HomeMy WebLinkAbout20171636.tiffRESOLUTION
RE: APPROVAL OF SUBDIVISION EXEMPTION, SUBX17-0009 - ROBERT BENSON
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board of County Commissioners, pursuant to its authority under
Section 30-28-101(10)(d), C.R.S., and Section 24-1-20 of the Weld County Code, did determine
at a public meeting held in the Chambers of the Board, that certain parcels of land to be divided,
as shown on the plat known as Subdivision Exemption, SUBX17-0009, does not come within the
purview of the definition of the terms, "subdivision" and "subdivided land," and
WHEREAS, the request for Subdivision Exemption, SUBX17-0009, was submitted by
Robert Benson, 25203 County Road 47, Greeley, CO 80631, for property which is located in part,
being more particularly described as follows:
Part of SE1/4 SE1/4 of Section 26, Township 5
North, Range 65 West of the 6th P.M., Weld County,
Colorado
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the above described parcels of land be, and hereby are, declared to be
exempt from the definitions of "subdivision" and "subdivided land" as set forth in
Section 30-28-101(10), C.R.S., and Section 24-1-40 of the Weld County Code.
BE IT FURTHER RESOLVED by the Board that approval of Subdivision Exemption,
SUBX17-0009, submitted by Robert Benson be, and hereby is, conditional upon the following:
1. Prior to recording the plat:
A. The applicant shall submit a sketch of the existing septic system in relation
to the proposed lot line to the Weld County Department of Public Health
and Environment. Evidence of approval from the Department of Public
Health and Environment shall be submitted to the Department of Planning
Services by the applicant.
B. The applicant shall address the requirements (concerns) of the Central
Weld County Water District, as stated in the referral response dated
April 7, 2017. Provide written confirmation from the Central Weld County
Water District that a new second water tap has been purchased and is
active on the site providing separate water service to each individual lot.
Written evidence shall be submitted to the Weld County Department of
Planning Services.
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2017-1636
SUBX17-0009
SUBX17-0009 - ROBERT BENSON
PAGE 2
C. The Subdivision Exemption Lot shall comply with the less than thirty-five
(35) acre maximum lot size required by Section 24-8-10.B of the Weld
County Code.
D. 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.
E. Items to be included on the plat:
1) The plat shall be titled: Subdivision Exemption No. 0961-26-04
S U BX 17-0009.
2) All approved accesses shall be clearly shown on the plat and
labeled with the approved access permit number (AP17-00209).
The applicant shall contact the Weld County Department of Public
Works to determine if a culvert is necessary at any approved road
access point.
3) County Road 47 is a paved road and is designated on the Weld
County Road Classification Plan as a local road, which requires 60
feet of right-of-way at full buildout. The applicant shall verify and
delineate on the plat the existing right-of-way and the documents
creating the existing right-of-way. If the existing right-of-way
cannot be verified it shall be dedicated. All setbacks shall be
measured from the edge of right-of-way. This road is maintained
by Weld County.
4) Setback radiuses for existing oil and gas tank batteries and
wellheads shall be indicated on the plat per the setback
requirements of 23-3-50.E of the Weld County Code.
5) All recorded easements and rights -of -way shall be delineated on
the plat by book and page number or reception number.
F. The following notes shall be placed on the plat:
1) This Subdivision Exemption is for adjustment of property lines
between two contiguous parcels.
2017-1636
SUBX17-0009
SUBX17-0009 - ROBERT BENSON
PAGE 3
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 2012 International Building Code, shall be
constructed within a 200 -foot radius of any tank battery or within a
150 -foot radius of any wellhead or within a 25 -foot radius of any
plugged or abandoned oil and gas well. 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 this Chapter in
accordance with Subsection 23-6-10.C of this Code.
3) Any future structures or uses on the site must obtain the appropriate
zoning and building permits.
4) The landscaping/screening on the site shall be maintained. Weeds
and vegetation shall be maintained in a manner to not become a
nuisance to neighbors.
5) The historical flow patterns and runoff amounts will be maintained
on the site.
6) Building permits shall be obtained prior to the construction of any
building. Buildings that meet the definition of an Agricultural 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 Services 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.
7) Building Permits issued on the proposed lot, will be required to
adhere to the fee structure of the County -Wide Road Impact Fee,
County Facility Fee and Drainage Impact Program Fees.
8) Potential purchasers are hereby notified that the proposed
Subdivision Exemption is located within the A -P (Airport) Overlay
District.
