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Home My WebLink About20022836.tiff 01/1E/2002 03:77 97E-395-0597 NORTH kELD WATER PAGE 62/02 BOARD OF DIRECTORS NORTH WELD COL . IV WATER DISTRICT GARY SIMPSON 33247 HIGHWAY 65 • LUCERNE,CO 90646 ROBERT ARNBRECHT W.M.McKAY DON POSSELT,DISTRICT MANAGER CHARLES ACHZIGER RALPH PRIOR P.O.BOX 56 • PHONE(970)356-3020 • FAX(970)395-0997 email: water@nwcwd.org January 18,2002 Sharyn Frazer AgPro 4311 Highway 66, Suite 4 Longmont, CO 80504 (970)535-9854 Fax Dear Sharyn: North Weld County Water District currently supplies domestic water to the following property: Rick Podburg(Podburg Dairy LLC) 19187 WCR 92 Pierce,CO 80650 Meter Number: 111901 Respectfully, &u..- - (n .4r' Colleen McGehee Office Manager 2002-2836 01-25-02 05:44PM FROM-DIVISION P'NWITER RESOURCES 3036662223 ,-., 1-366 P.02/03 F-03T REPORT DATE 41AI.V14MMLA 61 RFFiJ A4r 5`Id4M I%1111115 Mil CIMIIII I PAGE 64W 26 16*06 MST 2007 COLORADO DIVISION OF WATER RESOIJO:ES PERMIT 0 CTY OWNER INFORIMTAN ACTNRt STATUS 1ST USED ANN AREA DEOL WSLL WELL wTR SEC L.00 TwN P , ' ro CAT" Eft Dan wn MD 11F ;ISIS Derr APR ;RR ARFR alai n rWTH I F,i Ps N,'1Rn aTrt4 SFr 4MP REAR 4 765040 0 wa WOODS PENT PIERCE.CO 60100 An n 1 2. 0 IS Q 0 0 n0 NFNF 17 641 Y+.w S TYf06 1 wi, WACNER EENJAMIN 41.6AJ 20200 wCR 97 MARCO.0060650 EP oc 05-00-2000 1 A 11.24.1M4 a A ({w 1A on IA 1.. 1wry ITS* 3w NW 17 6h flaw S 46496 1 WEI. 1AAMNGTON R.0. 1336 GREER ST FT COW.IN9.CO 60524 I 06.11.1271 n 0 GW 1500 20 7 0 AFAR 17 AN AEA 3 66765 1 a MRMhGTON RD 13250RP8/STRFET PTCOUL94 CO 10621 I n 6. 07.1M11977 n lion am 'Ant_ 21 A 154,3.]SIIS HESE 17 6N 05W 5 60606 1 WEL EARMFGTONR0 UN GREEN STREET FT COIMMt CO 60531 A9_ 07.10.197? 0 1500 Rw 1500 42 0 17609.170E 'Fit 12 86 flSW y. 6466, 1 WEL BARMNGTON 801275 GREEN ST FT COLLIN1.CO 60521 1 69 10.20.1971 0 100 Ow 1500 21 10 75114131F NAAF 17 AN A7w 5 SONS I WEL ORSON ACFIES CO. 1225 GREER ST FT COLLINS.CO10621 1 0 LlA1-YIA n n_ Guy _15Jp i1 6 00 SEAM 17 AN Mw 4„ 66332 1 wEL r10.6WGER PAN 4621 E COUNTY RD 46 FT C04LN4.Co 60521 n 10-0M91L 0 0 9AIY 1,0" PO 10 16117018 4FIF 17 Ak sin. S 77906 1 WEL *SLAW SAM S WD 1 SOX 47 PIERCE.CO 90660 I p 1.1-36-1662 0 100 Ow IR00 S0 0 &M477AF SF SF 17 A90 FAN 5, 46436 1 WEL GREEN ACRES CO 1216 GREEN ST FT COLLINS.CO10624 a OAn.1971 a A INa LS nn 11 a nn SW SP 17 art 04w 4 M437 1 WEL DRIP.ACRES CO 1275 GREEN ST 7034465.CO 00524 1 P 90411-1X71 0 0 Ave 1400 20 T an AwcF 17_ AN N3w_ S 5832 I WEL NOL MC 0 Mut 46211 C01NTY 0040 PT COLLINS,CO 10621 A nM110.1R72 0 n RW 1400 70 In nn Aw43 17 Al Mw S SRDOR I WEL ANWIJESKI JOHN H PT 1 BOX SO FRCS.CO 60650 ' SA I © 11.51-1906 0 0 CM 31000 37 10 wins now NWSS 17 AN T45w I / IE/ 22011F 1 wa ANOREWJESKI J0N RT 100069 FIERCE.00 60650 3 I F16 A7.71-1977 0 4n an 1N m ill 17 Nns WILYµWSW 17 IN flaws 9YO 22020E I wa AAJSSKI JOW4 n RT 1 602 59 P VERGE.CO 60650 1 a nf.1A.1Mf n n Rau 1,1_00261 0 0 e4 onw Nwcw 17 AN 1.0W ., li-� 2509AD 0 WEL M 63KIJGINN FT.COLLin ,0010521 I I. A0 0 n 6 GW 0 0 0 yQ Jaw 4w 17 Oh mw 3 17291F I WEL ANLYOESK,aSh RT1 BOX 56%RCB.0010660. ✓ FP Ol-x19L , O 0 0 06 0 0 0 PAMIR allw Nwew J7 IN Irw S 46379 1 634 ANDRYESTRI JCNN H PT 4 DOA 72 FT COLLINS.CO 60624 S-4 6e 3 ® a n Ow v00 27 12 ps way 17 AN A5w_ 3 /It*N 1 W0. ANOJOHN it YESTRI JOHN RT 46007?FT�CCO�LUN$.CO 50524 �q V I AY ] 0 0 Ow IRO 30 17 nn Sw6W 17 IN 85w S 02-05-02 12:12PM FROM-DIVISION P^MTER RESOURCES 3038662223 T-506 P.05/09 F-I9T • .1wR47a • COLORADO DIVISION OF WATER RESOURCES RECEIVED t . 