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Parcel ID#: 131103000036 Lot A Size: +/-4.5 acres Lot B Size: +/- 5 acres Water Source: Lot A: Existing Central Sewer System: Lot A: Existing Septic Weld County Water District System Tap#610 Lot B: Proposed Septic Lot B: Proposed Central System Weld County Water District 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. ©/Q_;/95 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. 2. Prior to recording the plat: A. The plat shall be titled: Recorded Exemption No. 1311-3-2 RE-5048 All septic systems located on the property shall have appropriate permits from the Weld County Department of Public Health & Environment. The Environmental Health Division of the Weld County Department of Public Health & Environment was unable to locate a finaled septic permit for 9144 CR 26. Any existing septic system which is not currently permitted through the Weld County Department of Public Health & Environment will require an I.S.D.S. Evaluation prior to the issuance of the required septic permit. In the event the system is found to be inadequate, the system must be brought into compliance with current I.S.D.S. regulations. Written evidence of Public Health & Environment approval shall be provided to the Department of Planning Services. C. Lot A shall use the existing residential access point as no additional accesses shall be granted. XThe applicant shall address the requirements of the Department of Public Works as stated in their referral dated September 2, 2010. The applicant shall submit an Access Permit for the proposed new access to Lot B. Written evidence of Public Works approval shall be provided to the Department of Planning Services. E. 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. F. County Road 26 is designated on the Weld County Road Classification Plan as a local gravel road, which requires 60 feet of right-of-way at full build out. The applicant shall verify the existing right-of-way and the documents creating the right-of-way and this information shall be indicated on the plat. All setbacks shall be measured from the edge of future right- of-way. If the right-of-way cannot be verified, it shall be dedicated. This road is maintained by Weld County. G. The applicant shall address the requirements of Weld County School District RE-1 as stated in the referral response dated August 16, 2010. Evidence of such shall be submitted in writing to the Weld County Department of Planning Services. 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. 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 applicant shall provide the Weld County Department of Planning Services with a Statement of Taxes from the Weld County Treasurer showing no delinquent taxes exist for the original parcel. K. 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) 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. 5) 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. 6) Prior to the release of building permit, the applicant shall submit evidence of approval from the Platteville Fire Protection District to the Weld County Building Department. 7) 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. 8) 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. 9) 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) 10) 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) • • 11) Prior to the release of building permits on Lot 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. 12) 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. 3. The applicant shall submit three (3) 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. 4. 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. 5. 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 dhuerterco.weld.co.us 6. 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 Date September 21, 2010 Chris Gathman ❑ Planner III • 7-C-— 50443 Plat Checklist POC Planner Item Comments Check Check Proper size and material 24" x 36" or 18" x 24" /Minimum 3 millimeter polyester sheet Lettering No stick-on lettering / Minimum 8 pt. lettering Boundaries of Lots Scale Suitable Scale?(1"=200'or I"=100') Accesses indicated Shared Access? If so, is easement Certificate included? Roads labeled, including R.O.W Building Envelope(s) 1 Vicinity Map Suitable Scale?(Minimum 1" =2000') !/ North Arrow Legal Description Notes from Planner/ Development Standards Conditions of Approval &,31%.00\ TJ t l 9 _a._ Owners Certificate Notarial Certificate included?All owners must sign the plat, check the deed. Surveyors Certificate and All surveyed plats Surveyors Stamp Note: USR plats do not need to be surveyed Director of Planning Notarial Certificate included?(RE, SE, SPR, Final PUD if Staff Certificate Approved) Planning Commission (USR,COZ, Minor Sub. Final) wl IA Certificate Board Certificate (USR, COZ„ Minor Sub Final) (Final PUD, RE, SE&ZPMH if Board approved) `� Typical Road Cross Section (COZ, Final Minor Sub. and Final PUD) N 1A Easements N/A Please return the plat to the CAD Technician within 24 hours of receiving the plat. 4J1f 4N'trk I'/2-1 1/0 Planner on Call: (Initials) _ . fa1�5 J 1 11/2K/I0. Planner Signature: Date: 2—/6/(/ WELD COUNTY,COLORADO DEPARTMENT OF PLANNING SERVICE 918 10TH STREET GREELEY,CO 80631 PHONE: 970-353-6100,EXT.3540/FAX:970-304-6498 Date: 7, 20 I J ._s O Receipt No. 1 5 � 1 Received From: f:ci Permit Type No. Description Fee 4221-RE/SE I 22. I orI (an 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 MISC. ❑CASH ACHECK NO.8�Z TOTAL FEE 107) ted P Recei By' DL# M7 (i\, Exp. WELD COUNTY,COLORADO DEPARTMENT OF PLANNING SERVICES 1555 N 17T"AVENUE GREELEY, CO 80631 PHONE: 970-353 100, EXT.3540/FAX: 970-304-6498 Date:'- 2 20 1 Receipt No. 1 51 [ 9 Received From: I / I. ; ./ l (i Li t / 1 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-ZPCV/ZPAS 4430-MAPS/POSTAGE 4430-COPIES 4730-INVESTIGATION FEE 6560-RECORDING FEE 7 i. • ❑CASH ❑CHECK NO. iCREdIT"CARD TOTAL FEE I Receipted By/_ _1 ,/L ( i DL# Exp. Weld County School District RE- 1 Gilcrest • LaSalle • Platteville P.O. Box 157 14827 W.C.R.42 Gilcrest,CO 80623 Dr. Jo Barbie, Superintendent Phone 970-737-2403 Scott Spearnak, Director of Learning Services Fax 970-737-2516 Keith Ouweneel, Director of Support Services Metro 303-629-9337 Weld County Planning Department GREELEY OFFICE December 3, 2010 DEC 7 701n RECEIVED Mr. Chris Gathman Weld County Planning Department 1555 north 17 Avenue Greeley, Colorado 80631 RE: Case Number RE-5048 Dear Mr. Gathman: Weld County School District RE-1 has reached an agreement Edward and Mary Diller regarding RE-5048. Weld County School District RE-1 interests in this recorded exemption have been met. The Dillers will pay the In Lieu Payment of$1,054.20 at the time of sale or at the time of building permit. Please feel free to call me if you have any questions, 970-737-2403 Sincerely, Dr. Jo Barbie Superintendent of Schools BOARD OF EDUCATION Marsha Harris Randy Ray Ken Garcia David Eckhardt Steve Reams Mark Ortiz President Vice President Secretary Treasurer Director Director Our Total Commitment is to Provide an Exemplary Education and Safe Environment for all Students • Chris Gathman From: Mary Evett Sent: Monday, October 18, 2010 4:22 PM To: Chris Gathman Subject: RE-5048 Diller Condition #2, regarding permitting the existing septic system on proposed lot A, has been met. Mary Evett Environmental Health Services Weld County Department of Public Health & Environment 1555 North 17th Avenue Greeley, Colorado 80631 Office #: 970-304-6415, Extension 2216 Fax #: 970-304-6411 1 • • a it.jo DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 9 crt lilill (........."-.........