2017-1636
SUBX17-0009
SUBX17-0009 - ROBERT BENSON
PAGE 4
9) RIGHT TO EXTRACT MINERAL RESOURCES STATEMENT:
Weld County has some of the most abundant mineral resources,
including, but not limited to, sand and gravel, oil, natural gas, and
coal. Under title 34 of the Colorado Revised Statutes, minerals are
vital resources because (a) the state's commercial mineral deposits
are essential to the state's economy; (b) the populous counties of
the state face a critical shortage of such deposits; and (c) such
deposits should be extracted according to a rational plan, calculated
to avoid waste of such deposits and cause the least practicable
disruption of the ecology and quality of life of the citizens of the
populous counties of the state. Mineral resource locations are
widespread throughout the County and person moving into these
areas must recognize the various impacts associated with this
development. Often times, Mineral Resource sites are fixed to their
geographical and geophysical locations. Moreover, these
resources are protected property rights and mineral owners should
be afforded the opportunity to extract the mineral resource.
10) The Weld County Right to Farm Statement, as it appears in Section
22-2-20.J.2 of the Weld County Code, shall be placed on the map
and recognized at all times.
2. Additional Information.
A. A Weld County septic permit is required for any proposed home. The septic
system shall be installed according to the Weld County On -Site
Wastewater Treatment System (OWTS) regulations.
B. 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 Weld County Department of
Public Health and Environment recommends that the applicant review the
Weld County Code pertaining to septic systems to ensure that any installed
septic system will comply with all setback requirements found in the Code.
In the event the proposed lot is not of sufficient size to allow the installation
of a septic system, the lot may need to be enlarged.
C. The West Greeley Soil Conservation District has provided information
regarding the soils on the site. The applicant shall review the information
and use it to positively manage on -site soils.
3. The plat shall be prepared in accordance with the requirements of Section 24-8-
60 of the Weld County Code. The applicant shall submit an electronic copy (PDF)
of the plat for preliminary approval to the Department of Planning Services. Upon
approval of the plat, 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 County Clerk and Recorder by the Department of Planning
Services. The Mylar plat and additional requirements shall be recorded within sixty
(60) days from the date of the Board of Commissioners Resolution. The applicant
shall be responsible for paying the recording fee.
2017-1636
SUBX17-0009
SUBX17-0009 - ROBERT BENSON
PAGE 5
4. In accordance with Weld County Code Ordinance #2012-3, approved April 30,
2012, should the plat not be recorded within the required one hundred twenty (120)
days from the date of the Board of County Commissioners Resolution, a $50.00
recording continuance charge shall added for each additional three (3) month
period.
5. The Department of Planning Services respectfully requests the surveyor provide a
digital copy of this Recorded Exemption. Acceptable CAD formats are .dwg, .dxf,
and .dgn (Microstation); acceptable GIS formats are ArcView shapefiles, Arc Info
Coverages and Arc Info Export files format type is .e00. The preferred format for
Images is .tif (Group 4). (Group 6 is not acceptable). This digital file may be sent
to maps@co.weld.co.us. The Department of Planning Services respectfully
requests the surveyor provide a digital copy of this Recorded Exemption.
Acceptable format is a projected ESRI shapefile (.shp, .shx, .dbf, .prj) with a
defined coordinate system (i.e., NAD 1983 UTM Zone 13N, WGS 1984, NAD 1983
HARN State Plane Colorado North FIPS 0501 (US Feet)....etc.). This digital file
may be sent to maps@co.weld.co.us.
2017-1636
SUBX17-0009
SUBX17-0009 - ROBERT BENSON
PAGE 6
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 24th day of May, A.D., 2017.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORAO
ATTEST: Cam(idvi) Cam{ uzito;t,
Weld County Clerk to the Board t�
BY. Qjv
puty Clerk to the Board
APP AS
County Attorney
Date of signature: 09((31 l --j
C
Julie A. Cozad, Chair
"2 -e -.-----
Steve Moreno, Pro-Tem
EXCUSED
Sean P. Conway
ik- Freeman
I
arbara Kirkmeyer
2017-1636
SUBX17-0009
Signature: Owner or Authorized Agent
Date
SUBDIVISION EXEMPTION (SE) APPLICATION
FOR PLANNING DEPARTMENT USE
RECEIPT/AMOUNT # 1$
APPLICATION RECEIVED BY Pei &
DATE RECEIVED:
2
CASE # ASSIGNED: cif
PLANNER AIGNED:
TYPE OF EXEMPTION REQUESTED (check one
P ro p ett y I a n a l l u stm ent
Used with Recorded Exemption
Financing Purposes
Parcel Number q �D L-cQ 1d - Q - (, 0 - D _a 7
Public Utility Facility
Oil and Gas Production Facilities
Telecommunication Antenna Tower Facilities
02 digit number - found on Tax I.D. information, obtainable at the Weld County Assessor's Office, or vwwcg.v eid.co.us)
Legal Description
./.,2 7 9(7 --
Section _, awnship SbINorth, Range .:Lef\s/est
Has the property been divided from or had divided from it any other property since August 30, 1972? Yes No :X.