300 Colombia*Bldp.,150 Sharman 8t.. Denver. Colorado OM �' • • PERMIT APPLICATION FORM Ev26'J6 Trev3aue Application where l •I A PERMIT TO USE GROUND WATER 7 3 6 7 •pplicable.Type or I 1 A PERMIT TO CONSTRUCT A WELL Oil Print in BLACK PORT( IA PERMIT TO INSTALL APUardi � Res if` 72683Rfis,No . rtolkes or erasures unless ( I REPLACEMENT FOR NO Waled. 1 OTHER x/�E. WATER COURT CASE NO. >1 .141)APPLIG}1NT-Meiling address OOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN a ., •NAME • dalp tdrijeniti Receipt No. 7 49 ( / STREET Me. 3 *di 69• Basin Ora. • - CITY Mtn. (j0.. ROSSO IONS OF APPROVAL MAIM MO CONDITIONS TELEPHONE NO._ r1534•20.19 This well nit be used in such a way as to Cale no matgsiai injury to existing water righu. The 42) I[1CATION OF PROPOSED WELL nuance of the permit does not assure the applicant that no Injury will occur to mother vested water • right or preclude another owner of a vested water County Wad right from seeking relief in i civil court action. Nl>t z of the -11.Seddon 1, 1) Aim AB A SE2DAC$45'iNT OF MaPflC NO. NLI6TIN3 WILL MIST BEG PURIM AND Twp- B X ,Red. -. AA►ROp�a p.M. NO)3D01g1 TO TEIC REVISED AND A» in.si 'L I RULSB AND RW:UDATIONS FOR WATNSw WE4L AND PUN P (3)WATER-USE AND WELL DATA INNTAMAT= co l'NAtTOR9. TES ENICIp98D ABrnDAVIT .60, Cl! sr MX= wzmap Sin'Y (6o) DAYS AFTAN hoposp minimum pumping rata 1 1 323-"1@,�. TFJF COORTISEVTIDN Cr ISM NEM CI, AMMO* TS! ..--, WNa+L NO.a7eN•f r WA9 P]IRNGRD-ANp RANDOM). Avyrsgsannual-amount of Pound,water NO I L ,. THE MIMI P(AIPSTEr BitTE OP TENS IC SNNA7.L NOT to be appropriated lacre•renti _ IC1a:EED 300 I7( PURSLIANT TO DIVISION 1, COURT CASE Nerds of arts to be irrigated: 40 0% DX8>DC W-1328. mb 2) AVERAGE ANNUAL APSWalltIATION Cr via WELL CON- Proposed total depth(feat): 40t. BIM WWI TNNB APRISCANT'9 WELL MET NOS. RD-8 AND$e'R.aV-f (No. 2, W-1328) MIS, NOT =CM Aquifer pound water is to be abtuined from: 120 *anima FOR INRICIATION OP LAND IN 19Wy of illuvitss 6W}, Sae. 17, T. BE., R. 65v. Owner's wan deslpnalion Mail # 1 . ...... . MOUND WATFR TO BE USED FOR! ( I HOUSEHOLD USE ONLY-no irrigation ID) I I DOMESTIC(1) l ) INDUSTRIAL.(S) I ) LIVESTOCK 12) 2 I IRRIGATION (BI I I COMMERCIAL (4) ( )MUNICIPAL 181 ( )OTHER 19) 1 APPLICATIONROVEQ .. DETAIL THE USE ON BACK IN(11) PERMIT NUMBER ei2_2Q19-RF (4) MUL Ees. DATE IssuEp ED LESH DRILLING, INC. FEBO fl- 1� Nam EXPIRATION DATE E 21108 Seen BOX 56 r • Ault, Gala. 80610 EN qtr B34-2066 21 21 ialai By 1' Of X.r Telephone No. Lis.No. I.P. /- 0/ COUNTY 6 2 02-05-02 12:13PM FRCM-DIVISION P'""ATER RESOURCES 3036662223 .-. T-5C6 P.06/09 F-161 13Y ?t MICE OF TEE STATE Exam COLORADO DIVISION OF WATER RESOURCESACCORDIlig TO TEE TYPE ON• � -4.816 Centennial Bldg., 1313 Sherman St. =C� GRUM DEER PRIrtO' /[�/. MX NO. V elfl1i sta., aI or A�P� N�T�o Denver, Colorado 80203 RATER DIVISION EMEMT NAILED Y aM NEQUSET. STATE OF COLORADO Malip nett SS. f32-1104 .jll . 