HomeMy WebLinkAbout18370 Hwy 131 - 168909300002
December 3, 2019
Paul and Brenda Worley
18370 CO Highway 131
Bond, CO 80423
wetraft@raftcolorado.com
RE: Final approval of the: Septic System Installation, OWTS-016190-2019
Property location: 18370 CO Highway 131, Bond, Eagle County
Mr. and Mrs. Worley,
This letter is to inform you that the above-referenced permit has been inspected and finalized.
This OWTS major repair permit was approved to serve a total of three (3) bedrooms for the new
residence. The system installed under permit IS-0487 is active and serving the original residence at
the time of this letter. If the system, IS-0487, is abandoned in the future, it must be done in
accordance with ECPHA OWTS Regulation 43.9.C and the department must be notified so that permit
record can be closed.
Additional information about the maintenance your septic system needs can be accessed through
our website links, provided on the Environmental Health Department’s septic system resource page.
Be aware that changes in the use of your property or alterations of your building may require
commensurate changes to, or relocation of, your septic system. Landscape features, trees with tap
roots, irrigation systems and parking areas above the soil treatment area can cause premature
system failure. It is equally important that you notice and immediately repair dripping faucets and
hissing toilets as this will certainly cause the system to fail.
If you have any questions regarding this information, please contact us at (970) 328-8755 and
reference the OWTS septic permit number.
Best Regards,
Claire Lewandowski, REHS
Environmental Health Specialist III
Attachments: Certification Letter and Design – Septic System Flyer – Final Letter
PUBLIC HEALTH & ENVIRONMENT
(970) 328-8755
FAX: (970) 328-8788
environment@eaglecounty.us
Claire Lewandowski <claire.lewandowski@eaglecounty.us>
owts permit 016190-2019 - Worley's Residence
7 messages
Colorado River Guides Inc <wetraft@raftcolorado.com>Mon, Dec 2, 2019 at 12:42 PM
To: claire.lewandowski@eaglecounty.us, Gary Hill <garyhill@centurytel.net>
Claire,
Hoping this will meet your requirements. Please let me know if it's ok.
Thank you,
--
Brenda
(970)653-1001
18-11267 Worley Residence OWTS Observations Report.pdf
1318K
Claire Lewandowski <claire.lewandowski@eaglecounty.us>Tue, Dec 3, 2019 at 10:14 AM
To: Colorado River Guides Inc <wetraft@raftcolorado.com>
Cc: Gary Hill <garyhill@centurytel.net>
Thank you! This slipped my attention earlier when scanning my emails from yesterday. Gary came in as well and dropped
off a physical copy. If you have additional photos of the installation before backfilling, would you send them for review and
your record?
[Quoted text hidden]
--
Please note that beginning July 15 the Community Development Department will have new walk-in hours. The
office welcomes walk-in customers between 8 a.m. and 4 p.m. Monday through Friday, except holidays.
Claire Lewandowski, REHS
Environmental Health Specialist III
970-328-8755 (office)
970-328-8747 (direct)
environment@eaglecounty.us
www.eaglecounty.us
Claire Lewandowski <claire.lewandowski@eaglecounty.us>Tue, Dec 3, 2019 at 11:53 AM
To: dirthog3@gmail.com
Cc: Gary Hill <garyhill@centurytel.net>, blen@nwccusa.com, ttravis@nwccusa.com, Colorado River Guides Inc
<wetraft@raftcolorado.com>
Hi Chris,
You were the installer of the permitted OWTS at 18370 CO Highway 131. Can you confirm if, as well as how, the previous
failed tank and septic system were abandoned? I attached the permit for your convenience and reference.
Thank you,
Claire
[Quoted text hidden]
OWTS Permit-016190-2019.pdf
281K
Timothy Travis <ttravis@nwccusa.com>Tue, Dec 3, 2019 at 1:32 PM
To: Claire Lewandowski <claire.lewandowski@eaglecounty.us>, "dirthog3@gmail.com" <dirthog3@gmail.com>
Cc: Gary Hill <garyhill@centurytel.net>, Colorado River Guides Inc <wetraft@raftcolorado.com>
Hi Claire,
I spoke with Brenda Worley today about the exisng system. They are sll living in the exisng residence and using
the exisng system unl they can get the CO for the new residence.
