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Home My WebLink About20143491.tiff W Page 1 of 2 Customer: ANTHONY AND NANCY SANDOVAL Online WM ezPay ID: 00009-96384-63002 WASTE MANAGEMENT INVOICE Invoice Date: 06/01/2014 WASTE MANAGEMENT OF DENVER Invoice Number: 3671773-2514-2 18402 N 19TH AVE PMB 380 Account Number: 010-0520145-2514-2 PHOENIX,AZ 85023 Due Date: Due Upon Receipt (303)797-1600 (303)794-2403 FAX Total Current Gdar yes Total Amount Due 55.82 I 55.82 Account Summary - Description Please pay total amount due.Thank you for your Amount business. Previous balance S522 Total Credits and Adjustments 0.00 - Total Payments Received 55.82- n--- ____ Total Current Charges 55.82 Total Amount Due 55.82 _ Total Amount Past Due 0.00 Service Period: 06/01/14-08/39/14 I ;9 Service Location: 010-520145- Sandoval, Anthony And Nancy A2810 Matthews Ave Date Description Qty Amount 06/01/14 Curb service 1.00 49.35 06/01/14 Fuel/environmental charge 2.47 06/01/14 Administrative fee 4.00 Total Current Charges 55.82 If full payment of the invoiced amount is not received within 30 days of the invoice date, you will be charged a monthly late fee of 2.5% of the unpaid amount, with a minimum monthly charge of $5.00, or such late fee allowed under applicable law, regulation or contract. Additionally, if your service is suspended for non-payment, you may be charged a resume fee to restart your service. For each returned check, a fee will be assessed on your next billing equal to the maximum amount permitted by applicable state law. This invoice constitutes an offer by WM to provide service to you for a specified period.By accepting this, you agree to continue service during the specified time. Cancellation results in the forted of any prepayment unless prohibited by law.regulation,or contract. ,DEC 17 1ffre -WRJ-25.59, STATE OF.COLORADO - (9t?('';!f I`T`' DIVISION OF WATERiRESOURCES �z, '� Index No r�.�0] `y IDWD I—-Z--" (.7 ' OFFICE OF THE S ATE ENGINEERJU(, `21 19]O . Use } 111 . Mali WARR NCI Registered MAP AND STATEMENT FOR,WATEIR WELL FILING , 001.11ADD PERMIT NUMBER 27/9 47/4'.4 • STATE DIONIw • STATE OF COLORADO ) SS WELT LC1Cp TION COUNTY OF 1 .12I � _ o ?County Know all men by these presents: That the undersigned '•, 4{/ 'A of J(�Ca 'A, sec.• '- AL/st—tli L., cr T. /y G R.' ‘/„/1 4a P.M. claimant s), whose address is c..?._1.7 4.2.1- 7&-.).) INDICATE'WELL LOCATION ON DIAGRAM City'£,inuf/ , " ,?e i7 , states: NORTH 1 I i Claimant(s) is (are)the owner(s) of the well described hereon;ithe • j I I I total number of acres of land irrigated from this wel I is - I + T I I I work was commenced G� on this well by actual construction. - isi - j I j — 3 day of /Ct�Zx , 19 7e) : 3 I i i m the yield from said well is �d (gpm), for -- i- --L___L____ I I I ) I I I which claim is hereby made for ,/(17-ntn ltT/ purposes; I 1 I I SOUTH that the average annual amount of water to be diverted is acre-feet; and that the aforementioned WELL SHALL BE LOCATED WITH REFERENCE TO GOVERNMENT SURVEY CORNERS OR MONUMENTS, statements