Is this parcel of land, under consideration, the total contiguous land owned by the applicant? Yes
FEE OWNER(S) OF THE PROPERTY:
Name if�
},
i y
Work Phone #
ti_LL
4
ice
a ^ r
Home Phone # 714 , z;a L/ 2` ;Email Address JJkJc!nSo,fc(CCJ)O
Address: :VS tc)C 47;
City/State/Zip Code
atitSELicy
3101 l
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
w or f COnl
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.
Signature: Owner or Authorized Agent Date
SUBDIVISION EXEMPTION (SE) APPLICATION
FOR PLANNING DEPARTMENT USE DATE RECEIVED:
RECEIPT/AMOUNT # a CASE # ASSIGNED:
APPLICATION RECEIVED BY PLANNER ASSIGNED:
TYPE OF EXEMPTION REQUESTED (ceck one)
•
O
Property line adjustment
Used viith Recorded Exemption
Financing Purposes
D
O
O
Parcel Number i� �} I_Lo?IpL2.O o_-na_I
Public Utility Facility
Oil and Gas Production Facilities
Telecommunication Antenna Tower Facilities
(12 digit number -found on Tax ID. Information, obtainable at the Weld County Assessor's Office, or vi.ww_co. rr _corus)
n
Legal Description, gi .,. , Section , Township Nor thp Range ''est
Has the property been divided from or had divided from it any other property since August 30, 1972? Yes O No 'k a
Is this parcel of land, under consideration, the total contiguous land owned by the applicant?
FEE OvvrstEl S) OF THEPROPERTY:
Name:
Work Phone # _
M _
Address: le
I
City/State/Zip Code- h 11
5
Yes No 0
Home Phone #' -,mail Address
40.7;,
APPLICANT OR AUTHORIZED AG ENT (See Below: Authorization must accompany applications signed by Amazed Agent)
Name:
Work Phone # lore Phone # Email Address
Address:
City/State/Zip Code
l (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.
Signaitunc Owner or Authorized Agent Date Signature: Owner or Authorized Agent Date
Subdivision Exemption Application
Robert Benson
25203 Weld County Road 47
Greeley, Colorado 80631
October 24, 2016
To Whom It May Concern:
The purpose for separating my properties is to be able to sell them separately. Currently the property
line runs through South side of the garage of the property located at 25169 Weld County Road 47. I
need to move the line to the North to enable the use of the driveway and garage at this address.
Sincerely,
Robert E. Benson
Weld County Public Works Dept.
1111 H Street
P.O. Box 758
Greeley, CO 80632
Phone: (970)304-6496
Fax: (970)304-6497
Applicant
Name
Company
Address 4
)(t 47
ACCESS PERMIT
APPLICATION FORM
Property Owner, (1f different than Applicant)
Name
Address
City State Zip _
City,(r3,��1 t= Ley State Zip / Phone a_
Business Phone V76 Aca ua�St
Fax
Email
1
Panel Location & Sketch
The access is on WCR
/-,/ _ 7
Nearest Intersection: WCR Jr O _ & WCR 5 if9.
Distance from Intersection
Parcel Number end a ,el
Section/Township/Ranee
Is there an existing access to the property? Y NO
Number of Existing Accesses _ o
Roar Surface Type & Construction Information
Asphalt__ Gravel X Treated Other
Culvert Size & Type
Materials used to construct Access
Construction Start Date Alr Finish Date
Proposed=
o Temporary (Tracking Pad Required)/ $75
o Small Commercial or Oil & Gas/$75
n Field (Agriculture Only)/Exempt
Is this access associated with a Planning Process?
