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HomeMy WebLinkAbout20093441.tiffA III;i;WI V Cl CeRx�gtig i cpbbbbpuni <22kfi2tc<� p<tttltli n m L8 60 6 HIGHWAY 52 xg a m 0 cz S9 80 SS3»d osCj 'JN11S1%3 r MS0 SDI OK .0 400708 42.4 .ZYLZ£L -- 3.Z£.00.10S wQ wE- �w 0 R Iw io Q * acrN wwz S vn 0 .102 WtW U< gomagal crc3- W r E m�m 4P Eggg 0:, 4RN p> -z � g; W N I. ig Met L 0 U S 0 t 0 a n c1 PI Y w e COMM NOl£ S ETC. 0 0 a t zwri WUDc COLORADO DEPARTMENT OF PLANNING SERVICES SUBDIVISION EXEMPTION ADMINISTRATIVE REVIEW Applicant: Jerrold and Jeffrey Cooksey Case Number: SE -1145 Request: Subdivision Exemption in Conjunction with Recorded Exemption No. 4930 Legal Description: S2 SW4 of Section 7, Ti N, R61 W of the 6th P.M., Weld County, CO Parcel Number: 1481 07 000003 Parcel size: +/- 3.3 acres Planner: M. Martin Criteria Checklist Meets Criteria Yes No NA X X 1. The proposal is consistent with the policies of Chapter 22 of the Weld County Code. X 2. The boundary change or temporary use location which would be allowed on the subject property by granting the request will be compatible with the surrounding land uses. 3. In those instances when used pursuant to 24-8-30.A.1 of the Weld County Code, the request is the best alternative to dispose of existing improvements in conjunction with the companion Recorded Exemption. X 4. A lot being created for the purpose of financing will not result in the creation of a lot to be sold, shall be at least one acre in size, and will no longer exist upon termination of the financing arrangements. Approved With Conditions The Subdivision Exemption is approved in accordance with information submitted in the application and the policies of Weld County. The Department of Planning Services has determined through its review that the standards of Section 24-8-40 of the Weld County Code have been met. 1. Prior to recording the plat: The plat shall be titled: Subdivision Exemption No. 1145 B The applicant shall submit a joint ownership, access and/or operation maintenance agreement for the shared domestic well and irrigation well. This agreement shall be delineated on the plat and an appropriate certificate using the language set forth in the Weld County Code, Appendix 24-F.E shall be included. The SE Lot shall use the existing residential access point as no additional accesses shall be granted. &a09- 301 • • p 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. County Road 10 is designated on the Weld County Road Classification Plan as local gravel road, which require 60 feet of right-of-way at full build out. The applicant shall verify and delineate on the plat the existing right-of-way and the documents creating the right-of-way. 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. County Road 85 is a section line road, which requires 60 feet of right-of-way at full build out. The applicant shall verify and delineate on the plat the existing right-of-way and the documents creating the right-of-way. 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 not maintained by Weld County. The applicants shall submit to the Weld County Department of Planning Services a recorded copy of a deed describing the property as follows: S2 SW4 of Section 7, T1 N, R61W of the 6'h P.M., Weld County, CO. The applicant shall attempt to address the requirements (concerns) of Southeast Weld County Fire District as stated in the referral response dated 6/8/09. Evidence of such shall be submitted in writing to the Weld County Department of Planning Services. The applicant shall address the requirements (concerns) of Weld County Public Health and Environment as stated in the referral response dated 6/11/09. Evidence of such shall be submitted in writing to the Weld County Department of Planning Services. The Subdivision Exemption Lot shall comply with the two and one-half (2 1/2) acre net minimum lot size required by Section 24-8-40.L of the Weld County Code. 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. L. The following notes shall be placed on the plat: 1) This Subdivision Exemption was approved in conjunction with Recorded Exemption RE - 4930 for the purpose of dividing off a second set of existing residential improvements from the parcel. 2) 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. 3) Any future structures or uses on site must obtain the appropriate zoning and building permits. 4) Potential purchasers should be aware that groundwater may not meet all drinking water standards as defined by the Colorado Department of Public Health and Environment. The Weld County Department of Public Health and Environment strongly encourages well users to test their drinking water prior to consumption and periodically there after. 5) 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 Subdivision Exemption number. 6) 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. 7) 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.B.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. 8) Effective January 1, 2003, Building Permits issued on the proposed lots will be required to adhere to the fee structure of the Weld County Road Impact Program. (Ordinance 2002-11) 9) 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) 10) 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 • • Michelle Martin Planner II 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 2. 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. 3. The Department of Planning Services respectfully requests the surveyor provide a digital copy of this Subdivision 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. 4. The Weld County Department of Planning Staffs approval of this Subdivision Exemption is based upon satisfying the above conditions. 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 Board of County Commissioners with a recommendation for denial. 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 recordine added for each additio ' al 3 month period. Date: 7/4 O7 a:111 COLORADO May 20, 2009 DEPARTMENT OF PLANNING SERVICES SOUTHWEST OFFICE 4209 CR 24.5 LONGMONT, CO 80504 PHONE: (720) 652-4210, Ext. 8730 FAX: (720) 652-4211 Jerrold & Jeffrey Cooksey 42467 CR 10 Roggen CO 80652 Subject: SE -1145 - A Subdivision Exemption located on a parcel of land described as S2 SW4 of Section 7, T1N, R61 W of the 6th P.M., Weld County, Colorado. Dear Applicants: Your subdivision 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 subdivision 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. If you have any questions concerning this matter, please call me. Sincere'. / Michelle Martin Planner 4,26 WELD COUNTY, COLORADO t DEPARTMENT OF PLANNING SERVICES 918 10TH STREET GREELEY, CO 80631 PHONE: 970-353-6100, EXT. 3540 / FAX: 970-304-6498 Date: Received From: 20 j Cl Receipt No. 