03fa COUNTY OF _ _ 1973., well #2 DM 2/2/77 STATEMENT OF BENEFICIAL USE OF GROUND WATER - AMENDMENT OF EXISTING RECORD - LATE REGISTRATION ref�1r��7s� PERMIT NUMBER 22020-f' LOCATICN OF WELL ,X THE AFFIANT(51 t7obn 151. ay,drii.rki CC. — Wield whose moiling address .s ate . 1...Fnig K9 IN__ r.of the s. City Pia"ese Q.Q... - _A(1O6I1 Y-p _..E.. S — . lent _ � _ P rT•. +1 r.lrh :a i being eulr .—ern -Dori oath, deposes and says that he Ithey) Is (are) the owner(s) of the well described hereon, the well i1 located as described oho+c, of distances of 'NIA fee from the t._.OQAt' 1 Acct. line and ..452.—.-.ha iron; the n ne 1o,aa S Station line; water from this well was first applied to o beneficial use for the purpossis)described herein on the 28 µy,. .1111 day of P t1EEYY , 19, 53, the maximum sustained pumping rant of the well is eM^ gallons per minute, the pumping rote claimed hereby o . 157 - ._.,gall ens per minute; the total depth of the well .s .tweet _„feet, the average annual amount of water to be diverted is -snail.. acre-feet; for which claim is hereby mode for Trr{ ,tl ey' - perpe)s(s); the legal description of the land on which the water from this well 1s abed is • _of which ■„d vlsiek Ir illurtrntrd m the man nn the Mtn *jib Of thi1 fcfmr Mat this well was completed in compliance with the permit approved therefor; this Statement of fsemellefal use of ground warnsis filed fn compliance with low; he (they] hue (have) read The statomalts mode hereon; knows the content thereof; and that the same ore true of his (their) knowledge. (COMPLETE REVERSE SIDE OF THIS FORM) S;gnarars(*). Subscribed and sworn POP OFFICE irEO ONLY to before me on this day of , 19 Cow Cosy Ho WW 1.320 .... My Commission soiree: %sta. +Asir 01.. 1 -CI,. 632 ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO PURSUANT TO THE FOLLOWING CONDITIONS: Ccli use - -- D,.. _9.,k_ nut r M.., D;,. . . FEB 21977 e IWO STATE ENCi it —_�! 02-05-02 12:12PM FROM-DIVISION V ' TER RESOURCES 3038882223 - T-500 P.04/00 F-1ST sum F Mi.T '- Or STATE OF COLORADO ) �,� . " DIVISION OF WATER RESOURCES UkId 2a W59 ' .• ; . ,a!•ICE OF THE STATE EIROI?EER, iok .2•ROUN SECT;ON MUSD SCIA.33 •-• ;j ADO REGISTRATION NO.,1_O Ro. 7 4,,-f381nATE eleiNEER Registr 'JOHN PI. AflRIJESKI . jZ' ,.,` Date 19 Rte 4, Box 72 • P.O. Adt1t Fort Collins, Colorado 4. r . WELL LOCATION 10 10,2, WELL DATA County Weld_ DeW Diameter , in. kW ta.5 W Seaton Casing ;Sit, Plaim ft. Perfor. MIL—Litt q/ , M � RP' f / .^.Q- M Static aster Level Ft, from top 270' E. end 20t So. of NW corner of Witt ale of said Section 17N Yield m)(efs) from ft. • 1 Used for irrigation on/at Wit Ago 01^ �4 n . 17 .. 