Fax
E-mail
A- Existing Access A= Proposed Access
N
Lb
3
WCR 5
WCR SO
it Single Residential/75
n Large Commercial/ 150
ReNo
Required ►ttached Documents
- Traffic Control Plan -Certificate of Insurance
❑ Industrial/$150
❑ Subdivision/$150
o USR ❑ ICE a PUD ❑ Other_
- Access Pictures (From the Left, Right, & into the access)
By accepting this permit, the undersigned Applicant, under penalty of perjury, verifies that they have received all pages of the permit
application; they have read and understand all of the permit requirements and provisions set forth on all pages; that they have the
authority to sign for and bind the Applicant} if the Applicant is a corporation or other entity; and that by virtue of4their signature the
Applicant is bound by and agrees to comply with all said permit requirements and provisions, all Weld County ordinances, and state laws
regarding facJtU3e
Signature
• fretriated Name edge,e-7,et . Date -, '` /
Approval or Denial will be issued in minimum of 5 days.
Revised Date 6/29/10
Approved by
• i- 1 u• i• �.: 1:147:444.:
ice..- ' RTC. r •: •�'�.. r .�•
` � s L. ...frt. < J i ��' ,s y • sa F �i'tt' �. •-,
Applicant
N ame
Company
Address
Weld County Public Works Dept.
1111 H Street
PD. Box 758
Greeley, CO 80632
Phone: (970)304-6496
Fax: (970)304-6497
City 6feEnk
State
Business Phone
Fax
E-mail
cczip
e 6 103/
3'V$OY) /O tote°,
Parcel Location & Sketch
The access is on WCR
Nearest Intersection: WCR & WCR
Distance from Intersection _ �y� j''4 + L�
Parcel Number 0910/(4 WOO JIL 7
Section/Township/Range.
ACCESS PERMIT
APPLICATION FORM
Property Owner (If different than Applicant)
seipirsus
Name
Address
City State Zip
Phone
Fax
Email
Cat
A = Existing Access A= Proposed Access
t
Is there an existing access to the property? 'ES NO N
N umber of Existing Accesses e
Road Surface & Construction Information
Asphalt _ Gravel X Treated _ Other
1`
Culvert Size & Type I �CA4 vino ar
Materials used to construct Access
Construction Start Date
Finish Date
Proposed Use
❑ Temporary (Tracking Pad Required)/ $75
o Small Commercial or Oil & Gas/$75
o Field (Agriculture Only)/Exempt
U
tcR a,
341
cc
CI '4
WCR 50
*Single Residential
o Large Commercial/$i50
❑ Industrial/$150
❑ Subdivision/SIMI
Is this access associated with a Planning Process? S No ❑ USR ❑ RE ❑ PUD ❑ Other
Required Attached Documents
- Traffic Control Plan -Certificate of Insurance
- Access Pictures (From t h e Left, Right, & into the access)
By accepting this permit, the undersigned Applicant, under penalty of perjury, verifies that they have received all pages of the permit
application; they have read and understand all of the permit requirements and provisions set forth on all pages; that they have the
authority to sign for and bind the Applicant, if the Applicant is a corporation or other entity; and that by virtue of their signature the
Applicant is bound by and agrees to comply with all said permit requirements and provisions, all Weld County ordinances, and state laws
regarding foci ' rs construction.
Signatu
_gensileelL__ Printed Name
_r0 -17
gic2' /9000,1vi-
CENTRAL WELD COUNTY WATER DISTRICT
May 16, 2016
Robert. E. Benson
25203 County Rd 47
Greeley, CO 80631
RE: Tap # 1207
Dear Mr. Benson,
During a service call made to your property on May 16, 2016 it was determined that tap 41207 is serving two parcels.
District policy provides for water service to be extended to additional dwellings and/or parcels under specific circumstances.
If you are providing water service to a neighboring parcel from your tap you may be doing so in conflict of District policy.
Please be aware that in all circumstances Board approval is required for the use of a tap to provide water service to more than
one parcel.
District policies state... "A separate meter is required for each individually -owned property, except by a written agreement with the
District The Board of Directors of the Central Weld County Water District may consider special requests regarding the use of a tap to
provide water service to one or more parcels of land If an individual has owned the land to be considered for a minimum of ftve (5)
consecutive years, then a single tap may provide water service to divided parcels until at which time the divided parcels change ownership
then an additional tap or taps will be required to provide additional water service to those divided parcels. This policy may be amended
based on specific circumstance."
