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I y' .9I'o4SZ a•£z,8£e00 S `� Ii .. yb = a§g s € _..___ i Z'OaS 3O>'/I 1SViiiisON am.go arm O3Iat -.$I I a ► " € t a ittt644 DEPARTMENT OF PLANNING SERVICES WC RECORDED EXEMPTION ADMINISTRATIVE REVIEW COLORADO Applicant: George and Carolyn Ann Brown RE-4991 Planner: Ogle do Brown Farms, LLC Legal Description: E2 NE4 Section 21, T6N, R65W of the 6th P.M., Weld County, CO. Parcel ID#: 0803-21-0-00-019 Lot A Size: 5+/- acres Lot B 75+/-acres Size: Water Source: Lot A: North Weld County Water Sewer Lot A: SE-0900O52 District [NWSWD]Tap# 1481 System: Lot B: Proposed Septic Lot B: Proposed NWCWD Criteria Checklist Yes No X 1. Conforms with Chapter 22 of the Weld County Code and any adopted municipal plan. X 2. Compatible with the existing surrounding land uses. X 3. Consistent with the intent of the zone district. X 4. Consistent with efficient and orderly development. X 5. Complies with Recorded Exemption standards in Section 24-8-40 of the Weld County Code. X 6. Provides for adequate protection of the health, safety, and welfare of the inhabitants of the neighborhood and the County. Approved with Conditions The Weld County Department of Planning Services has determined through an administrative review that the standards of Section 24-8-40 of the Weld County Code have been met. This Recorded Exemption is approved with the following conditions in accordance with information submitted in the application and the policies of Weld County. 1. A Weld County septic permit is required for any proposed home. The septic system shall be installed according to the Weld County Individual Sewage Disposal System (I.S.D.S.) regulations. 2010-2069 2. Topographic or physical features of the proposed Lot, such as ravines, ditches, streams etc. may limit the area available for a new or replacement septic system. Prior to recording the plat the Weld County Department of Public Health and Environment recommends that the applicant review the Weld County Code pertaining to septic systems to assure that any installed septic system will comply with all setback requirements found in the Code. In the event the proposed lot is not of sufficient size to allow the installation of a septic system the lot may need to be enlarged. 3. Prior to recording the plat: A. The plat shall be titled: Recorded Exemption No. 0803-21-1 RE-4991 B. Lot A shall use the existing residential access point as no additional accesses shall be granted. C. Lot B shall use the existing agricultural/oil and gas/ ditch road access points necessary for agricultural operations as no additional accesses shall be granted. D. All approved accesses shall be clearly shown on the plat. The applicant shall contact the Weld County Department of Public Works to determine if a culvert is necessary at any approved road access point. If a drainage culvert is required, a 15 inch Corrugated Metal Pipe (CMP) is Weld County's minimum size. If the applicant chooses to place a larger culvert please contact the Weld County Department of Public Works to adequately size the culvert. E. County Road 43 is designated on the Weld County Road Classification Plan as a collector road, which requires 80 feet of right-of-way at full build out. There is presently 60 feet of right-of-way. An additional 10 feet shall be delineated on the plat as future County Road 43 right-of-way. All setbacks shall be measured from the edge of future right-of-way. The applicant shall verify the existing right-of-way and the documents creating the right-of-way. If the right-of-way cannot be verified, it shall be dedicated. This road is maintained by Weld County. F. The Colorado Department of Transportation (CDOT) has jurisdiction over all accesses to State Highways. Please contact CDOT to verify the access permit or for any additional requirements that may be needed to obtain or upgrade an access permit to Lot£. G. The applicant shall provide to the Weld County Department of Planning Services a copy of the access permit issued by the Colorado Department of Transportation (CDOT) which grants access to State Highway 392, or written evidence that the applicant has complied with the requirements of the Colorado Department of Transportation (CDOT). H. All vehicles located on the property must be operational with current license plates, or be screened from all adjacent properties and public rights of way, or be removed from the property. All other items considered to be part of a noncommercial junkyard must also be removed from the property or screened from adjacent properties and public rights-of-way. I. Lot A shall comply with the one (1) acre net minimum lot size required by Section 24-8-40.L of the Weld County Code. Net acreage calculations should not include reserved road right- of-way. J. The following notes shall be placed on the plat: 1) All proposed or existing structures will or do meet the minimum setback and offset requirements for the zone district in which the property is located. Pursuant to the definition of setback in the Weld County Code, the required setback is measured from the future right-of-way line. No building or structure as defined and limited to those occupancies listed as Groups A, B, E, F,H, I, M and R in Section 302.1 of the 2003 International Building Code, shall be constructed within a 200-foot radius of any tank battery or within a 150-foot radius of any wellhead. Any construction within a 200-foot radius of any tank battery or 150-foot radius of any wellhead shall require a variance from the terms of the Section 23-3-10 of the Weld County Code. 2) Any future structures or uses on site must obtain the appropriate zoning and building permits. 3) Lot A is not eligible for a future land exemption in accordance with Section 24-8- 20.C.1 of the Weld County Code. 4) WARNING: LOTS MAY NOT BE BUILDABLE DUE TO FLOODPLAIN OR FLOODWAY DESIGNATION. The majority of Lot A of RE-4991 lies in a Special Flood Hazard Area (SFHA) defined by the Federal Emergency Management Agency (FEMA). This SFHA is delineated on the current effective Flood Insurance Rating map (FIRM), Community Panel Map 080266 0627 C dated September 28, 1982. Portions of lots located in the current effective FEMA 100-year floodplain may not be buildable. 5) WARNING: LOTS MAY NOT BE BUILDABLE DUE TO FLOODPLAIN OR FLOODWAY DESIGNATION. Please be advised that owners of Lot A of RE-4991 may not be able to obtain building permits to construct non-agricultural structures. All construction or improvements occurring in the flood plain as delineated on Federal Emergency Management Agency FIRM Community Panel Map 080266 0627 C dated September 28, 1982, shall comply with the Flood Hazard Overlay District requirements of Chapter 23, Article V, Division 3 of the Weld County Code and all applicable FEMA regulations and requirements as described in 44 CFR parts 59 and 60.. 6) The installation of any septic system within the 100-year flood plain shall comply with the Weld County I.S.D.S. flood plain policy. Specifically, if the septic tank lids are not above the flood plain elevation, then the access to the tank manhole lids must be covered with 20 mil PVC and sealed with plumbers cement. In addition, a one-way valve must be installed on the effluent line between the tank and the absorption field. Therefore, any future pumping of the septic tank will require that the tank lids be sealed prior to backfilling, and any future upgrade of the septic system will require that a one-way valve be installed on the effluent line. In accordance with the State of Colorado I.S.D.S. Regulations, no septic system shall be installed with in the floodway. 7) Prior to the release of building permits, the applicant shall submit a recorded deed describing the Lot upon which the building permit is requested with the building permit applications. The legal description on such deed shall include the Lot designation and Recorded Exemption number. 8) Prior to the release of building permits, the applicant shall submit evidence to the Department of Planning Services that Lot B has an adequate water supply of sufficient quality, quantity and dependability. • • 9) Prior to the release of building permit, the applicant shall submit evidence of approval from the Eaton Fire Protection District to the Weld County Building Department. 10) Should noxious weeds exist on the property or become established as a result of the proposed development the applicant/landowner shall be responsible for controlling the noxious weeds, pursuant to Chapter 15, Articles I and II of the Weld County Code. 11) Building permits shall be obtained prior to the construction of any building. Buildings that meet the definition of an Ag Exempt Building per the requirements of Section 29- 1-20 and Section 29-3-20.6.13 of the Weld County Code do not need building permits, however, a Certificate of Compliance must be filed with the Planning Department and an electrical and/or plumbing permit is required for any electrical service to the building or water for watering or washing of livestock or poultry. 