\\ Greeley, 80631 063 COC �l,>rxe.tnk "lip Web:hnp:l/wvaw.co.weld.co.us/departments/healthenvironment/ Health Ad In nation Pubic Maaih&Clinical Environmental Health Communication Eravg ncy Preparanfnaa TV e:Records Semler Fax 970 Education T e:970.M O Fab:970.304_6410 Fab:970.304.6410 Tele:970.304.6415 Tale:970.306.6070 Far 970.304.6469 Tex 970.304.6612 Tex 970.306.6416 Fax 970 304.6411 Fax 970.306.6052 Fax 970.306.8169 Our,faun:Together with the caneruntiea we sera.in are working b make Weld County tee I,ealrbeel place to eve,lean.wore ono may. COLORADO October 7, 2010 Edward G.and Mary A.Diller 9144 County Road 26 Fort Lupton,Colorado 80621 RE: Edward G. and Mary A. Diller ISDS No.: 1000017 Permit No.: SE-1000023 On October 4,2010 ,an evaluation of the existing individual sewage disposal system at: 9144 County Road 26,Fort Lupton,Colorado; Section 03,Township 02 North, Range 67West, was conducted by Mary Evett,an Environmental Health Specialist of this department. The existing individual sewage disposal system is of sufficient size and capacity to adequately handle the proposed load. This evaluation is based on a final treatment capacity for a 3 bedroom residence. Be advised, neither the County of Weld nor any of its agents or employees undertake or assume any liability to the owner of the above property, to any purchaser of the above property or to any lending agency making a loan on the above property or in the report. This inspection was conducted for the purpose of determining compliance with current regulations and for detecting health hazards observable at the time of inspection. This does not constitute a warranty that the system is without flaw or that it will continue to function in the future. Inspections requested during periods of snow cover and high soil saturation may be of questionable value to potential buyers due to adverse conditions. Evaluations based on Statements of Existing (S.O.E.)relies on information the property owner provides, under oath, indicating current status of the system and representing to the best of his/her knowledge the system is not failing to function properly. If we can be of any further assistance,please contact our office at (970)304-6415. Sincerely, �Q fi61l/'f/tivr.7 Mary Evett Environmental Health Specialist ME/ms • • Weld County School District RE-1 Gilcrest •LaSalle • Platteville P.O. Box 157 14827 W.C.R. 42 Gilcrest, CO 80623 Dr.Jo Barbie, Superintendent Phone 970-737-2403 Scott Spearnak,Director of Learning Services Fax 970-737-2516 Keith Ouweneel,Director of Support Services Metro 303-629-9337 August 16, 2010 Weld County Planning Department Attention: Chris Gathman 1555 North 17th Avenue Greeley, Colorado 80631 RE: Case Number RE-5048 Dear Mr. Gathman: We have reviewed the application by Edward and Mary Diller for RE-5048 and have the following comments: Weld County School District RE-1 has developed methodology for Land Dedication and/or In Lieu Payments. The current In Lieu Payment amount per single family unit is $1,054.20. Based on the information provided, it appears that there are plans to build a new home on parcel B. Therefore, an in lieu payment in the amount $1,054.20 is due to the school district prior to approval of the recorded exemption. Sincerely, aQ� . $tti_ Dr. Jo Barbie Superintendent of Schools BOARD OF EDUCATION Marsha Harris Randy Ray Ken Garcia David Eckhardt Steve Reams Mark Ortiz President Vice President Secretary Treasurer Director Director Our Total Commitment is to Provide an Exemplary Education and Safe Environment for all Students • DEPARTMENT PLANNING SERVICES Kee tc6 1555 N. 17th GREELEY, COLORADO 80631 PHONE: (970) 353-6100, EXT. 3540 FAX: (970) 304-6498 111k. COLORADO Date: August 11, 2010 Applicant: Edward & Mary Diller Project: Two-Lot Recorded Exemption Case Number: RE-5048 Parcel Number: 1311 03 000036 Based on the information provided, a building permit is not required. Regards Ken Swanson Building Official Weld County Building Department WITWER, OLDENBURG, BARRY&JOHNSON, LLP Attorneys at Law 822 7th Street,Suite 760 Greeley,CO 80631 STOW L.WITWER,JR TELEPHONE: (970)352-3161 R.SAM OLDENBURG FACSIMILE: (970)352-3165 JOHN J.BARRY JACQUELINE JOHNSON SENDER'S E-MAIL ADDRESS PATRICK M.GROOM KENT A.NAUGHTON JJohnson(n?wobjlaw.com Weld County Planning Department August 10, 2010 GREELEY OFFICE AUG 13 701(1 Chris Gathman, Planner RECEIVE Weld County Department of Planning Services D 1555 N. 17th Avenue Greeley, CO 80631 Re: RE-5048/Diller Dear Chris: Thank you for you letter concerning the above referenced Recorded Exemption Application. I would like to receive copies of any referrals you receive, and I am happy to answer any questions that arise concerning this matter. Very truly yours WITWER OLDENBURG BARRY & JOHNSON 11ac ueline Johns cc: Edward and Mary Diller Kristine Ranslem From: Kristine Ranslem Sent: Monday, August 09, 2010 11:29 AM To: Bethany Salzman; 'cindy.einspahr@co.usda.gov'; 'Rebecca Toberman'; 'brucenickerson@me.com'; 'Troy Renken'; 'sbutherus@kbnengineers.com'; 'Barbara Cole'; 'Leah Heneger'; 'Jo Barbie'; 'Russ Kissler' Subject: RE-5048 Referral Attachments: Referral Sheet.pdf; Application.pdf We have just received a case (RE-5048) in which we ask that you review the attached material and send a referral to us by September 9, 2010. Attached is the application and referral sheet. You may send your comments to the Planner assigned to this case, which is Chris Gathman (cgathman(u�co.weld.co.us) If you have any problems with the attachments, we will provide hard copies upon request. Thank you! Kri.stLwe RbiwsLew. Planning Technician Weld County Planning Services 1555 N 17th Ave, Greeley CO 80631 970-353-6100 ext. 3519 1 • Kristine Ranslem From: Kristine Ranslem Sent: Monday, August 09, 2010 11:31 AM To: 'edwarddgdiller@peoplepc.com'; 'jjohnson@wobjlaw.com' Subject: Case RE-5048 Attachments: Applicant letter.pdf Please see the attached letter. If you have any questions, please let us know. Thank you! K.rktL ce Ra wsLevt& Planning Technician Weld County Planning Services 1555 N 17th Ave, Greeley CO 80631 970-353-6100 ext. 3519 1 DEPARTMENT OF PLANNING SERVICES 1555 N 17 AVE 1‘1" GREELEY, O 80631 PHONE: (970)353-6100,Y Ex t. 3540 FAX: (970)304-6498 O COLORADO August 9, 2010 Edward & Mary Diller do Jacqueline Johnson 822 7th St, Ste 760 Greeley CO 80631 Subject: RE-5048 - A Recorded Exemption located on a parcel of land described as E2N2NE4NW4 of Section 3, T2N, R67W 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 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 Firestone and Platteville Planning Commission for their review and comments. It is recommended that you and/or a representative be in attendance at the Firestone and Platteville Planning Commission meeting to answer any questions the Commission members may have with respect to your application. Please call Firestone at 303-833-3291 and Platteville at 970-785-2245, for further details regarding the date, time, and place of this meeting. If you have any questions concerning this matter, please call me. Sincerely, Digitally signed by Kristine Ranslem Reason: am the author of document st(J w1Wl/.w Location:155591 :hAve Date:20 2010..08..09 11:07:36-06'00' Chris Gathman Planner WITWER, OLDENBURG, BARRY&JOHNSON, LLP Attorneys at Law 822 7th Street,Suite 760 Greeley,CO 80631 STOW L.WITWER,JR. TELEPHONE: (970)352-3161 R.SAM OLDENBURG FACSIMILE: (970)352-3165 JOHN J.BARRY JACQUELINE JOHNSON SENDER'S E-MAIL ADDRESS PATRICK M.GROOM KENT A.NAUGHTON JJohnson awobjlaw.com July 22, 2010 Weld County Department of Planning Services 1555 North 17th Avenue Greeley, CO 80631 Ladies and Gentlemen: Enclosed herewith is an application for a recorded exemption submitted on behalf of Edward G. Diller and Mary A. Diller. When this application was originally submitted, the Department of Health and Environmental Services notified us that the septic permit we provided was insufficient and that the applicant needed to submit a"Statement of Existing for Septic System"form,together with a check for$160.00. We are submitting that form,together with an Authorization Form,an ISDS Sewage Disposal System Evaluation form,a Weld County Health Dept. System Cleaners Checklist form,a statement from Slim's Sanitation and a check for$160.00. We are also providing you with invoices documenting work done in 1997 to replace the prior septic system, as well as a receipt from the Health Department for the repair permit for that work. We believe that with the submission of this information, the application is complete and ready to be processed. Please feel free to call me if you have questions or concerns. Very truly yours, WITWER OLDENBURG BARRY & JOHNSON, LLP ) faequeline Johnsdir Enclosure cc: Edward and Mary Diller *set,itri WIiDc APPLICATION FLOW SHEET COLORADO APPLICANT: Edward & Mary Diller CASE #: RE-5048 REQUEST: Two-Lot Recorded Exemption. LEGAL: E2N2NW4NW4 3-2-67 LOCATION: South of and adjacent to CR 26 and approx. 