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 ( /7;; MISC. ❑ CASH 'E7 CHECK NO. - - /' " TOTAL FEE Receipted By: /7 _ DL# Exp. • POC Planner Plat Checklist Item Proper size and material Lettering Boundaries of Lots Scale Accesses indicated Roads labeled, including R.O,W Building Envelope(s) Vicinity Map North Arrow Legal Descnption Notes from Planner/ Development Standards Conditions of Approval Owner's Certificate Surveyor's Certificate and Surveyor's Stamp Comments Check j..Zheck 2\4" x„.32; or 18" x 24" / Minimum 3 millimeter polyester sheet No stick -on lettering / Minimum 8 pt. lettering Suitable Scale? (1"=200' or 1"=100')) Shared Access? If so, is easement Certificate included? Suitable Scale? (Minimum 1" = 2000') Director of Planning Certificate - Notarial Certificate included? All owners must sign the plat, check the deed. All surveyed plats Note: USR plats do not need to be surveyed Notarial Certificate included? (RE, SE, SPR, Final PUD if Staff Approved) Planning Commission Certificate Board Certificate Typical Road Cross Section Easements (USR, COZ, Minor Sub, Final) (USR, COZ„ Minor Sub Final) (Final PUD, RE, SE &c. ZPM . if Board approved) (COT, Final Minor Sub. and Final PUD) Please return the plat to the CAD`/Tfchn'clan within 24 hours of receiving the plat.10 2•401 a Planner on Call: Planner Simar ^e" tial , Date: 1.7 • Michelle Martin From: Sent: To: Cc: Subject: Mary Evett Tuesday, June 08, 2010 2:55 PM Michelle Martin jvcooksey@aol.com; Tom Parko RE -4930 and SE -1145 Cooksey The applicant has met all of the conditions of RE -4930 and SE -1145 required by Environmental Health Services. 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 WI�YG rga:44 C0WNhOO May 25, 2010 • DEPARTMENT OF PLANNING SERVICES Building Compliance Division 1555 N 17th AVE, Greeley, CO 80631 Website: www.co.weld.co.us E-mail Address: pgregory(a)co.weld.co.us Phone: (970) 353-6100, Ext. 3568 Fax: (970) 304-6498 WELD COUNTY BUILDING CODE VIOLATION NOTICE JERROLD V and JEFFREY A COOKSEY 42467 CR 10 ROGGEN CO 80652 Subject: BCV10-00060, W2 of Section 7, T1 N, R61W of the 6th P.M., Weld County, Colorado Dear Jerrold and Jeffrey Cooksey: Permit numbers BCR09-00305 and BCR09-00362 have now expired and the properties located at 42467 CR 10 and 42483 CR 10 are currently in violation of the following Sections of the Weld County Code: Section 29-3-10 "Building permit required." Section 29-8-40 "Expiration of permit." To bring the properties into compliance with the Weld County Code: Permit applications and all applicable documentation shall be submitted for the additions to the single family dwellings at both addresses, fees paid, the permits issued, and all inspections completed. SE -1145 and RE -4930 must be completed prior to final inspections on the additions. It is the intention of this office to assist and cooperate with you without imposing undue hardship; however, we have no discretion in this matter if you do not correct this violation within 14 (fourteen) days from May 25, 2010. Failure to do so will result in this office scheduling the violation before the Board of County Commissioners to consider whether to refer the case to the County Attorney's Office for legal action. Should you have any questions regarding this letter, or if you need any further information, please feel free to contact me at the above address, telephone number or e-mail address. If you wish to see me personally, please call to schedule an appointment so that I may reserve a sufficient amount of time with you. Peggy Gregory Building Compliance Officer pc: BCV10-00060 BCR09-00305 BCR09-00362 Michelle Martin, Planner III • I Jerry Cooksey 42467 WCR 10 Roggen, CO 80652 May 24, 2010 Dear Ms. Martin: This letter is in response to your email of last Thursday. Both houses involved in our RE and SE have house numbers that are visible from the road. We have spoken with the local fire chief and understand what they require from the mail boxes. Their request is being complied with and that criteria has been met. If you have any more questions regarding this, feel free to call me at 970-381-7226. Sincerely, Jerry Cooksey • Michelle Martin From: Michelle Martin Sent: Monday, May 10, 2010 2:54 PM To: 'cookc4cattle@rtebb.net' Subject: re -4930 and SE -1145 Attachments: re shell.doc; se shell.doc Jerry, Attached are copies of the staff report for RE -4930 and SE -1145. The following conditions still need to be addressed: RE -4930 A, B, C, D, E, F, G, I, J, L, M, N SE -1145 A, B, C, D, E, F, H, I, J, K, L Please note that many of these conditions pertain to the survey. Let me know if you have any questions. Michelle Martin Planner Ill 1555 N 17th Ave Greeley, CO 80631 mmartin@co.weld.co.us PHONE: (970) 353-6100 x 3540 FAX: (970) 304-6498 1 • DEPARTMENT OF PLANNING SERVICES 1555 N 17th Ave Greeley, CO 80631 mmartin@co.weld.co.us PHONE: (970) 353-6100, Ext. 3540 FAX: (970) 304-6498 April 26, 2010 Jerrold and Jeffrey Cooksey 42467 CR 10 Roggen, CO 80652 Re: Conditions of Approval: RE -4930 and SE -1145 Dear Applicants: On July 14, 2009 your applications fora Recorded Exemption and Subdivision Exemption was administratively approved by the Weld County Department of Planning Services with specific Conditions of Approval. One of the required Conditions of Approval grants the applicants sixty (60) days to submit a Mylar Plat, In addition to the Mylar Plat all conditions outlined in the staff report needs to be completed. Planning Services Staff is aware of the difficulty and associated delays in meeting the Conditions of Approval normally associated with land use cases, and is willing to work with you in completing your request. Please notify the Department of Planning Services, in writing, within 10 working days of your decision to complete the Recorded Exemption and Subdivision Exemption within the next 30 days. If you are unable to meet the Conditions of Approval and record the plat within 30 days of the date of this letter your case will be scheduled for a hearing before the Weld County Board of County Commissioners If you have further question, please contact me at the above address or call (970) 353-6100 x 3540. Sincerely, Michelle Martin Planner III • I Michelle Martin From: Sent: To: Subject: Mary Evett Monday, March 15, 2010 5:52 PM Michelle Martin FW: SE -1145 and RE -4930 One more thing I forgot to add... Condition No. 1 of SE -1145, regarding permitting the unpermitted septic system for the existing residence, has been met. Mary Original Message From: Mary Evett Sent: Monday, March 15, 2010 5:33 PM To: Michelle Martin Subject: SE -1145 and RE -4930 Michelle, The following is a status of Environmental Health's conditions for the referenced land use cases: 1. For both SE -1145 and RE -4930, need shared well agreement recorded along with a joint easement agreement indicated on the plat. (condition No. 3 of SE -1145 and condition No. 4 for RE -4930) 2. For both SE -1145 and RE -4930, need dimensions from the septic systems to the proposed property lines on the septic drawings that were recently submitted by Joel. (condition No. 2 of SE -1145 and condition No. 3 of RE -4930) 3. Condition No. 2 of RE -4930, regarding septic permit SP -0900042 must have final approval, has been met. Thanks, 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 4Keictri WI`RADOPc COLO • S APPLICATION FLOW SHEET APPLICANT: Jerrold and Jeffrey Cooksey CASE #: SE -1145 REQUEST: Subdivision Exemption in conjunction with Recorded Exemption RE -4930 LEGAL: S2 SW4 of Section 7, T1 N, R61W of the 6th P.M., Weld County, CO. LOCATION: North of and adjacent to CR 10 and east of and adjacent to CR 85. PARCEL ID #: 1481 07 000003 ACRES: +/- 80 acres Date B Application Received 5/18/09 ill Application Completed 5/19/09 Mm Referrals listed 5/19/09 mm Vicinity map prepared File assembled 51,a0i0j Case logged in computer "m ---2.