12) Any disturbance of wetlands shall require the applicant to contact the Army Corps of Engineers for permits pursuant to Section 404 of the Clean Water Act. 13) Effective January 1, 2003, Building Permits issued on the proposed lots will be required to adhere to the fee structure of the County Road Impact Program. (Ordinance 2002-11) 14) Effective August 1, 2005, Building permits issued on the subject site will be required to adhere to the fee structure of the Capital Expansion Impact Fee and the Stormwater/Drainage Impact Fee. (Ordinance 2005-8 Section 5-8-40) 15) Prior to the release of building permits on Lots A and B the Lot owner shall verify with the nearest Town/City or Sanitation District to determine the location of the nearest sanitary sewer line. In accordance with the Weld County Code, if a sewer line exists within four hundred (400) feet of the property line and the sewer provider is willing to serve the proposed structure, a septic permit cannot be granted by the Weld County Department of Public Health and Environment. Evidence of such shall be submitted in writing to the Weld County Department of Planning Services. 16) WELD COUNTY'S RIGHT TO FARM: Weld County is one of the most productive agricultural counties in the United States, typically ranking in the top ten counties in the country in total market value of agricultural products sold. The rural areas of Weld County may be open and spacious, but they are intensively used for agriculture. Persons moving into a rural area must recognize and accept there are drawbacks, including conflicts with long-standing agricultural practices and a lower level of services than in town. Along with the drawbacks come the incentives which attract urban dwellers to relocate to rural areas: open views, spaciousness, wildlife, lack of city noise and congestion, and the rural atmosphere and way of life. Without neighboring farms, those features which attract urban dwellers to rural Weld County would quickly be gone forever. Agricultural users of the land should not be expected to change their long-established agricultural practices to accommodate the intrusions of urban users into a rural area. Well-run agricultural activities will generate off-site impacts, including noise from tractors and equipment; slow-moving farm vehicles on rural roads; dust from animal pens, field work, harvest and gravel roads; odor from animal confinement, silage and manure; smoke from ditch burning; flies and mosquitoes; hunting and trapping activities; shooting sports, legal hazing of nuisance wildlife; and the use of pesticides and fertilizers in the fields, including the use of aerial spraying. It is common practice for agricultural producers to utilize an accumulation of agricultural machinery and supplies to assist in their agricultural operations. A concentration of miscellaneous agricultural materials often produces a visual disparity between rural and urban areas of the County. Section 35-3.5-102, C.R.S., provides that an agricultural operation shall not be found to be a public or private nuisance if the agricultural operation alleged to be a nuisance employs methods or practices that are commonly or reasonably associated with agricultural production. Water has been, and continues to be, the lifeline for the agricultural community. It is unrealistic to assume that ditches and reservoirs may simply be moved "out of the way" of residential development. When moving to the County, property owners and residents must realize they cannot take water from irrigation ditches, lakes, or other structures, unless they have an adjudicated right to the water. Weld County covers a land area of approximately four thousand (4,000) square miles in size (twice the size of the State of Delaware) with more than three thousand seven hundred (3,700) miles of state and County roads outside of municipalities. The sheer magnitude of the area to be served stretches available resources. Law enforcement is based on responses to complaints more than on patrols of the County, and the distances which must be traveled may delay all emergency responses, including law enforcement, ambulance, and fire. Fire protection is usually provided by volunteers who must leave their jobs and families to respond to emergencies. County gravel roads, no matter how often they are bladed, will not provide the same kind of surface expected from a paved road. Snow removal priorities mean that roads from subdivisions to arterials may not be cleared for several days after a major snowstorm. Services in rural areas, in many cases, will not be equivalent to municipal services. Rural dwellers must, by necessity, be more self-sufficient than urban dwellers. People are exposed to different hazards in the County than in an urban or suburban setting. Farm equipment and oil field equipment, ponds and irrigation ditches, electrical power for pumps and center pivot operations, high speed traffic, sand burs, puncture vines, territorial farm dogs and livestock, and open burning present real threats. Controlling children's activities is important, not only for their safety, but also for the protection of the farmer's livelihood.. 4. The applicant shall submit two (2) paper copies of the plat for preliminary approval to the Weld County Department of Planning Services. Upon approval of the paper copies the applicant shall submit a Mylar plat along with all other documentation required as conditions of approval. The Mylar plat shall be recorded in the office of the Weld County Clerk and Recorder by Department of Planning Services• Staff. The plat shall be prepared in accordance with the requirements of Section 24-8-60 of the Weld County Code. The Mylar plat and additional requirements shall be submitted within sixty (60) days from the date the Administrative Review was signed. The applicant shall be responsible for paying the recording fee. 5. In accordance with Weld County Code Ordinance 2005-7 approved June 1, 2005, should the plat not be recorded within the required sixty (60) days from the date the Administrative Review was signed a $50.00 recording continuance charge may be added for each additional 3 month period. 6. The Department of Planning Services respectfully requests the surveyor provide a digital copy of this Recorded Exemption. Acceptable CAD formats are .dwg, .dxf, and .dgn (Microstation); acceptable GIS formats are ArcView shapefiles, Arclnfo Coverages and Arclnfo Export files format type is .e00. The preferred format for Images is .tif (Group 4). (Group 6 is not acceptable). This digital file may be sent to maps(Wco.weld.co.us. 7. The Weld County Department of Planning Staff's approval of this Recorded Exemption Application is based on satisfying the Conditions of Approval. Should an applicant be unwilling or unable to meet any one of these conditions within 60 days of approval, then this case will be forwarded to the Weld County Board of County Commissioners with a staff recommendation for denial. By itt4 Date February 8, 2010 Ogle ❑ Planner tfr WELD COUNTY,COLORADO PARTMENT OF PLANNING SERVICES 918 10TH STREET GREELEY,CO 80631 PHONE: 970353.6100,EXT.3540/FAX:970-304-6498 Date: . 20 Receipt No. Received From: Permit Type No. Description Fee 4221-RE/SE 4221-ZPMH 4221-USR 4221-SITE PLAN REVIEW 4221-CHANGE OF ZONE 4221-PUD 4221-MINOR/MAJOR SUB #OF BUILDABLE LOTS 4221-ADDITIONAL 30% FEE FOR SUB's 4221-RE-SUBDIVISIONS 4221-BOA 4221-FHDP/GHDP 4430-MAPS/POSTAGE 4430-COPIES 4730-INVESTIGATION FEE 6560-RECORDING FEE ., i MISC. ❑CASH ❑CHECK NO. TOTAL FEE Receipted By: DL# Exp. • (it ‘ittelle DEPARTMENT OF PLANNING SERVICES 918 Tenth Street I GREELEY, COLORADO 80631 IWEBSITE: www.co.weld.co.us E- L: kogle@co.weld.co.us C. PHONE I(9710) 3FAX 970) 304-6498 COLORADO February 8, 2010 George and Carolyn Ann Brown Go Brown Farms, LLC Subject: Recorded Exemption Referral Comments and Planning Administrative Comments Dear Brown Farms, LLC: The Department of Planning Services' has reviewed your application and related materials for compliancy with the Weld County Code. We find that your proposed Recorded Exemption meets the intent of the Code and it has been conditionally approved by staff. We have enclosed our comments for your case. If applicable, please address all issues identified in the staff comments. Prior to submitting the Mylar, please submit two (2) paper copies of your plat for review by the Department of Planning Services.staff. Upon approval of the paper copies please submit a Mylar plat along with all other documentation required as conditions of approval. The Mylar plat shall be recorded in the office of the Weld County Clerk and Recorder by Department of Planning Services' Staff. The plat shall be prepared in accordance with the requirements of Section 24-8-60 of the Weld County Code. The Mylar plat and additional requirements shall be submitted within sixty (60) days after the date the Administrative Review was signed or after the date of the Board of County Commissioners resolution. There is an eleven (11) dollar recording fee per Mylar sheet that you will be responsible for paying to record the plat. If you need any further information, please feel free to contact me at the above address, telephone number or e-mail address. Sin ly, im O Planner Case File: RE-4991 • • Kristine Ranslem From: Kristine Ranslem Sent: Thursday, January 07, 2010 9:10 AM To: 'sixbrownies@skybeam.com' Subject: Case RE-4991 Attachments: Applicant Letter.pdf Please see the attached letter. ristCwe R2 wsLev1/2. Planning Technician Weld County Planning Services 918 10 Street, Greeley CO 80631 970-353-6100 ext. 3519 1 