN-EXISTING-WELL - - -Easting: Northing: - ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL 1) This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of this permit does not ensure that no injury will occur to another vested water right or preclude another owner of a vested water right from seeking relief in a civil court action. 2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in accordance with Rule 18. 3) Approved for the use of an existing well constructed under permit no. 108494-A. The issuance of this permit hereby cancels permit no. 108494-A. 4) Approved pursuant to CRS 37-92-602(3)(b)(ll)(A) as the only well on a tract of land of 40 acre(s)described as the SE 1/4 of the NW 1/4, Sec. 14,Twp.2 North, Rng. 65 West,6th P.M.,Weld County. 5) The use of ground water from this well is limited to fire protection,ordinary household purposes inside not more than three(3) single family dwellings, the watering ix poultry, domestic animals and livestock on a farm or ranch and the irrigation of not more than one(1)acre of home gardens and lawns. 6) Production from this well is restricted to the Alluvial aquifer. 7) The pumping rate of this well shall not exceed 15 GPM. 8) The return flow from the use of this well must be through an individual waste water disposal system of the non-evaporative type where the water is returned to the same stream system in which the well is located. 9).___This well shall be located no more_than 200 feet from the location_specified on this permit. � c ( J 1 3 1\1 Vtci app�a� - .0,./ LJL�I jaCa�ffo� (7.---; • 14 APPROVED n isIf /Li • State Engineer ELY JLV,Receipt No. 3661762 DATE ISSUED 10-31-2013 EXPIRON DATE L I'!V COLORADO DIVISION OF WATER RESOURCES/ Watt tH.Y FORM MUST BE SUBMITTED Y: 1313 Sherman Street - Room 818 OCT 1 t 1979 WITHIN 60 DAYS OF COMPLETION Denver. Colorado 80203 v OF THE WORK OESCRIBED HERE IMMO ON.TYPE OR PHINT IN BLACK WELL COMPLETION AND PUMP INSTALLATION REPORT i Mitt INK PERMIT NUMBER 1.01:‘..24:41 WELL OWNER Ca:071/2M•:nj,ebel . '.4 of the . . _..II'' . . %n1 Sec. lU:. .. _ _ . ADDRESS ?2762 ,H• 2P - Hudson, Colo. 806119. DATE COMPLETED. . .. _'77-9 .. , 19 .. HOLE DIAMETER WELL LOG 6-5/8 in. from ��__._to._60_-. ft. Water I From To Type and Color of Material Loc. Q in Firm, Sticky, Sandy Clay in. from _ . to ft 1n 71 Firm, Loose handy Clay tt/Stick r DRILLING METHOD_ . . _Standard Rotary Clay Streaks CASING RECORD: Plain Casing 1 .:r'i jrr. :!% :le.^... loose Gravel 1: .. y t--FR, `;tic'._y Clay Size 5. & kind . Plastic from ._ ... Q__to _.-0 __ft. >• ::n . 3c [•eci. Loose gravel hale Size & kind_.. from __ __._to ____ .._ ft. Size _. & kind . __..from ._.. - _ to._ __. .. ft Perforated Casing Size Li & kind Plastic from ...2.to- _O ft. Size . & kind . __ _...... from . _ ._ to___ft, Size & kind . . . .. _from _.. .._._ to .__ ft. GROUTING RECORD Material .- Cement Intervals 0.__>0:. .. _..... __..Placement Method . _ GRAVEL PACK: Size ..._ -. -3/8" ------- . . . _ . Interval TEST DATA Date Tested _....-_ , 19 _— Static Water Level Prior to Test .. . . .. 24 . . _. ft. Type of Test Pump _.- -------. . -----.---sfalex _.Length of Test_. . .. .. .. - .kQurs . ...--" _--- . Sustained Yield (Metered) .__ TOTAL DEPTH ___ . =G� - I Use additional pages necessary to complete tog. Final Pumping Water Level Hello