__ Letter to applicant mailed Referrals mailed Field check by DPS staff A1/14 Administrative Review decision: 61_O($2)-- .77/4/ Board of County Commissioners hearing Of applicable) County Commissioners Hearing Date Date B y Surrounding property owners notified Presentation prepared CC action: CC resolution received Plat recorded and filed 7//ho Overlay Districts Zoning Agricultural MUD Yes No X_ IGA Yes No X_ Airport Yes No X_ Geologic Yes No X Flood Hazard Yes No X Panel #080266 Date 07, ( 10 /4/yr SUBDIVISION EXEMPTION (SE) APPLICATION FOR PLANNING DEPARTMENT USE RECEIPT/AMOUNT # /$ APPLICATION RECEIVED BY DATE RECEIVED: CASE # ASSIGNED: PLANNER ASSIGNED: TYPE OF EXEMPTION REQUESTED (check one) Property line adjustment Used with Recorded Exemption Financing Purposes Public Utility Facility Parcel Number Lr 4±._O %_12. O b _Q 0 (12 digit number - found on Tax I.D. information, obtainable at the Weld County Assessor's Office, or www.co.weld.co.us). Legal Description , Section 7 , Township 1 North, Range C (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 4 --"<lo FEE OWNER(S) OF THE P RTY) ���ia� A. ciic k5ey Name: Work Phone # 970 7' "/-'q 3Home Phone # 303- f�'?- 5-AmonAddressCO0 �( C (/raitfc® rte bb Address: 1/19 67 I / C R- (D City/State/Zip Code g6c)9evi , co co C5? Torre V Coot APPLICANT OR AUTHORIZED AGENT (See Below: Authorization must accompany applications signed by Authorized Agent) Name: Work Phone # Home Phone # Email Address Address: City/State/Zip Code 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 to legal authority to sign for the corporation. I (we), the undersigned hereby request the Department of Planning Services to review this Subdivision Exemption on the above described unincorporated area of Weld County. wner or Authorited Agent Date SE Lot-- 42,-/c3 CA (ext5it✓�� 16( s -/?-/77 Sigyfature: Owner or Authoy('$d Agent Date -4- a The purpose of the proposed subdivision is to meet county standards, so that we can expand and improve our homes and enjoy our families while they are still young. We began purchasing this farm with the help of our grandfather back in 1985. We now own it and our two families are enjoying a teenage and a pre -teen girl in one family and a pair of 12 year old boys in the other. We plan to continue farming in this operation and to enjoy the numerous benefits of family agricultural life. We apologize for not starting on this process sooner, but we were unaware of the zoning restrictions regulating 70 and 80 year old homes. We ask for you expedite this process so that we might be able to complete our improvements before school starts and winter comes in the fall. Thank you. MAY -21-2010 FRI 04:30 PM • FAX NO, P. 01/01 . i �. s3 Weld County Treasurer Statement of Taxes Due AccountNumber R6551386 Parcel 148107000003 Legal Description 3671 W27161 (4R) Situ' Address 42467 10 CR WELD 0( )]a0 Account: 86551386 COOKSEY JERROLD V 1/2 1NT & 42467 Cit. 10 ROGGEN, CO 80652 Year 2009 Charges Tax Billed 52,488,79 Payments $2,488.79 Grand Total Due as of 05/21/2010 Tax Billed at 2009 Rates for Tax Area 2447.2447 Authority WELD COUNTY SCHOOL DIST RE3J NORTH TA BIJOU GROUNDW S. E. WELD FIRE AIMS JUNIOR COLLEGE HIGH PLAINS LIBRARY Taxes Billed 2009 " Credit Levy MEII Levy Amount 18,8040000' $778.34 21.7050000 $1,002.77 0,0300000 $1.39 5.7640000 5266.30 6.3120000 $291.61 3.2550000 $150.38 53.8700000 52,488.79 Values AG -SPRINKLER IRRIGATED LAND AG -DRY FARM LAND FARM/RANCH RESIDENCE -IMPS OTHER BLOCS,- AGRICULTURAL Total Balance $0.00 $0.00 Actu I Assessed $87,5' 3 $25,400 $1,5' I $440 $181,6.3 $14,460 520,3! a $5,900 5291,1 5 $46,200 ALL TAX LIEN SALE AMOUNTS ARE SUBJECT TO CHANGE DUE TO ENDORSEMENT OF CURRENT TAXES BY' HEE LIENHOLDER OR TO ADVERTISING AND DISTRAINT WARRANT FEES. CHANGES MAY OCCUR AND THE TREASURER'S OFFICE WILL NEED TO BE CONTACTED PRIOR TO REMITTP EE AFTER THE FOLLOWING DATES: PERSONAL PROPERTY AND MOBILE HOMES - AUGUST 1, REAL PROPERTY AUGUST 1 WELD COUNTY TREASURER Pursuant to the Weld County Subdivision Ordinance, the attached Statement(s)' Due, issued by the Weld County Treasurer, are evidence that, as of this date, all proper, special assessments and prior taxes liens currently due and payable connected with the a identified therein have been paid in full. Signed _ Date S —a) i 6 f Taxes taxes, rcel(s) % Weld County Treasure% Statement of Taxes Due Account Number R6551386 Assessed To Parcel 148107000003 COOKSEY JERROLD V 1/2 INT & 42467 CR 10 ROGGEN, CO 80652 Legal Description 3671 W2 7 1 61 (4R) SITUS: 42467 10 CR WELD 00000 Situs Address 42467 10 CR WELD 00000 Year 2008 Charges Tax Billed $2,267.90 Payments $2,267.90 Balance $0.00 Grand Total Due as of 05/18/2009 80.00 Tax Billed at 2008 Rates for Tax Area 2447 - 2447 Authority WELD COUNTY SCHOOL DIST RE3J NORTH KIOWA BIJOU GROUNDWAT S. E. WELD FIRE AIMS JUNIOR COL HIGH PLAINS LIBRARY Taxes Billed 2008 * Credit Levy Mill Levy 16.804000* 26.196000 0.029000 5.764000 6.323000 3.260000 Amount $652.82 $1,017.72 $1.13 $223.93 $245.65 $126.65 58.376000 $2,267.90 Values Actual Assessed AG -SPRINKLER $66,465 $19,270 IRRIGATED LAND AG -DRY FARM LAND $1,904 $550 FARM/RANCH $164,141 $13,070 RESIDENCE -IMPS OTHER BLDGS.- $20,546 $5,960 AGRICULTURAL Total $253,056 $38,850 ALL TAX LIEN SALE AMOUNTS ARE SUBJECT TO CHANGE DUE TO ENDORSEMENT OF CURRENT TAXES BY THE LIENHOLDER OR TO 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 Name: Jerrold & Jeffrey Clay County Towns & Cities Attorney Ault x Health Department _Berthoud Extension Office _Brighton Emergency Mgt Office - Ed Herring _Dacono x Sheriffs Office _Eaton x Public Works Erie _Housing Authority Evans Airport Authority _Firestone x Building Inspection _Fort Lupton x Code Compliance Beth Frederick _ Kim Ogle (Landscape Plans) ___ Garden City _Lin (Addressing Change of Zone) Gilcrest _x_Ambulance Services _Greeley Grover State _Hudson x Div. of Water Resources Johnstown _Geological Survey _Keenesburg _Department of Health _Kersey _Department of Transportation _LaSalle _Historical Society _Lochbuie _Water Conservation Board Longmont Oil & Gas Conservation Commission Mead Division of Wildlife x South Hwy 66 (Loveland) _North Hwy 66 (Greeley) _Division of Minerals/Geology Soil Conservation Districts _Big Thompson/ FTC Boulder Valley/Longmont x Brighton/SE Weld Centennial Greeley/West Greeley _Platte Valley West Adams _Little Thompson Federal Government Agencies US Army Corps of Engrs _USDA -APHIS Vet Service _Federal Aviation Admin (Structures over 200 ft or w/in 20000 ft of Pub Airport Federal Communications Comm Milliken _New Raymer Northglenn Nunn Pierce Platteville Severance Thornton Windsor Counties Adams Boulder Broomfield Lamer Other x School District RE -3 _Central Cob. Water Conservancy RR _Ditch Company _Art Elmquist (MUD Area) REFERRAL LIST Case #: SE -1145 Fire Districts Ault F-1 Berthoud F-2 Briggsdale F-24 _Brighton F-3 Eaton F-4 _Fort Lupton F-5 Galeton F-6 Hudson F-7 Johnstown F-8 LaSalle F-9 Mountain View F-10 Milliken F-11 Nunn F-12 Pawnee F-22 Platteville F-13 _Platte Valley F-14 _Poudre Valley F-15 Raymer F-2 x Southeast Weld F-16 Union Colony F-20 _Wiggins F-18 Windsor/Severance F - Commissioner Name: Referral List Case/4 (00 1(.57 a County Towns & Cities Attorney _Ault Ilh Department _Berthoud _Extension Office _Brighton _Emer cy Management Office - Ed Herring ___Dacono �She/ri fs Office Eaton t —Public Works _Erie _Housing Authority _Evans Airport Authority _Firestone wilding Inspection _Fort Lupton de Compliance _Frederick Assessor Office/Chris Woodruff (Final Plan) _Garden City Kim Ogle (Landscape Plans) _Gilcrest Lin or P gy (Addressing Change of Zone) _Greeley bulance Services Grover State _Hudson iv. of Water Resources Johnstown _Geological Survey _Keenesburg _Department of Health _Kersey _Department of Transportation _LaSalle _Historical Society _Lochbuie _Water Conservation Board _Longmont Oil & Gas Conservation Commission Mead D' sion of Wildlife _Milliken _South Hwy 66 (Loveland) _New Raymer _North Hwy 66 (Greeley) _Northglenn _Division of Minerals/Geology _Nunn Soil Conservation Districts Pierce _Big Thompson _Platteville Boulder Valley _Severance Brighton _Thornton Centennial _Windsor _Fort Collins Counties _Greeley _Adams Longmont _Boulder Morgan _Broomfield Platt alley _Larimer outheast Weld Other West Adams _Central Colo. Water Conservancy Dist Federal Government Agencies Left Hand Water _US Army Corps of Engrs chool District RE- 3 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 Fire Districts Ault F-1 Berthoud F-2 _Briggsdale F-24 _Brighton F-3 Eaton F-4 _Fort Lupton F-5 Galeton F-6 Hudson F-7 Johnstown F-8 LaSalle F-9 Mountain View F-10 Milliken F-11 Nunn F-12 Pawnee F-22 Platteville F-13 _Platte Valley F-14 _Poudre Valley F-15 _Raymer F-2 outheast Weld F-16 _Union Colony F-26 _Western Hills F-20 _Wiggins F-18 Windsor/Severance F-17 Legal Parcel ID # Zone Acres? USDA Airport _ --- Geo Haz FP? Panel# Road Impact Fee Area? (SW #1 _, #2 , #3 , Windsor ) IGA? ORD # MUD? rase # - I I ) Name - r ni)(� Legal Description - Case recieved $ i /a� UGB/ 1GA- (-✓ Check: UD - , / Airport - k_/Geo Hazard - u. ---Impact Fees -L—� -0C oF3 oa Case number ✓ Add to case list Original signature Referral list Short flow sheet Start comments 'roperty Research & Deed Check Water Septic Put on field check map I Draw on aerial Field check Field check sheet cz I- z W 0 0 U O (n C a) a) O a E a:r4 COLORADO Weld #y Planning Department GREELEY OFFICE • UN 107nnq F, r-EIVED Weld County Referral May 20, 2009 The Weld County Department of Planning Services has received the following item for review: Applicant Jerrold & Jeffrey Cooksey Case Number SE -1145 Please Reply By June 20, 2009 Planner Michelle Martin Project Subdivision Exemption in conjunction with Recorded Exemption RE -4930 Legal S2 SW4 of Section 7, T1 N, R61W of the 6th P.M., Weld County, Colorado. Location North of and adjacent to CR 10 and east of and adjacent to CR 85. For a more precise location, see legal. Parcel Number 1481 07 000003 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. U See attached letter. Comments: Signature Agency S.%gerA/-'r ai;47-re (Weld County Planning Dept. {•4209 CR 24.5, Longmont, CO 80504 4•(720) 652-4210 ext.8730 +(720) 652-4211 fax :vo, • Willie COLORADO I Weld County Referral May 20, 2009 The Weld County Department of Planning Services has received the following item for review: Applicant Jerrold & Jeffrey Cooksey Case Number SE -1145 Please Reply By June 20, 2009 Planner Michelle Martin Project Subdivision Exemption in conjunction with Recorded Exemption RE -4930 Legal S2 SW4 of Section 7, Ti N, R61 W of the 6th P.M., Weld County, Colorado. Location North of and adjacent to CR 10 and east of and adjacent to CR 85. For a more precise location, see legal. Parcel Number 1481 07 000003 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. Lw We have reviewed the request and find that it does /does not comply with our Comprehensive Plan e have reviewed the request and find no conflicts with our interests. U See attached letter. / / Comments: / 2�%�7, T 4 acres/rP s 6e ,/,---‘,-- `�/e C5I- Via- !'O4c -7 �i-,�-- A 9f%� di '"e!,_-_/:;=.9-0 S i Signature Agency CAT ,r7c ❖Weld County Planning Dept. ❖4209 CR 24.5, Longmont, CO 80504 :•(720) 652-4210 ext.8730 :•(720) 652-4211 fax -• • ::e.A......:-..-ticKa:g...gilitiettaal.• • (iitz Mae COLORADO Weld County Planning Confidant GREELEY OFFICE JUN z6' d County Referral RECEI May 20, 2009 The Weld County Department of Planning Services has received the following item for review: Applicant Jerrold & Jeffrey Cooksey Case Number SE -1145 Please Reply By June 20, 2009 Project Legal Planner Michelle Martin Subdivision Exemption in conjunction with Recorded Exemption RE -4930 S2 SW4 of Section 7, Ti N, R61 W of the 6th P.M., Weld County, Colorado. Location North of and adjacent to CR 10 and east of and adjacent to CR 85. For a more precise location, see legal. Parcel Number 1481 07 000003 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. dlr./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. U See attached letter. Comments: Signature Agency 5 E IA), Cons✓ Date +Weld County Planning Dept. ❖4209 CR 24.5. Longmont, CO 80504 t(720) 652-4210 ext.8730 +(720) 652-4211 fax • Mae COLORADO Weld County Referral May 20, 2009 The Weld County Department of Planning Services has received the following item for review: Applicant Jerrold & Jeffrey Cooksey Case Number SE -1145 Please Reply By June 20, 2009 Planner Michelle Martin Project Subdivision Exemption in conjunction with Recorded Exemption RE -4930 Legal S2 SW4 of Section 7, TIN, R61W of the 6th P.M., Weld County, Colorado. Location North of and adjacent to CR 10 and east of and adjacent to CR 85. For a more precise location, see legal. Parcel Number 1481 07 000003 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. Comments: Signature Agency X4;--) il‘ec€io t2'u :i- d ,{4),01:4 Date +Weld County Planning Dept. ❖4209 CR 24.5, Longmont, CO 80504 +(720) 652-4210 ext.8730 +(720) 652-4211 fax fittrie W1�Pc COLORADO • S MAY 2 1 2009 Weld County Referral May 20, 2009 The Weld County Department of Planning Services has received the following item for review: Applicant Jerrold & Jeffrey Cooksey Case Number SE -1145 Please Reply By June 20, 2009 Planner Michelle Martin Project Subdivision Exemption in conjunction with Recorded Exemption RE -4930 Legal S2 SW4 of Section 7, Ti N, R61 W of the 6th P.M., Weld County, Colorado. Location North of and adjacent to CR 10 and east of and adjacent to CR 85. For a more precise location, see legal. Parcel Number 1481 07 000003 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. U We have reviewed the request and find that it does /does not comply with our Comprehensive Plan U We have reviewed the request and find no conflicts with our interests. 4( See attached letter. Comments: Signature Agency 2.0) , s- Date ❖Weld County Planning Dept. +4209 CR 24.5, Longmont, CO 80504 ❖(720) 652-4210 ext.8730 +(720) 652-4211 fax istr4 WIIDC COLORADO • MEMORANDUM Weld County Planning Department GREELEY OFFICE MO' 29 2pn9 RECRIED TO: Michelle Martin. Planning Services DATE: May 27, 2009 FROM: Donald Carroll, Engineering Administrator SUBJECT: SE -1145, Jerrold & Jeffrey Cooksey trio 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): (June 2002) WCRs 10 and 87 are local gravel roads and require a 60 -foot right-of-way at full build out. There is presently a 60 -foot right-of-way. These roads are maintained by Weld County. Pursuant to the definition of SETBACK in the Weld County Zoning (23-190), the required setback is measured from the future right-of-way line. REQUIREMENTS: Utilize the existing access to this parcel. 