1/2 mile west of CR 21. PARCEL ID #: 1311 03 000036 ACRES: +/- 9.5 acres Date By Application Received 7/22/10 Application Completed 7/22/10 Referrals listed 7/28/10 CG Vicinity map prepared File assembled 8/c,I IO VP Case logged in computer Letter to applicant mailed —2- Referrals mailed Field check by DPS staff n 9/16100 eisH— Administrative Review decision: Ack'co q/z I / 1 O Board of County Commissioners hearing (if applicable) Date By County Commissioners Hearing Date Surrounding property owners notified Presentation prepared CC action: CC resolution received Date Plat recorded and filed K�65 /) Overlay Districts ��llll ME�� ` N eis1L- Th Zoning Agricultural — COM �� MUD Yes_No_X ` �a IGA YesNo_X_ -- 1 Airport YesNo_X_ ` ` , Geologic YesNo_X \ _ O� Flood Hazard Yes No_X_ Panel#080266 — �,��\ (c aS c�..� Lor�DiTti� UC • • RECORDED EXEMPTION (RE) APPLICATION FOR PLANNING DEPARTMENT USE DATE RECEIVED: RECEIPT/AMOUNT# /$ CASE#ASSIGNED: APPLICATION RECEIVED BY PLANNER ASSIGNED: Parcel Number 1 3 1 1 - 0 3 - 0 - 0 0 - 0 3 6 (12 digit number-found on Tax I.D. information,obtainable at the Weld County Assessor's Office,or www.cg,weld co,us) Legal Description E1/2 of N 1/2 of NE 1/4 of NW 1/4 , Section 3 , Township 2 North, Range 67 West Has the property been divided from or had divided from it any other property since August 30, 1972? Yes No Is this parcel of land, under consideration, the total contiguous land owned by the applicant? Yes y No FEE OWNER(S) OF THE PROPERTY: Name: Edward G.Diller and Mary A.Diller Work Phone# 970-302-5448 Home Phone # 970-785-6319 Email Address edwarddgdiller@peoplepc.coa Address: 9144 WCR 26 City/State/Zip Code Fort Lupton,CO 80621 APPLICANT OR AUTHORIZED AGENT (See Below:Authorization must accompany all applications signed by Authorized Agent) Name: JacquelineJohnson (See attached Authorization) Work Phone# 970-313-4775 Home Phone# Email Address iiohnson@wobilaw.com Address: 822 7th Street,Suite 760, City/State/Zip Code Greeley,CO 80631 Lot A Lot B Lot C Lot D Smaller Parcel Water Source Central Weld Co.Wato Central Weld Co.Wato Type of Sewer septic septic Proposed Use residential residential • Acreage `'( , 5 R_ ti ,s -e 5 .r{ Existing Dwellings? If Yes, list address If Yes, list address If Yes, list address If Yes, list address T below: below: below: below: .0 id 9144 WCR 26,Ft.Luiz% if 4 ij cR 24 (,i,, * If the property is vacant or unimproved write proposed water source and proposed sewer system for each parcel in the blanks above. For 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, notarized evidence must be included showing the signatory has the legal authority to sign for the corporation. gnat: Owner uthorized Agent Date Signature: Owner or Authorized Agent Date (4 ( Weld County Department of Planning Services 918 10ih Street Greeley, CO 80631 TO WHOM IT MAY CONCERN: The undersigned hereby authorize Jacqueline Johnson, of Witwer, Oldenburg, Barry & Johnson,LLP, 822 7'Street, Suite 760,Greeley,CO 80631,to act as their agent for this application for a recorded exemption. Dated this241 day of March, 2010. ` 1 G�, Edward G. Diller Mary A. IDiller RECORDED EXEMPTION (RE) QUESTIONNAIRE Edward G. and Mary A. Diller 1. Water supply statements addressing the following: a. Domestic use. The domestic water supply for Lot A is Central Weld County Water District. Domestic water for Lot B will be provided by Central Weld County Water District, as stated in the attached letter. b. Irrigation water. Five (5) shares of New Coalridge Ditch will remain with the site. 2. A statement explaining that the proposed lots will have an adequate means for the disposal of sewage in compliance with the underlying zone district and the Weld county Department of Public Health and Environment. A copy of the existing Septic Permit for Lot A is attached. An engineered septic system will be designed, constructed and permitted according to Weld County ISDS requirements for Lot B. 3. A description of how the property is being used. The parcel currently has one residence of approximately 1,500 square feet, a garage, a well shed and two and two outbuildings used for storage. The remainder of the property is currently used for lawn and pasture. 4. A description of the location, size,present and future use of the area where the proposed new lot will be created. The new lot, Lot B will be approximately five (5) acres in size and located south of and adjacent to WCR 26 and to the east of the existing improvements and Lot A. It is planned for future residential use. 5. A statement describing any unique physical characteristics on the site. The site is level with a slope from south to north and from the southwest and southeast corners to the middle of the property. 6. A statement indicating where a primary building envelope and/or alternative building envelope will be designated on any of the lots. No building envelopes are requested. 7. Is there a Business or Use by Special Review permit on the property? There is no Business or Use by Special Review permit on the property. Weld County, Colorado • . Page 1 of 3 Weld County, Colorado i ��, ' 7 q1— 4\ , I IV . , 1 ?,, 3,1 . -: , illIalik. . . r ro 1. fY ilk a S.R 1 , w g r+ . t . _ .. — 1V e,�C�urnyt Ccroraa '.' 'b� 7Oi___ iialli h ttp://maps2.merrick.com/MerricklMS/i ms?S ervi ceName=weldovr&Form=True&Encode=... 3/8/2010 • Weld County Treasurer Statement of Taxes Due Account Number R5363086 Parcel 131103000036 Assessed To 1.)ILL.ER EDWARD G 9144CR26 PT LUPTON.CO 80621 Legal Description Situs Address 20217-E E2N2NW4NW4 3 2 67 EXC UPRR RES(.50R) 9144 26 CR WELD 00000 Year Charges Billed Payments Balance 2010 Tax $848.99 $424.50 $424.49 First Half Due as of 02/15/2011 $0.00 Second Half Due as of 02/15/2011 $424.49 Tax Billed at 2010 Rates for Tax Area 2179-2179 Authority Mill Levy Amount Values Actual Assessed WELD COUNTY 16.8040000' $351.04 SINGLE FAM.RES.- $133,000 $10,590 SCHOOL DIST RE1 9.3930000 $196.22 LAND SINGLE FAM.RES- $129,453 $10,300 NORTHERN COLORADO WATER 1.0000000 $20.89 IMPROVEMTS (NC PLATTEVILLE-GILCREST FIRE 3.8030000 $79.44 Total $262.453 $20.890 AIMS JUNIOR COLLEGE 6.3600000 $132.86 HIGH PLAINS LIBRARY 3.2810000 $68.54 Taxes Billed 2010 40.6410000 $848.99 Credit Levy ALL TAX LIEN SALE AMOUNTS ARE SUBJECT TO CHANGE DUE TO ENDORSEMENT OF CURRENT TAXES BY THE LIENHOLDER OR rO ADVERTISING AND DISTRAINT WARRANT FEES. CHANGES MAY OCCUR AND THE TREASURER'S OFFICE WILL NEED TO BE CONTACTED PRIOR TO REMITTANCE 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 Tax Account Page 1 of 1 • • Tax Account Summary Account Id R5363086 Parcel Number 131103000036 Owners DILLER EDWARD G& DILLER MARY A Address 9144 CR26 FT LUPTON,CO 80621 Situs Address 9144 26 CR WELD 00000 Legal 20217-E E2N2NW4NW4 3 2 67 EXC UPRR RES(.50R) Inquiry Payment Date 04/05/2010 Payment Type (? First Second Taxes Due $411.60 Total Due $411.60 Update Value Area Id Mill Levy Tax Area 2179-2179 39.4070000 Actual Assessed SINGLE FAM.RES.