are made and this map and statement are filed in OR SECTION LINES BY DISTANCE AND BEARING. compliance with the law. ft. from section line. (North or South) x Clalmant(sl - - ft. from section line. Subscribed before me on this day of (East or West) 19_. Ground Water Basin My commission expires Water Management District Notary Public WELL DATA Domestic wells may be located by the following: Date Completed—ttI 9a 7C i LOT , BLOCK Static Water Level 3 7 ; SUBDIVISION Total Depth / io FILING # E ACCEPTED FOR FILING IN THE OFFICE OF THE STATE.'ENGINEER OF:COLORADO ON THIS DAY OF , 19 State Engineer FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM MUST BEAN ORIGINAL COPY;ON BOTH SIDES AND SIGNED. WHITE copy & GREEN copy must be filed with the State Engineer" vii#R'i'n 3O days after Well is completed: PINK copy is for the Owner & YELLOW copy is for the Dri Iler. I WELL LOG WELL DATA ' From To Type of Material Water Loc. Type Drilling la."-tee. ii /7 _fa../ �/� HOLE DIAMETER:, / / `p.5 C2,�a..ati e t7 7 in. from 0 ft. to ail ft. • v7115- „27 -� ica (/7 in. from 2,4/ ft, to. o'7C' ft. Q 7 e�G j7 _ in. from _ft. to ft. Cc ` CASING RECORD �9 ySryeitii . PllainCasing / s dvx pp��JJ Size,kindASfrom n ft. to a C ft. &° 9, ', ay (rAt / Size's kind Pi fromaft. to -.(7._:E_ft. 90 9C. �J�4'e'L (1 Size", kind from ft. to ft. �3 to .de4.,- Perforated Casing 3 r J/ X �oZO vttdl (0�c7 Size.'kind kind PL from C‘ ft. to es( ft, Size_.., kind from ft. to ft, Size_, kind from ft. . to_ ft. GROUTING R CORD Material / r. 4, Intervals Placement Method GRAVEL PACK RECORD Size X./ Interval tea' TEST DATA /� Date Tested yrc5/ ,�!/- mil, Type of Pump /QQ Length of Test ./.--z I</ Constant Yield 2-O Drawdown g 7 ' WELL DRILLERS STATEMENT The undersigned, being duly sworn, deposes and says: he is the driller of the well hereon described; he has read the statement made hereon; knows the content thereof, and the same is true of his own knowledge. Use additional paper if necessary to complete log. State of Colorado, County of } ss License No. ('/ /7 9 Subscribed and sworn to before me this day of , 19 My Commission expires 19 . Notary Public • WRJ-S-69- DIVISION OF WATER RESOURCES, DEPARTMEN OF NATURAL RESOURCEfl 101 Columbine Bldg., 1845 Sherman Stre t enver, Colorado 80203 y 40,119 J�, / / A PERMIT T USE GROUND WATER %ni lyF! 152' A PERMIT TO CONSTRUCT A WELL 1,`4. . c:�J9y„ APPLICATION FOR: / / REPLACEMENT FOR NO. f7 A PERMIT TO INSTALL A PUMP y1"• . / OTHER �itW7i' 4. PRINT OR TYPE LOCATION OF WELL APPLICANT # o6O a. rd Cc) Q ay COUNTY V.., ,C.1 ca.. _ U Street Address 3 a?/9 2r. Coe-. Co Ad etC irlf/ 4, of the 5 ' sec. 2_ 3 City & State PE/in) e ,e c 010 80.2/9 T. 1 W , R. �. 