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 other vegetation, other than grasses, need 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: SE -1145 M:\PLANNING - DEVELOPMENT REVIEW \SE -Subdivision Exemption\SE-1145.DOC 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 —Serra Id l�Do� �Picier �0k5 Phone 97C 37'�;'4' Address Jay? OCR /D City eit State Zip p 2. Address or Location of Access 4 O7 WC R /r� lfdggen Co 11:065A92913 ( 10 1(O�ea 12 Section --/ Township / /V Range b/ UV Subdivision Bloc Lot Weld County Road #: ID Side of Road tior-m Distance from nearest intersection Va TOO 919-gTe-791 3. Is there an existing access to the property? Yes Y No # of Accesses 4. Proposed Use: / ❑ Permanent Z/f Residential/Agricultural ❑ Temporary ICJ Subdivision ❑ Industrial 0 Commercial 0 Other 5. Site Sketch Legend for Access Description: AG = Agricultural RES = Residential O&G = Oil & Gas D.R. = Ditch Road = House O = Shed A = Proposed Access A = Existing Access OFFICE USE ONLY: 4- N; $-fa#e rem WC 5 &CR g? OCR 10 SWr• tIo°\ b Hew Road ADT Date Accidents Road ADT Date Accidents Drainage Requirement Culvert Size iceSleen h.c J / Ace-ess OCR 10 kes+d.e4 -fia /1c (Peas,/ Date Date Length Special Conditions 7 Installation Authorized ❑ Information Insufficient Reviewed By: Title: -7- • cstari COLORADO IlIWolif County Planning DeperfineM G3REFLEY QFFIQE Memoran �'` i- TO: Michelle Martin, W.C. Planning DATE: June 11, 2009 FROM: Mary Cavnah, W.C. Department of Public Health and Environment CASE NO.: SE -1145 NAME: Cooksey Environmental Health Services has reviewed this proposal to create a 3.3 acre subdivision exemption (SE) lot used in conjunction with RE -4930. There is an existing residence on the proposed SE lot which is served by an individual well (Permit No. 15444) that is shared by two homes (home on proposed lot SE -1145 and home on proposed lot A of RE -4930 to the west). Per phone message from Rick Neilson of the Colorado Division of Water Resources on June 10, 2009, Well Permit No.15444 may service 2 homes. There is no individual sewage disposal system permit on file with the Weld County Department of Public Health and Environment for the existing residence on proposed lot SE -1145. The following conditions are recommended to be part of any approval: 1. 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 septic permit for the septic system located on proposed lot SE -1145 of this application. 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(s). In the event the system is found to be inadequate, the system must be brought into compliance with current I.S.D.S. regulations. 2. All septic systems must be located on their respective lots and meet all lot line set back requirements. Provide a drawing of the septic system, with dimension and distances from lot lines, to W.C. Department of Public Health and Environment for verification of setbacks. 3. The application materials indicate that the two houses are proposed to share a common well. Therefore, the applicant shall submit a document providing for shared well operation and maintenance by both parcels of land. The declaration shall be recorded and the recordation number indicated on the plat. A joint easement agreement shall be indicated on the plat. 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 be need to be enlarged. Jun O2 2009 2:15PM RSERJET FRX p.2 Weld County School District Re -3(J) / 99 West Broadway I P.O. Box 269/ Keenesburp. CO 80643 Tel' (303) 536.20001 Fax'. (303) 536.2010 June Z 2009 Weld County Departtnent of Planning Services 4209 CR 24.5 Longmont, CO 80504 Case Number: SE -1145 Dear Mrs. Martin: After speaking with district administration officials it is the recommendation that Re -3J will only collect a fee in the amount of $1232.00 for Lot B on RE -4930. There will be no fees due to Re -3J for SE -1145 unless it is exempted into further lots in the thture. If more than this letter is needed please let me know. Sincerely, Susie Townsend Weld County School District Re -3J cc; Jerrold & Jeffrey Cooksey Jun 02 2009 2:15PM H ASERJET FAX a p.3 ERs Up to 55 DU/AC M M n 4, V b* a III a a a UN a O O O ..pypy C C z i• Q [i UN 8 8 8 -44 a 9 1 Iti h F ;tri kr ii 1 I 4nS iii 0 1,0 Hi Pg StraWjc Rennes rest Mr. • DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER RESOURCES June 12, 2009 Michelle Martin Weld County Planning Department 4209 County Road 24.5 Longmont, CO 80504 RE: Jerrold & Jeffrey Cooksey/ Two -Lot RE -4930 Jerrold & Jeffrey Cooksey/ SE -1145 Section 7, T1 N, R61 W, 6l" P.M. Water Division 1, Water District 1 Dear Ms. Martin: Bill Ritter, Jr. Governor Harris D. Sherman Executive Director Dick Wolfe, P.E. Director This referral does not appear to qualify as a "subdivision" as defined in Section 30- 28-101(10)(a), C.R.S. Therefore, pursuant to the State Engineer's March 4, 2005 memorandum to county planning directors, this office will only perform a cursory review of the referral information and provide informal comments. The comments do not address the adequacy of the water supply plan for this project or the ability of the water supply plan to satisfy any County regulations or requirements. In addition, the comments provided herein cannot be used to guarantee a viable water supply plan or infrastructure, the issuance of a well permit, or physical availability of water. According to the submitted information the water to supply two houses will be provided by existing well permit no. 15444, issued May 22, 1963. One house is on the 7.5 - acre lot described as Lot A and the other house is on the approximately 3.3 acres described as SE -1145. This well is permitted for domestic purposes and can be used to serve the two houses. the watering of owner's own large non-commercial domestic animals. and up to 1 acre of lawn and garden. An existing irrigation well permit no. 4169 -F -R services the 69 - acres described as Lot B. Should you have any questions in this matter, please contact Justina Mickelson of this office. Sincerely, ?4 Vaal -447,4 - Keith Vander Horst, P.E. Designated Basins Team Leader cc: Jim Hall, P.E. Division 1 Office Brent Schantz, Water Commissioner Office of the State Engineer 1313 Sherman Street, Suite 818 • Denver, CO 80203 • Phone: 303-866-3581 • Fax: 303-866-3589 www.water.state.co.us M es O v rss YV' 'J i t 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 JecrsId Conk It fter0ook5ey' Phone 970-371-7Pb 9X-3%/-99/ Address g2' /? 4?CR /0 City jib ! art State 2. Address or Location of Access , b C Rear o Section 1 Township J /✓ Range b to Subdivision Bloc Lot Weld County Road #: 10 Side of Road A/or-111 Distance from nearest intersection 1/a /'�irG 3. Is there an existing access to the property? Yes 3/ No # of Accesses 4. Proposed Use: / ❑ Permanent I+3/Residential/Agricultural ❑ Industrial ❑ Temporary O Subdivision U Commercial ❑ Other 5. Site Sketch Legend for Access Description: AG = Agricultural RES = Residential O&G = Oil & Gas D.R. = Ditch Road = House O = Shed = Proposed Access • = Existing Access �c )4Tjhuaay Nit WC 5 IACR f eestdent'ia l Acc'eG3 JCR O Res+d,en fia /4ccess>�, OFFICE USE ONLY: Road ADT Date Accidents Date Road ADT Date Accidents Date Drainage Requirement Culvert Size Length Special Conditions O Installation Authorized ❑ Information Insufficient Reviewed By: Title: CERTIFICATE OF CONVEYANCES STATE OF COLORADO COUNTY OF WELD WELD COUNTY DEPARTMENT OF PLANNING SERVICES Lawyers Title Insurance Corporation 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 Southwest 1/4, of Section 7, Township 1 North, Range 61 West of the 6th P.M., County of Weld, State of Colorado. CONVEYANCES (If none appear, so state): Reception No. 1024891 I Book 1220 Page 571 Reception No. 1881930 Book 960 Reception No. 1971541 I Book 1034 Reception No. 2011742 Book 1071 Reception No. 2249600 I Book 1298 Reception No. 2307453 Book 1355 Reception No. 2307455 Book 1355 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 Lawyers Title Insurance Corporation is hereby limited to the fees paid for this Certificate. In Witness Whereof, Lawyers Title Insurance Corporation, has caused this Certificate to be signed by its proper officer this 11th day of May, 2009, at 7:00 am. Order No. 09-04309 By Law - s Title Insurance Corporation Aut#ofi ed `g.Qature KNOW ALL MEN BY THESE PRESENTS: That Hayjuond-.H. Roark and Ivan - F. Ouff of the County of Weld and State of Colorado, for the consideration of Ten Dollars and other valuable considerations, in hand paid, hereby sell and convey to Clarence M. Roark of the County of Weld and State of Colorado, the following property situate in the County of Weld and • State of Colorado, to -wit: The West Half (W+) Section Seven (7), Township One (1) North, Range Sixty-one (61) Went of the sixth princ:,,._) meridian. - The Southeast quarter (SE+) Section Twelve (W2), Tors - ship One (1) North, Range Sixty-two (62) Weet of the sixth principal meridian. The West Half (W-) Section Thirty-six (36), Township One (1) North, Range Sixty-two (62) Hest of the sixth prin- cipal meridian. with all its apjn:rtenances. The actual consideration for this deed is the partitioning of property in which the parties hereto have an equal interest. Signed and delivered this d yd.. - day of December, A.D., 1947. 