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Home My WebLink About762474.tiff S DEPARTMENT OF PLANNING SERVICES RECORDED EXEMPTION ADMINISTRATIVE REVIEW Applicant: Robert Plant Case No: RE- 1907 Legal Description: E2 SW4 Section 22, T7N, R65W of the 6th P.M., Weld County, Colorado Parcel Identification Number: 0551 22 000009 Larger Lot Size: 74 acres Smaller Lot Size: 4 acres Criteria Check List Meets Criteria Yes No X 1. Conformance with the Weld County Comprehensive Plan and any adopted municipal plan. X 2. Compatible with the existing surrounding land uses. X 3. Consistent with the intent of the zone district. andord erly 4. Consistent withefficient development. X 5. Complies with Recorded Exemption standards in Section 11.8 of the Weld County Subdivision Ordinance. X 6. Provides for adequate protection of the health, safety, and welfare of the inhabitants of the neighborhood and the County. APPROVED WITH CONDITIONS 1. The Department of Planning Services has determined through the review, that the standards of Section 11.4.2.1 through 11.4.2.6 of the Weld County Subdivision Ordinance have been met. This Recorded Exemption is approved with the following conditions in accordance with information submitted in the application and the policies of the County. 2. The Environmental Protection Services Division of the Weld County Health Department was unable to located septic systems serving the home located at 21361 WCR 90. Any existing septic system which is not currently permitted through the Weld County Health Department will require an I.S.D.S. Evaluation prior to the issuance of the required septic permit. In the event the system is found to be inadequate, the system must be brought into compliance with current I.S.D.S. regulations. 3. Prior to recording the plat, the applicant shall place the following note on the plat: 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. 4. All access shall be clearly shown on the plat. 5. The applicant shall submit a mylar plat to the Department of Planning Services to be recorded in the office of the Weld County Clerk and Recorder. The plat shall be prepared in accordance with the requirements of Section 11.7 of the Weld County Subdivision Ordinance. The plat shall be submitted within sixty (60) days from the date of approval by the Department of Planning Services. The applicant shall be responsible for paying the recording fees. Date June 20. 1996 Kern D. Ke ey Current P nn /9 ,7 'iq A WELD COUNTY,COLORADO DEPARTMENT OF PLANNING SERVICES 1400 N. 17TH AVENUE GREELEY,CO 80631 (970)353-6100 EXT.3540•FAX(970)352-6312 `r'c� r J DATE � 19 % ECEIPTOfOO5 1 (C5T NO. TYPE FEES 4221 -REISE 4221 ZPMHIMHZPIZPAD 4221-USR 4221 -SITE PLAN REVIEW 4221 -COZ 4221 -PUD 4221 -SUBDIVISION 4221 BOA 4221 -MINOR SUB 4221 •FHDPIGHOP 422 65 -RECORDING FEE Fc IC707 St 913 22,DO 4430-MAPSI ATIONS 4730-INVESTIGATION FEE 4430-POSTAGE/HANDLING 2 2-Do ❑ CASH C.1'CHECK NO- t\-37 TOTAL BY / - A,L ) WHITE•CUSTOMER CANARY-FINANCE COPY • DEPARTMENT OF PLANNING SERVICES PHONE (970)353-6100, EXT.3540 IIDFAX (970) 353-6213 C. WELD COUN GREEY LEY1400, COLORADO STRATIVE OFFICES N. 17THVENUE COLORADO May 23, 1996 Robert Plant 21361 WCR 90 Ault, CO 80610 Subject: RE-1907 located in the E2 of the SW4 of Section 22, TBN, R65W of the 6th P.M., Weld County, Colorado. Dear Mr. Plant: Your recorded exemption application is being processed. If it is determined that the application meets the approval criteria of the Weld County Subdivision Ordinance, you will be notified that the recorded exemption is approved. If the staff determines that the application does not meet the approval criteria,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. Sincerely, dalpr Kerni D. Keithley Current Planner KDKljeb S Recorded Exemption Field Check inspection date: June 17, 1996 Case Number RE- 1907 Applicant Robert Plant Legal Description E2 SW4, Section 22, TBN, R65W of the 6th P.M. Location North & adjacent to WCR 90, east of WC( R 43 N N Qg- "W ciatW VZJ E A' C 4 I . 