-LAND- 1112 133,000 10,590 SINGLE FAM.RES-IMPROVEMCS- 1212 129,453 10,300 Total Value 262,453 20,890 Taxes $823.21 [he amounts of taxes due on this page are based on last year's property value assesments. https://www.weldtax.com/treasurer/treasurer-web/accountj sp?account=R5363086 4/5/2010 Identify Results Page 1 of 3 WELD COUNTY ASSESSOR PROPERTY PROFILE Account#: R5363086 Parcel#: 131103000036 Tax Area: 2179 Bordering County: Acres: 9.5 Township Range Section Quart. Sec. Subdivison Name Block# Lot# 02 - 67 - 03 - 0 - - Owners Name &Address: Property Address: DILLER EDWARD G & Street: 9144 26 CR 9144 CR 26 City: WELD FT LUPTON, CO 80621 Additional Owners: DILLER MARY A Business/Complex: Sales Summary Sale Date Sale Price Deed Type Reception # 6/28/1984 $110,000 X0012540 Legal Description 20217-E E2N2NW4NW4 3 2 67 EXC UPRR RES (.50R) Land Valuation Summary Land Type Abst Code Unit of Number of Actual Value Assessed Measure Units Value Residential 1112 Acres 9.5 Land Subtotal: 9.5 $133,000 $10,590 Buildings Valuation Summary Bldg# Property Type Actual Value Assessed Value 1 Residential 2 Out Building 3 Out Building Improvements Subtotal: $129,453 $10,300 Total Property Value $262,453 $20,890 Building Details Account#: R5363086 Parcel#: 131103000036 Owners Name &Address: Property Address: DILLER EDWARD G & Street: 9144 26 CR 9144 CR 26 City: WELD FT LUPTON, CO 80621 Building# Property Type 1 Residential http://maps2.merrick.com/Website/Weld/setSgl.asp?cmd=QUERY&DET=PP&pin=13110... 5/11/2010 Identify Results Page 2 of 3 Individual Built As Detail Built As: Ranch 1 Story Year Built: 1972 Exterior: Frame Masonry Veneer HVAC: Hot Water Baseboard Interior Finish: Drywall Built As SQ Ft: 1519 # of Baths: 2 Roof Type: # of Bdrms: 3 Roof Cover: Composition Shingle # of Stories: 1 Rooms: 7 Units: 0 Garage: Attached SQ Ft: Detached SQ Ft: Basement: Total SQ Ft: Finished SQ Ft: Account#: R5363086 Parcel#: 131103000036 Owners Name&Address: Property Address: DILLER EDWARD G & Street: 9144 26 CR 9144 CR 26 City: WELD FT LUPTON, CO 80621 Building# Property Type 2 Out Building Individual Built As Detail Built As: Detached Garage Year Built: 1972 Exterior: Frame Hardboard HVAC: None Interior Finish: Built As SQ Ft: 816 # of Baths: 0 Roof Type: # of Bdrms: 0 Roof Cover: # of Stories: 2 Rooms: 0 Units: 0 Garage: Attached SQ Ft: Detached SQ Ft: Basement: Total SQ Ft: Finished SQ Ft: Account#: R5363086 Parcel#: 131103000036 Owners Name &Address: Property Address: DILLER EDWARD G & Street: 9144 26 CR 9144 CR 26 City: WELD FT LUPTON, CO 80621 Building# Property Type 3 Out Building Individual Built As Detail Built As: Shed - Utility Year Built: 1985 Exterior: HVAC: None Interior Finish: Built As SQ Ft: 56 # of Baths: 0 Roof Type: # of Bdrms: 0 Roof Cover: #of Stories: 0 Rooms: 0 Units: 0 Garage: Attached SQ Ft: Detached SQ Ft: bttp://maps2.merrick.com/Website/Weld/setSq I.asp?cmd=QU E,RY&DET=PP&pin=13110... 5/11/2010 REFERRAL LIST Name: Edward & Mary Diller Case #: RE-5048 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 _Eaton _Eaton F-4 x Public Works _Erie _Fort Lupton F-5 _Housing Authority _Evans _Frederick _Airport Authority x Firestone _Galeton F-6 x Building Inspection _Fort Lupton _Hudson F-7 x Code Compliance _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 _Greeley _Milliken F-11 _Grover _Nunn F-12 State _Hudson _Pawnee F-22 Div._ of Water Resources _Johnstown x Platteville F-13 _Geological Survey _Keenesburg _Platte Valley F-14 _Department of Health _Kersey _Poudre Valley F-15 _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 _North Hwy 66 (Greeley) _Nunn _ Division of Minerals/Geology _Pierce x Platteville Soil Conservation Districts _Severance Big Thompson/ FTC _Thornton _Boulder Valley/Longmont _Windsor _Brighton/SE Weld _Centennial Counties _Greeley/West Greeley _Adams x Platte Valley _Boulder _West Adams _Broomfield _Little Thompson _Larimer Federal Government Agencies Other _US Army Corps of Engrs x School District RE-1 USDA-APHIS Vet Service _Central Cob. Water Cons Federal Aviation Admin (Structures _RR over 200 ft or w/in 20000 ft of Pub _Ditch Company Airport _Art Elmquist(MUD Area) Federal Communications Comm Name: 1.1‘1‘1-5— 111 Referral List • case# 3E— b v County Towns&Cities Fire Districts Attorney Ault Ault F-1 X Health Department Berthoud Berthoud F-2 Fxtension Office Briahton Briaasdale F-24 Emeraencv Management Office-Fd Herring Dacono Briahton F-3 Sheriffs Office Faton Faton F-4 X Public Works Erie Fort Lupton F-5 Housing Authority Evans Galeton F-6 Airport Authority X Firestone Hudson F-7 X Buildina Inspection Fort Lupton Johnstown F-8 X Code Compliance Frederick I aSalle F-9 Assessor Office/Chris Woodruff(Final Plan) Garden City Mountain View F-10 Kim Gale(I andscaoe Plans) Gilcrest Milliken F-11 Lin or Peaav(Addressina Change of 7one1 Greeley Nunn F-12 Ambulance Services Grover Pawnee F-22 State Hudson X Platteville F-13 Div of Water Resources Johnstown Platte Valley F-14 Geological Survey ICeenesbura Poudre Valley F-15 Department of Health Kersey Ravmer F-2 Department of Transportation I aSalle Southeast Weld F-16 Historical Society I ochbuie Union Colony F-26 Water Conservation Board I onamont Western Hills F-20 Oil&Gas Conservation Commission Mead Wiaains F-18 Division of Wildlife Milliken Windsor/Severance F-17 South Hwy 66(Loveland) New Ravmer North Hwy 66(Greeley) Northalenn I eaal Division of Minerals/Geoloav Nunn Parcel ID# Soil Conservation Districts Pierce 7one Acres? Bia Thompson X Platteville USDA Boulder Valley Severance Airport `1 rip Briahton Thomton Geo Haz )40 Centennial Windsor FP? 140 Panel# Fort Collins Counties Road Impact Fee Area? Greeley Adams (SW#1 #2 #3 Windsor 1 r,I onamont Boulder IGA? t`c ORD# Moraan Broomfield MUD? No X Platte Valley Southeast Weld Other _West Adams Central Colo.Water Conservancy Dist Federal Government Agencies _Left Hand Water _US Army Corps of Enqrs X School District RE-9- _USDA-APHIS Vet Service Art Elmquist(MUD Area) Federal Aviation Admin(Structures over Ditch Company, over 200 ft or w/in 20000 ft of Pub Airport Commissioner Federal Communications Comm • • Weld County Planning Department GREELEY OFFICE MEMORANDUM ��p �' 'nfn Kit RECEIVED TO: Chris Gathman, Planning Services DATE: September 2, 2010 WI I DC. FROM: Heidi Hansen, P.E., Public Works Department 44" COLORADO SUBJECT: RE-5048, Edward & Mary Diller 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: WCR 26 is a local gravel road and requires a 60-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: 1. The applicant shall utilize the existing access to Lot A. 2. The applicant shall submit an Access Permit for the proposed new access to Lot B. The form and instructions are attached. Please contact the Public Works Traffic Engineer with any questions about the access permit. 3. 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: This area IS NOT in a Special Flood Hazard Area (SFHA) as determined by the Federal Emergency Management Agency (FEMA). pc: RE-5048 Page I of; M:\PLANNING—DEVELOPMENT REVIEW\RE-Recorded Exemption\RE-5048.docx • • WELD COUNTY ROAD ACCESS INFORMATION SHEET Weld County Department of Public Works 111 H St PO Box 758 Greeley CO 80632 Phone: (970 )356-4000 x3750 Fax: (970) 304-6497 Road File#: Date: RE # : Other Case#: 1. Applicant Name at,.�w,..d e w$„.? �k. 0-1\\41. Phone `\D'?Cii "(03 y WCI Address `l\tL City is L..pJon stat/0 zip tsobat 2. Address or Location of Access NAY Q 'a-b Section eb Townshipo2tC) Range(ol W Subdivision dock J_ot Weld County Road t ale Side of Road S Distance from nearest intersection 3. Is there an existing access to the property? Yes V No #of Accesses I 4. Proposed Use: (1CPermanent ()(Residential/Agricultural ( Industrial ( Temporary ( Subdivision ( Commercial ( Other 5. Site Sketch Legend for Access Description: r AG = Agricultural RES = Residential O` O&G = Oil&Gas t a D.R. = Ditch Road ❑ = House O = Shed A = Proposed Access + = Existing Access 19 aH 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- ( Co to y� Weld Co •unty Public Works • Dept. , 4,- i - < 1111 H Street ACCESS PERMIT p „. rn P.O. Box 758 G `� Greeley,CO 80632 APPLICATION FORM �C/C 440 Phone: (970)304-6496 Fax: (970)304-6497 Applicant Property Owner(If different than Applicant) Name Name Company Address Address City State Zip City State Zip Phone Business Phone Fax Fax E-mail E-mail ♦= Existing Access A= Proposed Access Parcel Location&Sketch The access is on WCR Nearest Intersection:WCR &WCR WCR Distance from Intersection Parcel Number Section/Township/Range t ce cc Is there an existing access to the property? YES NO N 3ij 3 Number of Existing Accesses Road Surface Type&Construction Information Asphalt_ Gravel_ Treated Other WCR Culvert Size&Type