Please let me know that you have received this message or if you need any further informaon.
Regards,
Tim Travis, P.E.
NWCC, Inc.
(970) 879-7888 ext. 103
(970) 879-7891 fax
ttravis@nwccusa.com
2580 Copper Ridge Drive, Steamboat Springs, CO 80487
******************************************************************************
PRIVILEGED AND CONFIDENTIAL: Communications sent from NWCC, Inc., may contain sensitive information. This communication, including attachments, is
for the exclusive use of addressee and may contain proprietary, confidential or privileged information. If you are not the intended recipient, any use,
copying, disclosure, dissemination or distribution is strictly prohibited. If you are not the intended recipient, please notify the sender immediately by return
email, delete this communication, and destroy all copies.
[Quoted text hidden]
[Quoted text hidden]
[Quoted text hidden]
[Quoted text hidden]
--
Please note that beginning July 15 the Community Development Department will have new walk-in hours. The
office welcomes walk-in customers between 8 a.m. and 4 p.m. Monday through Friday, except holidays.
Claire Lewandowski, REHS
Environmental Health Specialist III
970-328-8755 (office)
970-328-8747 (direct)
environment@eaglecounty.us
www.eaglecounty.us
Colorado River Guides Inc <wetraft@raftcolorado.com>Tue, Dec 3, 2019 at 2:02 PM
To: Timothy Travis <ttravis@nwccusa.com>
Cc: Claire Lewandowski <claire.lewandowski@eaglecounty.us>, "dirthog3@gmail.com" <dirthog3@gmail.com>, Gary Hill
<garyhill@centurytel.net>
Claire, Also, current system at old house did not fail and has not been abandoned. Brenda Worley
[Quoted text hidden]
--
Brenda
Colorado River Guides Inc.
www.raftcolorado.com
(970)653-1001
Claire Lewandowski <claire.lewandowski@eaglecounty.us>Tue, Dec 3, 2019 at 5:04 PM
To: Colorado River Guides Inc <wetraft@raftcolorado.com>
Cc: Timothy Travis <ttravis@nwccusa.com>, "dirthog3@gmail.com" <dirthog3@gmail.com>, Gary Hill
<garyhill@centurytel.net>
Hi, thank you for the response and clarification! I can final the permit. For your existing systems record, will the
system remain in place, be abandoned, or remain active?
[Quoted text hidden]
[Quoted text hidden]
Colorado River Guides Inc <wetraft@raftcolorado.com>Tue, Dec 3, 2019 at 5:36 PM
To: Claire Lewandowski <claire.lewandowski@eaglecounty.us>
Cc: Timothy Travis <ttravis@nwccusa.com>, "dirthog3@gmail.com" <dirthog3@gmail.com>, Gary Hill
<garyhill@centurytel.net>
Claire,
System will remain active.
Brenda
[Quoted text hidden]
' EAGLE \7UNTY DEPARTMENT OF ENVIRONI,'--�TAL HEALTH
CALL FOR FINAL INSPECTION B 6th & Broadway PERMIT MUST BE POSTED ON
BEFORE COVERING ANY PART Eagle, Colorado,$I.6, LOCATION OF INSTALLATION
OF INSTALLED SYSTEM
Box 850„,
PERMIT ND 48�' (this does not constitute
a building or use permit)
Owner Ernest W. & Evelyn Shue
/ 93'70
System Location Highway 131 - 2 miles north of Bond on Hwy 131
Licensed GM&WorInstaller•
* Conditional Construction approval is hereby granted for a 1,000 gallon
XX; Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate 1 inches in 20 minutes.._ 720 sq ft.
absorption area per bedroom 240 sq. ft.