1" It VOibutot ) 9;.:11=1,r ) ss %FNiu_ ) �::dbove and foregoing instrument was acknowledged before me p l.Llft29th day of December, A.D., 1947 by Raymond H. Roark and Ivan F. Doff. My commission expires: commiumn Expire: M.v. lo, 19ee 0071 Notary Public AR1661930 B 0960 RED 0188193 02/82' 14:33 870.00 1/001 MARY ANN FEUERSTEI 'K B .RECORDER. WELD COUNTY, CO 44ai; PATENT NO. 6246 04141141001lit4MM102,944atti CLAPeNC8. V P0411$_ And ra„a<tot r rielinetea ait,,e/rayymeaditoiff-dsatay ay fiozai�orij�i�z.2G- a,ar.rrc�iiary the N rth est nw'rter (p' ) .ea t5. SnnfFw.eF n .rfe. (6ri) of Serti on Devon (7) Toanehtp Onw (1) North Pante Sixty-one (61) 'Y .t of'the Sixth.(6th) Principal Meridian, and The Southeast Quarter (SPµ) of Section Twelve (12), Township a e (1) North. Naaee Sixty-two (62) West of the Sixth (6th) Principal Y,-idlen,- rontesntng Fot- Hundred Sixty-trm and thirty-six one -hundredth'', (467 as) acres more or 1-cs according: to 'United States survey: - - P•serrinr however. to the'Sfa`e e..C-Co'cradn all riehte to any end all minerals. ores and metals of anv 'rind end character and all coal. asoheltum oil. ram or other like auhctance of the -same as may be necessary for the proper sad convenient working of such -minerals and substances; - Sublect to any and all easements or riser`s-of-way heretofore leeellyobtained and-nowin eull force and effect. if en y there be, edraQrruG�re e r,�,c�y,107,414o irri� euar area i. docw 1 SioreAat+ air%` ,rvz, cdza�iOiUy� zca�eroa�ay Carr a� .�aiieza��.�ir�� iaa.esuasc� ,ai' ,l!'l%u°Ja J/�{Z!!/I7.(/ill Cid�®(.s'/u/�Ana. /%gyp/ / y hia heirs Jpj�all% .Q/L(A ,R'CASIZ//�FOay.L//Cq�c i"fO L,Riyi'!/,laa%Z1G66 lialll/ //Oi/6B' Siren/ •tGL e a ri s fran �4 cn�� iarrt/o �g�ra�ollevagta his heirs Arrjll(/cfIL�ea �aa Permanent School lard Weld County Cert'f'c.te re m -• .., hove '+-n c AR1971541 B 1034 REC 01971541 06/22/84 16:01 $6.00 F 1345 MARY ANN FEUERSTEIN CLERK b RECORDER WELD CO, CO 1/002 DEED OF DISTRIBUTION BY CO -PERSONAL REPRESENTATIVES THIS DEED is made by RAYMOND H. ROARK whose address is 2815 83rd Avenue, Greeley. Colorado 80634 and IVAN F. DUFF whose address is 11171 60th Avenue, Arvada, Colorado 80002, as Co -Personal Representatives of the Estate of C. M. Roark. also known as Clarence M. Roark, deceased, Grantors, to C. M. ROARK TRUST, c/o Raymond H. Roark, 2815 83rd Avenue, Greeley, Colorado 80634, Grantee. WHEREAS, Grantors were duly appointed Co -Personal Representatives of said estate by the District Court in and for the County of Weld and State of Colorado in Probate No. 82PR191 on July 13, 1982 and are now qualified and acting in said capacity; and WHEREAS, Grantee is entitled to distribution of the hereinafter described real property. NOW, THEREFORE, pursuant to the powers conferred upon Grantors by the Colorado Probate Code. Grantors do hereby convey, assign, transfer and release to Grantee the following described real property situate in Weld County, Colorado: W1 of Section 7, Township 1 North, Range 61 West of the 6th P.M. and the SE; of Section 12, Township 1 North, Range 62 West of the 6th P.M., Weld County, Colorado. with all appurtenances. Signed and delivered this ✓•o h day of ''In? 1984. Raylaon H. Roark, Co -Personal Representative Ivan F. Duff, Co -Personal Representative STATE OF COLORADO) ) ss. COUNTY OF WELD ) I, Kathryn I. Rusch, a Notary Public, do hereby certif H. Roark, who is personally known to me to be the person whose subscribed to the foregoing Deed of Distribution By Co -Personal and who is personally known to me to be one of the Co -Personal of the Estate of C. M. Roark, also known as Clarence M. Roark, before me, this day in person and upon oath swore to the truth therein stated and acknowledged that he signed and delivered sa of writing as his free and voluntary act. `.+^'..,,,,,. IN WITNESS WHEREOF, I have hereunto set my hand and official i'r_ y 0. l �"i�s� ` g�issipH expires: • : 1984. Witness my hand and official seal. y that Raymond name is Representatives Representatives deceased, appeared of the facts id instrument seal this ibB 1034 RE971541 06/22/84 16:01 $6.111 2/002 F 1346 MARY ANN FEUERSTEIN CLERK 6 RECORDER WELD CO, CO STATE OF COLORADO ) ss. COUNTY OFc'.t/cL I, � +4c.r , a Notary Public, do hereby certify that Ivan F. uff, who is ho persona to me to be the person whose name is subscribed to the foregoing Deed of Distribution By Co -Personal Representatives and who is personally known to me to be one of the Co -Personal Representatives of the Estate of C. M. Roark, also known as Clarence M. Roark, deceased, appeared before me, this day in person and upon oath swore to the truth of the -facts therein stated and acknowledged that he signed and delivered said . 'ipttrumg9t ;of writing as his free and voluntary act. : S1&I TtIESS WHER '": BR�fi clay of ♦:, -1}l l&iWn expires: t lrc0-1 /%-/f-TO OF, I have hereunto set my hand and official seal 1984. Witness my hand and official seal. • Notary Public AR2011742 B 1071 RE 1742 05/31/85 16:27 $3.00 4b001 F 1170 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO Gulp ooai iaiiv c.`Wafiarjty6Deed n THIS DEED is a conveyance of the real property described below, including any improvements and other appurtenances (the "property") from the individual(s), corporetion(s), partnership(s), or otherentity(ies) named below as GRANTOR to the individual(s) or entity(ies) named below as GRANTEE. The GRANTOR hereby sells and conveys the property to the GRANTEE and the GRANTOR warrants the title to the property, except for (1) the lien of the general property taxes for the year of this deed, which the GRANTEE will pay (2) any easements and rights -of -way shown of record (3) any patent reservations and exceptions (4) any outstanding mineral interests shown of record (5) any protective covenants and restrictions shown of record, and (6) any additional matters shown below Under "Additional Warranty Exceptions". The Specific Terms of This Deed Are: Grantor: (Give namelsl end pldcele) of residence:If the spouse of the owner -grantor is laming in this Deed to release homestead rights. identity grantors as husband and wife.) C. M. Roark Trust (being the same trust as C. M. Roark Testamentary Trust described Route 1, Box 466E in Affidavit recorded July 10, 1984 in Book 1036 under Reception Grain Valley, MO No. 1973451.) 