"Where one meter serves more than one dwelling and/or business unit, the following shall apply: A monthly surcharge of $3..50 for each
dwelling and/or business unit for two or more units shall be paid to the District in addition to the regular rate schedule in effect Once a
customer's water service has been designated as having an additional residence involved and a dwelling unit charge has been assessed
to the account, the dwelling unit charge will remain on the account indefinitely, regardless of whether the additional residences are
occupied or not No refunds fin' dwelling unit 7a ges will bewailed In the event that the additional residence has been removedfrom
the property, or the water service line has been permanently disconnected to the additional residence, the customer may request that
the dwelling unit charge be removed from their account. This request must be in writing, stating the circumstances involved, and will
be addressed by the Board at the next regular scheduled meeting. The customer will then be advised of the Board's decision in writing.
In the event that the parcel of property involving additional residences is sold, so that the gone owner - one property" rule is violated,
a second water tap will have to be purchased to serve the additional residence.
Attached is a form for you to complete and return to request consideration from the Board of Directors to continue
serving more than one parcel until one or more parcels change ownership. Please note that the cost of a water tap
(currently a minimum of 26,100.00) will be added to final charges when they are requested from a title company.
If the Board considers a special request on your behalf after you have notified the office, a signed approval will be added to
your file; Thank you in advance for your cooperation. Please contact the office to discuss this matter further at
970-352-1284 or for questions or comments.
Thank you,
,411/7 in -42
Roxp ne Garcia, Office Manager
2235 2nd Avenue • Greeley, Colorado 80631 • Phone (970) 352-1284 • Fax (970) 353-5865
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CLORADO
LOAN APPROVAL
Pt. -492
DEPARTMENT OF HEALTH
1516 HOSPITAL ri',.1r,D
I E L EY, COLORADO cto.ii
ADMINISTRATION (303) 353-0586
HEALTH PROTECTION (303) 353-0635
COMMUNITY HEALTH (303) 353-0629
Request No: 131-90
Date Received;
Date Forwarded:
9/07/90
9/12/90
Fee Paid: $50.Oo Date: 9/10/90
TO WHOM LT MAY CONCERN: Review and inspection report regarding water and the sewage
disposal system for an existing dwelling:
SEND TO:
Pick-up
INFORMATION: Address 25203 WCR 47, Greeley, Colorado 80631
Legal: PT Sf4 , PT
Subdivision
PHONE II
Sec 26 . T 05 R 65 W, Age of Septic _
Lot Blk * Filing
Property Owner I BENS0t471 ROBERT E. & KATHY Original Owner Same
Tank. Pumped on 9/7/90 By Slim's s Sanitation_ Service
DEPARTMENTAL RECORD SEARCH: Permit a C-850091 Name Benson, Robert E.
339-5295 Home
686-0525 Work
(Robert)
1985
Bathrooms 3 Bedrooms s 4 Total Acreage 1
Tank Capacity 1,000 gals. Field Size 408 sq. f t , Water Supply
Date of Final Inspection August 16, 1985
a MI5,
Central Weld
a
INSPECTION COMMENTS: Date of inspection
Soil Conditions: Dry X Saturated
Residence: Occupied X Vacant
•
September 11 , 1'0
Snow-covered
. S
FINDINGS: Sewage Disposal System: Satisfactory X Other
Bacteriological Water Test: Acceptable x Other
COMMENTS:r There is evidence that a ortion of the leachf ield is being driven over
occasionally, this can lead to failure of the system.
piie7f
DATE: September 12, 1990 SIGNA'I' F�.E: a%c' :f / S
1 -r s• r
Director,
Enviro,n enta Pr. o tettion Services
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 withour
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 rime the sample was taken
4
•
a
0
_INSPECTION DATE: 9 sa it, 40 AREA ALL
Residence:.
SPECIALIST'S INSTRUCTIONS:
NEED: l. Le.56
2. �_ Gam'_
3.