# of bedrooms 3 x 240 sq. ft, minimum requirement
MINIMUM REQUIREMENTS:
gallon septic tank (two -
compartment
720 sq. ft. leach field
May we suggest
Date March 9, 1981 n�'
ctor Erik W. Edeen
FINAL APPROVAL OF SYSTEM: CF +�
No system shall be deemed to be in compliane with the Sewage Disposal Laws Mil the assembled system
is approved prior to covering any part.
Septic Tank cleanout to within " of final grade or aerated access ports above grade.
Proper materials and assembl / Or
1W Adequate absorption (or dispersal) area. l �S � /"'�'ct
Adequate compliance with permit requirements. ( —7 It`f
cc
�l
Adequate compliance with County and State regulations/requirements.vU{�,1
Date JJ� Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE 3/24/81: Erik Edeen
advised that conditional final approval
*CONDITIONS: givenfor the above installation as pei
1. All .installation must comply with all requirements of the County Individual Sewage Disposal Regulations,abo`
adopted pursuant to authority granted in 25-10-104, CRS 1973 amended 25-1-614, CRS 1973
2. This permit is valid only for connection to structures which have fully complied with County Zoning and
building requirements. Connection to or use with any dwelling or structures not approved by the building
and Zoning office shall automatically be a violation of a requirement of the permit and cause for both
legal action and revocation of the permit.
3.28 3. Section III, 11requires any person who constructs, alters, or installs an individual sewage disposal
system in a manner which involves a knowing and material variation from the terms or specifications con-
tained in the application of permit commits a Class I, Petty Offense ($500.00 fine - 6 months in jail or
hnth
PLEASE RETURN THIS PORTION WITH YOUR SITE PLAN AND FEES
° 3'�8--7311 - 949-5257 927-3823
ENVIRONMENTAL HEALTH
BOX 850
EAGLE, COLORADO 81631
PERMIT FEE = $75 PERCOLATION TEST FEE = $50
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
NO. Z— 7
NAME OF OWNER:
C
1.),
Z
ADDRESS:
e=a
fdHONE:
NAME OF APPLICANT (IF DIFFERENT FROM OWNER):
ADDRESS:
DESIGN ENGINEER OF SYSTEM (IF APPLICABLE):
ADDRESS:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM:
PHONE:
PHONE:
ADDRESS: PHONE:
PERMIT APPLICATION IS FOR: (. New Installation ( ) Alteration ( ) Repair
LOCATION OF PROPOSED FACILITY: County Lot Size e�* �D <
City or Town,
LEGAL DESCRIPTION:
if within
City or Town Limits
— —
STREET (RURAL) ADDRESS:
IS SYSTEM DESIGNED FOR
BUILDING OR SERVICE TYPE: (Check applicable category)
( t4- Residential - Single-family dwelling ( ) Residential - Triplex
( ) Residential - Duplex ( ) Residential - Quadplex
( ) Commercial - State usage
# Persons # Bedrooms
WASTE TYPES: (Check all applicable)
Commercial or Institutional ( Dwelling
( ) Non -domestic wastes ( ) Transient Use
( ) Other
SOURCE AND TYPE OF WATER SUPPLY: ( Well ( ) Spring
Give depth of all wells within 200 feet of the system:
If supplied by community water, give name of supplier:
TYPE OF IfV,9IVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( V Septic Tank ( ) Aeration Plant ( )
( ) Vault Privy ( ) Composting Toilet ( )
( ) Pit Privy ( ) Incineration Toilet ( )
( ) Greywater ( ) Other
( Garbage Grinder
( Dishwasher
( ✓)' Automatic Masher
( ) Creek or Stream
O
Chemical Toilet
Recycling, Potable Use
Recycling, Other Use
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ( ) Yes ( v'j"' No
Signature Date c-_� /11 /� /F/
INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER
GROUND CONDITIONS: Percent Ground Slope:
Depth to Bedrock (per 8' Profile Hole):
SOIL PERCOLATION TEST RESULTS:
FINAL DISPOSAL BY: ( )
(
Depth to Groundwater Table:
Minutes per inch in Hole No. 1
,z
Minutes per inch in Hole No. 2
Minutes per inch in Hole No. 3
Absorption Trench, Bed or Pit ( ) Evapotranspiration
Above Ground Dispersal ( ) Sand Filter
Underground Dispersal ( ) 'Wastewater Pond
Other
-�/�
PLAT OF
TRACT 49
T 2 S, R 83 W of the
6th P.M.