taL-- DEPARTMST OF PLANNING SERVICES 918 10TH Street GREELEY, CO 835411 PHONE: (970) 353-61010 0, Ex t. 3540 FAX: (970) 304-6498 COLORADO January 6, 2010 Brown Farms, LLC George Brown 13700 Hwy 392 Greeley CO 80631 Subject: RE-4991 - A Recorded Exemption located on a parcel of land described as E2NE4 of Section 21, T6N, R65W of the 6th P.M., Weld County, Colorado. Dear Applicants: Your recorded exemption application is being processed. If it is determined that the application meets the approval criteria of Chapter 24 of the Weld County Code, you will be notified that the recorded exemption is approved. If the staff determines that the application does not meet the approval criteria or if staff has concerns with the application, staff may elect to forward the application for review to the Board of County Commissioners. You will be notified and asked to appear before the Board of County Commissioners at a public hearing. You will be informed of the hearing date prior to the hearing. The Board of County Commissioners will then consider your application and make a final decision on the recorded exemption. It is the policy of Weld County to refer an application of this nature to any town or municipality lying within three miles of the property in question or if the property under consideration is located within the comprehensive planning area of a town or municipality. Therefore, our office has forwarded a copy of the submitted materials to the Eaton and Greeley Planning Commission for their review and comments. It is recommended that you and/or a representative be in attendance at the Eaton and Greeley Planning Commission meeting to answer any questions the Commission members may have with respect to your application. Please call Eaton at 970-454-3338 and Greeley at 970-350-9741 for further details regarding the date, time, and place of this meeting. If you have any questions concerning this matter, please call me. Sincerely, Reason:I have reviewed this document Location:918 10th Si,Greeley CO Date:2010.01.07 08:55:20-07'00' Kim Ogle Planner ' " Wi`De APPLICATION FLOW SHEET COLORADO APPLICANT: Brown Farms LLC CASE #: RE-4991 REQUEST: Two-Lot Recorded Exemption LEGAL: E2NE4 of Section 21, T6N, R65W of the 6th P.M., Weld County Colorado. LOCATION: South of and adjacent to State Hwy 392 and west of and adjacent to CR 43 PARCEL ID #: 0803 21 000019 ACRES: 77 +/-Acres Date By Application Received Application Completed 1/04/10 KO Referrals listed 1/06/10 KR Vicinity map prepared 1/06/10 KR File assembled Ih'/0 Case logged in computer Letter to applicant mailed Referrals mailed C. Field check by DPS staff Administrative Review decision: IIXIycA1t '( .�j •h Board of County Commissioners hearing (if applicable) Date By County Commissioners Hearing Date Surrounding property owners notified Presentation prepared CC action: CC resolution received Date/t B J Plat recorded and filed RQQ 5/6./4 ,�r/� L.J� •I I V t1) 1 Overlay Districts Zoning Agricultural MUD Yes_ No_x_ IGA Yes_ No_x_ Airport Yes No_x_ Geologic Yes No_x_ Flood Hazard Yes No_x_ RECORDED EXEMPTION (RE)APPLICATION FOR PLANNING DEPARTMENT USE DATE RECEIVED: RECEIPT/AMOUNT# /$ CASE#ASSIGNED: APPLICATION RECEIVED BY PLANNER ASSIGNED: Parcel Number Q 8_0 ,3_-_,2_ L - Q - 0._- D L (12 digit number-found on Tax I.D.information,obtainable at the Weld County Assessors Office,or www.co.weld.caus) Legal Description(529< oe ig) A 4/4/E.*' Section 2/, Township & North, Range West Has the property been divided from or had divi ed from it any other property since August 30, 1972? Yes No X Is this parcel of land, under consideration, the total contiguous land owned by the applicant? Yes X No FEE OWNER(S)OF THE PROPERTY: Name: gal- /j/?O7+'/V /cZm'5 lie Work Phone# 5?-42,63-0W Home Phone#7, • O Email Address 5/k /avec,/eSeStyleatift, lo, Address: /3700 //c✓7 37Z City/State/Zip Code G;eee/er 6 doG3/ APPLICANT OR AUTHORIZED AGENT(See Below:Authorization must accompany all applications signed by Authorized Agent) Name: £2O/2c Seel vA-' Work Phone#970 453-O.y'"/Home Phone#770 353 d71/Email Address S'J-4,', 'I./.es-5' ,' •&A, Address: /92"/' 'x372 City/State/Zip Code r!' 6 ter 6 9063/ Lot A Lot B Lot C Lot D Smaller Parcel Water Source .7;_ P /98/ ivet l h (L/p f . Type of Sewer 1305 Proposed Use 2tPs , Acreage J 7S". Existing Dwellings? If Yes, list address If Yes, list address If Yes, list address If Yes, list address below: below: 2/j/OG below: below: a Yea 3293514d/3 /1/ �� {/ If the property is vacant or unimproved wnte pro water source and p sewer system for each parcel in the blanks above. For ✓J `� example,if a well and septic is proposed state:proposed well,proposed septic. I (We) request that the following described property be designated a Recorded Exemption by the Weld County Board ofCountyCommissioners. I (We) hereby depose and state under penalties of perjury that all statements, proposals, and/or plans submitted with or contained within the application are true and correct to the best of my (our)knowledge. Signatures of all fee owners of property must sign this application. If an Authorized Agent signs, a letter of authorization from all fee owners must be included with the application. If a corporation is the fee owner, notarize vidence must be included showing the signatory has the legal authority to sign for the corporation. /z- Lq, o ( l Wh^ I/ /2' L9-c7 ? . ' ature: Owner or Authorized Agent Date Signature: Owner or Authorized Agent Date f4 ( HIV 11111 Hall III 111111 IIIHI III IIIII IIII IIII • 36442/1409 0 :44P Weld Cunty, CO 9% 16of916 R16.00'ZD00.00 2S Steve MorenooClerk& Recorder Alter Recording Return To: Brown Farms,LLC 13700 Hwy 392,Greeley,Co.80631 STATEMENT OF AUTHORITY 1. This Statement of Authority relates to an entity named: Brown Farms,LLC, 2. The Entity is a Limited Liability Company 3. The Entity is formed under the laws of: Colorado 4. The mailing address for the entity is 13700 Hwy 392, Greeley, Co. 80631 5. The name and position of each person authorized to execute instruments conveying, encumbering, or otherwise affecting title to real property on behalf of the entity is: George Charles Brown as Member and Carolyn Ann Brown as Member 6. The authority of the foregoing person(s) to bind the entity (a) is not limited () is limited as follows: 7. Other matters concerning the manner in which the entity deals with interests in real property: 8. This Statement of Authority is executed on behalf of the Entity pursuant to the provisions of C.R.S. Section §38-30-172. Executed this: December 10, 2009 ems'orge Charles Br n eildniNel 1-A Carolyn Ann Brown STATE OF: Colorado COUNTY OF:Weld The foregoing instrument was acknowledged before me this 10th day of December,2009,by: George Charles Brown and Carolyn Ann Brown as Members of Brown Farms,LLC Witness my hand and seal. �j My commission expires 44,..M.,24,__ ' /.,24, — ebc / tart'Public Recorded Exemption Questionnaire for parcel #080321000019 E1/2 of NE1/4, sec21, township6N Range 65W 1. a. a letter from North weld Water District is attached to show adequate water for both lots. b. 12 shares of the Pleasant Valley Ditch stays and an augmented well #0105716 with the farm lot B. 2. A septic application has been filed with public health for a permit on Lot A which is attached. Lot B (if and when there would be any building) would have an engineered septic system designed constructed and permitted according to Weld County 3. Lot A has one farm house and a garage. Lot B is farm ground that will have various crops such as corn, beets, hay, wheat, etc. There is an oil and gas well head and tank battery in the southeast corner. It will be flood irrigated and is currently not planted until spring of 2010 and then corn will be planted. 4. Lot A will be a five acre parcel with the house and we intend to keep it in our possession. Lot B will be the farm ground and we intend to keep it also in our possession. 5. The sand creek ditch runs diagonally though the very most north east corner of lot A. Lot B has no special characteristics. 6. The most optimal building envelope for Lot B would be the very southwest corner. Lot A has the existing buildings 7. There is no business or use by special review permit on the property of Lot A or B 'Weld County Treasurer • Statement of Taxes Due _,_ a(mmr Numher W6599786 Pucci 080321000019 — _ Situs Address Legal Description 100AF E2NE4 21 6 65 EXC ALL EXIST R/W&EASE Account:W6599786 BTCTCLTNG LAND LLP 53 OLD TOWNSTTG RD BOULDER,CO 80302-9237 Year Charges Billed Payments Balance $880.00 .'0 / ' 2008 Special Assessment $880.00 •i. Grand Total Due as of 12115/2009 _ F $0.00 Tax Billed at 2008 flutes for Tax Area 7110-7110 Authority MITI Levy Amount Values Actt. it Assessed NORTHERN COLORADO WATER 1000.000000 $880.00 6003 C $0 Taxes Billed 2008 1000.000000 5880.00 Total r. $0 ALL TAX LIEN SALE AMOUNTS ARE SUBJECT TO CHANGE DUE TO ENDORSEMENT OF CURRENT TAXES BY 1 16 LIENHOLDER OR TO ADVERTISING AND DISTRAINT WARRANT FEES. CHANGES MAY OCCUR AND THE TREASURER'S OFFICE WILL NEED TO BE CONTACTED PRIOR TO REMITTA I': E AFTER THE FOLLOWING DATES' PERSONAL PROPERTY AND MOBILE HOMES•AUGUST 1,REAL PROPERTY-AUGUST 1 Weld County Treasurer P.O.Box 458,Greeley CO 80632 1400 N 17th Ave.Greeley CO 80631 (970)353-3845 ext.3290 -- - - --, - - __ —.. ___ _ —_ II WELD COUNTY TREASURER Pursuant to the Weld County Subdivision Ordinance,the attached Statement(si {.Taxes it Due, issued by the Weld County Treasurer,are evidence that, as of this date,all propel ;;taxes, special assessments and prior taxes liens currently due and payable connected with the f arcel(s) identified therein have been paid in full. • ! • •Signe - �l5Date /2//37(2,7 i I li - '• Weld County Treasurer S Statement of Taxes Due -.