8.468 " —et ------I-- -- ( eaription of laws or stay I i Water conveyed by size W a I j $ PUMP DAtA I 1 • Type Electric Sine ( I Driven by 3 RPM at RPM I I Well was first used December 31, 1958 l i S cis for irrigation using using_a mmm WELL TO BE LOCATED AS ACCUR- Well enlarged , 19_ to SMALL SQUARE S WHICH REPRESENTS deepened 40 ACRES; OR IF IN A TOWN OR (gpm)(cfs)(ft) SUBDIVISION FILL IN THE FOLLOW- ING: LOG SHOULD RE GIVEN ON REVERSE • SIDE IF AVAILABLE Towa or Subdivision Street address or Lot and Bloch — The above wall (haa) (YMI been registered in the Office of the State Engineer prior III General Adjud !Caticn, Water Dist #3 to May 1, 1957. If Registered give Filing No/ 9-}0 r3. c tv i1,strum 11217 If NOT Registered prior to May 1, 1957, a $5.00 filing fee accompanies this form. . The above statements are true and correct to the be of my knowledge and belief. • . ,. ... bed and Sworn before me /L4-44 / this •. ...�..`4inY of it- U. .- 14 b .My comp-1161in expires tsant 6:" VEAL) y✓sfa.i . fee u_1 it # I it�PIM a fir+ ROM men, ,` Ma. (LC-f Fo FOR STA� ENGINEER'S USE 1 I Located in de strict, #xe! County to • 0 Registration No. P in /—,L-4 . an r, ... -4i , lA See- /72Q/ F 02-05-02 12:14PM FROM-DIVISION ''1TER RESOURCES 3036662223 *••••N T-S06 P.05/09 F-19T $411.092• COLORADO DIVISION Qp WATER RESOURCES RECEIM� ' y it s 101 Columbine 81dg 1845 8hemsas it rad,Donor.Coloo a0eoa �rFF�. Y • egatl?APPLICATION FORRM a 05 73 Applkaecn °neat be wows whet ( )A PERMIT TO USE GROI.IND WATER rN oas_y__ *Pile Type or ( )A PERMIT TO CONSTRUCT A WELL , Pant In BLACK FOR: ( )A PERMIT TO INSTALL A PUMP INK.No orentrikoa or sans sa1Iis ( I REPLACEMENT FOR NO. .Et•placaastt Ao. um sloven (thinics uaretie. InitNled. Chia da ttsa N 36704 tend) 1 )anon Cl) APPLICANT•meiling address FOR OFFICE USE ONLY: DO NOT WRITE IN This COLUMN NAME Jam is. Aadriiaskt Receipt No. Oat' ' / STREET R0. l. Don 58 Basin Diaz. CITY PSerea. Colo. 80660 rsus.l RAM . DON Col TIONSOE,(1PPRAVAE TELEPHONE NO. 836'2020 This well shall be used in such a way as to cause no material injury to existing water rights The (2) LOCATION OF PROPOSED WELL • issuance of the permit does not assure the applicant that no Injury will occur to another vesnd water Coumr Wins right or preclude another owner of a vested water ►ieht from seeking relief in a civil court action. 1., All a of Me 81f K,Sateen 17 APPROVED AS A REPLACEMENT FOR WELL NO. 7 IN Twp _IL— L Rnp• 6S B PM 5. 17. TOM, R6510; AS DECREED IN CIVIL ACTION • NI6704"IN WELD COUNTY. THE US! OF MATER FROM THIS (S) WATER USE AND WELL DATA WELL, CORIUMWITH TWO OTHER WELLS IN THE OF SAID S.17 IS LIMITED TO THE IRRIGATION OF I ACRES IN THE SO OF THAT SECTION. THE OLD LL 'Proposed maximum pumping rate(awnl E87 NEST Si PLUGGED AND ABANDONED ACCORDING TO WELL DRILLING CONTRACTOR'S RULES AND REGULATIONS. Agape annual amount of Roe!L, • all.asaaa m Di aplaro an psdrrs Ann,rte, 'amazed elth 2 tee additional walla _.. . Number of airs to be Irrlaatad: PO Propaad toW depth N al: 30' Aquifer ground was'is to be ccmined from: • AlltroLool Ow~ 1 Wen assignation • QROUNQ Iy4TER TO RE USED FOR; - I I HOUSEHOLD USE ONLY•no irrigation(0) I I DOMEITIC t1) 1 I INDUSTRIAL (5l ( I LIVESTOCK (2) (X I IRRIGATION ON 1 I COMMERCIAL(4) I I MUNICIPAL(Ni I I OTHER IBL AppLICAJiON APPROVER. ' PERMIT NUMBER 017291-F (4) DRILLER JUN 2 2 DATE ISSUED �a . Name t..fi 'nr111'4 g t'.a. EXPIRATION DATE a 22 1974 Street Dolt 56 . . - . . ypElel/► • Cry Agit- Cob*jenny8063Q ia1 �jil� A ) TMepnone No._ 834.2868 Lia.No. 23, BY I'D_ /al DDUNTY 43 02-05-02 12:13PM FROM-DIVISION Y 'TER RESOURCES 3036662223 T-606 P.07/09 F-191 Well drilled by Lie. No. �-., Permanent , Pulp Installed by , Lic. No• Meter Serial No. _.....