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Home My WebLink About20101930.tiff • • • 1 , ,A\A'I ER UISTRIC'I. PR \ GUS I PRESENT 1 PREVIOUS I PRESENT 1 n ?ATE II READ:NG I READING J 101630 COGBLJRN, JESSIE P. ' 12/011 01/01 ' 22 23 113473 COUNTY ROAD 17 IPLATTEVILLE, CO 80651 , Pay online am WWW.CWsWD.COM GAIMIWSH, WATER CHARGE PAST DUE 1 16 . 50 43 . 00 rills.AAI(ll'NT 101630 59 . 50 I6,I,III,IIII„II,I,I,Ii 111111IIIl„IiIiILI„1L;ii,ii;i,i • cam® chmitAl.\\PI ('C M'Nil \TER UIS FRI('I »35'_nd A,1)cni'c_(hc<Ic'.CO 50(,31 IF 9T1-352-I'_5-I PREVIOUS PRESENT PREVIOUS PRESENT DATE I_---DATE READING READING 102181 12/011 01/01 89 92 SIIIMIllier C/O ROBERT COLLINS 13187 COUNTY ROAD 17 PLATTEVILLE, CO 80651 Pa o line a WWW.CW• ' .COM GALLONS \i:ATE' CWt GE PAST SUE 3 18 .15 0 . 00 lhapc Slumn inII,nn,aaul canon- PI S0 TE0N ACCOUNT NUMBER T 102181 18 . 15 II,II,II,1„111,II11,,,,IIIII,,,,,I III,,,,I,l,i„1,I,,,I ll,,,i • 2010-1930 WATER SUPPLY INFORMATION SUMMARY Section 30-28-13344 C.R.S. requires that the applicant submit to the County:Adequate evidence that a water supply that • is sufficient in terns of quantity, quality and dependability will be available to ensure an adequate supply of water. 1. NAME OF DEVELOPMENT AS PROPOSED X /� 'MI— (1912-4, ,S (i j f ':f t- 2. LAND USE ACTION O /aft E a AI r • a ,er F 3. NAME OF EXISTING PARCEL AS RECORDED ; ESa' 7/ " " SUBDIVISION i xyq- FILING (fl BLOCK 4_ LOT y A 4. TOTAL ACREAGE I 5. NUMBER OF LOTS PROPOSED ,. PLAT MAP ENCLOSED KYES / 6. PARCEL HISTORY-Please attach copies of deeds.plats et ether evidence or documentation. /e/A M bQ_;4'" A.Was parcel recorded with county prior to June 1, 1972?%YES 0 NO L a. ✓ B. Has the pared ever been part of a d-vision of land action sine June 1, 19727 ''r" OYES 0 NO If yes, dawdle the previous action 7. LOCATION OF PARCEL • Include a map Maiming the project area and tie tonsillar'setllan corner. _ _ ,__..__..___.__.__ _-- 114 OF l 114 SECTION .04-±1 TOWNSHIP 7.,74- E1EN ❑ S RANGE/C ; 7 ❑ E 0,W PRINCIPAL MERIDIAN: 0 8TH %N.M. ❑ UTE 0 COSTILIA ' 8. PLAT•Location of all wets on property mast be plotted and permit numbers provided /V / Surveyors plat Oyes ❑ No Root scaledscaledhand drawn sketch ❑ Yes ❑ No 9. ESTIMATED WATER REOUIREMENTS-Gallons per Day or Acre Foot per Yew 10. WATER SUPPLY SOURCE �— __•_____ __..___._ ❑ EXISTING 0 DEVELOPED ❑ NEW WELLS - 1 WELLS SPRING ® - s HOUSEHOLD USE I of units GPO AF WELL PERMIT NUMBERS/ o�oo J7 ME wit ��j/JI ❑cam ay(ad" sus COMMERCIAL USE p '2 of S.F. GPD 0 J,' o saw o O IMO IRRIGATION/I of acres GPD AF �� — STOCK WATERING A 0J of had GPO AF 0 MUNICIPAL WATER COURT DECREE CASE NO.'S ❑ ASSOCIATION OTHER - GPD AF 0 COMPANY a mss ICT ` �O 43/4/TOTAL GPD AF NAME 07-"'ir 2/'e" G LETTER OF COMMITMENT FOR SERVICE 0 YES 0 NO 11. ENGINEER'S WATER SUPPLY REPORT ❑ YES )ZNO IF YES• PLEASE FORWARD WITH THIS FORM. She say be rgmM be=MIT review is compmaed) 12.TYPE OF SEWAGE DISPOSAL SYSTEM X SEPTIC TANKILEACH FIELD 0 CENTRAL SYSTEM • DISTRICT