TR. 48
4 S 890 50'02 E
2 WITNESS CORNER 1324.74'
SET 19.80 FEET
SOUTH TRUE COR.
TR. 47
TRACT 49
w 3
O O O -
o 0 40.029 ACRES Q
i° PC) ° M)
f
0 0 —
i
z cn
w
a
m
cD
z
cc
W
{
m
i 6 3 N 89055'32"W 4
131 9.31'
T R . 50
O Denotes a U.S.G.L.0). brass
cap set in place.
f I, B. James Burk, being a duly registered
(land surveyor in the State of Colorado, do
hereby certify that this plat is a correct
:representation of a survey made by me durin
March of 1980, to the best of my knowledge p�j,[� LAND SURVEYING CO.
and belief., pEJRK
,•, .�a4 .%„:.f ..............3;s/80. GYPSUM, COLORADO
B: James Burk R.L.S. 11204 date DATE OF SURVEY DRAWN 8Y
MARCH 27,1980
SCALE FILE NO.
1 IN. = 300 FT.
------
IMPROVEMENT LOCATION CERTIFICATE
\
\,—POWER
LINES
—243.1
-'-
0 SATELLITE DISH
-_- --__10-
OPEN �=="=
DECK
«=="POLE
SCALE: ,.�
/
'-_---' ACCESS ROAD ^5')
� '~° ^^''~—~~~' '^~'—''�"'~°
s�xoo� c�wu ..�~�~._ � -'~�=^...~,,~,,.
_,~^~'
or i.prn—m-1
. �~='~,^^~^'^~~"~
SCALE:.��� upon^~ "~ ..^'~~~` .. _� ,^`~.^� ~ °~~ .°'
��~�~. u..
1 STATE HIGHWAY NO. �. . '~�� .~ . *~~.-^~ '
,-~. on ^~^°. . '..` .,� = ~.~....
^,~�~`°
, described pi. _~.~~� .~`, � ^�....
^^^v+ cross— � ��—_ept as —P�1' C4 LEGAL DESCRIPTION
..~, °. ~~`.~ ,
�~^.,/~=^� ~~, °_`u ,~°^~.~.�. �,u�
�^."~,.^^~~.
- -
| ��������`�—����~~— �'a.."
.. -- .
67-
EAULE COUNTY ENVIRONMENTAL HEALTH
ROUTE FORM
ot NAME
------------
SATE REFERRED APPLICATION NO.
OCATI0N
i
'lease review the attached ap icationn"d return it and this completed form
=o the Environmental Health Office..
MLMNINC_ Complies with: Yes N
Subdivision Regulationsi
Zo ing Regulations
Recommend Approval
3omments :���
31,TILDING: Set Backs
tl/ Site
Ass
Other
Recommend A-
,omments:
%NGINEER
Roads
Grading
Drainage
Recommend ApprovaLk
,omments:
----......,. l- Lvty 1 ZO 1
FEE: $50
APPLICATION NO.
9171
0[A'ER:
LEGAL DESCRIPTION: l
<
y�
RURAL ADDRESS :
TYPE OF
DWELLING:
OF
BEDROOMS
DATE OF
TEST: �-- � `—1
TYPE
OF SOIL:
TEST HOLES PRESOAKED: YES N0
TIME
WATER DEPTH
INCHES OF
FALL
RATE
1
Z 3 1 2
3
1
2
3
1
2
PERCOLATION RATE: /��—
'�w" � TANK SIZE:
'7
SQUARE FOOTAGE PER BEDROOM:
_LEACH FIELD SI E:
Site has been reviewed and tested for pe 1ation rate.