-,. ❑ Flew Meter pore Installed Owner of land en which water Is.bapus used '— WELLS THE AREA ON WHICH THE WATER IS MUST MUSTEBE SHOWN ARP OR CROSSH CAPACITY ON THEADIAGRAM BELOW. This diayrwn represents nine (9) sections. Use the CENTER SQUARE (one section) re Inclitatethe.location of the well, if possible. I I I I I I -- - - - + + - + - + + . + . • - • { ' } - +-• -. + ,- +- ,- + - . . + - + - NOR,TH SECTION L IE I I _ - NORTH _ .• N J WO rn ' _r` ' .. _ I ---- e.. x �� 2 r + -- + A. -_ --- i + - + - Ir w 1 I SOUT1f SECT ION LIFE } re -- + - + - t - 1- - + _ + I 1 I I i - Th1! SCALE OF Tr! DIAGRAM IS TWO INCHES E7UALS ONE-MIL E .. + — + — t — t — + — t - -. i --1, Mile;-- . , WATER EQUIVALENTS TABLE(Rounded Ftpuros) An aen•feat corers 1 acre of lend 1 feat deep. 1 cubic foot per wand(de) . . . 449 gallons per minute(cum). 1 acts•fact . . . 43,560 eeb:c feet . . 225,900 gallons. 1,000 rpm pumped continuously for one day produces 4.42 acre-feet. 100 rpm pumped continuously for one yea preducee 160 ocredsst. (WHIT! AND PINK COPY TO BE FILED WITH THE STATE ENGINEER PINK COPY WILL al RETURNED TO 011010 a S DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT — 1555 Y 17TH AVE GREELEY, CO 80631631 WEBSITE: www.co.weld.co.us I ADMINISTRATION (970) 304-6410 FAX (970) 304-6412 O PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420 FAX (970) 304-6416 ENVIRONMENTAL HEALTH SERVICES (970) 304-6415 COLORADO FAX (970) 304-6411 April 18, 2002 Highland Dairy Rick Podtburg 4311 HWY 66#4 Longmont, CO 80504 RE: ISDS No.: 02-036 Permit No.: SE-0200029 Dear Mr. Podtburg On April 18, 2002,an evaluation of the existing individual septic disposal system at 19187 CR 92, Pierce,CO 80650 Section 17, Township 08 North, Range 65 West, was conducted by Deborah Blandin, an Environmental Specialist of this department. Based on all available data the field is undersized by an estimated 45%. Because the system was installed prior to the adoption of statewide guidelines by the Colorado Board of Health,the County considers this system to be"grand fathered"and will not require that the system be brought into compliance with current regulations. The Department recommends that the absorption field be brought into compliance with current Regulations. Please be advised that should you decide to repair your system,a repair permit must be obtained and a site evaluation must be conducted prior to any alterations to the system. If upon review of the USR for this property it is determined that increased hydraulic flow will result, an evaluation and inspection must be performed by a registered professional Engineer. 