Materials used to construct Access Construction Start Date Finish Date Proposed Use o Temporary(Tracking Pad Required)/$75 n Single Residential/$75 o Industrial/$150 ❑ Small Commercial or Oil& Gas/$75 o Large Commercial/$150 ❑ Subdivision/$150 o Field (Agriculture Only)/Exempt Is this access associated with a Planning Process? ❑ No o USR ❑ RE o PUD o Other Required Attached Documents -Traffic Control Plan -Certificate of Insurance -Access Pictures (From the Left, Right,&into the access) By accepting this permit,the undersigned Applicant, under penalty of perjury,verifies that they have received all pages of the permit application;they have read and understand all of the permit requirements and provisions set forth on all pages;that they have the authority to sign for and bind the Applicant,if the Applicant is a corporation or other entity;and that by virtue of their signature the Applicant is bound by and agrees to comply with all said permit requirements and provisions,all Weld County ordinances,and state laws regarding facilities construction. Signature Printed Name Date Approval or Denial will be issued in minimum of 5 days. Approved by Revised Date 6/29/10 Access Permit Instructions 1. Access Information Sheet/Access Permit Please complete all components of the document including: -Applicant Information -Property Owner Information(if different than Applicant) -Parcel Location& Sketch -Road Surface&Construction Information -Proposed Use 2. Traffic Control A typical Traffic Control Plan is provided on the Weld County website. If the Traffic Control Plan warranted exceeds the provided typical Traffic Control Plan please include the expanded Traffic Control Plan with the submittal. 3. Certificate of Insurance The Certificate of Insurance may be waived by Public Works Staff 4. Pictures at Access Please include 3 pictures at the Access(digital or hardcopy) - Looking down the roadway to the right of the access - Looking down the roadway to the left of the access - From the roadway into the access location 5. A Copy of the Issued Permit must be kept on the Project Site for review by PW staff. For Questions or further information,please contact: Janet Carter-Traffic Engineer or Amy Burry-Utility Coordinator/Permit Agent jcartcrlttico.weld.co.us abwry(c .co.wcld.co.us 970.304.6496 ext 3726 970.304.6496 ext 3764 1111 • WELD COUNTY ACCESS PERMIT • f Weld County Public Works Dept. Phone: (970)304-6496 1111 H Street After Hours: (970)356-4000 P.O. Box 758 !"r Emergency Services: (970)304-6500 x 2700 Greeley, CO 80632 V " Inspection: (970)304-6480 go Permit Number: AP10-00077 Issuance of this permit binds applicant and its contractors to all requirements,provisions,and ordinances of Weld County,Colorado. Project Name: access on WCR 26 Expiration date: 04/05/2011 Applicant Information: Property Owner Information: Name: Edward G. Diller Name: Edward G. Diller Company: Company: Phone: 970-785-6319 Phone: Email: edwards_dillerpc@yahoo.com Email: Location: Proposed Use: Access is on WCR: 26 Temporary: Nearest Intersection WCR: 26 &WCR: 19 Single Residential: Distance From Intersection: 1500 Industrial: Number of Existing Accesses: 1 Small Commercial: Planning Process: RE RE-5048 Oil&Gas: Large Commercial: Road Surface Type&Construction Information: Subdivision: Road Surface: Gravel Field(Agricultural Culvert Size&Type: 18"corrugated steel Only)/Exempt: Start Date: Finish Date: Materials to Construct Access: gravel Required Attached Documents Submitted: Traffic Control Plan: Yes Certificate of Insurance: No Access Pictures: Yes A copy of this permit must be on site at all times during construction hours Daily work hours are Monday through Friday DAYLIGHT to'/:HOUR BEFORE DARK(applies to weekends if approved) Approved MUTCD traffic control/waming devices are required before work begins and must remain until completion of work Special Requirements or Comments Approved by: /J Weld County Public Works Date: 10/14/2010 a6,4Print Date-Time: 10/14/2010 12:15:34PM Report ID: PW00008v001 Page 1 of 1 6,t ‘ Memorandum TO: Chris Gathman, W.C. Planning DATE: September 9, 2010 • FROM: Lauren Light, W.C. Department of Public COLORADO Health and Environment CASE NO.: RE-5048 NAME: Diller Environmental Health Services has reviewed this proposal to exempt 5 acres from a 9.5 acre site. Proposed lot A will consist of 4.5 acres and proposed lot B will consist of 5 acres. There is an existing residence on proposed lot A which is served by Central Weld County Water District (Tap 610) and an individual sewage disposal system SP-9700128 (which never received final approval) and SE-1000023. The septic system will need to receive final approval through this Department. A tap from Central Weld County Water District and an individual sewage disposal system 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. All septic systems located on the property shall have appropriate permits from the Weld County Department of Public Health & Environment. The Environmental Health Division of the Weld County Department of Public Health & Environment was unable to locate a finaled septic permit for 9144 CR 26. Any existing septic system which is not currently permitted through the Weld County Department of Public Health & Environment will require an I.S.D.S. Evaluation prior to the issuance of the required septic permit. In the event the system is found to be inadequate, the system must be brought into compliance with current I.S.D.S. regulations. Additionally, please note the following: 1. 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. • • Print Form Keiss CWeld County Referral• August 9 2010 COLORADO The Weld County Department of Planning Services has received the following item for review: Applicant Edward& Mary Diller Case Number RE-5048 Please Reply By September 9, 2010 Planner Chris Gathman Project Two-Lot Recorded Exemption Legal E2N2NE4NW4 of Section 3, T2N, R67W of the 6th P.M., Weld County, Colorado. Location South of and adjacent to CR 26 and approximately 1/2 mile west of CR 21. For a more precise location, see legal. Parcel Number 1311 03 000036 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. El We have reviewed the request and find that it does/does not comply with our Comprehensive Plan 0 We have reviewed the request and find no conflicts with our interests. ❑ See attached letter. O Please notify me of any public hearings regarding this request. Comments: Upon review of my case files and computer,no violations were noted. Signature Date 08/10/10 Agency oning Complia c ficer +Weld County Planning Dept. +1555 N 17th Ave, Greeley,CO.80631 4(970)353-6100 ext.3540 4(970)304-6498 fax E E. !f! j§ | \ ! CD I \ E) } k \ ! / ® h g-A I ; ! !7-)f!a % i - \ E % ] k _a H$ ; § f) / { ■ a } ! r|li ! ! \/ 2 g k a Iii tlf f ( . & = k i \ IKgr; ! g § S 1 � „ , 3 42 ig 4 9 C ) RSIS k \ I I 2 , 0 )f , ca f '77 . '!;5 ) § , 7! ! : E2 1111 t 21 k;., � ! !� or �q $ k f \ § ) | : t�;-||+ ) . §; !! | . �_m z. { \ \7)/i |i e -22 ! ! { � E Old IJ \ n{// \ ! & f ] k Z3 rfOPM ulitem h n l2 6861? °N © § @© D9 / [ IA §d AS : SS « in I Print Form • Wunty Planning Department GREELEY OFFICE cfea AUG 13 nun RECEIVED CWeld County Referral• August 9 2010 COLORADO g The Weld County Department of Planning Services has received the following item for review: Applicant I Edward & Mary Diller Case Number RE-5048 Please Reply By September 9, 2010 Planner Chris Gathman Project Two-Lot Recorded Exemption Legal E2N2NE4NW4 of Section 3, T2N, R67W of the 6th P.M., Weld County, Colorado. Location South of and adjacent to CR 26 and approximately ''/x mile west of CR 21. For a more precise location, see legal. Parcel Number 1311 03 000036 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. O We have reviewed the request and find that it does/does not comply with our Comprehensive Plan NWe have reviewed the request and find no conflicts with our interests. ® See attached letter. ❑ Please notify me of any public hearings regarding this request Comments: lit, ;3 cal .n 7`� 34O aThit8h16n61C pi an •� • . at eb U��'1� cvr edc l �y111el blivi On/ o ifi rtie r111C•Q, wto A VMS CCM; Signature Date elan Agency OWeld County Planning Dept. +1555 N 17'"Ave, Greeley,CO.80631 +(970)353-6100 ext.3540 +(970)304-6498 fax • Print Form Weld County Planning Depaltlned GREELEY OFFICE AUG 18 pm RECEIVED Weld County Referral C. COLORADO August 9, 2010 The Weld County Department of Planning Services has received the following item for review: Applicant Edward & Mary Diller Case Number RE-5048 Please Reply By September 9, 2010 Planner Chris Gathman Project Two-Lot Recorded Exemption Legal E2N2NE4NW4 of Section 3, T2N, R67W of the 6th P.M., Weld County, Colorado. Location South of and adjacent to CR 26 and approximately 1/2 mile west of CR 21. For a more precise location, see legal. Parcel Number 1311 03 000036 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. 