1 c>t e E DU CQ,ert.Ll i OV- ( ��ut('LU ' LOYU s / 04 I I , s /4)02 90, Q ph bcLLcaciciri .l : :,t r. w QQ . p Do.LLC ruyn, Unsafe Conditions UU Inadequate sight distance to west(500' clear view @55 mph) Setbacks /structure from access Bridge location from access (less than 200') Weeds Landscaping Inadequate distance from road intersection or railroad crossing None observed at time of inspection Total Number of Accesses in a Mile State Highway / D Weld County Rd. Weld County Rd. Residences / Residences _ Residences Other Structures Other Structures _ Other Structures Agricultural Agricultural Agricultural Commercial _ Commercial _ Commercial Road Surface WCR Paved WCR vel Unimproved Requested enginnering to inspect site Yes Date: Comments: m / /n CLt (fCc � )LQ O_ ! 1(9 i w'Lt i-t- ern i ` / JE-)1 Q ,/ hatLE a pacdcK Cam-- 0 y d act.04A44 el bhp A, 4) 06 4-� l.� l erri Keithley s u ent Plann�` a9veiL/L&2CC ,L%& c�C L-�/L) • S ADMINISTRATIVE REVIEW FLOW SHEET CASE# RE-1907 APPLICANT: Robert Plant REQUEST: Recorded Exemption with Subdivision Exemption LEGAL: E2 SW4, S22,T8N, R65W LOCATION: North &adjacent to WCR 90, east of WCR 43 PARCEL NUMBER: 0551 22 000009 Date By Application Received May 20, 1996 Kerri Keithley Application Completed May 22, 1996 Kerri Keithley Referrals listed Ina InaH a3 File assembled -31a3¶c cc Letter to applicant mailed -512 let Co Vicinity map prepared Referrals mailed S(zso(S,, Chaindexed 51 3(Ct(i -43 Field check by DPS staff WI1/9(-1 �r1 Administrative Review decisionafprnied L/ /9tD St�Ccf History card completed cp l/(o Date By COMMISSIONER HEARING DATE Surrounding property owners notified Air photo and maps prepared CC action: CC resolution received History card completed Recorded on maps and filed 1 - 2U- 4 U Overlay Districts Zoning si Airport Yes_ No )( Geologic Yes No )C Flood Hazard Yes No K APPLICATION FOR RECORDED EXEMPTION Department of Planning Services, 1400 N. 17th Avenue, Greeley, Colorado 80631 Phone (970) 353-6100, Ext.3540, Fax#(970) 353-6312 FOR PLANNING DEPARTMENT USE ONLY: APPLICATION FEE 15 190,cv RECORDING FEE CASE NUMBER IOE— I qqo-y RECEIPT NUMBER d3a Li Lv ZONING DISTRICT F� APPLICATION CHECK BY te-D1S TO BE COMPLETED BY APPLICANT: (Print or type only except for required signatures). I (we), the undersigned hereby request that the following described property be designated a recorded exemption by the Weld County Board of County Commissioners. LEGAL DESCRIPTION: E? SW4, Section 22, TBN, R65W TOTAL ACREAGE: 80 Has this 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? YesNo Does the parcel of land under consideration lie in any of the following Overlay Districts? Flood Hazard: Yes_No X ;Airport: Yes_No X ; Geological Hazard: Yes_No X FEE OWNERS OF PROPERTY: Name: Robert R. Plant Home Phone# 970-834-2080 Address: 21361 WCR 90 Work Phone# City/State/Zip Code Ault, CO 80610 Name: Patty M. Plant Home Phone# 970-834-2080 Address: 21361 WCR 90 Work Phone# City/State/Zip Code Ault, CO 80610 Water Source: Larger Parcel well or NWWD Smaller Parcel well Type of Sewer: Larger Parcel septic/ leach field Smaller Parcel septic leach field Proposed Use: Larger Parcel farming Smaller Parcel existing home Acreage: Larger Parcel 74 Smaller Parcel ± 4 acres Existing Dwellings: (Yes or No) no (Yes or No) yes Existing Dwelling Address (if applicable): Larger Parcel none Smaller Parcel 21377 WCR 90 and 21361 WCR 90 I hereby state that all statements,proposals,or plans submitted with this application are true and correctorrr to the best of my knowledge. —)Ur �}4 Signature: Owner or Authorized Agent o rce A . 