- Account Number RI 266586 Parcel 080321000019 Situs Address Legal Description 13737 E2NE4 21 6 65(3R)SITUS:32855 43 CR WELD 3285543 CR WELD Account: R1266586 • BICKLING LAND LLLP . C/O ARCHIL L BTCKLING 53 OLD TOWNSITE RD BOULDER,CO 80302 Year Charges Billed Payments Balance 2008 Tax $1,888.34 $1,688.34 Grand Total Due as of 12/1512009 / $0.00 Tax Billed ar 2O08 Rates for To Area 3860-3868 11 Authority Mill Levy Amount Values Actu I Assessed WELD COUNTY 16.804000' $471.87 F AG-FLOOD LAND 533,3: i $9,660 ED SCHOOL DIST RE2 30.149000 5846.58 AG-GRAZING LAND Si ) $20 NORTHERN COLORADO WATER 1,000000 $28.08 FARM/RANCH $230,01 3 518,370 (NC RESIDENCE-IMPS EATON FIRE 9.000000 $252.72 6.323000 $177,55 OTHER BLDGS,- Su ) $30 AIMS JUNIOR COL AGRICULTURAL HIGH PLAINS LIBRARY 3.280000 591.54 -' Total $264,7 5 $28,080 Taxes Billed 2008 66.536000 51,668.34 •Credit Levy ALL TAX LIEN SALE AMOUNTS ARE SUBJECT TO CHANGE DUE TO ENDORSEMENT OF CURRENT TAXES BY 1 IF LIENHOLDER OR TO ADVERTISING AND DISTRAINT WARRANT FEES. CHANGES MAY OCCUR AND THE TREASURER'S OFFICE WILL NEED TO BE CONTACTED PRIOR TO REMITTA CE AFTER THE FOLLOWING OATES: PERSONAL PROPERTY AND MOBILE HOMES-AUGUST 1,REAL PROPERTY-AUGUST 1 _ .. -,,, ----.., r- ._ .-.._ • Iii WELD COUNTY TREASURER . Pursuant to the Weld County Subdivision Ordinance, the attached Statement(s) rr Taxes Due,issued by the Weld County Treasurer, are evidence that, as of this date, all proper) f taxes, special assessments and prior taxes liens currently due and payable connected with the' r vrcel(s) identified therein have been paid in full, . Signe % ,C y// .�� Date_�_. YC� ' REFERRAL LIST Name: Brown Farms LLC Case#: RE-4991 County Towns & Cities Fire Districts _Attorney Ault _Ault F-1 x Health Department _Berthoud _Berthoud F-2 Extension Office _Brighton _Briggsdale F-24 _Emergency Mgt Office- Ed Herring _Dacono _Brighton F-3 _Sheriffs Office x Eaton x Eaton F-4 x Public Works _Erie _Fort Lupton F-5 _Housing Authority _Evans _Frederick _Airport Authority _Firestone _Galeton F-6 _Building Inspection _Fort Lupton _Hudson F-7 x Code Compliance Ann _Frederick _Johnstown F-8 Kim Ogle (Landscape Plans) _Garden City _LaSalle F-9 _Lin (Addressing Change of Zone) _Gilcrest _Mountain View F-10 _Ambulance Services x Greeley _Milliken F-11 _Grover _Nunn F-12 State _Hudson _Pawnee F-22 Div._ of Water Resources _Johnstown _Platteville F-13 _Geological Survey _Keenesburg _Platte Valley F-14 _Department of Health _Kersey _Poudre Valley F-15 x Department of Transportation _LaSalle _Raymer F-2 _Historical Society _Lochbuie _Southeast Weld F-16 _Water Conservation Board _Longmont _Union Colony F-20 _Oil & Gas Conservation Commission _Mead _Wiggins F-18 _Milliken _Windsor/Severance F-17 Division of Wildlife _New Raymer South Hwy 66 (Loveland) _Northglenn Commissioner x North Hwy 66 (Greeley) _Nunn _ _Division of Minerals/Geology _Pierce _Platteville Soil Conservation Districts _Severance Big Thompson/ FTC _Thornton _Boulder Valley/Longmont _Windsor _Brighton/SE Weld _Centennial Counties _Greeley/West Greeley _Adams _Platte Valley _Boulder _West Adams _Broomfield _Little Thompson _Latimer Federal Government Agencies Other _US Army Corps of Engrs x School District RE-2 _USDA-APHIS Vet Service _NWCWD _Federal Aviation Admin (Structures _RR over 200 ft or w/in 20000 ft of Pub x Sand Creek Ditch Airport Company Federal Communications Comm _Art Elmquist(MUD Area) ! • REFERRAL LIST Name: b lAhrl S Case#: PE-400 County Towns & Cities Fire Districts _Attorney _Ault _Ault F-1 jC Health Department Berthoud Berthoud F-2 _Extension Office Brighton _Briggsdale F-24 _Emergency Mgt Office- Ed Herring _Dacono Brighton F-3 _Sheriffs Office Eaton X Eaton F-4 )L Public Works Erie Fort Lupton F-5 _Housing Authority _Evans _Galeton F-6 _Airport Authority Firestone _Hudson F-7 _Building Inspection _Fort Lupton _Johnstown F-8 X Code Compliance N.-Ann_S-Beth _Frederick _LaSalle F-9 Kim Ogle (Landscape Plans) Garden City _Mountain View F-10 _Lin (Addressing Change of Zone) Gilcrest _Milliken F-11 Ambulance Services Greeley _Nunn F-12 Grover _Pawnee F-22 State Hudson _Platteville F-1 3 Div._ of Water Resources Johnstown Platte Valley F-14 _Geological Survey _Keenesburg Poudre Valley F-15 Department of Health _Kersey Raymer F-2 X Department of Transportation _LaSalle _Southeast Weld F-16 Historical Society _Lochbuie _Union Colony F-20 Water Conservation Board _Longmont _Wiggins F-18 Oil & Gas Conservation Commission _Mead Windsor/Severance F-17 Milliken Division of Wildlife _New Raymer Legal CaNg4 91- ✓a- 49`5 _South Hwy 66(Loveland) � _Northglenn Parcel ID# hRO3 21 /) 06 113 s North Hwy 66 (Greeley)`'Vlli le _Nunn Zone Acres? •71 _Division of Minerals/Geology _Pierce USDA nt4tY, _Platteville Airport N0 Soil Conservation Districts _Severance Geo Haz No Big Thompson/ FTC _Thomton FP?per /Ab? Panel # Boulder Valley/Longmont _Windsor IGA? 1\10 ORD# _Brighton/SE Weld MUD? No Centennial Counties Greeley/West Greeley _Adams _Platte Valley _Boulder West Adams _Broomfield Little Thompson _Larimer __J tixl 5,9a I Federal Government Agencies Other I US Army Corps of Engrs Y School District RE- di .._,I m _USDA-APHIS Vet Service _Central Colo.Water Conservancy Dist Federal Aviation Admin (Structures __RR ,�" over 200 ft or w/in 20000 ft of Pub p) ,Ly y Ditch Company, . oi eA,Q,Q,2— Airport _Art Elmquist(MUD Area) Federal Communications Comm .C MoC - -' Commissioner • • Kristine Ranslem From: Kristine Ranslem Sent: Thursday, January 07, 2010 9:09 AM To: Ann Siron; 'Hice-Idler, Gloria'; 'sandra.billings@state.co.us'; 'brandon.muller@state.co.us'; 'tunrein@eaton.k12.co.us'; 'alano@nwcwd.org'; 'dsantillanes@eatonfire.org' Subject: RE-4991 Referral Attachments: Referra Sheetl.pdf; Application.pdf; Map.jpg We have just received a case (RE-4991) in which we ask that you review the attached material and send a referral to us by February 6, 2010. Attached is the application, map, and referral sheet. You may send your comments to the Planner assigned to this case, which is Kim Ogle (kogle anco.weld.co.us) If you have any problems or have any questions, please don't hesitate to contact me at the number below. Thank you! IcyistLvve RPiK,SLevN. Planning Technician Weld County Planning Services 918 10 Street, Greeley CO 80631 970-353-6100 ext. 3519 1 . Prim Form 1441- 17\narligH Weld County R eferral IIJanuary 6, 2010 COLORADO The Weld County Department of Planning Services has received the following item for review: Applicant Brown Farms LLC Case Number RE-4991 Please Reply By February 6, 2010 Planner Kim Ogle Project Two Lot Recorded Exemption Legal E2NE4 of Section 21, T6N, R65W of the 6th P.M., Weld County, Colorado. Location South of and adjacent to State Hwy 392 and west of and adjacent to CR 43. For a more precise location, see legal. Parcel Number 0803 21 000019 The application is submitted to you for review and recommendation. Any comments or recommendation you consider relevant to this request would be appreciated. Please reply by the above listed date so that we may give full consideration to your recommendation. Any response not received before or on this date may be deemed to be a positive response to the Department of Planning Services. If you have any further questions regarding the application, please call the Planner associated with the request. Please note that new information may be added to applications under review during the review process. If you desire to examine or obtain this additional information, please call the Department of Planning Services. F We have reviewed the request and find that it does/does not comply with our Comprehensive Plan c/We have reviewed the request and find no conflicts with our interests. F See attached letter. F Please notify me of any public hearings regarding this request. Comments: fzt, (tc -pu..l Sri OCLV . n0 vi U Ply-fl c�r� n'61-O Signature Date / _ r -16 Agency �Yl` t zweld County Planning Dept. x918 10u Street Greeley,CO.80631 x(970)353-6100 ext.3540 2(970)304-6498 fax 01/08/2010 FRI 13: 35 FAX ld1002/002 • , Print Form l , Weld County Referral January 6, 2010 COLORADO The Weld County Department of Planning Services has received the following item for review: Applicant Brown Farms LLC Case Number RE-4991 Please Reply By February 6,2010 Planner Kim Ogle Project Two Lot Recorded Exemption Legal E2NE4 of Section 21, T6N, R65W of the 6th P.M.,Weld County, Colorado. Location South of and adjacent to State Hwy 392 and west of and adjacent to CR 43. For a more precise location, see legal. Parcel Number 0803 21 000019 The application is submitted to you for review and recommendation. Any comments or recommendation you consider relevant to this request would be appreciated. Please reply by the above listed date so that we may give full consideration to your recommendation. Any response not received before or on this date may be deemed to be a positive response to the Department of Planning Services. If you have any further questions regarding the application, please call the Planner associated with the request. Please note that new information may be added to applications under review during the review process. If you desire to examine or obtain this additional information, please call the Department of Planning Services. E We have reviewed the request and find that it does/does not comply with our Comprehensive Plan ($ We have reviewed the request and find no conflicts with our interests. See attached letter. fl Please notify me of any public hearings regarding this request. Comments: n Signature \ A �kA� (t»„t/11 Su(4 Date Agency A-tc& SC 0Cr .. 