0 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. ir„ErSee attached letter C Please notify me of any public hearings regarding this request. Comments: Signature- Date CJ-- ^� to 16 ZDI rJ Agency V-r tx.tU tb ( 1 t007 +Weld County Planning Dept. +1555 N 17"Ave, Greeley,CO.80631 +(970)353-6100 ext.3540 4-(970)304-6498 fax • • CERTIFICATE OF CONVEYANCES WELD COUNTY STATE OF COLORADO DEPARTMENT OF PLANNING SERVICES COUNTY OF WELD Heritage Title Company 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 E ''/3 of the N 'A of the NW'/< of the NW % of Section 3, Township 2 North, Range 67 West of the 6th P.M., County of Weld, State of Colorado. CONVEYANCES (If none appear, so state): I Reception No. 1566115j Book 664 I Reception No. 1972205) I Book 1035 This certificate is made for the use and benefit of the Department of Planning Services of Weld County, Colorado. This certificate is not to be construed as an Abstract of Title, Opinion of Title or a Guarantee of Title and the liability of Heritage Title Company is hereby limited to the fees paid for this Certificate. In Witness Whereof, Heritage Title Company, has caused this Certificate to be signed by its proper officer this 15th day of July, 2010, at 7:00 am. Order No. H0272959 Heritage y''tie Company By: Authorized Signatory v• e et°' Recorded at !'aleck-- m. WPB._2°1971.--. 644 Re epBea Na • _15£&1 ANN EOMDt Rends RECORDER'S STAMP THIS DEED, Made this 7e dal of 'April 10 71,between ' Slate Documentary Fee ALFRED P. FROHLICif and RUBY L. nOHLICH Dote .AP.R.2.Q..1971.. $ ......L.9.b of the City and County of Denver end State of Colorado,of the first port,and • EDWARD R. VAN WESTENBERG and BETTY ANN VAN WESTERBERG _ / of the County of Weld and State of Colorado,of the second part: - III') -- WITNESSETH,that the gold part - of the first pert,for and in consideration of the eum of `t ---Nine Thousand Five Hundred and no/100---------_ DOLLARS. (ilt to the add parties of the first part in hand paid by the said parties of the second pert,the receipt whereof is rJ\ herebyconfessed and acknowledged,here granted,bargained,sold and conveyed,end by these presents do I grant,bargain,sell,convoy and confirm unto the said parties of the ascend port,their heirs and naphtha forever,not in tenancy in common but In Joint tenancy,all the following described lot or parcel of land,situate,lying end being in the County of Weld end State of Colorado,to wit: The East Half of the North Half of the Northwest Quarter of the Northwest Quarter (E)I2N)12NWMv%) of Section Three (3), Township Two (2) North, Range Sixty-seven (67) West of the 6m P.N., Weld County, Colorado, together with Five (5) Shares of T1 Capital Stock in the Coal Ridge Ditch Company; Except end eubject to reservations 9 and conditions as contained in the Government Patent of Record, reservations ae v. ? fin contained in instrument dated October 5, 1885 end recorded November 2, 1885 in Book 50, Page 155, Weld County Records, all existing roads, highways, ditches, utilities, reservoirs, canals, pipe lime, power, telephone or water lines, rail- roads, and rights of way and easements therefor, and etkeg xlj a ee2¢ement over and across the South 10 feet of the W)kf/dRi74NW$/1roromatNe 8d&I §idge"Hitch Co. 1 Lateral to the East Boundary of said tract allowing the Grantees herein, their .ta-e heirs and eo gns, to 'natant o at and maintain an it 1 a ion pipe line either 1 surface or sub surface el vet irrigaon water o the tract heroin described, 1 TOGETHER with ail and singular 1e horeditaments end appurtenance. thorounto a clanging.or In anywise T appertaioing,the reversion and reversion'',remainder and remainders,rents,Issues and profits thereof; and all the 1 estate,right,title,interest,claim and demand whatsoever of the weld parties of the first part,either In law or n equity,of,In and to the ohove bargained promisee,with the hereditament'and appurtenances. O TO RAVE AND TO HOLD the said premises above bargained and described,with the appurtenance,,unto the said o parties of the second part,their helm and aseigea forever.And the said parties of the first part,for them n solves ,their heirs,executers,and administrators do covenant,grant,bargain end agree to and with the —I said parties of the second part,their heirs end assigns,that at the time of the onsenling and delivery of three prow- e of eats they arewell indeed of the premises above conveyed, a. of good, sure, realer; In absolute and Sefcaslble -Ir estate of inheritance,In law,in fee simple,and ha we goad right,full power and lawful authority to grant,bar- e gain,sell and convey the same in manner and form aforesaid,and that the same are free and clear from ell fanner and other grant.,bargains,Bales,Ilene,taxes,assessment.and encumbrances of whatever kind or nature Beaver. st N Except General Taxes for 1971 which the Grantees herein assume and agree In to pay; rt o and subject to that certain oil and gee lease dated October 20, 1970 with Energy o o Minerals Corporation recorded in Book 636 under Reception No. 1557739; o and the above bargained premises In the quiet and peaceable possession of the said parties of the second pert,their _I heirs and assigns,egeinot all and every parson or persons lawfully claiming or to claim the whole or any part thereof, the avid parties of the first part shell and will WARRANT AND FOREVER DEFEND. 6.1 IN WITNESS WHEREOF the saido port lee of the first part have hereunto eat theirhand and N r seal the day and year firer above written. m •c r_ Signed,Sealed and Delivered in the Presence of . 'f%a p1 ohliph .-- [SEAL) _. _... _.. ... .M1C." n ,2� ndl.- c¢i. .._[SEAL) • �i'by Pro)ilfc . LEi . __ _. .ISEAL) 9]. t—�i -OKSTATE t1F COLORADO, 1 • n) }` };aunty o! Weld ee. arse..' JG1., '.'!'Se foragoln()QOikllinent was acknowledged before me thin 7m day of April loll.1k; fN1 WWed'P. Frohliok and Ruby L. Frohlick My commission expire! January 19 ,10 72.Witness my hand and official seal. c ... _� ` _"-- `\ ,a C, Na PSl. WARRANTY a6.O—To Joint T.nrnoe,unafore PublLNsY lac rent Waal.ones.a,l,rWo.—e.ee elmrplIY L-fnv a perinr.el aainor e here Ines;came or:mmes;Yl�he,nr ell fief b rose Iallvn p of(total to .ally r,u ,tn8e Ines I"sort name of.uch craterpr, ableer.owlho are'jsone er eWrr otel,,n or level eonponan,,,n TNg I, oral rc y otnemtenemenf.Wee.Ina-I-i Colorsdo aevl.ea Wlatubr into. . • B 1035 REC 01972205 06/28/84 15132 $3.00 1/001 AR1972205 Kan F 0249 MARY ANN FEUERSTEIN CLERK 6 RECORDER WELD CO, CO WARRANTY I)EED FILING'MT%NI° ll TNI4 DEED, Made Oils 27th day of Juno le 04 It between II EDWARD R. VAN WESTENRERG MD BETTY ANN VAN WESTENBER !I State Documentary Fee II of the Count)of Weld rind'1014 d J111.2„�., ,,,^ 11 Dote.. Colorado,of the_first part,and $ ,// 41742 EDWARD G. DILLER AND MARY A DILLER L whoa legal o ldrtnh to 9144 W. C R II 2 p Ft Lupton, Colo i oftht Loon)of Weld and State of • Colorado,oft In.nceond port — II N ITNI SS/T11 t hot lb,nano party of lilt find part for and In tensed,lotion of t he elm of 1 ONE HUNDRED TM THOUSAND MD no/l0n DOI TANS and either goal and)ainmble ronhnlernnonx to the end port) of rho find part in land pout.y the end partµ.of the atrond port the reel opt ails roof is hr rrh)ronftatl el and urknoululg.d has granted brag,until odd and Mill.yid non II by Cheat prat nth dutx grant bargain.,.n .amt) 111111 lone' ono tho and p ot to x of r,n.ml port t her be ins std I' mongols fortstr not in It none)meonnran Inn ayrnn•Iaun, all the fnllna,ng dto,nlad lea or porn of II land nnuatr,)ng tin lining on the (mint)of Weld and Stall oft°Penuln mull The E 1/2 of the N 1/2 of the NW 1/4 of the NW 1/4 of Section 3, Township I I, North, Range 67 West of the 6th P M 1 RESERVING UNTO THE GRANTORS ALL MINERAL RIGHTS NOW OWN2D BY SAID GRANTORS II 'I nine knob n u.inn Lt and monda r 9144 W C R It 26, Port Lupton, Colorado 8O621 IPH.PTIII H wit h rill anal huu•ulur the he ndnome lit,HIM npparn nonce till to onto la Pinola or on lily%rl I pro r tmmn, and the. rt vl r,lun WO n tl rovou remand.r stud a method.to re On t a into mid profit.tbtnu( nod all Alit ji 0411111 regal tilt ntt rat rl'un and d,ntond a boom on r of l ht mild Pal)oftbl flint pill 1 robins I,n ler a melt) and I I and loth,;thorn bargee)n.Ind pre anli Ohl he ruloono 111.44 nnil sggnerte n um,s II TO RAYI A••l)T0111)111 the end pot meta'done hid gaoled and do ace ht.' tut!Ole opining mind. onto toe mud yartun of Ibt no tun'part rho or h,e•rind nongnn fill.to, And the .