0551 a s OOWOS 5 • Responses Recorded Exemption Questionnaire Filed in conjunction with a subdivision exemption pertaining to E''ASW'/, Section 22. TBN, R65W 1. See Exhibit A that shows existing well on Lot A drilled in 1991, and Exhibit B, a letter from the North Weld County Water District stating that two water taps are available for the remaining lots if needed. 2. The existing residence have septic systems in place and with the proposed size of Lot A and SE Lot there is sufficient area to install a replacement system in the event of failure of the existing system. Lot B is of sufficient size to enable a system to be installed under Weld County Health Department Guidelines. 3. Lot A and SE are currently used as rural residence and Lot B as an irrigated farm. None of the land is considered prime according to the Weld County Comprehensive Plan due to the erodibility of the soils. There is currently five miniature horses plus an aviary for peacocks. Lot A has one existing residence, barn, open front shed and miscellaneous other outbuildings. The SE lot contains existing home and a utility shed. Lot B is irrigated cropland utilizing well water varying degrees of soil and slopes. There are no oil wells currently located on the property. 4. To facilitate the sale of the property, a caring family, raising their children could live in either home because of existing improvements. They could, in turn, continue to improve the property. Lot B would continue to be used as an irrigated farm and possible new home on an area with less productive soils. 5. The existing residences would be used as rural tracts consisting of approximately 4 acres and 2 acres respectively. Both Lot A and SE Lot are in the southern portion of the property adjacent to WCR 90, which is approximately five (5) miles east of Pierce. The remaining seventy-four (74) acres would also adjoin WCR 90 and is currently used as farmland. 6. We are unaware of any adopted "municipal plan" and/or "intergovernmental agreement(s)" that this proposal would effect. 7. The existing area has several rural acreages. The trend in the area has been to preserve existing farm facilities as rural acreages while the land is being utilized as part of larger farm operations. Example, LDS Church property to the west. This proposal would be compatible with the surrounding area. 8. The existing district has numerous acreages indicating that this proposal would fit in very well. The proposed use would be compatible with existing ordinances and the comprehensive plan as it would be the same use as the existing area. 9. This would be an orderly development as there is no change in use. It is still agricultural and would encourage the continuation of rural family living rather than having vacant rural farm buildings. The likelihood of the existing buildings being better maintained and location close to adjacent acreages may encourage community atmosphere. The property is adjacent to existing domestic water, has an existing domestic well, power and propane gas service available. The property will be regulated by Weld County, State and other governmental agencies in regards to adequate standards. Since the proposed uses are compatible with the surrounding area, the interest of the public, homeowner and subdivider are considered to be safeguarded. This proposal does follow the procedures and standards for recorded exemptions in conjunction with subdivision