1/. W/_, 6 P.M. Street or Use of ground water f,-,,at; Lot & Block Owner of land on which well City_ or is located Subdly. ! Filing Owner of irrigated land Ground Water Basin Number of acres Water Management to be irrigated District Legal description of irrigated land LOCATE WELL ON THE BACK OF THIS SHEET Drillero. i 2 Other water rights on Driller's /� this land Address` [/,,2f ,`j2�e�ef•//i /�i-4 Aquifer (s) ground water is to be obtained � from la a_.....a , Signature of oloplicant Storage capacity AF CONDITIONS OF APPROVAL_ ANTICIPATED PUMPING RATE /2 GPM AVERAGE ANNUAL AMOUNT OF GROUND WATER TO BE APPROPRIATED Acre-feet ESTIMATED WELL DATA Anticipated start of drilling 42f 1976 Anticipated start of use 19 Hole Diameter: 2 in. from 1 ft. to ,al/ ft, APPLICATION APPROVED: in. from ft. to oR C ft. VALID FOR ONE (1) YEAR AFTER DATE ISSUED UNLESS EXTENDED FOR GOOD CAUSE SHOWN TO Casing: THE ISSUING AGENCY Plain Cos in. from C) ft. to ft. PERMIT NO. 4 2 CONDITIONAL L7 in. from IZ/ ft. to � ft. JUL 3 1970 DATE ISSUED Pert. 67 "-in. from q(1 ft. toot. in. from ft. to _ft. STATE ENGINE'R ESTIMATED PUMP DATA D Outlet BY rApes Type HP __ Size ' APPLICATION MUST BE COMPLETED SATISFACTORILY BEFORE ACCEPTANCE (OVER) THE LOCATION OF THE PROPOSED WELL SHALL BE SHOWN ON THE DIAGRAM BELOW WITH REFERENCE TO SECTION LINES OR GOVERNMENT SURVEY CORNERS OR MONUMENTS, feet from (North or South) section line feet from (East or West) section line IF WELL IS FOR IRRIGATION, THE AREA TO BE IRRIGATED MUST BE SHADED OR CROSS-WATCHED, This diagram represents nine (9) sections. Use the CENTER SQUARE (one section) to indicate the location of the well . "41----1 Mile I I I I • + - + - + - + - + — + - I I I -4 I I -. + — + 4 + — + — + — + - I I i I - - - + - + - X N I I I I I d 2 - + - + - I I A I I - + - + - + - + • - + - + - I I I I I I - + - +, - + - + - + - + - L I I THE SCALE OF THE DIAGRAM IS TWO INCHES EQUALS ONE-MILE Scanning Cover Sheet for Septic Permits Permit # G19700463 Permit Type: Health/ EHS History/ EHS Conversion History Situs Street Address 2810 MATHEWS AV Situs City, State, Zip Sec/Town/Range: 23-01 N-66W Application Status: Finaled Application Date: 03/11/1996 Parcel # (12 digits) 147123201003-R6252386 Owner Full Name: WRAY HOWARD & DIANA Owner Address: 2810 MATTHEW AVE FORT LUPTON,CO 80821 Owner Phone #: 303 6597116 Contact Name: Contact Address: Contact Phone# Information above has been Verified in Accela by employee noted below x re.-60, '1v-h May 05, 2009 Processed by: Date Report ID: EHS00024v003 Page 1 of 1 Print Date-Time: 5/5/2009 1:35:21 PM • . , - HSP106P • INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT NO. (:i--700463 WELD COUNTY HEALTH DEPARTMENT NEW PERMIT �, ENVIRONMENTAL HEALTH SERVICES - 1517 16TH AVENUE COURT, GREELEY, CO 80631. 353-0635 EXT 2225 )WNER WRAY, .HOWARD & DIANA ADDRESS 2810 MATTHEW AVE PH (303) 6'39••-7114 FT LUF'TON CO 8062:1. iDDRESS OF PROPOSED SYSTEM 2.810 MATTHEW AVE FT L.UPTON CO 8062:1. ..E(3AL.. DESCRIPTION OF SITE:: SEC 23 'T'WP 1 RNG 66 3(JBDIVISIONc COUNTRY ESTATES LOT 3 BLOCK 2 FILING 0 JSE TYPE: RESI:DENTIAL. SOE_ UPDATE 05.01.92 PERVICE,S PERSONS 2 BATHROOMS 2.00 LOT SIZE 110.00 ACRES BEDROOMS 5 BASEMENT PLUMBING YES WATER SUPPLY PWELL 1PPL.ICATION FEE $0.00 LEEC 'D BY X STAFF SIGNED BY DIANA WRAY DATE 06/29/70 DATE: 06/29/70 'E::RCOL-ATION RATE 2. 