a
PL-An#41/
c
LOAN APJP0VAL
CLOSING DATE
MAIL OR
r
NEW LOAN OR
Request No:
/3i -9b
Date Received: 771 -
Date Forwarded:
Fee Paid:$50.(50_, . !Q_, Date: 9-10470
Y
9 I°
TO WHOM IT MAY CONCERN: Review and inspection report regarding water and the sewage
disposal system for an existing dwelling:
SEND TO:
INFORMATION: Address
Legal: PT 5(4 , PTSec +► T= R 65 ' , ' gc of Septic
siSOM
Subdivis irn
•
PHONE # 33914 -*;515" ilfln
Property Owner
c n se, _ A
Tank Pumped on et--1-it
DEPARTNENTAL RECORD SEARCH: Permit
8
4.".*2?tsztorte
G
rI
4444-bosas tug -
, Lot t BIk_ ,
e 4* O0%1 Original Owner sa rye _
Bathrooms Bedrooms
Tank Capaoi tynr gal ., Field Size_ + ' sq . ft. ?Water Supply._
Date of Final Inspection
game
9
ff., es/Walls-
Total Acreage
_Cat:awe, Is
INSPECTION CC} MENT : Dine of 'inspection9IiiJ9o_____
Soil Conditions: Dry Saturated Snow—covered
Occupied VRean t
FINDINGS: Sewage Disposal System: Satisfactory Other
Bacteriological Water Test: Acceptable_ "t,,,, - Other _
• 4n; i :
r
DATE:Ve-a CMATUR "
at as a
Environment h.ealth
p
e c,- list
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
arty lending agency nakiag a loan on the above property in connection with either its
en ,mination 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 r. r that It will continue to function in the future, Inspection requested during
periods of snow cover and high soil saturation may be of questionable va!ue to potthtial
Fusers due to adverse conditions. Water sample reports reflect the bacteriological quality
:4: f the water supply at the tine the sample was taken.
S 1 '' E -: 'V 1� L LI ► T t ?'_ Owner ealiestsandaerYssaa
15:00eil
Application No. S i.C'c
.a5)03 wag'?
Dice
Sub
.,
S.
PT sat!. R,4.5
Lot 011 Black al Filing
.F' ERCOLATLON TEST DATA: Start Time
E
10
min.
1 rig)
I 0
min.,
/13 2"
to
110
min.
min.
min, ,,
m
coin.
min.
Hole
Ho,
Hole
Depth
inch
H2O/098-
Remain.
inch
/0
mint
inch
ZS'
2 ��0
3min.
fr
en. ii.
xein.
si
, citiq
20-,692
1 I
goo
H
I
--
f-'
a
`
2
i
1�
`
...._fliglilig
3
0
itm
ger 3
LI.•
fire)
I .-, I-
/9 -KY/
i
245-11
WI A
3 /
27
51 .' 9
3 1/
3 .fr
I
T3T
fir telt
/5- 5
1.24),
fitte-62
4
1
H
2
371A
3
f
-
2.
'
,
1
e
ta
n
in ea
3 52(
3 dici'
3 ti,
1
.3,
J
20—#2.•..
...Ai,
ittnize
/9-.0
j}1 .(Jq�
rJj )l■p
4, 5
sh,.
%SP-
,
271
1 3 ttd
Zp fer
I
ire
All measurements s in i iim, unless
add H2
otherwise indicated.
local
44
1
. verag:e Race
;Environmental Health ,, �'
Specialist � � ' �`
��
r
3
2
PLOT PLAN
W 47 _
asaezi.l
Depth
inches
094 Lifenelfran yearit9. *ea
•
SOIL PROFILE
Description
Had 671ZER.,
swasialli
r "- r .
' F:s 1 d'> f
OWNER BEN,'°
side
4*
Pt /
RD B E R 1
J! N I)
i
eIr '! J. •! 1,1 L. Isa• s1, W E
.jI IQ
ADDRES ' t .,T •
PROIS
i'a'OSia D SiSYSTEM
I C•,a C' AI i : t.' ti' # "• LaI: ' Y' -r r i m
1... I.r. •„r i 1 •.., a! >_, t.t %.,r I 't S 1 1t4./p‘
SUBDIVISION:
LII
Ij 9.1
S JulY
Ito
tX•' a_, l; .
t' ... 141 1 . . salt 11. '
N � .a
a.i ♦ •� aw lad I
APPLICATION
VT
•% .1.
RESIDENTIAL
In tutu . ' C) ne
u� tt r
._ 4. •
u.ml
tt
n. r14
4.Ma
i
Ir
`�J' fla I ly� M1 1t7�' Ifa. r' f 1 ''t' I�_ M PERMIT
Yaia• less' C O LOUNT a1' 1-I -5 A LM T1' I -I UEFA I: 'f
$., N :C I'' � I;;: 14 '1Al... H I.f. "1" I" -I E h V ; C E
I••1 , I�':'A I._ ROAD,; 1-" F! I: I... F� ' a: 0063 i
J!�L tYt -t
I
a
tI
tort III. YYP I EM E.
I'
.. . /lc.
w.4 EXT.