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, Deborah$landin Environmental Health Specialist DB/dyc Enclosure WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE (970) 304-6410 FAX (970) 304-6411 STATEMENT OF EXISTING RECEIPT Receipt Number: HES-02026 Amount: $10.00 Date: 04-11-2002 Payment Method: Check Notation: CHECK 1901 Initials: CS Owner Name: HIGHLAND DAIRY-PODTBURG Applicant Name: FRAZER SHARYN Permit Number. SE-0200030 Parcel Number: ?? Site Address: 14672 SW4 17 8 65 EX C UPRR RES (4R) 96191 87 WCR 92% J oration: 19187 CR 92 WEL Total Fees: $10.00 Total All Payments: 10.00 This Payment: $10.00 Balance: S0.00 Account Code Description Amount 256041400-4221-400 Statement of Existing $10.00 xr HEST WELD COUNTY DEPARTMENT OF PUBLIC SE# Ir1LTH AND ENVIRONMENT '� ORG PERMIT# -*MR ''7 1005 N. 17'AVENUE REPAIR# GREELEY, COLORADO 80631 LOAN# WilDe FAX:PHONE: 04-8415 ISDS# FAX: (970)304-6411 COLORADO STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN BLACK INK ONLY) PARCEL# 05511700o I7 0o0 0 13 PROPERTY OWNER AtG'hIf1.1YA wr3Q.1C11-1'od1•I0wtcj PHONE NO. 130 434- 89 a4 MAILING ADDRESS 51,51 lute 4a inntrtnSIou)n C , pp5 4 City State. Zip DESCRIPTION OF BUILDING (ex. house, mobile/modular home,shop,office) les t4e.ncG- � r SITE/LOCATION ADDRESS iql SZ W(ac.. q Z TI, kroG Co 80(x+50 City State Zip LEGAL DESCRIPTION PT PT SECTION I1 TOWNSHIP 8 RANGE Ce 5 SUBDIVISION LOT BLOCK FILING CENCUS TRACT as •U k LOT SIZE/ACRES l ltt au n.c. COMMERCIAL YES/ RESIDENTIAL NO NUMBER OF PERSONS BASEMENflLUMBING YES e BEDROOMS_ BAITIRO-OMS FULL_____ 3/4 I/Z_j__ WATER SUPPLY PUBLIC f )NO UTILITY NAME 14.GJCU0D - PRIVATE YES/4c5) CISTERN WELL YES re WELL PERMIT# SYSTEM SIZE: Septic tank material is constructed of Cove,',P.and has /100 gallons capacity. FIELD: Trench 76O square feet or Bed square feet YEAR INSTALLED I t-1 0 You are required to draw a diagram of the system on the reverse side of this form in black ink only and indicate location,length,width,and distance from the dwelling. The undersigned property owner hereby certifies that the above described septic system is in fact installed,as described,and exists at this time on the parcel of ground identified by the above legal description and further states that the system is/is not in good working order and to the best of his/her knowledge is/is not failing to function properly. I further understand that any falsification or misrepresentation may result in revocation of any permit granted based upon this information hereby submitted and in legal action for perjury as provided by law. DATE Subscribed ayd sworn to before is day of }9g aM Witness my hand and official se g'T` ETA 9&Li��9 My mission expires: 7 •IO • 0 1 • lD •05 • ' DATE I N ARY PUBLIC NA%.pO tG.:O STATEMENT OF EXISTING SSP. ma a COL ENVIRONMENTAL HEALTH SPECIALIST „/".. .. 7. T' N \ . I SoL. mac, fro, d c,cr 9g. r Kit(7:4;"\\ DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 N. 17x' Greeley, CO 80631 Website: www.co.weld.co.us Administration: (970) 304-6410 Fax: (970) 304-6412 Public Health Education &Nursing: (970) 304-6420 Fax: p70)304-6416 Environmental Health Services: (970)304-6415 COLORADO Fax: (970)304-6411 April 18, 2002 PODTBURG DAIRY Rick Podtburg 5651 CR 42 Johnstown, CO 8O534 RE: Rick Podtburg No: 02-035 Dear Mr. Podtburg: On O4/17/20O2 an evaluation of the