exemption and thereby secures equitable handling of the plan. The absence of wooded terrain negates the possibility of injury from fire. Although this possibility exists as with any other residence that can be damaged by fire, the close proximity to the Pierce Volunteer Fire Department would be a great benefit to the property owners. There would be minimal effect on agricultural production and would be offset by the possibility of improving their appearance of existing improvements. This as an irrigated farm, therefore there will be water available in sufficient amounts to farm the property. The likelihood of families living on the property raising farm animals would be an enhancement of the rural beauty that exists now. Again, the property will continue to be used in an agricultural manner. Therefore, there should not be any changes in erosion, sedimentation, etc. There is very little likelihood of enough surface being hard surfaced or build on to increase runoff. In any event, any construction would require a building permit, thereby notifying the county of such increase in flooding possibilities. The property is not located in any known flood plains. There are not any extremely steep slopes that would encourage mud slides. The Ault/Pierce School District would likely want to build any new facilities closer to town than on this particular property. REFERRAL LIST NAME: Robert Plant CASE NUMBER: RE-1907 REFERRALS SENT: May 23, 1996 REFERRALS TO BE RECEIVED BY: June 13, 1996 COUNTY TOWNS and CITIES Attorney Ault _X_Health Department _Brighton Extension Service Broomfield Emergency Management Office Dacono Sheriffs Office Eaton _X_Public Works ,/ Erie Housing Authority Evans Airport Authority Firestone Building Inspection Fort Lupton Frederick STATE Garden City Division of Water Resources Gilcrest Geological Survey Greeley Department of Health Grover Department of Transportation Hudson Historical Society Johnstown Water Conservation Board Keenesburg Oil and Gas Conservation Commission Kersey La Salle FIRE DISTRICTS Lochbuie Ault F-1 Longmont Berthoud F-2 Mead Briggsdale F-24 Milliken Brighton F-3 New Raymer Eaton F-4 Northglenn Fort Lupton F-5 Nunn Galeton F-6 Pierce Hudson F-7 Platteville Johnstown F-8 Severance La Salle F-9 Thornton Mountain View F-10 Windsor Milliken F-11 _X_Nunn F-12 COUNTIES Pawnee F-22 Adams Platteville F-13 Boulder Platte Valley F-14 Larimer _Poudre Valley F-15 Raymer F-2 FEDERAL GOVERNMENT AGENCIES Southeast Weld F-16 US Army Corps of Engineers —Windsor/Severance F-17 USDA-APHIS Veterinary Service Wiggins F-18 Federal Aviation Administration Western Hills F-20 Federal Communication Commission OTHER SOIL CONSERVATION DISTRICTS Central Colo.Water Conservancy Dist. Brighton Panhandle Eastern Pipe Line Co. Collins Collins Tri-Area Planning Commission _X_Greeley _X_Ault School District Longmont West Adams COMMISSION/BOARD MEMBER - (it ‘it." :•• • GoUC ,s t\9g6 DEPARTMENT OF PLANNING SERVICES I e\0•10 PHONE (970)353-6100, EXT.3540 �G FAX (970) 352-6312 C. WELD COUNTYGREELtINISTTIVE OFFICES E1400 Y COLORADO 17TH 80631E COLORADO May 23, 1996 CASE NUMBER: RE-1907 TO WHOM IT MAY CONCERN: Enclosed is an application from Robert Plant for a Recorded Exemption applied for in conjunction with a Subdivision Exemption. The parcel of land(0551-22-0-00-009)is described as the E2 of the SW4 of Section 22, T8N, R65W of the 6th P.M., Weld County, Colorado. The location of the parcel of land for which this application has been submitted is north of and adjacent to Weld County Road 90, east of Weld County Road 43. For a more precise location, see legal. This application is submitted to you for review and recommendation. My comments