µ1d part) of the nl.t p art for luni.e If Lo he or, II atruunh and adinnusl rutonit dot.cove Pant kraut buluun Mil ,gill to toil both the .ind inn to.,,f Ohl humid p lit II t bu r Mara noel anuaan duet ill the tine 01i1„ 1 IOU uluis ends In r)of the„ pr...111. It, I.b e II,stroll of till pro mum. ndmtt u,nt.)4,1 no of gevnl ouu to lanolin, rend mih fu„till, e,'at, if loll,atom, 111 Lb III fe. mind. tin,,has (�i fi good right,hell pear and lion bit nolhori) to grant h rtul n n II soulr'.leiI) the .um, el ma nu,r and norm Om.WWI goo I xnd;hut lb%dine. Ile fin sod do m lie ii all(unnlr and of het k rule Ii nun', .n It,rlit a tort, none,• lit.and 5,71 ( to Santis of whitenei l,i '11 Mot I l)11 except 1984 taxes due andpayable In 1985 and b a u�)sequonF years, RighLh of ay recorded October 14, 1889 in ook 86 at Page 273, IIt) Coal reserved by Union Paceric Railway Capon/ in the Deed recorded novemd)er 2 I 1885 in Book 5O at page 155, Right of way recorded November 18, 193O in Book 963, II et page 16, ,I, , , 'nil Ott ulna burrow,.4 In list... lop Ill. qµ111 Paid lit ,hil poi .0 a I I Il,i .old Imrtn.•r rho J.,'will punt Iill mono, of tilt on 'btu ue.wn nii,l 1111 hell. ma u,.,tn.if.bob.ur too ay nuns dl WO e i 1 r) ❑t nab a .1us luwfnlb clonal lit or u r I itt.nil in 11 ell el 0111 011111141 a„f the .nil p u l)d t h. hoot p u 1.bull nerd b dl tt Melt It a\1 A\n II H)1{I\I It Pill-M1 Ih, .uM1d unml, , , n Old]iutludt Chi 'dull d l lilt iii it It it the nil tad n „ mid tau tr., ,s e shop.1 1111p111 able bead)a unit Po I\1),l N I SS N II I II I III Us Hs,'l„tot ill tin fin O111 111,hi l l u 11W Ni I Ia.1,111,1 stud•„d Oil d o trill), a ring 11.041 Nolte II - /n �d II Wilt it M lit'land till,',n 11 of .o It'or lit. of GVOay/Aidu/� tri •SI nil I �JPPdward RRR Van Wentenbergra t Bet�y Mn Van Westenberg /f II - 1 SEA I.) II ST ATE.OF tuLnllADrl ,!�I C,nra)if 1 • lg4 4O ) II llu•finepaug ia.uan,rnl sutnul knob lodgtll!what.me 111.. 27th dut,d u'we/ ..i ...••• . ..•du84 . II 1p. Edward R. Van Weatenberg and Batty Mn Van Wentenberg /e 41/11C9 ;,, , iQfl J , 11)1 nrxpll e, oats A. e rr ,tit Fr //' o with.— pl nil ood..lrni l., ,I • SO.NIA. 14ag Rllltl III—Iu Wnl final.—lul„t1' tor lu.,..,er•:air n .ii ,. 1.11,. „u,o„ .a.. ,.n an • i wem couLtay abeam Dept,. !1J!c Company Name: S//iti1S j-) ; to /yen I;)c , Phone number: 9?c' -may 6W I Customer Name: gopco a , )Jr/- n / ##9 / Address of Pumping: 9/1-/L/ We Id coanly Pea " Fyf LA//me e 80 6.2%Pumping Date: Tun e /t/A 90/0 1. Tank Size: /Spt7 Gallons Pumped: JSy)D 2. Lift Station: Yes No )( If yes, functioning: Yes No 3. Excessive water running back into tank from field? Yes No 1( If yes, estimate in gallons: 44 . 4. Liquid level in tank over inlet line? Yes No X 5. Tank Construction (check one) Concrete X Metal Brick Plastic or Fiberglass Cesspool or Seepage Pit Other 6. Tank Construction Observed: One Compartment Two Compartment k 7. Inlet/outlet tees and/or baffles in good condition? Yes )( No 8. Filter on outlet cleaned and inspected (if applicable)?Yes No n/� 9. Access to clean-out lids within 8 inches of grade? Inlet: Yes x No Outlet: Yes )C No 10. 20 ml. plastic replaced and sealed over tank lid (flood plain only)? Yes No fy 11. Tank/lid structurally sound and water tight? Yes y No 12. Obvious cracks/leaks observed? Yes No )( If yes, explain area: 13. Other conditions noted which may affect proper functioning of system? 14. Reason for Service: Maintenance K Real Estate Sale Emergency/Backup Other 15. Notes: • Slim's Sanitation PD Box 385 LaSalle CO 80645 970-284-6951 Email. slimssanitatton@yahoo.com WORK ORDER Bill to: Date Ordered: ;'�• • -- '-. Ordered By: _ ; ' �: ' • PO Number: E _'r: -t. L-: .1, Phone Numbor: ( ) ; • Tank Address. — - _ Route: - Gallons: r' ''�- f i - — - - -- Disposal Site: • • ; , r 3tructionsiRernarks: r.' ' '_ '' !" h !: /" ( .• Services Ordered: Performed By-Amount f grease Trap __ - - - -- ,, 'H Septic Tank �i i"1 • — -- --- — I] ?dean Vat [] Lift Station [] Animal Waste [][I[ B;oforr, -------- - l ---=— --- . Senior Di rct Total Due: $ Cash H Check [] # . i' [] Make Checks Payable to Slim's Sanitation. inc.• • Signature- Satisfied Completion of,lob Print N3rne .4N jobs dons ere COD We ere no!ono? ..1ccopflrq char...4..3ccounts!11 Char"jes muit et,e c,:;ared through 1hs o/t?f;;3;'! M ^© N n c v r I�I O RO Q 1 o f o s cT 1 rIf l w J - AR-1 1> a- k 1 p_ G> o t,„` m E p N .�s T O N v s g 1 I n _ `''� Q i w 6 1 2 Y I n w I S V } 1 • a 6 !' I -16 w -_'` w 1 g d I � S c:5�e 4 _, T cl Illcc — g �• g Di 0 o U�� w 6 o N I!, Z 99 Qt 9 a N U U W j • !I • , , • l ! ERIE PRE-CAST CONCRETE PRODUCTS, INC. 4060 Weld County Road 1 ERIE, COLORADO 80516 (303) 665.9380 (303) 828.3949 PHONE DATE I \ CUSTOMER'S ORDER NO. // 3- 77 NAME 7 ADDRESS 5$e�� Ui S. . --. - l91? C SOLD BY CASH COD. CHARGE ON ACCT. MDSE.RETD. PAID OUT OTY DESCRIPTION PRICE AMOUNT /25-0 7 d / .-2 6O.-y Sw, t, c f�--.d)!t S'© °o /o)o' 4/ „�Q< I p, - }-� .tea �° /- //3sf c !.2s ox 0 sVi e° cis- 5 s ,3_ T X60 Li- 679-.P qV ,.47 ) , TAX 4_2Sr 5-5- RECEIVED BT \ TOTAL y20 ` (9 S� All claims and returned goods � �� 27 902 MUST be accompanied by this bill. dtu 0 ***** ********************************************************************** WELD COUNTY HEALTH DEPARTMENT (970) 353 -0635 RECEIPT ********,******************************************************************* Receipt Number: 97000577 Amount : 240 . 00 04/01/1997 11 : 02 Payment Method: CHECK Notation : 5472 Init : RBUSTILL Owner Name : DILLER EDWARD G & MARY A Applicant Name : DILLER EDWARD Permit No : SP-9700128 Parcel No : 1311 03 000036 5363086 Site Address : Location : 9144 WCR 26 FORT LUPTON CO Total Fees : 240 . 00 This Payment 240 . 00 Total ALL Pmts : 240 . 00 Balance : . 00 *************************************************************************** Account Code Description • Amount 256041400-4221-400 New Septic Permit . . 00 256041400-4221-400 Repair Septic Permit 125 . 00 256041400-4221-400 Vault Permit . 00 256041400-4221-400 Site Evaluation 115 . 00 256041400-4730-400 Potable Water Sample . 00 Description : HOUSE Commercial (Y/N) : N Residential (Y/N) : Y Acres : 10 . 