existing individual septic disposal system at: 19187 CR 92, Pierce; Section 17, Township 08, Range 65, was conducted by Deborah Blandin, an Environmental Specialist of this department. The existing individual septic 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, Deborah Blandin Environmental Health Specialist form:pa03Appvd r WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE (970) 304-6410 FAX (970) 304-6411 STATEMENT OF EXt TIN RECEIPT Receipt Number: HES-02025 Amount: $10.00 Date: 04-11-2002 Payment Method: Check Notation: CHECK 1901 Initials: CS Owner Name: HIGHLAND DAIRY-PODTBURG Applicant Name: FRAZER SHAYRN Permit Number: SE-0200029 Parcel Number: ?? Site Address: 14672 SW4 17 8 65 EX C UPRR RES (4R) %191 87 WCR 92% Location: 19187 CR 92 WEL Total Fees: $10.00 Total All Payments: 10.00 This Payment: $10.00 Balance: $0.00 Account Code Description Amount 256041400-4221-400 Statement of Existing $10.00 xr HEST WELD COUNTY DEPARTMENT OF PUBLIC SE# O? (-20l )d I it 6 'ThLTH AND ENVIRONMENT ORG PERMIT# 4 tot ‘,;' 1055 N. 17TH AVENUE REPAIR# GREELEY,COLORADO 80631 LOAN# es., WilDe PHONE: (970)304-6415ISDS# O1-O3 6 FAX: (970) 304-6411 COLORADO STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN BLACK INK ONLY) PARCEL# 065 ��0000I n PROPERTY OWNER is ttVIM - indit jlq1 PHONE NO. �D31 434-89a4 MAILING ADDRESS 5�ti I W t.R.. -41111110 �hn wn co 865 214 City State Zip DESCRIPTION OF BUILDING(ex. house,mobile/modular home,shop,office) DQA)u.A1 bO3-kn SITE/LOCATION ADDRESS ( %81 W C& Q Pt ere OD 80195o City State Zip LEGAL DESCRIPTION PT PT SECTION 11 TOWNSHIP e¢) RANGE c 6 SUBDIVISION LOT BLOCK FILING CENCUS TRACT a S •01 LOT SIZE/ACRES COMMERCIAL YES J RESIDENTIAL YES/ ) NUMBER OF PERSONS BASEMENT PLUMBING YES IC) BEDROOMS /x.10... BATHROOMS FULL 3/4 1/2 WATER SUPPLY PUBLIC s S I s UTILITY NAME 4td'm CN►?4l Jae" PRIVATE YES/NO CISTERN S/NO WELL YES/NO WELL PERMIT# SYSTEM SIZE: Septic tank material is constructed of Co4vCAePf. and has /000 gallons capacity. FIELD: Trench square feet or Bed Geo square feet YEAR INSTALLED i C. I el You are requ• Yred to draw a diagram of the system on the reverse side of this form in black ink only and indicate location,length,width,and distance from the dwelling. The undersigned property owner hereby certifies that the above described septic system is in fact installed,as described,and exists at this time on the parcel of ground identified by the above legal description and further states that the system is/is not in good working order and to the best of his/her knowledge is/is not failing to function properly. I further understand that any falsification or misrepresentation may result in,revocation of any permit granted based upon this information hereby submitted and in legal action for perjury as provided by law. 4.11.0 — #4,141.4*: .‘ DATE Subscribed and sworn PSyrr.-. ; this (I* day of A-41'1/44 , 199.2.000-- by Witness my hand;ntTofficial seal. t My co mission expires: 1 •(0 •0 5 CultoDATE i't,Op*• .•• . O ..OPP. NO ARY PUB C . .. . _.. STATEMENT OF EXIST I' VIEWED BY ENVIRONMENTAL HEALTH SPECIALIST Mg • • • • t e yn --1 • • 10J Hello