NAME t fit y t : ' :e. C ❑ LAGOON 0 VAULT • LOCATION SEWAGE HAULED TO 0 ENGINEERED SYSTEM (AIWA a copy of weieewiop 1aivi 0 OTHER • - WELD COUNTY DEPARTMENT OF PUBL• SOE# Cg BOO SO HEALTH AND ENVIRONMENT ORG PERMIT # 1555 N. 17" AVENUE REPAIR#' ' fertii. GREELEY, COLORADO 80631 LOAN # PHONE: (970)304.6415 ISDS # • VINDIg FAX: (970) 304-6411 STATEMENT OF EXISTING FOR SEPTIC SYSTEM a ,p�A (PLEASE FILL OUT IN BLACK INK ONLY) //'caf r eaur l'red Ca/4 PARCEL NO. t' 1, ac 2 90 co o Z 7 Q 270 7Ys43 PROPERTY OWNER gitssi A co Afate PHONE NO. (970i 7 FS-247 MAILING ADDRESS /3 if 73 C ryryU17 /A1G l-.// CO gain ®lets Muir /� / eR /y City State Zip / ¢ eit5 70 �J�f� B co///I� DESCRIPTION OF BUILDING (ex. house,col/eel' home, shop, office) #0 Cc 5 -( SITE/LOCATION ADDRESS 13 N 73 C R 17 Sivgx,F9,N2cE lie T City State Zip LEGAL DESCRIPTION PT PT 5 ECTION .4I TOWNSHIP II!" RANGE Ai7LC t SUBDIVISION LOT / BLOCK FILING 6 , CENCUS TRACT LOT SIZE/ACRES / 6O ,,ateQ.X . si COMMERCIAL YES /i O RESIDENTIAL E /NO NUMBER OF PERSONS/ BASEMENT PL 'BING YES 1 a BEDROOMS j BATHROOMS - FULL / 3/4 1/2 WATERSUPPLY -PUBLIC YE /Na NAME A-/L4/ wg7zC Wain_ PRIVATE ES0 WELL YES es CISTERN YE IQ WELL/CISTERN# /fAP • SYSTEM SIZE: Septic tank material is constructed of Ca.- CKs7( and has `` /8OO gallons capacity. FIELD: Trench square feet or Bed square feet YEAR INSTALLED (i/14, 0 l4,4.--•- 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. (,t,,v- 'f .-O"......E.-- 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 de ription and further states that the syste is is not In good working order and to the best of his/her knowledge is no failing to function properly. f 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 y perjury as rovided-� (#yy DATE OW NER Subscribed and sworn to before me this >77 0 day of /l/' d v , 20 (% By +- 13, l1civ c12itl. tzt,5 Witness my hand and official seal. M co Ission expires 04- ,,4-ZD(Z._ 11/80/09 {� DATE NOTARY PUBLIC STATEMENT OF EXISTING REVIEWED BY • ENVIRONMENTAL HEALTH SPECIALIST • • Weld County Environmental Health Services Department 1555 N. 17th Avenue Gre eley, 80631 Phone: (970)e 304-6415 Fax: (970) 304-6411 e COLORADO RECEIPT November 30, 2009 Application Number: ISDS-0900036 App Type: Health\Residential\ISDS\na Owner Name: JESSIE P COGBURN 13187 CR 17 PLATTEVILLE, CO 80651 Site Address: 13473 CR 17 PLATTEVILLE, CO 80651 Rcpt# Pmt Type Pmt Method Ref# Pmt Date Amount Cashier Comments EHS-0900370 Paid Credit Card 11/30/2009 $ 150.00 SCERRILLO Total Payments: $ 150.00 • • • Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, ) 3 80631 Phone: ((970) 304-6411 5 Fax: (970) 304-6411 "lige COLORADO RECEIPT November 30, 2009 Application Number: SE-0900050 App Type: Health\Residential\Statement of Existing\na Owner Name: JESSIE P COGBURN 13187 CR 17 PLATTEVILLE, CO 80651 Site Address: 13473 CR 17 PLATTEVILLE, CO 80651 Rcpt# Pmt Type Pmt Method Ref# Pmt Date Amount Cashier Comments EHS-0900368 Paid Credit Card 11/30/2009 $ 10.00 