00 Number of Persons : 6 Basement Plumbing (Y/N) : N Number of Bedrooms : 3 Bathrooms-> Full : 1 3/4 : 1 1/2 : • Water Public (Y/N) : Y Utility Name : CENTRAL WELD WATER Water Private (Y/N) : Cistern (Y/N) : Well (Y/N) : Water Permit No : NOTICE Applicant acknowledges receipt of the individual sewage disposal system guide and that the completeness of this application is conditional upon further mandatory and additional tests and reports as may be required by the Weld County Health Department to be made and furnished by the applicant or by the Weld County Health Department for purposes of the evaluation of the application; ar the issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under article 10, title 25, CRS as amended. The applicant certifies that the proposed system will not be located within 400 feet of a community sewage system. The undersigned hereby certifies that all statements made, information and reports submitted herewith and required to be submitted by the applicant are, or will be, represented to be true and correct to the best of my knowledge and belief, and are designed to be relied on by the Weld County Health Department in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application and in legal action for perjury as provided by law. ,�j / X .jr r kIVV/ 7 `/-/-?7 OWNER/APPLICANT Date • .11 AUTHORIZATION FORM RE: 1,c, PERMIT APPLICATION I.S.D.S. EVALUATION n SALE OF PROPERTY WATER SAMPLE N.3c dot represent aL $$ A. IL tS1: I1theproperty Agent/Applicant) —} ( w er) UU located at c\\yy at, Fl. 4m LEGAL DESCRIPTION: SEC 4') TWN RNG („1 SUBDIVISION NAME: LOT BLK I can be contacted at the following phone#'s: Home Work IDD - " Isb - H")-5 Fax# `J7 D- 35A - '5165 The property owner can be contacted at the following phone #'s Home 970 7 S E31 9 Work cj'?U IU - 5-q Fax # NA • Correspondence mailed to (only one): 71 Agent/Applicant Property Owner DATE J 7-7/ ar7c J ('yam;. �• OWNER'S SIGNATURE � t/�7 ��'5- -�� - • • ISDS NO: DATE RECEIVED: RECEIVED BY: FEE: INDIVIDUAL SEWAGE DISPOSAL SYSTEM EVALUATION SITE ADDRESS OR LOCATION: I /'/ L( W C K 9 6 rt r-t a £01. PARCEL NO: I3 I I -03 -0 - on--0:?b THIS CAN BE OBTAINED FROM THE ASSESOR'S OFFICE AT (970) 353-3845 EXT 3650 OWNER: Ed,coo I'd G. CI" // ary r fJF e PHONE: 9;-.0 ---7,11r- 63/ MAILING ADDRESS: ()MP WE 4.C7C /rc.;/- 1- ( ird, ' (Q . qD/12 / Q ar CITY STATE ZIP )r APPLICANT NAME: )gJ)d f'6( C& / ar y A 0, f/e, APPLICANT ADDRESS: i.- e rticimCJ (IF DIFFERENT FROM OWNER)CITY STATE ZIP PHONE: ri-x•-7nS" ' ALT #: C-%'70 ' 5(4 -c'/4.P FAX: /)o n e aNJ. NNH LEGAL DESCRIPTION: PT: PT: SEC: 3 TWN: , N RNG: 4 7 w SUBDIVISION: NA LOT: BLK: ( FLG: WATER SOURCE: Cell ira I We, ICt' r,,44 I / 1,44/0 Itn ((!ACRES:, 9,r rj n <'/'F'S • 4 rA'�ORIGINAL OWNER OF SEPTIC SYSTEM: IJrt 4 . Pa 1/['F_Ctu1: beer ' PERMIT NO: -7) 0 79 S SOE: YES / NO DESCRIPTION OF STRUCTURE CURRENT FLOW: LL ADDITIONS: PROPOSED TOTAL: c • DESCRIPTION: /9:O1. IL'i:c/1 • /1 B n /S�n �� O st 7 PERSONS: ? ? BEDROOMS: J j BATHROOMS: BASEMENT PLUMBING: No Nq NI/ NEITHER THE COUNTY OF WELD NOR ANY OF ITS AGENTS OR EMPLOYEES UNDERTAKE OR ASSUME ANY LIABILITY TO THE OWNER OF THE ABOVE PROPERTY, TO ANY PURCHASER OF THE ABOVE PROPERTY OR TO ANY LENDING AGENCY MAKING A LOAN ON THE ABOVE PROPERTY OR IN THE REPORT. w WELD COUNTY HEALTH DEPARTMENT.. 15th Street and 17th Avenue 7/e) P. O. Box 1227 No. Greeley, Colorado Application for Permit to Install, Construct, Alter or Repair Individual Sewage Disposal System. Owner, or,Sponsor Address Phone - / r ,i _ j flits�"i/J! '? ' , , 'c a,-/ J['' Address of Site <_% . '% ,i a, , 'y , : . i,'7. •.. , j . .rams Mailing Address Jr - ' °' i :.General Information ` 7 i .. ' Septi'le„,,Tapk 1. Living Units 1. Liquid Capacity, °�6 ,: Gallons 2. No. of Bedrooms 2. Dimensions / D 3. No. of Baths l %b"% 3. Material 4. Basement Drain 4. Type Inlet 5. Automatic Dishwasher - Type Outlet 6. Garbage Disposal /1 c ` --'(/ 7. Automatic Laundry SddoAdar Treatment 8. Size of Lot " � ' 9c7)4 !_ , 9. Type of Soil . ,li_ —C /9 Field �� ` Bed` N U ° 10. Percolation Test 1. No.of distribution lines c. 11. Water Supply h �s1 " — 2. Trench: Width ' _T' ,,�,ength. '' 12. Lot Grade 3. Type Filler Material ' 't,..-4- ,..c 13. Water Table Depth 4. Depth of Fi11ep-M eA. ri)r_1�; 14. Other 5. Gravel Size I ( / C' j,� 6. Type Tile r.,,.t _` r `� 7 7. Depth of Cover �' ' ' 8. Other The Permit is to remain in full force and effect for six (6) months from date, until revoked for non-compliance This system will be constructed in accordance with the above specifications and regulations governing non municipal sewage disposal systems, in accordance with Regulation No. 1 of the Weld County Health De partment. Date: 7---',--, :./ '.' Applicant: The plans and specifications as shown are approved, pending payment of permit fee. y Sanitarian: / L/ t - Date: / ' ! — The above system inspedted and found to comply with the plan and description. f Installed by ' / Date: r ` Sanitarian: � PERMIT FEE $ ' f Received by c'.- ,, " Date — ',,' Please use reverse side for Plot Plan or use separate sheet of paper. te:4„ eD COUNTY DEPARTMENT OF PUBLICSOE#HL AND ENVIRONMENT ORG PERMIT # 1555 N. j7TM AVENUE REPAIR # GREELEY, COLORADO 80631 LOAN # WILD 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. f3 I1 -C1� 3- 0 - GC - 1, ?‘ /� c PROPERTY OWNERJ4 4j,fl)dr `�/yhhty�l,A 1k PHONE NO. (9 V) 78S--063/ 9 MAILING ADDRESS 9Hi/ We/i rote /'l rl y ,4tvd -2( Aiit/iy Ion, G. ell 621 City State Zip DESCRIPTION OF BUILDING (ex. house, mobile/modular home, shop, office) AntSe SITE/LOCATION ADDRESS 7/9q eve/ES courtly 42ottcfo en , ./"/Z Vier, re, 4106-2 1 EJ N,2 NE `/ NWq City State Zip LEGAL DESCRIPTION PT PT SECTION .3 TOWNSHIP Al RANGE 4 7 SUBDIVISION N As LOT BLOCK FILING CENCUS TRACT 1I ( a LOT SIZE/ACRES 9•.c COMMERCIAL YES L.`3' RESIDENTIAL ES /NO NUMBER OF PERSONS ,3 BASEMENT PL ING YES /© BEDROOMS 3 BATHROOMS - FULL / 3/4 / 1/2 . { WATER SUPPLY - PUBLIC ES NO NAME CNl'lt/^Q / 1�P.Idr,,n .t* a/41-er J1S//tie./ PRIVATE YES/NO WELL YES/NO CISTERN YES/NO WELL/CISTERN# SYSTEM SIZE: Septic tank material is constructed ofCo/1CretE: and has Iceo gallons capacity. FIELD: Trench square feet or Bed 1geo square feet YEAR INSTALLED j9 9'7 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 systenxl is not in good working order and to the best of his/her knowledge is/ s not failing to function properly I further understand that any falsification or misrepresentation may result in revocation of any permit granted based upon this information hereby submitted and in legal action for perjury as proyided by law. TE 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 • CENTRAL WELD COUNTY WATER DISTRICT April 19,2010 Edward G.&Mary A. Diller 9144 County Road 26 Fort Lupton, CO 80621 RE: Additional Water Service Dear Mr. &Mrs.Diller: This letter is in response to a request for water service to serve the following property described as follows: A portion of the E %3 of the NE %of the NE ''4 NW '/of Section 3,Township 2 North,Range 67 West, Weld County,Colorado. Water service is presently available to the above described property by tap number 610 located at Weld County Road 26 between Weld County Roads 19&21.Additional water service can be made available to this property,provided all requirements of Central Weld County Water District,Northern Colorado Water Conservancy District and the Bureau are satisfied. Please note that you are responsible for confirming that this property has met the requirements of Northern Colorado Water Conservancy District and the Bureau of Reclamation.To do this,you may contact Marilyn Conley with Northern Colorado Water Conservancy District at 970.532.7700. Central Weld cannot issue a tap until all requirements are satisfied. Central Weld County Water District requires that contracts be consummated within one(1)year from the date of this letter or this letter shall become null and void unless extended in writing by the District.Please contact the Central Weld office for further information about water service. Due to the rapid cost increase of raw water, existing tap fees may not apply for water service to this property. The District will not notify,by separate letter,any prospective landowners or land purchasers of tap fee or line extension cost increases. The cost of a tap fee and/or improvements will have to be paid in advance to the District by the prospective customer in accordance with District policy. It is your responsibility to confirm with your local Fire Protection Authority if fire flow water capacity is required for your project. If you have any questions regarding the above,please contact this office. Sincerely, CENTRAL WELD COUNTY WATER DISTRICT#17W.Zadeera Manager JWZ/rg 2235 2m Avenue• Greeley, Colorado 80631 • Phone(970) 352-1284 • Fax (970) 353-5865 John W. Zadel, General Manager Hello