11»z.c— Ri a *Weld County Planning Dept. a91810m Street Greeley,CO.80631 *970)353-6100 ext.3540 *970)304-6498 fax 41 L--- -) Weld County Referral Wilk January 6, 2010 RECEIVED COLORADO JAN - 8 2010 Wild Com hthic wuu amt The Weld County Department of Planning Services has received the following item for review: Applicant Brown Farms LLC Case Number RE-4991 Please Reply By February 6, 2010 Planner Kim Ogle '"Project Two Lot Recorded Exemption Legal E2NE4 of Section 21, T6N, R65W of the 6th P.M., Weld County, Colorado. Location South of and adjacent to State Hwy 392 and west of and adjacent to CR 43. For a more precise location, see legal. Parcel Number 0803 21 000019 The application is submitted to you for review and recommendation. Any comments or recommendation you consider relevant to this request would be appreciated. Please reply by the above listed date so that we may give full consideration to your recommendation. Any response not received before or on this date may be deemed to be a positive response to the Department of Planning Services. If you have any further questions regarding the application, please call the Planner associated with the request. Please note that new information may be added to applications under review during the review process. If you desire to examine or obtain this additional information, please call the Department of Planning Services. ❑ We have reviewed the request and find that it does/does not comply with our Comprehensive Plan We have reviewed the request and find no conflicts with our interests. See attached letter. liC ❑ Please notify me of any public hearings regarding this request. Comments: ' �J I - 2G -l6 / Signature z, b� - .s _� Agency -114 L4e-r 1c Date :•Weld County Planning Dept. +918 10th Street Greeley,CO.80631 +(970)353-6100 ext.3540 +(970)304-6498 fax wow bounty Planning Department • • GREELEY OFFICE IAN 27?PtC MEMORANDUM RECEIVED IDTO: Kim Ogle, Planning Services DATE: January 26, 2010 C FROM: Heidi Hansen, P.E., Public Works Departmea4 COLORADO SUBJECT: RE-4991, Brown Farms LLC The Weld County Public Works Department has reviewed this proposal. Staff comments made during this phase of the process may not be all-inclusive, as other concerns or issues may arise during the remaining application process. Issues of concern must be resolved with the Public Works Department. Our comments and requirements are as follows: COMMENTS: Weld County Road Classification Plan (FHU): The Colorado Department of Transportation (CDOT) has jurisdiction over all accesses to the state highways. Please contact Gloria Hice-Idler at the Greeley office (970-350-2148 or 970-350-2163) to verify the access permit or for any additional requirements that may be needed to obtain or upgrade the permit. (State Highway 392) WCR 43 is a collector road and requires an 80-foot right-of-way at full build out. There is presently a 60-foot right-of-way. This road is maintained by Weld County. Pursuant to the definition of SETBACK in the Weld County Zoning (23-1-90), the required setback is measured from the future right-of-way line. REQUIREMENTS: The applicant shall utilize the existing residential access to Lot A. Utilize the existing agricultural, oil and gas, and ditch roads that are necessary for your agricultural operation (Lot B). Pursuant to Chapter 15, Articles I and II of the Weld County Code, if noxious weeds exist on the property or become established as a result of the proposed development, the applicant/landowner shall be responsible for controlling the noxious weeds. All vegetation, other than grasses, needs to be maintained at a maximum height of 12 inches until the area is completely developed. FLOOD HAZARD DEVELOPMENT STANDARDS: The majority of Lot A lies in a Special Flood Hazard Area (SFHA) defined by the Federal Emergency Management Agency (FEMA). This SFHA is delineated on the current effective Flood Insurance Rating Map (FIRM), panel number #0802660627C, dated September 28, 1982. Portions of lots located in the current effective FEMA 100-yr floodplain may not be buildable. Add the following to the Plat: "WARNING: LOTS MAY NOT BE BUILDABLE DUE TO FLOODPLAIN OR FLOODWAY DESIGNATION. Please be advised that owners of Lot A of RE-4991 may not be able to obtain building permits to construct non-agricultural structures. All construction or improvements occurring in the floodplain as delineated on Federal Emergency Management Agency FIRM Community Panel Map #0802660627C dated September 28. 1982, shall comply with the Flood Hazard Overlay District requirements of Chapter 23, Article V, Division 3 of the Weld County Code and all applicable FEMA regulations and requirements as described in 44 CFR parts 59, 60, and 65." The installation of any septic system within the 100-year floodplain shall comply with the Weld County I.S.D.S. floodplain policy. In accordance with the State of Colorado I.S.D.S. Regulations, no septic system shall be installed within the floodway. pc: RE-4991 Page I of I M:\PLANNING—DEVELOPMENT REVIEW\RE-Recorded Exemption\RE-4991.docx WELIPUNTY ROAD ACCESS INFORMAT•SHEET Road File#: Date: RE# : Other Case#: Weld County Department of Public Works 111 H Street, P.O. Box 758, Greeley, Colorado 80632 Phone: (970)356-4000, Ext. 3750 Fax: (970)304-6497 1. Applicant Name Witt Mt/ FrPRMS ZLC- Phone 970-353-dS/? Address /37 l ,y 372- City l/IFL—/'Y State Cv zip C6 2. Address or Location of Access 3,2.RCS- Lv , V.3 o.cgE/E Y Cu 6Is 4,3/ Section 9/ Township Range GSR/ Subdivision Block — Lot — Weld County Road#: y,3 Side of Road (1,E5 /1— Distance from nearest intersection 77o 3. Is there an existing access(es)to the property? Yes X No #of Accesses 9 4. Proposed Use: ❑ Permanent ' Residential/Agricultural 0 Industrial ❑ Temporary 0 Subdivision 0 Commercial 0 Other 5. Site Sketch KO w of idase Legend for Access Description: AG AG = Agricultural 4„fd s pFI,71rSEu RES = Residential O&G = Oil&Gas .4G�p'R. D.R. = Ditch Road _1 D = House 0 77/5' Of 1w}1r: O = Shed es A C2 (d o.. �k 4e e' Ni h o ................................... OFFICE USE ONLY: Road ADT Date Accidents Date Road ADT Date Accidents Date Drainage Requirement Culvert Size Length Special Conditions 0 Installation Authorized ❑ Information Insufficient Reviewed By: Title: • • Weld County Planning Department GREELEY OFFICE MM ? 02010 itlfti\t" MemorandEtVED TO: Kim Ogle, W.C. Planning wig C DATE: January 19, 2010 • liv�. ' • FROM: Mary Evett, W.C. Department of Public COLORADO Health and Environment CASE NO.: RE-4991 NAME: Brown Farms LLC Environmental Health Services has reviewed this proposal to exempt 5 acres from an 80 acre parcel. Proposed lot A will consist of 5 acres and proposed lot B will consist of 75 acres. There is an existing residence on proposed lot A which is served by the North Weld County Water District (meter #1481) and an individual sewage disposal system (Permit No. SE-0900052). Proposed lot B is currently vacant and a new individual sewage disposal system and a tap from North Weld County Water District will be installed on proposed lot B when a residence is constructed. The following conditions are recommended to be part of any approval: 1 . A Weld County Septic Permit is required for the proposed home septic system and shall be installed according to the Weld County Individual Sewage Disposal Regulations. Please note, the lot owners shall verify with the nearest Town/City or Sanitation District to determine the location of the nearest sewer line. In accordance with the Weld County Code, if a sewer line exists within 400 feet of the property and the sewer provider is willing to serve the proposed structure, a septic permit cannot be granted by the Weld County Department of Public Health and Environment. 2. The installation of any septic system within the 100-year flood plain shall comply with the Weld County I.S.D.S. flood plain regulations. In accordance with the Colorado I.S.D.S. Regulations, no septic systems shall be installed within the floodway. Please contact Weld County Public Works to verify flood plain vs. floodway. Additionally, please note the following: 1. The existing septic system is within the 100-year flood plain. The installation of any septic system within the 100-year flood plain shall comply with the Weld County I.S.D.S. flood plain regulations. Specifically, if the septic tank lids are not above the flood plain elevation, then the access to the tank manhole lids must be covered with 20 ml PVC and sealed with plumbers cement. In addition, a one- way valve must be installed on the effluent line between the tank and the absorption field. Therefore, any future pumping of the septic tank will require that . • the tank lids be sealed prior to backfilling, and any future upgrade of the septic system will require that a one-way valve be installed on the effluent line. 2. Topographic or physical features of the proposed lot, such as ravines, ditches, streams, etc. may limit the area available for a new or replacement septic system. Prior to recording the plat the Division recommends that the applicants review the County Code pertaining to Septic Systems to assure that any installed septic system will comply with all setback requirements found in the Code. In the event the proposed lot is not of sufficient size to allow the installation of a septic system the lot may need to be enlarged. 