or recommendation you consider relevant to this request would be appreciated. Your prompt reply will help to facilitate the processing of the application and will ensure prompt consideration of your recommendation. Please reply by June 13, 1996, so that we may give full consideration to your recommendation. The failure of any agency to respond within 21 days may be deemed to be a favorable response to the County. Please call Kerri D. Keithley, Current Planner, if you have any questions about the application. Check the appropriate boxes below and return to our address listed above. 1. We have reviewed this request and find that it does/does not) comply with our Comprehensive Plan for the following reasons. 2. We do not have a Comprehensive Plan, but we feel this request (is/is not) compatible with the interests of our town for the following reasons: 3. 4- We have reviewed the request and find no conflicts with our interests. 4. A formal recommendation is under consideration and will be submitted to you prior to: 5. Please refer to the enclosed let�t}er� Signed: 4 C,-� • c) � Agency: 1 >w� �. c C 2 Date: I 5 - 30 L}(o • • 441,141. MEMORAnDU WIIDe Kerri Keithley, Current Planner July 10, 1996 To Date COLORADO Don Carroll, Project Coordinator ,c(u From Subject: RE-1907, Robert Plant Access: I have visited with Jay Freeze, Mr. Plant's engineer, on relocating an access point to Lot B. Lot B • is an agricultural field. The existing accesses through Lot A and the subdivision exemption lot, both lead back to Lot B. When these two lots are sold, the access will be cut off to Lot B. There is an existing access to WCR 90 to Lot B. This access point will be closed and a new access point will be granted directly west of Lot A to accommodate Lot B. No additional accesses were granted. Please find attached the revised Weld County Access Information Sheet identifying the proposed access and the elimination of the existing access to Lot B. cc: Commissioner Hall RE-1907 file plan Q ��`aC1C)\ 1 1ti�996 Q le WELD coon ROADACCESSINFQRMATION SHEET Weld County Public Works Department 933 North 11th Avenue,P.O.Box 758, Greeley,Colorado Phone: (970) 356.4000, Ext.3750 1. Applicant Name Robert R. Plant Phone 834-2080 Address 21361 WCR 90 City Ault State CO Zip 80610 • 2. Address or location of access 21361 WCR 90 and 21 377 WCR 90 Section 22 Township 8N Range 65W Block Lot Subdivision Weld County Road# 90 Side of Road N N S E or W Distance from& number of intersecting 1800 East WCR 43 and WCR 90 3. Is there:an existing access to the p operty? Yes X No #of accesses 1 4. Site Sketch: N Lo't F sr A -Nil IIP- i cc WCR90��Sl Ixj64y6AcloiSf3 3 -71 . 5. Proposed use: Industrial X Permanent X Residential/Agricultural _ _ Temporary _ Commercial _ Subdivision _ Other OFFICE USE ONLY -' 3 Road PO ADT r 78 Date 6-8(0Accidents / Date Road 43 ADT 9; Date /-Fo Accidents 54 Date Drainage Requirement: Culvert Size Length t.. Other Comments: Installation authorized Information Insufficient , . ,, . - Special Conditions • * No new arrP.ss rPrjiiirPrl Farb ylnr ham nne Pxistinp accPs�p N , i :" Tile Reviewed by: a M ;lt � '4 se " s ;,a 0/. �" r , ay a ` R- d• RI r 4r Ant p y1[-; 1 # P 'v ,,AN' . 