We recommend: APPROVAL DISAPPROVAL
DATE:
w EAGLE COUN
ENVIRONMENTAL HEALTH OFFICER
1�
M91'')-Rrv.
Application must
be complete where
applicable. Type or
print in BLACK
I N K. No overstri kes
or erasures unless
initialed.
COLORADO DIVISION OF 1^JATER RESOURCES
818 Contenniul bldg., 1313 Sherman St., Denver, Colorado 80203
,{. m e, ,., -'
PERMIT APPLICATION FORM
( ) A PERMIT TO USE GROUNDWATER
(i<) A PERMIT TO CONSTRUCT A WELL
FOR:( ) A PERMIT TO INSTALL A PUMP
t 1) HrrLIUAI\1 I - mailing address
cy c• �/
NAME l 0
( ) REPLACEMENT FOR NO.
( ) OTHER
WATER COURT CASE NO,
STREET-
CITYO D / �_ � l t _r-u' ✓j :1
% l es-L>,/_
(State) (Lip) .�.
TELEPHONE NO.G-
(2) LOCATION OF PROPOSED WELL
c•
County(4, 'i-
J L '/< of the 5 �k %, Section
9 C —,
Twp. c� Rng. G P.M.
M.S) (E,W) ,
(3) WATER USE AND WELL DATA
Proposed maximum pumping rate (gpm)
Average annual amount of ground water 4-
to be appropriated (acre -feet): —
Number of acres to be irrigated:
Proposed total depth (feet) : / 0 L-1'
Aquifer ground water is to be obtained from:
Owner's well designation
GROUND VVATER TO BE USED FOR:
( ) HOUSEHOLD USE ONLY - no irrigation (0)
(}<) DOMESTIC (1) ( ) INDUSTRIAL (5)
LIVESTOCK (2) ( ) IRRIGATION (6)
( ) COMMERCIAL.(4) ( ) MUNICIPAL (8)
( ) OTHER (9)
DETAIL THE USE ON BACK IN (11)
(4) DRILLER
Name
Street
City
(State) (Zip)
Telephone No. Lit:. No.
�EGEI V ED
FED! 7 1s8'
WATER ItE�CJURCES
SUITE ENGUIE98
0..04
FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN
Receipt No.—/ t�— //5/
Basin
Dist
CONDITIONS OF APPROVAL
This well shall be used in such a way as to cause
no material injury to existing water rights. The
issuance of the permit does not assure the applicant
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.
APPROVED PURSUANT TO CRS 1.973, 37-92-602
(3)(b)(II) AS THE ONLY WELL 017 A TRACT
OF 35 ACRES OR MORE DESIGNATED AS y0
ACRES IN SC- % X5.
�. Sec �F T
APPROVED FOR DOMESTIC USE, INCLUDING THE
IRRIGATION OF NOT OVER Ott ACRE OF HOME
GARDENS AND LAWNS.
APPLICATION APPROVED
PERMIT NUMBER 118743
DATE ISSUED
I.D. S _6 3 COUNTY
hJR-26-77
,-�•� •`' \' COLORADO DIVISION OF WATER RESOURCES '
THIS FORM M ST BE SUBMITTED 1313 Sherman' Street - Room 818
VITHIN 60 DA S OF COMPLETION Denver, Colorado 80203
OF THE WORK DESCRIBED HERE-
N. TYPE OR PRINT IN BLACK WELL COMPLETION AND PUMP INSTALLATION REPORT
NK. PERMIT NUMBER 11^lk3
WELLOWNER :..:.e, a _�>70 3/. , 3 'i ,
/. of the /. of Sec. ,
ADDRESS -". .. .:G]: ^gib ;Cs.`Oy' �,.0=c,:? T. 5 R. P.M.
DATE COMPLETED ,,tine ?' 19` 1 HOLE DIAMETER
r �
WELL LOG
— in. from to �� ft.