01/08/2010 FRI 13: 35 FAX IfINUI/uue 40 • 200 Park Avenue 4 K> a r °fi > aF a` r Eaton,CO 80615 * r .3 = (970)454-3402 +*+ y r�1e (970)454-5193 Fax e �' ��xL v r : "3 7 Fax �I V\ To: Kim Ogle—Weld County From: Tim Unrein Fax: (970)304-6498 Pages: 2 Phone (970)353-6100 Date: 1/8/2010 Re: Weld County Referral Response CC: ❑Urgent H For Review O Please Comment O Please Reply ❑Please Recycle Attached please find our response to the referral for Brown Farms LLC RE-4991. 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Y EE �� 'i}� }� 6 =3 i 3 Id l,4. ,i .1 .' , • ' I a < IY i �: a ■ 1 - 1; 3 at11 'IA E arm:a.]xataol: 4 § -F a i tL eo+nnvatul�otaMiliiaartiitua t 1f i'-3 it.. q ql,°,f �y ! k E p is a is A=la �d�s ��i s14 • ' WELDIPIUNTY ROAD ACCESS INFORMAT•SHEET Road File#: Date: RE#: Other Case#: Weld County Department of Public Works 111 H Street, P.O. Box 758, Greeley, Colorado 80632 Phone: (970)356-4000, Ext. 3750 Fax: (970) 304-6497 1. Applicant Name />%lfa ✓t/ FM 5 Z' C Phone 770-353-o Ls"-/Address /37vb /fL✓Y 392- City 6 L=/'/,=1' State Zip_ t'63/ 2. Address or Location of Access 31.&SS /vC/Q y 3 /tee/6-y- A. 6l / Section / Township l Range GSA/ Subdivision Block — Lot — Weld County Road#: 93 Side of Road (eit 3 f Distance from nearest intersection 770 / 3. Is there an existing access(es)to the property? Yes X No It of Accesses 9 4. Proposed Use: ❑ Permanent Residential/Agricultural ❑ Industrial ❑ Temporary ❑ Subdivision ❑ Commercial ❑ Other 5. Site Sketch yso/A/of I,r,1Eds2 Legend for Access Description: AG. AG = Agricultural aysor-_tISf_ RES = Residential AG/O O&G = Oil&Gas D.R. = Ditch Road = House 0 72/s of -clef = Shed Res Qf �s�G NT ti age- ..................... OFFICE USE ONLY: Road ADT Date Accidents Date Road ADT Date Accidents Date Drainage Requirement Culvert Size Length Special Conditions ❑ Installation Authorized ❑ Information Insufficient Reviewed By: Title: • s CERTIFICATE OF CONVEYANCES WELD COUNTY STATE OF COLORADO DEPARTMENT OF PLANNING SERVICES COUNTY OF WELD The UNIFIED TITLE COMPANY OF NORTHERN COLORADO hereby certifies that it has made a careful search of its records, and finds the following conveyances affecting the real estate described herein since August 30, 1972, and the most recent deed recorded prior to August 30, 1972. LEGAL DESCRIPTION: The East 1/2 of the Northeast 14 of Section 21, Township 6 North, Range 65 West, of the 6`h P.M., Weld County, State of Colorado. CONVEYANCES (if none appear, so state): Reception No. 3664947 , Book Reception No. 2750558 , Book Reception No. 928464 , Book 1122 Page 577 The certificate is made for the use and benefit of the Department of Planning Services of Weld County, Colorado. This certificate is not to be constructed as an Abstract of Title nor an opinion of Title, nor a guarantee Title and the liability of UNIFIED TITLE COMPANY OF NORTHERN COLORADO, is hereby limited to the fee paid for this Certificate. In Witness whereof, UNIFIED TITLE COMPANY OF NORTHERN COLORADO, has caused this certificate to be signed by its proper officer this 15 day of December, 2009, at 5:00 p.m. Company: UNIFIED TITLE COMPANY OF NORTHERN COLORADO B ' Authorized Signature 3690 W 10th Street 2nd Floor Greeley,CO 80634 7,/utteet Phone 356-3551 I LEECOMPANY Fox 356-2063 „t,,,,. ho,. J t 'iOoi y39� c y i Co b'Ur/3i WARRANTY DEED • D� THIS DEED,made this 10th day of Deeember,2009,between Bidding Land,LLLP,a Colorado Limited Liability Limited Partnership,duly organized and existing under and by virtue of the laws of the State of Colorado, grantor(s),and Drown Farms,LLC,a Colorado Limited Liability Company, duly organized and existing under and by virtue of the laws of the State of Colorado,whose legal address 13700 Hwy 392,Greeley,Co.80631,gantoe(s); WITNESS, that the grantor(s), for and in consideration of the sum of THREE HUNDRED TWENTY THOUSAND AND 00/100 DOLLARS (Sf20,000,00), the receipt and sufficiency of which is hereby acknowledged,has granted,bargained,sold and conveyed,and by these presents does grant,bargain,sell,convey and confirm,unto the grantee,its successors and assigns forever,all the real property,together with improvements, if any,situate,lying and being in the County of Weld and State of Colorado,described as follows: The East one-half(B 1/2)of the Northeast Qurter(NE 1/4)of Section Twenty-one(21),Township Six(6) North,Range Sixty-five(65)West of the 6th P.M.,County of Weld,State of Colorado.It 6 the intent of the Grantor to convey ell water and water rights sonata with the transferred property Inducting springs and spring rights,wells and well rights,both tributary and non-tnbatary,on,ender,apperteaaat to,or ued on the lands herein described,including but not limited to the following: 12 Shares ofMann!Volley Lateral Co., and with One Irrigation Well with permit number R-402 decreed In case number W1403 and Augmented order the Cache Ls Poodre Water Users Assalatioa, Grantor Reserves 1/2 of ell OH and Gen Minerals. also known by street and number as: 32855 CR 43,Greeley,CO 80631 TOGETHER with all and singular the herediternena and appurtenances thereunto belonging or in anywise eppeartaining,and the reversion and reversions,remainder and remainders,rents,issues and profits thereof,and all the estate,right,title,interest,claim and demand whatsoever of the grantor(s),either in law or equity,of in and to the above bargained premises,with the hereditameuts and appurtenances. TO HAVE AND TO HOLD the said premises above bargained and described,with the appurtenances,unto the grantee, its successors and assigns forever. The grantor(s),for itself, its successors and assigns,does covenant, grant,bargain and agree to and with the grantee, its successors and assigns,that at the time of the unsealing and delivery of these presents,it is well seized of the premises above conveyed,has good,sure,perfect,absolute and indefeasible estate of inheritance,in law,in fee simple,and has good right,full power and lawful authority to grant, bargain,sell and convey the same in manner and form as aforesaid,end that the same are free and clear from all former and other grants,bargains,sales,liens,tans,assessments,encumbrances and restrictions of whatever kind or nature whatsoever, except general tails for the current year and nbeequent yeas,and except easements, covenants,conditions,rmtrietlons,taaanitions,and rights claw of record,If any, The grantor(s)shall and will WARRANT AND FOREVER DEFEND the above-bargained premises in the quiet and peaceable possession of the grantee,its successors and assigns,against all and every person or persons lawfully claiming the whole or any pert thereof. The singular number shall include the plural,the plural the singular,and the use of any gender shall be applicable to all genders. IN WITNESS!WHEREOF,the grantor has executed this deed on the date set forth above. Bidding Land,LLLP,a Colorado Limited Liability Limbed Partnership 1111111111111111111111111III111111111111III11111IIIIIIII 0 By Archie L.Blckling as General Parahser I of 1 f 6.00 032,009 00 Sieve Moreno C:44P Weld lerk 6 Recorder STATE OF COLORADO COUNTY OF WELD I as. The foregoing instrument was acknowledged before me this December I0,2009,by Bidding Land,LLLP,a Colorado Limited Liability Limited Partnrship by Archie L.Buckling as General Partner My Commission expires:3�jN Wiiprass my handdn) official seal. 440 l.i Notary Public WARRANTY DEMD(Coq la Grp) rare••afloat nimrvmo Cot `Alec C. DATA•• Pacmrlai al' 'o'clock n Book Page _5-53 No. Recorder - `c°pecial Warranty-Deed . THIS DEED u conveyance of the real progeny deaedbed below,including any Improvements end other appurtenance,(the 'Plotter: Nom the ndiulduarl:l corpotelion(4),partnershipCs 1.9e other enlily)e l named below as GRANTOR Io the IndIvWuai a or entit loo1 below at GRANTEE. 1 The GRANTOR hereby sells and conveys the properly 10 the GRANTEE,end the GRANTOR warrens,the tills egalml all persona claiming under Me GRANTOR.except 101 any penlculer mailers denoted below under"Ado lllonel Warranty Excepbondend e.