24,4q •. aid County Planning Dept. mEmoRAnDum R JUN 1 8 1996 W I`'P C. ECEIVE® Kerri D. Keithley To Weld County Planning Date June 17, 1996 COLORADO From Trevor Jiricek, Supervisor, Environmental Protection Servic Subject: Case Number: SE-593 & RE-1907 Name: Plant, Robert PT SW4 of Section 22, Township 08 North, Range 65 West Environmental Protection Services has reviewed this proposal; the following conditions are recommended to be part of any approval: 1. The Environmental Protection Services Division of the Weld County Health Department was unable to locate septic permits for the septic systems serving the homes located at 21377 WCR 90 and 21361 WCR 90. Any existing septic system(s) which is not currently permitted through the Weld County Health Department will require an I.S.D.S. Evaluation prior to the issuance of the required septic permit (s) . In the event the system(s) is found to be inadequate, the system(s) must be brought into compliance with current I.S.D.S. regulations. TJ/rb-0617 a rif DEPARTMENT OF PLANNING SERVICES ' PHONE (970)353-6100, EXT.3540 Weld County Planning Dept. FAX (970)352-6312 O WELD COUNTY ADMINISTRATIVE OFFICES 1400 N. 17TH AVENUE MAY 2 9 1996 GREELEY, COLORADO 80631 COLORADO ,, , EIVED May 23, 1996 CASE NUMBER: RE-1907 TO WHOM IT MAY CONCERN: Enclosed is an application from Robert Plant for a Recorded Exemption applied for in conjunction with a Subdivision Exemption. The parcel of land(0551-22-0-00-009)is described as the E2 of the SW4 of Section 22, T8N, R65W of the 6th P.M., Weld County, Colorado. The location of the parcel of land for which this application has been submitted is north of and adjacent to Weld County Road 90, east of Weld County Road 43. For a more precise location, see legal. This application is submitted to you for review and recommendation. Any comments or recommendation you consider relevant to this request would be appreciated. Your prompt reply will help to facilitate the processing of the application and will ensure prompt consideration of your recommendation. Please reply by June 13, 1996, so that we may give full consideration to your recommendation. The failure of any agency to respond within 21 days may be deemed to be a favorable response to the County. Please call Kerri D. Keithley, Current Planner, if you have any questions about the application. Check the appropriate boxes below and return to our address listed above. 1. We have reviewed this request and find that it does/does not) comply with our Comprehensive Plan for the following reasons. 2. We do not have a Comprehensive Plan, but we feel this request (is/is not) compatible with the interests of our town for the following reasons: 3. V We have reviewed the request and find no conflicts with our interests. 4. A formal recommendation is under consideration and will be submitted to you prior to: /55.. ) d�jJPPlleeaase refer to the enclosed letter. /�o c�-Cast d ,t Sign 1 Agency: Date: bir.,y, 22> /996 r• E \IP Su 'AI Sec*, on ) 1 ) 13 j j (jcL ) ///, /7 / , //// // / / SC�a�� / ( .// „/ // /\ // / ' / / rl / ; / //' a ' L :iA // <— We Go > lir er �{omes S& dot \\ - Access "1W ti L ' j 3 ) 2& Vicinity MGe Scn1e_ In = a,000 . o ;j, 3 / /;; 17 1[ �' r 3 09 ..-d 44 ! • 55 K 44 10 11 55 29 20 c +I t 71 \_ 1 15 / 14 J 71 • 29 �0 6/ 72 w 7 I ( J i 73 ti tw o 22 € 23 . 0..... 1.- ..!!! 2 : 't ...alu ^ , 4 . n ' �.. ti• 55 _ N. y , kr ' dr , i � . ' L 4s �j +l.a u'�, �`, [ am 1a n � Y",, ( 'u' j- r ',, '. 1�' , 42 r Y • i • � • ll 141i4 DEPARTMENT OF HEALTH ig 0 1517- 16 AVENUE COURT GREELEY, COLORADO 80631 WI • LOAN APPROVAL ADMINISTRATION(303)353-0586 HEALTH PROTECTION (303)353-0635 COMMUNITY HEALTH (303)353-0639 COLORADO n�� , REQUEST NO. : 30-91 W t R tii) DATE STCNIVED: 8130-91 lyl'), DATE FORWARDED: 8-08-91 FEE PAID: $ 90.00 DATE: 8-05-91 TO WHOM IT MAY CONCERN: Review nd inspection report regarding water and the sewage disposal system for an existing dwelling: SEND TO: HENRY DILL/JACK SCHNE DER PHONE NO. : 834-2508 ALTERNATE: ( INFORMATION: Address: 21361WCR 90, AULT, COLORADO 80610 Age of Septic: 1950 Legal: PT , PT , Section 22 , Township 08 North, Range 65 West Subdivision , Lot Block , Filing Property Owner: HENRY DILL Original Owner: HENRY DILL Tank Pumped on: AUGUST 2, 1991 By: FLOYD BAINBRIDGE DEPARTMENTAL RECORD SEARCH: Permit No. : G-919103 Name: HENRY DILL Bathrooms: 1 Bedrooms: 2 Total Acreage: 80 Tank Capacity: 300 gallons Field Size:50+LONG square feet Water Supply: PRIVATE WELL Date of Final Inspection: N/A INSPECTION COMMENTS: Date of Inspection: AUGUST 6, 1991 Soil Conditions: Dry XXX Saturated Snow-covered Residence: Occupied XXX Vacant FINDINGS: Sewage Disposal System: Satisfactory OtherSEE COMMENTS Bacteriological Water Test: Acceptable OtherCONTAMINATED WITH BACTERIA COMMENTS: ACCORDING TO CURRENT ISDS REGULATIONS FOR A TWO (2) BEDROOM HOME. THE FOLLOWING WERE FOUND TO BE OUT OF COMPLIANCE: 1) THE 300 GALLON SEPTIC TANK IS UNDERSIZED. THE MINIMUM REQUIREMENT IS 1,000 GALLONS. 2) THE LEACHFIELD IS 55 PERCENT UNDERSIZED. A PORTION OF THE LEACHFIELD IS LOCATED IN A CORN FIELD. THE LEACHFIELD SHOULD NOT BE LOCATED IN AN AREA THAT IS TILLED OR DRIVEN OVER. DATE: AUGUST 9, 1991 SIGNATURE: ( iJ� O� D�Z1$ éi 1/4 �'Ir. Envir nmental Protection Speciat 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 in connection with either its examination of the property or in the report. This inspection was conducted solely for the purpose of detecting health hazards observable at the time of inspection, and does not constitute a warranty that the system is without flaw or that it will continue to function in the future. Inspection requested during periods of snow cover and high soil saturation may be of questionable value to potential buyers due to adverse conditions. Water sample reports reflect the bacteriological quality of the water supply at the time the sample was taken. 9/0 9/ 3 � � �� Lucia, 130"4/ 7 a. STATEMENT OF EXISTING SEPTIC SYSTEM , (PLEASE FILL OUT IN INK) / r OWNER OF RECORD: OP Y1if 1 U:I l r� . Phone: ' y3y agog MAILING ADDRESS: Q13 (D / LJCR 1' n D A pLA �+ ep " Oao/U City State Zip SITE ADDRESS: E 1 %)(. I Ue_e. 14 90 , ik + CO - _ . . . City Scatc Zip LEGAL DESCRIPTION: PT SiaJ��/ PT € �6_, Section 2)._ Townsl.ip 911 e. Range iof (E) SUBDIVISION LOT BLOCK FILING NUMBER OF PEOPLE: I Bedrooms: gL Bathrooms: I Water Supply Welk RESIDENTIAL OR COMMERCIAL: RQ 5, \ C"v1 1.4 Lot Sire: Sb Acres SYSTEM-SIZE: Tank is Constructed of QQfl �w"Te , and has .`35Lj gals capacity _ _ (material) FIELD: Bed or tench sq. ft. Date System Installed:/9 J 11 You are required to draw a diagram of the system on the reverse side of this form and Indicate position,, 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 in good working order and to the best of his/her knowledge 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. I1/ p1 I - 5 /f9/ - .✓�,1� D6re L' yiJ�1J� Owncr�; 2� I Subscribe �ann�d/swoorn to] be/foo/wrenme th�ils/ r5 aay of Q,//Q{ ( - - , 19q by .fLT ft(1., 2 .t-% . a./ l/ !!fir �_ Witness my hand and official seal_ Hy commission ercnire OA) 5 IC')/ • ---- Dace i -Notary Public .STATEMENT OF EXISTING REVIEWED.'BY_�. - . . -' _ _._ _Environmental Protection Specialist Dace s ag 8 8 ay y:6b - 3 m ai a - a _S i Si '5u_b a40 a �i .._ 0 _z U° O c ° -v '11a6 a z i z u �+ 6, L u a ', B O N mZy"<o < 6 - €v -,$a=a J - o w - d� ao 0 ys • 5 F - i6 %Sipa $ ot� _ _d v' - c e x2 IzZron ' ' 13 ° m Illil E'°1III `�, j cY`54 e c-`'6 - �6 E E go 1210 t. K o La € 0 6 3 F� 8 Ey w m ii `! ' _ y - z W y s y v a� iN a yo t1 _ :ill 5 0` oY - eye tl5 b Y Y° nil '�3 �' :t.�-v' Y ` a a'.; t�E.¢o :� ¢ ;g _- a 22r'R�e tmtWWW i a_ .} i. aY3 i8 5si ul ' Y' -��-§ cif ii 6slg - �I • iII ia if �€ ga sa �r ISo a 6a ; S.>. C'° sfig 5 6a.ghagag oi o=8s=s na -irk i PI* CC F E ! 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