; �Q
Water
From
To
Type and Color of Material
Loc.
in. from to ft.
in. from to ft.
:•
��
hits .andzt,;ne
DRILLING METHOD
J�•
�:��
?�:1 .a�g�GTI`3
CASING RECORD: Plain Casing
1.00•
-'Zed .`+. 3ankda; ,one
Steel 0 20
Size & kind from to ft.
l
Size4" & kind ='lactic from IQ to IN, ft.
1COw
1301
dray 32azdstane
Size .& kind from to ft.
Perforated Casing
Size liN & kind='Z2S4C from 90• to no ft.
Size & kind from to ft.
Size & kind from to ft.
GROUTING RECORD
Material Cement
Intervals Q to 200 .
3
Placement Method Poured
I IiGRAVEL PACK: Size 1 �
Interval
TEST DATA
Date Tested 6/3/$1 19
•
Static Water Level Prior to Test SQ ft.
AIX
>� :. _ . Y ,:, .:>;Type ATest Pump
Length of Test L,
Sustained Yield (Metered)
TOTAL DEPTH la
Use additional pages necessary to complete log.: Final Pumping Water Level
13o :. _ _
PUMP INSTALLATION REPORT
P Imp Make
, roe
3-)wered by HP
Pump Serial No.
*.rotor Serial No.
,ate Installea
?ump Intake Depth
,'remarks
+:'ELL TEST DATA WITH PERMANENT PUMP
Nate Tested
`static Water Level Prior to Test
F ength of Test
Sustained yield (Metered)
Pumping Water Level
Remarks
Hours
GPM
W
AI
3 WATER
J
W
v TABLE
W
J
Q J
.4
ry
w
J
a
I
d
coN E Of
F'
DEPRESSION
CONTRACTORSSTATEMENT
The undersigned, being duly sworn upon oath, deposes and says that he is the ccntractor of the well or
pump installation described hereon; that he has read the statement made hereon; knows the content
thereof, and that the same is true of his own knowledge.
7
Signature License NO.
State of Colorado, County of `` �� SS
Subscribed and sworn to betore me tFTs '"`�Uayaof�Aires OciobM 2te119_
My Commission expires: , 19
Notary Public
FORM TO BE MADE OUT Iry UUAURUFLIUAlt:: WHITE FORM must be an original copy on both sides and signed. I
WHITE AND GREEN copies must be filed with the State Engineer. PINK COPY is for the Owner and YELLOW COPY is for the Driller.
% THE LOCATION OF THE PROPOSED WELL and the area on,
which the water will be w-ed niteu be indicated on the diagram below.
Use the CENTER SECTION (1 section, 640 acres) for the well location.
+ - I- -.1 -- I- . -.. I - . I-- --._ -+ --- -I- -- +
- 1 MILE, 5280 FEET yl
-�- i- + + + + + +
I I l
—
—t- —
I
�NORTHL
f-
I
4-
- +
I
-I--
-I—
I
-I-
- -+- -
(10)
_—
II
+
_ The scale ofthediagram is 2 inches = 1 mile
Each small square represents 40 acres.
WATER EQUIVALENTS TABLE (Rounded Figures)
An acre-foot covers 1 acre of land 1 foot deep --- -
1 cubic foot per second (cfs) ... 449 gallons per minute (gpm)
A family of 5 will require approximately 1 acre-foot of water per year.
1 acre-foot ... 43,560 cubic feet ... 325,900 gallons.
1,000 gpm pumped continuously for one day produces 4.42 acre-feet.
1AfAi'GR IA/Ill QC t ict=n.
(6) THE WELL MUST BE LOCATED BELOW
by distances from section lines.
U ' .' ft. from �i ��v� sec. line
north or South)
L<? 20 ft. from //��1� sec. line
(east or west)
LOT BLOCK FILING
SUBDIVISION
(7) TRACT ON WHICH WELL WILL BE
LOCATED Owner:
No. of acres Will this be
the only well on this tract?
(8) PROPOSED CASING
POOGRAM
Plain Casing
in. from �'
17
ft. to '5 ft.