SCERRILLO Total Payments: $ 10.00 • • • • in rtccounain awrign Art's Sanitation Service %ee l r fIt, f. Arthur C. Beierle/Bradley A. Beierle • S 16373 Weld County Rd.28,Platteville,Colorado 80651 t " �_ Ii Prompt,Dependable Service Every Day except Saturday = ") Metro: (303) 659-2355 i: , I �, o. " Platteville: (970) 785-6335 . /� Septic Tanks—Grease Traps—Lift Stations ..p��-�sr. — — Holding Tanks--Electronic Locator Service Recommended Septic Tank Cleaning Cycles: 1-2 People:Every 3-4 years. 3-5 People:Even/2 years. 5-7 People:Every year. 7+People:Every 8 months minimum. serviceman: /IC,/ Date: 6-29 tecord# Name: CC, 7/7-ev s t _/$ j cj- t Tem 9 — 3 Phone: 7a— �f 2 :ounty: -Gt/e/n Billing Address: City,State,Zip: ob Address: /3 y73 [a,c.IC /7 :lean: Septic Tank K Grease Trap Lift Station Holding Tank Other o>4 tank Size: ei tom' Gallons Working Capacity 1 j Gallons Removed Building: Vacant Occupied tank Construction: Concrete k Plastic_ Metal_ Other Structurally Sound&Water Tight:YR' No_ Compartments: Z 3amesltees: Inlet:Good Bad Missing_ Outlet:Good xl Bad Missing_ Lift Pump Functioning: Yes_No iyYorking Level: Normal Below Above Solids Extra Heavy: Drain Field Running Back: Yes No How Much? Any Other Problems Observed: Reason for Service: Maintenance Real Estate Sale Emergency/BaCkup_ Other Cost: $ 23 .3' .00 4dditional Services: ( pi]-Service Call $ .00 pection Service: NAWT [ ] Standard [./] Diagnostic [ ] -. $ .00 [ ] Digging Labor @$ .00 per"h Hour $ .00 [ ] Locator Service to locate septic tank and mark approximate location of access lids $ .00 ( ] Extra Equipment/Extra Pumping Time: $ .00 ( ] Other: / $ .00 Credit Terms:/' Jt7 $-. - Total Cost: $ Z� 5 .00 All services shall be due 30 days from date/of service.Any accounts that are 30 days Past Due will be charged a late fee of twenty five dollars($25.00). Any accounts 90 days Past Due will be turned over to a collection service and the customer will be responsible for all costs incurred in the collection of the Past Due account. Signature: X Ø -6lbale4411dett ed/A417 ' 714} Damage Waiver Art's Sanitation Services assumes no responsibility for damages inside of the curb or property line where damage may occur to: • I acknowledge the Damage Waiver and authorize the driver to cross the ptupci ty as referenced above. Signature: X DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N 17TH AVE GREELEY, CO 80631 WEBSITE: www.co.weld.co.us ADMINISTRATION (970)304-6410 FAX (970) 304-6412• PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420 FAX (970)304-6416 ENVIRONMENTAL HEALTH SERVICES (970) 304-6415 COLORADO FAX (970) 304-6411 December 10,2009 Jessie P.Cogburn 13187 County Road 17 Platteville,Colorado 80651 RE: Jessie P.Cogburn ISDS No.: 0900036 Permit No.: SE-0900050 On December 2,2009,an evaluation of the existing individual sewage disposal system at: 13473 County Road 17,Platteville,Colorado; Section 29,Township 03 North, Range 67 West, . was conducted by Mary Cavnah,an Environmental Health Specialist of this department. This evaluation is based on a final treatment capacity for a 2 bedroom residence. Based on all available data, it cannot be determined if the field is adequately sized for the structure served.There were no visible signs of failure at the time of the inspection. 