1 MIN PER INCH LIMITING ZONE:: 0 FEET :OIL TYPE SUITABLE PERCENT GROUND SLOPE: 0% DIRECTION 2E:QUIFRE::S ENGINEER DESIGN NO 'FiOM THE APPLICATION INFORMATION SUPPLIED AND THE ON—SITE SOIL PERCOLATION DATA "HE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED: SEPTIC TANI< 1,500 GALLONS, ABSORPTION TRENCH 170 SO. FT.. OR ABSORPTION BED SO. FT. :N ADDITION, THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS AND 1ONDITIONS a "I•dIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT lAY BE: REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPAR'T'MENT FOR REASONS SET T)RTH 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 )EPARTNENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR INADEQUACY OF THE iE:WAGE DISPOSAL.. SYSTEM. X STAFF 07/29/70 ENVIRONMENTAL SPECIALIST DATE -HIS PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM CONSTRUCTION HAS 4OT 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" "ZONAL.. 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- 'L-ET'ED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT. iYSTEM INSTALLER RHODES CONSTRUCTION FINAL INSPECTION DATE 08/28/70 iYSTEM ENGINEER APPROVAL X STAFF "YPE OF SYSTEM INSTALLED TANK ENVIRONMENTAL SPECIALIST "HE ISSUANCE OF THIS PERMIT DOES NOT IMPLY COMPLIANCE WITH OTHER STATE, COUNTY )R LOCAL REGULATORY OR BUILDING REQUIREMENTS, NOR SHALL IF ACT TO CERTIFY THAT 'HE SUBJECT SYSTEM WILL OPERATE IN COMPLIANCE WITH APPLICABLE STATE, COUNTY AND .00AL REGULATIONS ADOPTED PERSUANT TO ARTICLE 10, TITLE 25, CRS 19'73„ AS AMENDED, :XCEPT FOR THE PURPOSE OF ESTABLISHING FINAL APPROVAL OF AN INSTALLED SYSTEM FOR :S'SLJANCE OF A LOCAL.. OCCUPANCY PERMIT PURSUANT TO CRS 1973 25--10--111 (2) . IRIGI:NAL.--APPL.ICANT; COPY-.WCHD WCHD-E:HS, MAY, 1984 r • WELD COUNTY HEALTH DEPARTMENT 15th Street and 17th A ' P. O. Box 1227 110 ‘3 Greeley, Colorado Application for Permit to Install, Construct, Alter or Repair Individual Sewage Disposal System. Ow9ey or Sponsor Address Phone o 6-ca not,.a & d Ai/2 a 3a /5./ de� if �°_.,�, es.,,..a.,� 73 - ,Q � Address of Site el, /3 canary-s "- ��a-3"z..'cC ` e )n. 7b. "i7�J im Mailing Address- 'i/Fa �`-a�st -� -v er+-Pa- .heady S ccrQ&T V - e- (r General Information Septic Tank . 1. Living Units / 1. Liquid Capacity Jo o ^ Gallons - 2. No. of Bedrooms . 2. Dimensions W_- D • 3. No. of Baths /' 3. Material i4.+ C ? 4. Basement Drain 5t 5 4. Type Inlet 5. Automatic Dishwasher if e S ? Type Outlet" q n ' 6. Garbage Disposal N o ~ 7. Automatic Laundry !J. e s Second y Treatment A . B. Size of Lot /o Ac.aeS //y 9. Type of Soil Sondra �� a � Field /d r, Bed ` 10. Percolation Test 1. No.of distribution lines ti ' 2- 11. Water Supply We// 2. Trench: Width Length 12. Lot Grade B. Type Filler Material 13. Water Table Depth 4. Depth of Fine; Material istu u a —a ov`41' 14. Other 5. Gravel Size ".Z 6. Type Tile 7. Depth of Cover tn-/+--+-1/4 al/ .z.