64029 Grantee: (Give names) and address(es)', statement of address. including available road or street number, is required.) Lyle V. Cooksey, Jerrold V. Cooksey, and Jeffrey A. Cooksey 41509 State Highway 52 Roggen, CO 80652 Form of Co -Ownership: lit there are Iwo or more grantees named. they will be considered to lake as tenants in common unlessme words "in joint tenancy" or wards of the same meaning are added in the space below.) Tenants in Common Property Description: (include county and slate.) West 1/2 of Section 7, Township 1 North, Range 61 West and the Southeast Quarter of Section 12, Township 1 North, Range 62 West of the 6th P.M. except any and all minerals, ore and metals of any kind and character, and all coal, asphaltum, oil, gas and other like substances in or under said land, the rights of ingress and egress for the purpose of mining. together with enough of the surface of the same as may be necessary for proper and convenient working of such minerals and substances, as reserved in Patent from the State of Colorado, recorded February 2, 1982 in Book 960 as Reception No. 1881930, Weld County, Colorado., together with all grantor's right, title and interest in and to two irrigation wells and one domestic well. Property Address: 17284 Weld County Road 8, Wiggins, Colorado 80654 Consideration: (Thestatement of a dollar amount is optional: adequate consideration for:Ms deed win be presumed unless In,, conveyance is identified as a gilt; in any case this conveyance Is absolute, final and unconditional.) $270,000.00 Reservations -Restrictions: 111 the GRANTOR intends to reserve any interest in the properly or to conveyless Ivan eteowns, or ti meGRANTOP Is resettling tee GRANTEE'S right in the property, make appropriate Indiceuort None Additional Warranty Exceptions: Include deeds of (rust being assumed and other matters not covered above.) None Executed by the Grantor on flay 31 le 85 Signature Clause far Corporation. Partnership or Association: Name of Granter: Corporation. Partnership or Association By By Attest' State Documentary Fee Dote ..MAY..3..1--198J--- $ a.7:.GCz..... Signature Clause for In dlvldual(a): C. M. ROARK TRUST By: SDI- “,,r, `'�`'`� l{' 6I cd Raymond H. Roark, Trustee Grantor Grantor Grantor STATE OF COLORADO I Ss. COUNTY OF WELD I The 'outgoing instrument was acknowledged bet ore me Iris 31st day of May .1985 ey it and H. Roarky Trust WITNESSTrustee of the C. M. Roark Trust also known as C. M. Roark WITNESS my hand and official seal. My cormOanrtlaarAV: JO Hy toys, SG4jE OW......... )7, ) SS. G bNCY,�,,O,,??(tF fl n y, 0j I ?It tare Q M311Wnent was icknowledged before me this day of . 19. f '4*ahe umeidEsitkarante t9 or If Grantor's Corporation.Partnership or Association. than identify signers asprestdentor vice president end secretary or 6st:0)tih1.secretary olicsDoretiOn: or as partner(s) al partnership; or es authorized mempegsl of association.) W ITNeSi nO+ Rend 2nd official seal. My. comnlNasapplraa: Notary Public j > %Notary Pudic A2 .2.2 .<61:a, th W&J/ e 1981 UPDATE LEGAL FORMS P.O. Boa nets -Greeley. Colorado 80631 13031 as6.6a60 NO. 201 8 1298 249600, 05/09/91 09:50 65b 1/001 AR224,600:e. F 0981 ANN FEDERSTEIN CLERIC & RECORDER WELD CO, CO QUIT CLAIM DEED THIS DEED, Made this a' day of 'J7fiuf .04/. between Lyle V. and Pauline Cooksey Trust oldie •County of Weld and Stare of Colorado, gsnlod * and Lyle V. Cooksey and Pauline I. Cookery, husband and wife, as Tenants in Common and not Joint Tenants whose legal address is 41509 Highway 52 Roggen, Colorado 80652 of the Cormty of Weld and Stain of Colorado, grantee(s), WITNESSETH. That the grantor($ for and in consideration of the sum of No consideration DOLLARS the receipt and sufficiency of which is hereby aelrow(edged. ha S remised, released. sold, conveyed and QUITCLAIMED, and by these presents does remise. release sell. convey and QUITCLAIM unto the grantee(s), their heirs, successors and assigns, forever, all the right, tide. interest. claim and demand which the grantor(%) has in and to the sal propmty, together with improvements, if any, sumte lying and being in the County of Weld and State of Colorado, described as fogows An undivided one-third (1/3) interest in the West rh of Section 7, Township I North, Range 61 West and the Southeast Quarter of Section 12, Township 1, North Range 62 West of the 6th P.M.; together with all of grantor's right, title and interest in and to two irrigation wells and one domestic well, save and except all reservations contained in Patent recorded February 2, 1982 in Book 960 as ,Reception No. 1881930, Weld County, Colorado. also known by sheet and number as TO HAVE AND TO HOLD the same, together with all and singular the appurtenances and privileges thermmo belonging or in aura= t eauntoappet"_g, and all the anm,right,title. interestaodcLaim whatsoevq of the gamete). tither in law oramity, to the only proper use, trrc6t and hehoof of the grantee(s), their heirs and assigns tome. IN WITNESS WHEREOF The grantm(skba s =cured this deed on the dam set forth above. STATE OF COLORADO. ss. County of Weld. fI The foregoing inset It was aclalowladged before me this a7 — day of by Lyle V. Cooksey and Pauline Cooksey, Co -Trustees of the Lyle V. and Pauline Cooksey Trust. p My ouyr asiiarpirs / — /O . 19/j . Wsmas my hand and official seal. . &i inh\ uo'1s j.St Ifin-papb nwctraw and• V. Cooke , t ee online Cooksey, Co -T tee 199/, /fay Li 9183 W. WARREN OR. LAKEWOOD,CO 80227 No.933. Ret 3att QOWCAM DEED 6DdrminSbase. 170 Ware Si. • ow. CO sam— On; 29bnm-109D AE21074S3 8 1355. V112307453 10/20/92 13:08 $5, 1/001 F 0711 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO SPECIAL ViARRAPTY DEED THIS DEED, Mak tM. die F 's d....r t<t.ttn Pauline I. Cookery the °many of Weld Sbw ..t tool"rsL, eram,na Jerrold V. Cockney and Jeffrey A. Cockney *I.ru kcal .dder..,. 42467 weld County Road 10, Roggen, CO 8065 of de (lgnl. in Weld . SUIe el. ul,Iral° er.mwrr I STATE DOCUM NTARY FEE Date _ $ 4el4 W1 SETH. T'us d,c grantor., •nand in ...,.wale. Pont the .un, of Sixty two tboueand two btu:hired sixty and 50/100 ($62,260.50)----_--JDOH.ARi. the raceme and wlh.em. of .bah ,. II erth, ., Irvv.kdged hat g netted. Paetnne'l ...;,I and, unn n rd. and hi nine pmannl. ie gram. bargain. sll..,m.e. and .,maim woe the :ran ec -, their Lrrr, and an, n, hn, per ill lh, aal pngonl r"grlll<I anti nnpn'ncnwnt.. if any. ,Pone. loin and temp In 'he I ..un.,.n Weld . Suw ul ( dmmhcd n Milt.% An undivided one -sixth (1/6) interest, representing all of the grantor's interest in and to the following: W 1/2 Section 7, Township 1 North, Range 61 West of the 6th P.M.; and SE 1/4 Section 12, Township 1 North, Range 62 West of the 6th P.M.: together with all of the grantor's right, title and interest in two irrigation wells and one d'mestic well, save and except all reservations contained in Patent recorded February 2, 1982, in Book 960 as Reception .Io. 1881930, Weld County, Colorado. d,n\I,,.n tr. weed and m,nhct a. 42467 Weld County Road 10, Rogge.,, CO 80652 TOGETHER .Rh all and .Popular he M1nNnurnle an.l apponenan:. rhera,. 4lun::nr ,.r ,n arnor apiv na,arnr. and the nxevun and memoir, renarnder and erma,uJen rem. ,.•ur• and pet mh them., and all Ih „•r ne rah' Iola mar,' a . pun and demand w behoove ul'he prannwl ii. ether in Um or calmer... ii. nl and to the al..e has erne] per m, w,lh !kw In+rJnarumli amt aprymenamr. TO HAVE AND TO HOLD theI pmt Ivaonchreuned and J.'a hMl anti the 'pr"'",,r. nm., ;he pl.r,rrdrLr. their hat and a..Ipm hwe.a The grannmt ho her f her h'.r..nW pr r.,.nar repro .em.nnr. or .u.. e•.nr. .t, „n,'nant and see dui she .hall and will WARRANT .