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, /r 4 • Mary Cavnah Environmental Health Specialist MC/ms • ELD COUNTY DEPARTMENT OF PUBLIC • SOE# n9 o0051 tHEALTH AND ENVIRONMENT ORG PERMIT# 1555 N. 17TH AVENUE REPAIR# GREE LEY, COLORADO 80631 LOAN # PHONE: (970)304.6415 ISDS# 1 On[ /mir a ch [ FAX: 411 STATEMENT 30T OF EXISTING FOR SEPTIC SYSTEM p Q Q (PLEASE FILL r/ OUT IN BLACK INK ONLY, cd�� S ARCELNO. /.2 a l Q' t aOOO2 1 �I62S� CRf( fro- trf-`12-5. ffas P -y- A y (� PROPERTY OWNER O G S.17Les P' CO AM /tom PHONE NO.�Lgra) 1 r 44539 MAILING ADDRESS i i /3 C R i d/a nry/ y -S/ fiea:fe mAil ra l3«7 CA- �� a g4Cv//f� cloy State Zip i pie ittMi , n r DESCRIPTION OF BUILDING (ex. house, mobile/modular home, shop, office) /f oaf C 0 SITE/LOCATION ADDRESS l 3 �t C X / , .9651 Nr 40,a5f > 4 v City State pZip ry f IA LEGAL DESCRIPTION PT≤ PT S ENS SECTION 2 _I TOWNSHIP 7-..?,4, RANGE /1 `! e p • SUBDIVISION LOT / BLOCK FILING .1/1-4.5 CENCUS TRACT LOT SIZE/ACRES /6 9 , %oc X • COMMERCIAL RESIDENTIAL ES NO �y NUMBER OF PER ONS BASEMENT PLU:ING YES WD BEDROOMS_ BATHROOMS - FULL ] 3/4 1/2 WATERSUPPLY -PUBLIC YES O NAME d I ley C- -WCGr • PRIVATE YE / O WELL YE /N9) CISTERN YES I WELL/CISTERNS , SYSTEM SIZE: Septic tank material is constructed of CO.vcktte and has /0 70' gallons capacity. FIELD: Trench square feet or Bed square feet YEAR INSTALLED 1 -it-k tvw You are required to draw a diagram of the system on the reverse side of this form in black ink only and indicate location,le gth,width,and distance from the dwelling. GL ,v k NOW 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 not in good working order and to the best of his/her knowledge i. not ailing 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 p by 1 (ii3ot O9 i�� 1 t� DATE OWjy�ER Subscribed and sworn to before me n this �0 ��''''" c�c day of ii v , 20 d J toe 14 W- Q-V� C c*Lt Ln.,"J — By Witn s my hand and official seal. y com fission expires�yy - 1 - ac-,1 1130/09 ►n' (J DATE NOTARY PUBLIC • STATEMENT OF EXISTING REVIEWED BY ENVIRONMENTAL HEALTH SPECIALIST • Virg, .W kil Clorpintylgeoltith • flc Srlelr-Lrit U Wc Phone number 720 .out 6a is Company Name: �()nl ./�� /1'1 � i Customer Name: �- �1 x"`o Address of Pumping: )31%1 LUC Q 17 Pumping Date: I I lq' 09 1. Tank Size: i ODD Gallons Pumped: /DOO 2. Lift Station: Yes_No yes, functioning: Yes No 3. Excessive water running back into tank from field? Yes No c-- If yes, estimate in gallons: 4. Liquid level in tank over inlet line? Yes_No 5. Tank Construction(check one) Concrete ✓ Metal Brick_ Plastic or Fiberglass Cesspool or Seepage Pit Other • 6. Tank Construction Observed: ✓ One Compartment_Two Compartment 7. Inlet/outlet