° - 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: fie-ter ..e/ .29 /77o Applicant: /'` . . . ^ ' The plans and specifications as shown are approved, pending payment of permit fee. Sanitarian: 0. /�r W Xi ep? Date: 7 . /' The above system • spected and foun to comply with the plan and description. Installed by l �fa Date: ' d Sanitaria !14-en_ N PERMIT FEE $ Received by ( 1474 Date Please use rever side for Plot Plan or use separate sheet of paper. 0Ve2 , ..Var. {Q - - `` • .• • . . 1 _ . - • • ;: }: • . d} . ' WELD'CODNTY HEALTH DEPARTMENT SOE 707Qf INVIRONMENTAL PROTECTION SERVICES [1:J!! !! LOAN $ / - 1517' 16th Avenue Court ISDS Greeley, Colorado 80631 rr--,^,�, REPAIR p X303)353-0635 Weld�"�'t7 lth Department STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN SLACK INK ONLY) OWNER OF RECORD: ..A .d (X Gt4)/2,7 // PHONE: 45- 7 - 7//4 MAILING ADDRESS: A S/o 7 vv,2.2/Jt.J 2 • . . go a/ City tate Zip SITE ADDRESS: x98/0 WAS Qasz-,: Ss.,d /r P1, . voL./ City State Zip LEGAL DESCRIPTION: PT: PPPT: SECTION: TOWNSHIP:_ RANGE: SUBDIVISION: C.s. / a LOT:_ BLOCK:_ FILING: NUMBER OF PEOPLE: vy BEDROOMS: 4, BATHROOMS: a WATER SUPPLY: RESIDENTIAL / COMMERCIAL BASEMENT PLUMBING: Y N LOT SIZE: acres SYSTEM SIZE: Tank is constructed of i and has j...5-60 gallons capacity (material) FIELD: Bed or Trench square feet. DATE SYSTEM INSTALLED:&e_ /976 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. Date Owner eVir Subscribed and sworn to before me this / day of �'Nlt4- , 1992, by 1T) a_/1/O- U.) rex Witness my hand and official seal. My commission expirees:: u,� 5 �/q/q 57 9friatati 19.9x �� Notary Qlic 3I STATEMENT OF EXISTING REVIEWED BY: rkft0b' En ironmental Protection Specialist M • 1- _ ' g 31 ga 0 • O p.. t.0 . //icy .t44.44,-c, =--42a--.14 244.,.f 4- -= i s a o BLACK INI( ONLY! • W E 5 '.'WELD •COUNTY HEALTH-DEPARTMENT a SOE 9 3 .ENVIRONMENTAL-PROTECTION SERVICES IRAN 4 i - G — 2 7dp Y� • 1517 16th Avenue Court ISDS 0 `Greerey, Colorado 80631 Department REPAIR# (303)353-0635 �P C011I1Ly��Q�[fl DQ(�RIDI2IIL. ' STATEMENT OF EXISTING FOR SEPTIC SYSTEM • (PLEASE FILL OUT IN BLACK INK ONLY) OWNER OF RECORD: Hn„do rS�, A„.,J Brc , a Wray PHONE: 4.3-7 - 77/' MAILING ADDRESS: 8/1 'War/4w ao-4— Q . f ". _7 a . go‘_ / City State Zip SITE ADDRESS: 48/6 Vev42r� a,,..-f_ ,4 - g $06 2/ City State Zip LEGAL DESCRIPTION: PT: PT: SECTION: 2 3 TOWNSHIP: i/' RANGE: 6 6 . SUBDIVISION: en u.,fr y E5 4-q 71 e S LOT: 7 BLOCK: a FILING: NUMBER OF PEOPLE: a BEDROOMS: 3_ BATHROOMS: e( WATER SUPPLY: 214.Lt- &SIDENTIAI) I COMMERCIAL BASEMENT PLUMBING: Y N LOT SIZE: /0 acres SYSTEM SIZE: Tank is constructed of Ce.,•cisct and has /0 O O gallons capacity (material) FIELD: Bed - or Trench loo it square feet. DATE SYSTEM INSTALLED: /970 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. ,/O 7,44 Date ..p/ ///Own Subscribed and sworn to before me this (14;yyi�-, day of S(D/'�,(f , 1992. by Latta,- al 99 d Witness hand and official seal. My c• on expires: / •y�� /493 ��,�q 194 �. nApfi . nr r . Date / Notary Public",y' �I,�,�{ > STATEMENT OF ERISTING REVIEWED BY: ,l(�4.10-10k; Env'r••..ental Protection Specialist of ',. • 0 pp N I '.t� ' SLACK INK ONLY! W E c OO t.l (.o " DEPARTMENT