- cepl ler any of the following.ma Mira satsbllehad by the GRANTOR end evidenced by recorded document: aesemena,(table-al- way.mineral arena,minaret lemon.end protective convenanla end rnldclmne.The GRANTOR does not warrant aping'the Ilan et the gonerel Properly leeee for the year of this Dead. Tho Specific Terms el TNh Deed Are: Granter: (Give coma%)and place(*)of'4.mce II 1h spews of ma ewnery,enlor le laming in ml,Dead la,eWne hemeleed name.Identity oranlo,e as husband and rip Edith Evelyn Bickling 32855 Weld County Road 43 Greeley, Colorado 80631 brinier (GNI nemgel and eoouulnl,L"bman,at edamt including e.upol,tow Of n,nl number.it rpwredI Bickling Land, LLLP, a Colorado Limited Liability Limited Partnership c/o Archie L. Bickling 53 Old Townsite Road, Boulder, Colorado 80302 Form of Co-Ownership: ill thege.r,lacer men stemma named,they will be donators pWua Sinn in cemmen omen he we,Da'In lout tenancy'or ward&onna som mown wadded N I ha space below I Properly Deocrlpllan: Ilnnnoe county and sap The East one—half (E1/2) of the Northeast Quarter (NE 1/4) of Section Twenty—one (21), Township Six (6) North of Range Sixty-five (65) West of the 6th P.N., together with all water rights, ditch rights,deep water rights, including but not limited to eight (8) shares of the capital stock of The Cache la Poudre Irrigating Company, eight (8) shares of the capital stock of the Cache la Poudre Reservoir Company, and 140 units of the Big Thompson Project Water of the Northern Colorado Water Conservancy District & twelve (12) shares of the capital stock of The Pleasant Valley Lateral Co. Properly Aedreae: 32855 Weld County Road 43, Greeley, Colorado 80631 4)1 Consideration: (The ileleeqnc old deli.,amount it*phone:enamel'amlak.faecolot Nu and NW be preowned unties tame conveyance it laenldied as a wit.en any cam m,e canerywca ts eb.WN..anal and eKe,mreconi1 I . Raaarvetlona-Restriction aline GRANTOR plena,to mores ny warm lea Inc pecpeny or to canny pm man IN own&,ono the GRANTOR ea ettirming me GRANTEE'S nano en the properly,make appropriate ned,e.lon I a n O aAdditional Warranty Ece ntto e: Itnctude dew olloaf ,WNW Omer,nelter.era A7]. tt record or as may exist by use on the pprt'am�nises, ads governmentaa(iel : z-ususn Ge g${ _ Lions, all matters that would be disclosedeby an inspection of the praises by a ` incuirye inquiry of persons in possession and subject to natters that would be disclosed by an b accut survey, including but not limited to discrepancies, conflict in boundary lines S age in area, ens is end other facts whi correct survey mould disclose whi public record, a ch are mQt shown of pcup or ins t$wax en pew Ii �- e,.lw ..e claw lea Cefpeueral 18 nllon,P.Mu.]dp er Amecpllem llgnaYn gauss her NaiHeua,(m Name of Emma, Cnrpor.li on ""°`""°n Pannu,lu° yn wick J"ryl�� '� °' Edith ith Evelyn Bickling Grant� By Br Oramoe crf,n1E,(1 r, Ow"' stare ordeadeaoo e I • i ttdudT4 qr. VELD 's mp,angaro moor acYroupeaed Mime Ty Nn r,cp du; Bdittp Evelyn Bickling 18th stye February, •mE2000 •••, / w,TNESS myhaeSnd Wham mw 11/24/01 5(.44/424:1—) ':..SIRTf.G1 vNv Maa,1'��,VJI COUNTY or - m rm souping rnewume ,re,akrpaaeged miw@ me ml, By day 0' a I'name•nm.awa G,anior(m w,r Ganior itCnr potation.Peilnannhr efassateoon IMn,ten,iiy signora••erm,dem or rc.pnwu.nl end nerneryo, n..... smnnry el L6po,elan CI ea emleeelal Oe Menewahtp.b aS esteemed memento el mammon I WII NESS my head.nd°Thad mY lay L mnleeles notes• Nwry PM* P0alIIS•Greeley,Greeley.Oaaa I D I 'UPDATE• LISAL CMaf We Ylr Iwal asa•nw 2750558 02/18/2000 03:27P IA Buhl Tsukamoto 1 261 0l I R 5.00 0 0.00 Weld County CO • 1O/1J/06 10:14 r 6d, WELD COM7Y CLERK & REC �aO4 _--- F£dd? fi 5 d l' : en N. 1! 1 I i+� y i,. , . � W_ p175 d w d I�. f ya ..,.,{[f .:�� !Sij '•S�S�'A4in�'f 4y ki .1,d4 /gA,e(S L ;. �d�ebtby��,,!,./.t�.. I\ yi a r"�� :'" Y Y .d std AO�A.la4G {{ x�y . . is /d, L/ d u/de4, fi z. t ,, , _ j „ �fl� 16011ttL 's 11 - e December - is . ' a m7y,a+ 4(aitiemeestedaw forty-thre f --------- ---..6.••••-•41._-_a-:4J_ '� , • • H�ti'apd.!‘— _li.,, - --- Gaabet Weld, �:..- i:_-�4aLStfilhamtswkoe ARCHIE L. C.`BTCICLIAC and EDITH It fir +HM(CHLy1P d: . fl i . ad.,- 0.4 et Weld, .t'atieletr delrala to tat.emnl mat: tlllnaa0'i,that lib w pay of Ibe eat Put,du ad Ineantnhteer or O.woo et Ten Dollar. (410) and other valuable considerations Demostai te 0 14 pay d an dart Pet In ad p.id b the.Id pollee el 1M End let.the mill abated le M aga..dewd had acb.atdpet ha.a mks,isms.mid m!roped.W 17 m assess ey y bee - : F boa w9,aop tad Wane rube the am maw d Da minted pert.Lod la tap a man hat Y Salt lead,Oa.edam ef Ilea et antes.d a.Mn.d.dpi et nth Eat flan,11 attain- ing thattbel lag argued of lull,Out;b44 ad bent au Comte d tea:tea: �� Weld sad Skala d Odin&. : • The Eaat one-half (Pate}) of the Northeast Quarter (NEI) of Section twenty-ona (E1) in Township six (6) North of Range sixty-flea (a) West of the 6th P.Y., containing eighty acres more or lees; alto eight chorea or the Capital Stock of The Cache La Poudro IrrigatiOn Company, and eight chorea of the Capital stock of The Cache La Poudre Reservoir Company; -n. rostrata.fa en .d dealer as bm.dlyano and.ppFtu.a.m thanes'Herald.go It"'WOW apflttio ,.d the muds=she nettle,.,nudger end ender,,no%bum sad may tbena:end all the edam,elght sae,latent wham sad damsel♦batanw of the ES pay of the In;pert eahtr la law or cualt.of.In ad In Ur shank tatad.d'mama%at Om ledoditase4 end appudcwnne. TO HAVE AND TO HOLD the add'gains cam,!scale and dwoR.y.(Y as tppdmenna is.On "IA Partin ed tha Mood pmt,lb..tminr etas MS aide.,ad IM Met ad..der.et sea Dow am fee- Dean Ad ao ta4 earl y at lie and pan,In hla.,I r, his MOON®aoaoa sad dmHnNton. d, es a newel,gout,panda td.pas to and with the.a4 path of tla wed initiate swirly,f them. ilea added Yid the belts end man,of nth lenln,,aµ et Sae Urns of the'Mao;ad deanery at Owe runts. he ill .,p.elad el the pnsW.ab,n romped,en ref dead tan.petted,abedde tee lido- fmdble eats a1 Inhaance,In law,l fee Amply sod be a deed Ogg tea ewer ad b..Tpl euaafty Ie grunt. borais,are ad tummy ao sin*In mover sal tarn at.rwld.as sal ae ease an dine ell clear hem ell Tamar ' .ad ether ands,tamales,.ly Bate,lanai,esemwaa tad l aambreetea of edaynr Had or nature 0000rr, except taxes for 1943, payable in 19441 W the.ben bunked mho la the add and peswlle pwwedan of ma add make of the stead puns the survivor of On,Dodo Wlte.d the kiln sad pains d each aurrim.waled all.d.0n7 mean or Paola In.f.*T dtlalt a to tWm ao wade er any Wet thereat Donald piety of at trot port gull tad wilt WARRANT AND TOILET=OEYOW. DI WITNESS WZEBWF the-Id pan y of lb.Int part la e b at his bed and tau the deg and lee gut.bm mime. 7 61pest Saarland Delivered In the hams w .: - '-•••;•.:.:::',/� .[BEAT.) ..._,..__......_..__.._.7...._/.._...!Bret] ...__a_ ........._....._...........___._....._..._ _,wawa _...[StAtj ._......___..._ wawa._wawa bite 7,e• a}•r,....., I� BCATs 07 COLORADO, : s;+e t .I d rt'd- City and costa d Denver. j` + • �,. w The fen Isdneseet nu abm.tsfd befon me the /7 1 cP U O ter . `. date,f December ,le-13 hr uL:4U_AT N. BIC(TINO. Lrdawlf SfD�i' YlyNapa wl bed ad ruW,I mg Ib analog*,tpfa. De a ember 15, 1946, see was Nov ul. walla MT bas.zee T .n—T i,alnia.0Yr ee.acv.nu usury Lei ma use. 1! ,aNn I errygps.:4p m cry liner emu a R{ :._Iq age a arrlasa 1.pla�tareeaastee yi�eQlyfy�r aaymw��W q pemlm ~tl�t nano et Mn aura.woke--am peace w ease mRal wean MaYamm,aaNa(ItiM1.�,m Ietesid*a1a1.ItYN,1t ` {'F ',..t .v L.:'E. c,;` V:'lT •' I :1�= 1'ti.`.1 ._ ...,::3;l i;:'=1::15" • -W,; r4:: .:!c.•;r;.{;, . ce 3vcf'.:earr_f air•.I I =L'. ♦I, ,'I ',r1 SC.X•=:3 • LI:f$il: .`sv:I' E 'ill:';, • :. 1:1;3:15 0997 _. ..... ..._....._._._ •�. -[.•(..,'^fP .-..h1.. .,;ai5'r.2d 11�3t•v, oral December 21.2009 Grown Farms.LLC 13700 Hwy 392 Greeley.CO 80i331 970 353.0751 This letter is in response to your inquiry regarding water service to the batwing described property. Approx 32839 WCR 43.Proposed Lot B in a portion of the E is of the NE:•.of Section 2.1,'EN:R85W of the o Prime Meridian. Parcel 080321000019 1. Water Service is presently being provided to the above mertioned property through meter 1 481.loca'ed at 32855 WCR 43 also known as Proposed Lot A. 2. thuth Weld County Water District is able and intends to provide water service to the above-mentoned property, provided all requirements of the District are satisfied. If contracts have not been completed with North Weld County Water District within one year from the date of this letter,the District may refuse to supply water to the above-mentioned property. The District reserves this right to refuse service,in the event that raw water is unavailable,and,or pipeline or Filter Plant capacity is not capable to provide additional service Before a water tap may be purchased,the applicant must provide a copy of a Warranty Deed,a Physical Address,this letter,and a thirty(30)foot easement for the existing waterline must be granted. 3. As additional consideration for this Letter of Intent to provide service.Property Owner agrees to sign and execute any necessary Easements and Rights-of-Way regarding specific locations,widths,size of pipeline(s)and descriptions for Water Lines as determined by the District. This Agreement is conditional upon execution and recording of the Easement and Right-of-Way Agreement,and until such Easement and Right-of-Way Agreement is finalized to the satisfaction of The District and recorded.District shall not be required to provide any services of any type. 4. The District requests that for any County Process,including but not limited to a Recorded Exemption(RE),Subdivision Exemption (SE),Use by Special Review(USR).Planned Unit Development(PUD),Minor Subdivision or Off-Site Construction Plans within Weld or Latimer County that the respective County place North Weld County Water District on the referral list. Furthermore.the District requests that the applicant submit the plat to North Weld County Water Districr for review prior to submitting the plat to the County for filing. The District may need additional waterline easement(s)or waterline improvements to provide service to the parcels being created or modified if the plat is recorded without District approval.additional easements may have to be recorded and/or additional waterline improvements will need to be constructed in order to maintain or establish new water service(s). 