tees and/or baffles in good condition?Yes ✓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 Outlet: Yes 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 N./ER) 12. Obvious cracks/leaks observed? Yes_No / If yes, explain area: 13. Other conditions noted which may affect proper functioning of system? o 14. Reason for Service: Maintenance eal Estate Sale Em e rgenc y/Backup Other �� y 15. Notes: • No Fleto Cep,. K AS • 126139 3.Uc /Li UP IPIC CUSTOMERS ORDER NO. DEPARTMENT DATE NAME `r.2)0.1) C/�^ ,-,-... ADDRESS I 13 /g7 141rP ) 7 CITY,STATE,41P-7-1 11(A11144 Al 0/). SOLO BY C H O.O.D. CHARGE ON ACCT. MOSE RETO PAID OUT .717 QUANTITY DESCRIPTION PRICE AMOUNT 2 3 • 4 /a" i bin- eh„-1, - mil ' 7n, MAtn \, • 5 • ` 6 7 • 8 /71 _ 10 77SPeol ta� E ' • 12 1 ii 13 \\ 14 15 + 7617 �,,{ ( • 18 19 20 )90 :4?) RECEIVED BY • agate KEEP THIS SUP FOR REFERENCE 5805 stocrtti(‘ Weld County Environmental Health Services Department 1555 N. 17th Avenue Gre eley, CO 80631 Phone: (970) 304-6415 5 Fax: (970) 304-6411 "lig CI COLORADO RECEIPT November 30, 2009 Application Number: SE-0900051 App Type: Health\Residential\Statement of Existing\na Owner Name: COGBURN JESSIE P 13473 CR 17 PLATTEVILLE, CO 80651 Site Address: 13187 CR 17 PLATTEVILLE, CO 80651 "loll.* Pmt Type Pmt Method Ref# Pmt Date Amount Cashier Comments EHS-0900369 Paid Credit Card 11/30/2009 $ 10.00 SGARCIA Total Payments: $ 10.00 • • • Weld County Environmental Health Services 1555 17th Avenue ___� Greeley, CO 80631 � -' Phone: (970) 304-6415 Fax: (970) 304-6411 � a e COLORADO RECEIPT November 30, 2009 Application Number: ISDS-0900037 App Type: Health\Residential\ISDS\na Owner Name: COGBURN JESSIE P 13473 CR 17 PLA, CO 80651 Site Address: 13187 CR 17 PLATTEVILLE, CO 80651 gat it Pmt Type Pmt Method Ref# Pmt Date Amount Cashier Comments EHS-0900371 Paid Credit Card 11/30/2009 $ 150.00 SGARCIA Total Payments: $ 150.00 • • DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N 17TH AVE GREELEY, CO 80631631 WEBSITE: www.co.weld.co.us 111-111 C ADMINISTRATION (970) 304-6410 FAX (970)304-6412 PUBLIC HEALTH EDUCATION AND NURSING (970)304-6420 FAX (970) 304-6416 ENVIRONMENTAL HEALTH SERVICES (970)304-6415 COLORADO FAX (970) 304-6411 December 10,2009 Jessie P, Cogburn 13187 County Road 17 Platteville,Colorado 80651 RE: Jessie P. Cogburn ISDS No.:0900037 Permit No.: SE-0900051 On December 2,2009, an evaluation of the existing individual sewage disposal system at: 13187 County Road 17, Platteville,Colorado; Section 29,Township 03 North,Range 67 West, was conducted by Mary Cavnah,an Environmental Health Specialist of this department. This evaluation is based on a final treatment capacity for a 2 bedroom residence. Based on all available data, it cannot be determined if the field is adequately sized for the structure served. There were no visible signs of failure at the time of the inspection. 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, • Mary Cavnah Environmental Health Specialist MC/ms Hello