.... � rcm
ft. to-ft..
Perforated casing
in. from
ft. to 16�—� ft.
in. from
ft, to ft.
(9) FOR REPLACEMENT WELLSgivedistance
and direction from old well and plans for plugging
it:
Owner(s): ���'�✓� S% l� % /�� .S_ G< No. of acres: -
Legal description: �—} F _ i /u% o•f
(11) DETAILED DESCRIPTION of the use of ground water: Household use and do stic wells must indicate type of disposal
sys m to be_useq. g
(12) OTHER WATER RIGHTS used on this land, 6cluding wells. Give Registration and Water Court Case Numbers.
Type or right Used for (purpose) Description of land on which used
Al a//Z=
(13) THE APPLI.CANT(S)� STATES) THAT THE INFORMATION SET FORTH HEREON IS
TRUE TO THE BEST OF -IIIS KNOWLEDGE.
SIGNATURE OF APPLICANTM
i
Use additional sheets of paper if more space is required.
Policy
No. A 25983
GRUN®FOS-
5 Year
%s through 1 '/2 HP
Submersible Pump
Protection Application
Dear Grundfos Dealer:
To make certain your customer's
Grundfos submersible pump is fully
covered under the supplemental
Performance PLUS protection program,
READ AND FOLLOW THESE _
INSTRUCTIONS CAREFULLY. Please
type or print clearly.
Complete this policy application in
full. Then sign and date the application.
Your customer should keep the top
white copy of the application. Keep the
yellow copy for your records and send
the two remaining copies (pink and
goldenrod) to your Grundfos distributor.
Should the pump fail due to any of
the conditions specified under
Performance PLUS prior to the
expiration of the 5-year term of the
policy, your customer should contact
you. You then pull the pump and
determine if the cause of failure is
within the terms of the Performance
PLUS policy. If it is, Grundfos will
repair or replace the pump at no
charge through your distributor.
Performance PLUS does not cover
the labor charges involved in pulling
and reinstalling the pump.
The Performance PLUS protection
policy covers all Grundfos domestic
submersible pumps up through 11/2
HP. It is limited to the original owner of
the pump and is non -transferable.
Customer Name
Address
City -- _� c- � -1� � l�, i)
State ��- Zip
Grundfos Dealer Name
71�! y^�/r Jr✓ !;k% yt r
Address ? �T'' IY/- i_,. (� . ✓'!', �`_' 1
Cityr'�
State (, 0'- Zip
Pump Model:
Serial Number:
Phase & Volts:
Horsepower:
Date Installed:
Application:
Pumping/Water Level:
Pump Setting:
SO`
0
Well Inside Diameter:
Depth:
Flow (GPM):
Lightning Arrestor Type:
New Installation or
Brand of Pump Replaced:
Replacement:
I certify that a proper lightning arrestor has been installed with this
Grundfos submersible, and
that the unit has been installed in accor-
dance with the Grundfos I
allation and Operating Instructions.
Dealer Signature:
Date:
SP-SL-007 1 1/26/85
PRINTED IN U.S.A.
V
�T
IS
Cfsv
JOB NAME
PL
i Ds ' �)
0�3_ oo -aGa /93 7d
`7
I
JOB NO. .,.
JOB LOCATION
BILL TO
DATE STARTED
TE COMPLETED
DATE BILLED
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
--------- ---------------- --------- TOTAL LABOR
INSURANCE
PERMIT # 487 -
SALES TAX
OWNER: Evelyn Shue (q *k MISC.COSTS
LOCATION: 18370 - Highway 131 - 2 miles north of Bond
INSTALLER: James Matlock
SIZE OF TANK: 1,000 gallons
DWELLING: residential - 3 bedrooms x 240 sq.ft. TOTAL JOB COST
PERC RATE: one inch/20minutes (720 sq.ft.) GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
Finalized: 3-20-81 By: Erik Edeen
NET PROFIT
ILDER Pdnted in USA
-3 0 o
.