Y a fNene
'70 tlt,
1)DI�;I:",.1 2.5 �'i 69 WCF�: 47
�et.r� iferiae' 1_
' Cn/ ,004 Carr
3 'X`HR '.l�OI��'i;
ae
1f
DRUMS , ' h, � 'I:' i` iAN "1' (.1ia•a
rEr
I�e'1aa
eat l+r 1 of ay
' I• { ft C— �ew iw
DAP"
I�'' I::: i��ls icat t:J Ilta all.
IO
S O , I,., 1� 1 ' i'
I L 4 • , f✓! !fl
aM 4
,_
t: 4 Y` L..
a
It
, r rt If'ti Y
/6
_ai -a Itt4 .iY .d1
es t. M .F. I
yr
M •t ••r fa• a•,
47
Yt
c'�r-' j'4 Jj £
h} tin t.a Iiu
Tub
wi
tit
f1t
■'_1 k l Jar
1'tiI$tl..t
CO #:1 r• '} i
ftJ
LOT 0 BLOCK 0
• L O T
ni ht .I. T y Itut a a laf M•F
u..J i :0 tlI r��' `t' E:. I 1 WATER SUPPLY
MIN PER INCH
I•�I,a-1 1.1.1,.I''tL_�' It.i t, Ii Er I "A�N
Ifn'h°:IflIFlT
II MIN ISIS WI'
I In
NO4 G bOO9 i
FERN r lr
PH ( , r -
I
I-• J.�_ti. J(
�M1 .. 44 ,t (it
T I .0 1•+ rr Ie�r
TC W7CWD
SIGNED :� ' ROBERT I' fie l.. A I F;.i` �'�a��l
WATER .�T ■ • B L E:. ,ir IT` It•' '�' H
GROUND SLOPE
DIRECTION
,.a 1�1� �;� # 'r I•� I .: APPLICATION . INFORMATION , � ,J I� ! I,..:I: I�: %� '1' l'�I I::: ti.J ! r ' :I: � �:�
••,.. II.I l4� FO .LLOWING i :I.MINIMUM :�, X .. �� I.a. '�!T :i;:� ; F�� I::: :c I�' ��� 'r :� �� ,' I�+�: RETIRED:
IN rinp{ADDITION cd
.�.. Il Ja .'
MAY
SEPTIC TANK1
t '~
GALLONS, ABSORPTION TRENCH
I v I4I •.14-I 4
:11.
'T H1,' PER1l i t TV
vun
TO
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et
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A
9r 51,51,
COI i ■ t r i ('1, 1
laws _;.
r1,■ I ,
la••1
+i
ii
FOLLOWING ADDITIONAL TERMS AND
' yt „ • Ll. IIa, 454;
4 /}1./ ow !J
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WELD COUNTY HEALTH DEPARTMENT dfs7
1555 17th Ave.
Greeley. Cede
Ph. 3 4540
!32 43 B.P. No.
M R, No.
Application for Permit to install, Construct, Alter or Repair Inclivid .. ewage Disposal System,
Owner Add ti Phone
6 a",
Legal scription
Dir ction
General
1. Living Units
t No. of Bedrooms
S. No. of Baths — - 1
4. Basement Drain
�a
elan
5. Automatic Dishwasher
S. Garbage Disposal i --
7. Automatic Laundry _
8. Size of Lot . 9. Type T of Soil tialaraste
10. Percolation Test
11. Water Supply
12. Lot Grade
18. Water Table Depth
14. Other
5aJ(cjoe (17
MW?
1. Liquid Capacity
2. Dimensions W
v'-3. Material '#
4. Tne Inlet
Tank
7.'n"e'Oatle't
Fiel
Gallons a
LI
Secondary dary Treatment
B
1. No of distri tion lutes
. French Widths.... ----•
3. Type Filler Material
4. Depth of Filler Material
5. Gravel Size
6. Type ale - --- _ -
7. Depth of Cover
8, Other
The Permit is to remain in 4u11 force and effect for six (6) months from date, until revoked for non-compliance.
This- system em wilt be constructed in accordance with the above specifications and regulations governing non=
municipal sewage disposal systems, in accordance with Regulation No. 1 of the Weld County Health De-
partment. Owner cannot transfer permit. .)<II 1 I
ter: . -*As/Ai .ir-
. 4 r
Date - pplicant:
y �
The s and specifications as shown are approved, pending pm
Sanitaria
Date :
The above system inspect d found p comply with the plan and ' r. iptiien}
Initalled by
PERMIT FEE _
Received by
Please use reverse side for Plot
le 00
Sanitarian: _
or use serateeet of paper.