%llh(Nil VI ft III IISIIItwah.r vrparnl pr'nuo.n, Ow tp,rrt and ;via cahle .,,.v'..Iun ul the Fddhh9l.1. their hen adanpn. again: all an te. prniiii 'r ., lair ,neiMuhdl'.u.,,r'arlawn,4 hi Ihnnn.h or 'Hilo rho ''hurts, is WITNESS Will RH)E the crania", hall ..n Lord rh,..ee,I ..n rlo' date ., ...nt Pone STATi Of (l)b IRAIJNI Ovally The foreruns, emolument von atarInland iwl.we me ,h,. M Pauline I. Cookery •11 m *I:4"M EWbeefy?aid fioira <r ,•( ./(' et. F /-ri l f Pauline 1. Cockney / V pins.. m, hand and 0A. Pal anal l. ,.,mm,..,,.r, W . Ne. K. Pr% Say. •ti PAL MAa* .l t I nar with. I PUM,N,ne wamM IFm r, I„M.,. .n ,...., ablB 1355 REC %455 10/20/92 13:14 $5.00 001 AR2J11795S F 0713 MARY ANN FEUERST.SIN CLEAR 6 RECORDER WELD CO PERSONAL REPRESENTATIVES EKED iTev ate Estate) THIS DEED is made by Pauline I. Cooke _ a. Pentmal Representative of the Estate o1 Lyle V. Cockney . deceased. Grantor. to Jerrold V. Cooksey_atad Jeffrey A. Co,keey __. fir ntre 42467 Veld County Road 10, Roggen, whose legal address u Colorado 80652 STATE DOCUMENTARY FEE Dale /n�__2% $ th•,43 of the ...aunt) of Veld_ ..... . . __.____ .___ of cure Colorado WHEREAS, the Last Will and Testament of the abum•nancd decedent was nude and executed in the lifaime of the decedent, and is dated Hat' 2_ _ .19 _9S.._. , which Will was duly admitted to WWI (informal) December 9 19 91 by the -__ District _ _ _ Court CCourtin and for the probate on em County on _ Veld __ . Stine of Colorado, Probate No. 9IFR281 ; WHEREAS. Grantor was duly apprnnted Ptrvmal Rcprcuntatrve of said listate an December 9 19 AL and is now qualified and acting in said capactty NOW. THEREFORE. pursuant to the power conferred upon. Grantor by the Colorado Probate Code. Grantor does hereby sell. camry assign. tnnsfe• and set over unto said Grantee (pxpiti "y r' (for and in consideration of Sixty Mot tpoossnd two hundred sixty and 50/100 ((62,260.50) Dollars)" ( yCIIIMI- fl VBpe• the following described real property situate in the —__ County of .Jin1A .. State of Colorado: An undivided one -sixth (1/6) interest, above decedent's interest in and to the W 1/2 Section 7, Township 1 North, Range and SE 1/4 Secticn 12, Township 1 North, P.M.y together with all of the decedent's right, title and interest in two irrigation wells and one domestic well, save and except all reservations contaired in Patent recorded February 2, 1982, in Book 960 as Reception No, 1881930, Weld County, Colorado. representing all of the following: 61 west of the 6th P.M.; Range 62 West of the 6th also known by street and uwmber a 42467 Weld County Road 10, Roggen- CO 80652 With all appurtenances. subject to covenants. easements all restrictions nl record. and subject to general ptaperty lases for the year 19 Si.. anld-m h eet-No As used herein, the singular Includes the plural and the plural the singular. Executed Ct e -._1 ___-.. 19 STATE OF COLORADO 1fI ('ANTY Of ._. "Y.er"4. -54_.44. Pauline- T. cno!'g-y .4 the lstnr,a } The foresmng instrument w as xkn•wledge,l before me this _ 5.1-k by Pauline I. Cooka.ey as Penrmal Representative of the E•ate of . Lyle V. (:ookse7 Wnnea rrry,heipil t o(fiaal seal My orhn iwaq es & _:_-alJ 1. .. . .7 CD III in t%IMt Vwen Vr• •rrJI ••9n4runst.NQ• y o1 14r.mai Heprrwmana Ik.eawa atc-db. --. _ .19 CPOIC M.1147, rrasnr.L.alPtle4nTUnr smrn,wawe. P,IL. NN..P,e, 1. w'.rra 1. err r u s',: l.pl ria rM IT a Jana Rot 2d¢ OP COLORADOatIGWPSOo ry Fm/toW App IY)ATQI TA PPnrrr TO os GROUND WATfl A mAy no ii A POINT TO COlonmWT A WILL eaea Applbtt e II away- LOCATION or ant. C0MM Wag wld an SIM _Ai aisles =hi/4=r 20 Trade Pa -0r AP Rapp IL aId for Osmotic Noll Paps Y I♦e. 61y Used for twat Sec). 1Tl caserth Tarei an Adios ee u & Pod! No. bit Total aroma irjtlod m b4 rte PlUWA?EO DATA OP W U. Nola slow_ 2—b.Io_ZEJL lab R ggi Cub( WALL Jo. boa 0 b_a_It. b. Com to ft. Opa Poe K rtmj_tort. D —b PUMP DATA: Type taboo .IIP Aon irea Os WNW. dole wt ip 6l• '. IO.. PMgplkrpbl PM rs ddllbl3Ll TINS APPLICATION APPROVED PEWIT NO. 155( 4 zoom DATE 22 1963 - is To.. or Pdurbm. Locate wLL b 40 moo ( Wag sate k .sr as p.®ie. taro mew to � waft. WOO loo neared br .we otter W. ROmrtle or Womack. ApPnsmt MWor f n.e •.11��..cdAb.�y� Wrap P 0 lox SI0 Part Mormon Colorado ROTII — $ATWPACTORT WIIPLETICW RI .= FOR APPROVAL OW APPLCAT3I Wilk COLORADO WELD COUNTY DEPARTMENT OF Pali �EALTH AND ENVIRONMENT 555 N. 17TH AVENUE GREELEY, COLORADO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411 SOE# ORG PERMIT # REPAIR # LOAN # _ ISDS # STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN BLACK INK ONLY) PARCEL NO. yq cy/ 0.7 0 CO 000 3 PROPERTY OWNER J(}7 Cnoi el re 71,15 MAILING ADDRESS /). 4' �j ICC / (J PHONE NO. (D L'/y- S &% City State Zip DESCRIPTION OF BUILDING (ex. house, mobile/modular home, shop, office) /t pu SITE/LOCATION ADDRESS ua YK3 W (, 10 , P.O3,en ( d SO(75),_ t// City State Zip LEGAL DESCRIPTION PT '2) City PT 2LJ/t,5ECTION 7 TOWNSHIP / A. RANGE SUBDIVISION LOT BLOCK FILING CENCUS TRACT LOT SIZE/ACRES COMMERCIAL YES / 'Of RESIDENTIAL YE / NO NUMBER OF PERSONS 41 BASEMENT PLUMBING / NO BEDROOMS 3 BATHROOMS - FULL_L 3/4 / 1/2 WATER SUPPLY - PUBLIC YES / NQ) NAME PRIVATE &E9/NO WELL . /NO CISTERN YES VO WELL/CISTERNar _ SYSTEM SIZE: Septic tank material is constructed of ,^v4creit and has gallons capacity. FIELD: Trench square feet or Bed square feet YEAR INSTALLED curt Sy51'em Was' pct' - Piesfoi� Wndil irUZltasoci othreporfy iaWSyn./Aui Tenctar.tj welt since. 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 describe and exists at this time on the parcel of ground identified by the above legal description and further states that the syste is is not in good working order and to the best of i' /her knowledge is s n 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 Iggal action for en u as provided by law. DATE OWN Subscribed and sworn to before me this By k.flie-ty A oks4 Witness my hand and official seal. My c mission expiry <$LOo k L - DATE LNUTARY PUBLIC 4� STATEMENT OF EXISTING REVIEWED BY day of (ay , 20oq. 7 ENVIRONMENTAL HEALTH SPECIALIST liP Opt Weld d A. �.Jr w c � u r Inc J �.. Company Name; ( r t?L yl A 9 Customer Name: �a ri: Cob C), .enti 0111 Address of Pumping: '1 9 B3 W , ). t Q Pumping Date: Z 1. Tank Size: 7 $ 0 Gallons Pumped: 2 5 2. Lift Station: Yes No X- If yes, functioning: Yes No 3. Excessive water running back into tank from field? Yes No x If yes, estimate in gallons: 4. Liquid level in tank over inlet line? Yes k No Phone number. b 3i a 7(0 wit 5. Tank Construction (check one) Concrete Metal Brick Plastic or Fiberglass Cesspool or eepage Pit Other 6. Tank Construction Observed: One Compartment x Two Compartment 7. Inlet/outlet tees and/or baffles in good condition? Yes X No 8. Filter on outlet cleaned and inspected (if applicable)? Yes No 9. Access to clean -out lids within 8 inches of grade? Inlet: Yes >t No Outlet: Yes 2( No 10. 20 ml. plastic replaced and sealed over tank lid (flood plain only)? Yes No 11. Tank/lid structurally sound and water tight? Yes A- No 12. Obvious cracks/leaks observed? Yes No X If yes, explain area: 13. Other conditions noted which may affect proper functioning of system? 14. Reason for Service: Maintenance X Real Estate Sale Emergency/Backup Other 15. Notes: S S Septic Cleaning Line Locating Video Inspection Excavation r -- Customer I k C Da et Address tL2 5 'sX c 'i / cT' City & County Phone 9703 WCR 59 Keenesburg, Co 80641 Business phone & fax (303) 732-9208 Steve's cell (303) 710-0127 Chris' cell (303) 710-0501 OOk Tank Size 7 -Ca- <1000 1250 1500 Other Tees & Elbows in place Compartments Condition Labor Hours Locating Hours Video Inspection Hours We apprcerint''Jaun J3uouteoo Labor is one -hour minimum Yes Per hour Date Price 225-C 2 3 Poor Price Per hour Per hour Price Price c Total; 2 �� Hello