OF PUBLIC T &ENVIRONMENT 0 1555 N. 17Th AVENUE GREELEY COLORADO 80631 WWW.CO.WELD.CO.US fir t ADMINISTRATION(970)304-6410 ' PUBLIC HEALTH EDUCATION&NURSING(970)304-6420 W� FAX(970)304-6416 ENVIRONMENTAL HEALTH SERVICES(970)304-6415 FAX(970)304-6411 • COLORADO SEPTIC LOAN APPROVAL CLOSING DATE: 06-19-2001 REQUEST NO. : 01-032 NEW LOAN DATE RECEIVED: 06-08-2001 FEE $95.00: 06-08-2001 TO WHOM IT MAY CONCERN: Review and inspection report regarding water and the sewage disposal system for an existing dwelling: Mail To: Susan Hardy C/O Remsax Owner No.: 303-696-7676 12000 Pecos Street Ste 8160 Owner No.: Westminster, Colorado 80234 Realtor No.: 303-457-4800 Fax To: Tax No.: 303-252-8133 Pick Up: INFORMATION: Address:2810 Mathews Ave. Ft. Lupton Age of Septic: 1970 Legal: PT: PT: SECs�23 TWN:_ _N RNG:__66 Subdivision: Country Estates LOT:3 HLE:_j_ FLO: Property Owner: Dave Morrison Original Owner: Wrav, Howard Tank Pumped on: 05-79-2001 Sy: A-1 Septic Service Licensed: yes PERMIT ON RECORD: Name: Wrav,\Howard Permit No.: 019700463 Bathrooms:___ Bedrooms:._5__ Total Acres: 8.74 Date of Final Inspection:08-28-1970 Water Supply: Well Well Permit- No.: 41922 Tank Capacity: 1000 gallons Leachfield Size: 900 Square Feet XNSPECTION FINDINGS: Date of Inspections 06-12-2001 SOIL CONDITIONS: Dry EX Saturated Snow-covered RESIDENCE: Occupied ID[ Vacant SEWAGE DISPOSAL SYSTEM: Satisfactory Other See Comments BACTERIOLOGICAL WATER TEST: Acceptable Other See Comments COMMENTS: See pace 2 of 2. • DATE: lS Qot1 SIGNATURE: Ctivvi .ctric. 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 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 currant status of the system and representing to the best of his/her knowledge the system is not failing to function properly. June 14, 2001 • . Loan Approval Request No. : 01-032 Dave Morrison Page 2 Based on all available data the tank is undersized by 500 gallons for a 5 bedroom home. The Department recosnends that the tank size be increased by 500 gallons. Please be advised that should you decide to repair your system, a permit is required from this Department prior to any alterations to the system. TOTAL COLIPORM PRESENT/E. COLI ABSENT: In accordance with the microbiological standards set in the Colorado Primary Drinking Water Regulation and the Standard Methods for Drinking Water and Wastewater, the presence of any conform bacteria renders the water potentially unsatisfactory and unsafe. A Chlorination procedure may be recommended in addition to a follow up test (see enclosed instruction sheet) . VOA\ jt\p_,1 12-Mi Environmental Health Specialist Date SEPT?C LOAN EVALUATION T/ . � SPECIALIST INSTRUCTIONS: wag 1 111k. :g--COLORADO INFORMATION NEEDED: CLOSING DATE: a// ! REQUEST NO. : • -. FAX FEE($2.00) : DATE BECEI SEC: I✓' L1p, { / REFIN CE FEE $90.00/ 10 .0:-` . I:a. �• i,�.IIJY ff • To WHOM IT MAY CONCERN: Review and inspection report regarding water and the sewage disposal eye.tem for existing dwellin/ (� O nsr„�(r+r1/�� / y yf �. Mail.To: Ply/ (`1•(j Owner No. : ,,v:5 " {(J T67YJ(H) Owner No. : (w) xQ Realtbr No. : _ Fax To: I y/ /1 Fax No.: ... _ Pick lup- a l0 o� ` 1432 Palm- rrtcto.