5.The District recommends that based on the number of family members arid livestock along with other information provided in the Water Tap Request Form,your irrigated landscaping square footage not exceed approx.6,000 square feet. The (ewrrnm rwlalnnr is based till the Full Standard Tap allocation and should be utilized to optimize delivery without surcharge. Additional allocation should be purchased for landscaping areas larger than the recommended area. 6. The District recommends that anticipated raw water be purchased through the District. The District guarantees treatment and delivery of raw water purchased. All water that is delivered over the allocation(with surcharge)is subject to water availability Water purchased through the District shall be 70%delivery of an Acre-Foot of water,if the allotment for Colorado-Big Thompson(CBT)project water,which is determined by the Northern Colorado Water Conservancy District.S 50%or greater.North Weld County Water District will restrict the delivery as necessary when the CBT allotment is less than 50%. A portion of the Raw Water Fee is utilized by the District to construct storage reservoirs. 7. Tap Options and Requirements A. The District offers a Full Standard Tap option for those landowners with lot sizes greater than 0.33 Acres(14,500 sq ft). This option allows the tap to utilize 228,000 gallons of water and plant investment capacity during a water yearfor delivery without surcharge. B. For landowners with lot sizes greater than 0.20 acres(8.800 sq ft)but less than 0.33 Acres(14.500 sq ft)OR those landowners with verifiable irrigation rights or well permits for outside water use,the District offers a 75%Tap option. This tap provides the landowner with 171,000 gallons of Water and Plant Investment capacity during a water year for delivery without surcharge. The fees are 75%of the Full Standard Tap Fees. C. The District offers a third option for those landowners with lots less than.2 acres(8,800 sq ft)or with a Board Approved Irrigation System or Board Approved Commercial Enterprise. This tap allows the landowner to utilize 50%of the Full Standard Tap or 114,000 gallons per water year for delivery without surcharge. The fees for this option are 50%of the Full Standard Tap Fees. Refer to the following page for a break down of the Districts'Tap Fees,Usage Rates.and Surcharge Rates. Sincerely, Alan Overton North Weld County Water District N'I.ccal i wncalslc i'r of rnrcnl'.(R.Int:nrL'wntdoc I o!2 -._:: L.r`.-:•R'rrl_t'AP7 . . rc • I'+i^tr•: '}. .. • r;.. December 21.2•Jup The Tap Fees quoted below,shall be valid for ten(10)business days from the date the applicant receives this letter and the tap fees must be paid within the ten(10)business days to receive the fees as quoted below. The Meter Set Fee as stated below is valid only for the location shown on the attached map. After ten(10)business days.the costs will be subject to the then in effect rates(current cost)established by the District.The District is not responsible for notifying individuals,banks,lenders.prospective buyers,real estate agents or anyone else.in any manner.of a change ct rates and or lees TAP FEES INSTALLATION COST Rate;ti`ates for tine Aae•Foct Unit iJ=FU) S8.500 Meter Set Fee 51.400 Storage Fee Portion of Raw Water Fee $1,000 Supplemental Fee S 225 Base Portion of Plant Investment Fee i 31.500 Distance Portion of Plant Investment Fee •• Thirty(30 font easement must be granted for existing S,.u." f20 miles) f S--- watertne. legal description will be created TOTAL Up-Front COSTS For STANDARD TAP(See _ $24,625.00 Paragraph 7 for Options)_PER TAP Price is valid for ten 10'business day ham receiving this letter. minimumPressl3re 35 psi_ Normal Pressure Range l 55 psi to 55 psi — -- I Maximum Pressure { --—_—70 ___._ .. . .._...— After the water tap has been purchased(Raw Water AFU&Plant Investment Fee)the applicant has one year in which to have the meter set. The Oistnct requires 45 days prior notice to setting a meter.li the meter has not been set within twelve months from the purchase date and the applicant requests to relinquish the meter.the District shall refund The applicant 98%of the purchase price paid by applicant.tithe meter remains unset for thirteen to eighteen months after the initial purchase date and the applicant requests to relinquish the meter,the District shall refund the applicant 90%of the purchase price paid by applicant. If the applicant does not choose to relinquish the meter within one year of the applicant purchasing the meter and the meter remains upset,the account will begin billing the minimum monthly amount. Usage.Rates and Fees Usage Amount ----. ... _-- Charge or Rate Per Month 0000 gallons__. —._.. $28.50kinimum Effective 01101:10$29.00 Minimum 10,000 gallons aid up 32.85 per 1.000 gallons Effective 01/0110$2.90 per 1,000 ' . gallons Water Surcharge Surcharge Will be assessed when an account's year to date usage exceeds the annual water allotment. Currently the surcharge is S0.10 per 1,000 gallons in addition to the standard monthly usage fee. This fee is to recover the Districts cost to obtain additional water rights for delivery. Rate Differential Charge North Weld County Water Districts customers have the option of transferring Colorado Big Thompson(CBT)Project Water that they own or control to the District,on an annual basis. This water is utilized to increase the amount of raw water allocated to a tap. The District will treat and deliver this water without water surcharge. A Rate Differential charge of 525 00 per acre-foot will he assessed on all of these transfers. Plant Investment Surcharge Surcharge will be assessed when an account's year to date usage exceeds the Plant investment Allotment. The transfer of additional water will not remove this charge. Additional Plant Investment Units must be purchased to increase the allotment and reduce the Plant lnvestrthent Su>.harges.These rates are in addition to the standard monthly usage fee. 0 to 456,000 gallons above the Plant Investment Allotment 53.50 per 1,000 gallons —----_—_.._ • More than 455 000 gallons above the Plant Investment Allotment $1.75 per 7,000 gallons . Allocation Table Full Standard Tap Water Allocation:228,000 gallons Plant Investment Allocation:228,000 gallons ` 5%Tap Option 'Water Allocation:171,000 gallons Plant Investment Allocation:171.000 gallons 50%Tap Option_ i Water Allocation 114,0009allons Plant Investment Allocation:114,000 gallons _ —__ A tap may b i aiotled more than 1 unit of Water anctior Plant Investment. In this case the allotment is the crass X 228.000 gallons= Annual Allocation.(eg.Water Allocation 5 x 228.000=1.140,000 gallons Annual Allocation) NA real rkgantoili•tvtla hull,rvAIXcm.lr.:,a.irc 2of7 Appro‘eif b,, . i Univ.li I'9P0i'. i.L( I i e F-- ------ - ----I j - In6µ (F5IUI ' or) y O C r m QZr co u p U c e -J -Ojjj !y i M S N m - W ova 3 O Min o u Q n _ n ow -0°) W EL M N 3 a O x O O ~' W n a O J C - a O 1 44 ti ._ E7 HO PiaM 31 _o 3 CO IS a m aki 0 O 0 O { " c a s O. m • E I C `m O m - m N O = o I. m o W n i s T ', � 2 I LI cr Fan r1ncrv=run-euuLIc- SOE# t,(N HEALTH AND ENVIRONMENT- ORG PERMIT# 0 555 N. 17'" AVENUE * REPAIR#T GREELEY, COLORADO 80631 LOAN # VIII PHONE: (970)304-6415 ISDS # FAX: (970) 304-6411 STATEMENT OF EXISTING FOR SEPTIC SYSTEM COLORADO (PLEASE FILL OUT IN BLACK INK ONLY) PARCEL NO. (7e032-104900/? PROPERTY OWNER B,eOIA/1 / mum S LGC PHONE NO. 927 )3S3-02,S/ MAILING ADDRESS /37hp Ails/* 392- - 6:orc/FY 8063/ City State Zip DESCRIPTION OF BUILDING (ex. house, mobile/modular home,shop,office) /4 SITE/LOCATION ADDRESS ?z g55 /toe y,3 rk, /. City State Zip LEGAL DESCRIPTION PT C 2- PTAC rSECTION 21 TOWNSHIP 6 RANGE 4s SUBDIVISION LOT te' BLOCK - FILING V, CENCUS TRACT LOT SIZE/ACRES . 7 /QC 4 TA 75A7C TQ COMMERCIAL YES(CD RESIDENTIAL (ca/NO NUMBER OF PERSONS y BASEMENT PLUMBING YES NO BEDROOMS .3 BATHROOMS - FULL,/ 3/4 1/2 WATER SUPPLY - PUBLIC (fa/NO NAME /r/v7,fij Air ici Co &jS in tier# /pew/ PRIVATE YES/NO WELL YES/NO CISTERN YES/NO WELL/CISTERN# � SYSTEM SIZE: Septic tank material is constructed of CO C and has /O.Ot7 gallons ca aci y'. FIELD: Trench square feet or Bed / square feet YEAR INSTALLED 1Ytb 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/is not in good working order and to the best of his/her knowledge is/is not failing to function properly. f 0w • I further understand that any falsification or misrepresentation may result in revocation of any permit grantertbased upon this information hereby submitted and in legal action for perjury as provided by law. uu-i PV-DC- 53 li./p1 DATE / OWNER Subscribed and sworn to before me this day of 20 By Witness my hand and official seal. My commission expires DATE NOTARY PUBLIC STATEMENT OF EXISTING REVIEWED BY ENVIRONMENTAL HEALTH SPECIALIST i S Recorded Exemption Questionnaire for parcel #080321000019 E1/2 of NE1/4, sec21, township6N Range 65W A septic application has been filed with public health for Lot A Hello