— f plti e.t�ttY/E hu 4 _ INFORMATION: - Address: al/CD ' 71w�V"�.IAAI IT/L I YIAYil4 Age of Septic:P Legal: PT: PT: SEC: �� 'LniN I N rrJJ RNG: ll9�f w \` Subdivision /j} LOT: � R: ,S�PLG:_ Property Owner:' Origin]. Owner: '/U''�'1�� BtOlr Tank Pumped on: By: c. 7Q1L(L.C... .J r,LLiicensed: Yes/No PERMIT ON WORD: Name:. &1 fRL P rmit No. . `�•� 9.O.E.�•��eQa�//�d'� Bathrooms: a ooms: �C.J Total Acres: Date of Final, I a ection:�T Water Supply: U Well Permit No. : Y�7 Tank Capacity: I1b17v Gallons )I 77��Q�/m�pyv�Leachfield Size: 100 Square Fee t INSPECTION FINDINGS: Da e of Inspection:Me/(Z/t a SOIL CONDITIONS: Dry Saturated ll Snow-covered RESIDENCE: Occu ied Vacant �{y�/�� {., . SEWAGE DISPOSAL SYSTEM: Satisfactory OtherSCLC �+"•:"':'•'L BACTERIOLOGICAL WATER��%1 TEST: Acceptable Other anothr .i 0.% COMMENTS: Sex. ,callL.. z4Z DATE: • . • i SIGNATURE: Environmental Protection Specialist Neither the County of Weld, nor aa„r 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 t . 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 observab .e at the time ofi,inspection, and does not constitute a warranty that the system is without flaw Or that it will continue to functic:. 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 we--car 0•.snply at the time the sample was taken. Evaluations based on Statements of Existing S„Q.E.) relies on information the property owner provides, under oath, indicating curr-••-.t scCUe of the system and representing to the best of his/her knowledge the system is -. t. fa_1'ing to function properly. • 14t- DEPARTMENT OF HEALTH 1517. 19 AVENUE COURT ' GREELEY,COLORADO 80631 C LOAN APPROVAL ADMINISTRATION (303)353-0538 O HEALTH PROTECTION (303)353-0635 COMMUNITY HEALTH (303)353-0639 COLORADO REQUEST NO.: 136-92 DATE RECEIVED: 04/29/92 DATE FORWARDED: 05/01/92 FEE PAID: $ 95.00 DATE: 04/29/92 TO WHOM IT MAY CONCERN: Review and inspection report regarding water and the sewage disposal system for an existing dwelling: SEND TO: DIANA PHONE NO.: 659-1234 PICK-UP ALTERNATE: INFORMATION: Address: 2810 MATTHEWS AVENUE, FORT LUPTON, CO Age of Septic: 1970 Legal: PT , PT Section 23 , Township 01 North, Range 66 West Subdivision COUNTRY ESTATES , Lot 003 , Block 002 , Filing 000 Property Owner: WRAY, HOWARD & DIANA Original Owner: SAME Tank Pumped on: 04/29/92 By: ART'S SANITATION DEPARTMENTAL RECORD SEARCH: Permit No. : 700463 Name: WRAY, HOWARD Bathrooms: 2 Bedrooms: 5 Total Acreage: 10.00 ACRES Tank Capacity: 1500 gallons Field Size: 900 square feet Water Supply: PRIVATE WELL Date of Final Inspection: 08/28/70 INSPECTION COMMENTS: Date of Inspection: 04-30-92 Soil Conditions: Dry XXX Saturated Snow-covered Residence: Occupied XXX Vacant FINDINGS: Sewage Disposal System: Satisfactory XXX Other Bacteriological Water Test: Acceptable XXX Other COMMENTS: DATE: 05/01/92 SIGNATURE: vironmental 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. Hello