Date;
Date
r
is6t4
• -
• .•
•
•
Weld County Treasurer
Statement of Taxes Due
Account Number R3923686
Parcel 096126000028
Legal Description
12839-N PT SE4 26 5 65 BEG 918'N & 30'W SE COR W208.6' N200.2' E208.6' S200.2' TO BEG
Account; R3923686
BENSON ROBERT E
25203 COUNTY ROAD 47
GREELEY, CO 80631-9769
Situs Address
25203 COUNTY ROAD 47 WELD
..o a s es a s ass s a so s we at s a a s s i am id Si IS Si ii i i ii S is i Y MP Ilk / It M! IN SI i! In AP as' 10 s Ir MO I, ifs ,!Y V: rb Y Y di Y MI i
Year Tax
Interest
Fees
Payments
Balance
Tax Charge
2016
$ 894.06
$0.00
$0.00
(S447.03)
$447.03
Total Tax Charite
$447.03
First Half Due as of 03/10/2017
Second Half Due as of 03/10/2017
$0.00
$447.03
Tax Billed at 2016 Rates for Tax Area 0698 - 0698
Authority
WELD COUNTY
SCHOOL LIST #6
NORTHERN COLORADO WATER
(NC
CENTRAL COLORADO WATER
(CCW
CENTRAL COLORADO WATER
SURD
LASALLE FIRE
AIMS JUNIOR COLLEGE
HIGH PLAINS LIBRARY
WEST O REELEY CONSERVATION
Taxes Billed 2016
Mill Levy
15.8000000*
36.3 3 50000
1.0000000
2.0040000
1.58 30000
5.1540000
6.3 080000
3.27 10000
0.4140000
Amount
$196.56
$452.01
$12.44
Values
SINGLE FAM.RES.
LAND
SINGLE FAM.RES-
IMYROVEMTS
$24.93 Total
$19.69
$64.12
$78.47
$40.69
$5.15
71.8690000
$ 894.06
Actual
$30,526
$125,760
$156,286
Assessed
$2,430
$10,010
$12,440
Weld County Treasurer
Pursuant to the Weld County Subdivision Ordinance, the attached Statement(s) of Taxes
Due, issued by the Weld County Treasurer, are evidence of the status as of this date of all
property taxes; special assessments and prior tax liens attached to this (these) account(s),
Current year's taxes are due but not delinquent.
Signed- ned � iv -C,
Date: 301
Weld County Treasurer
Statement of Taxes Due
Account Number R3923586
Parcel 096126000027
Legal Description Sites Address
12839J PT SE4 26 5 65 BEG 801' N & 30' W OF SE COR W208.6' N117' E20S.6' 8117' TO BEG (.56A 25169 COUNTY ROAD 47 WELD
IvIiL )
Account: R3923586
BENSON ROBERT E
25169 COUNTY ROAD 47
GREELEY, CO 80631-9769
,a SAO Jiilib MI SI GU IN R IN MI M' ! a PP 4` a M Si !l 'S SP IS In•• !r 34 MP _
Year
Tax Charge
Tax
Interest
Fees
Payments
Balance
2016
Total Tax Charge
$546.20
$0.00
$0.00
($273.10)
$273.10
$273.10
First Half Due as of 03!1072017
Second Half Due as of 03/1012017
$0.00
$273.10
Tax Billed at 2016 Rates for Tax Area 0697.0697
Authority
WELD COUNTY
SCHOOL DIST #6
NORTHERN COLORADO WATER
(NC
CENTRAL COLORADO WATER
(CCW
CENTRAL COLORADO WATER
SUBD
LASALLE FIRE
AIMS JUNIOR COLLEGE
HIGH PLAINS LIBRARY
WEST GREELEY CONSERVATION
Taxes Billed 2016
Mill Levy
15.8000000
36.3350000
1.0000000
2.0040000
1.5830000
5.15 40000
6.3 080000
3.2710000
0.4140000
Amount Values
$120.06
$276.15
$7.60
$15.23 Total
$12.04
$39.17
$47.94
$24.86
$3.15
71.8690000
$546.20
SINGLE FAM.RES.-
LAND
SINGLE FAM.RES-
IMPROVEMTS
Actual
$21,435
$73,996
Assessed
$1,710
$5,890
$95,431 $7,600
Weld County Treasurer
Pursuant to the Weld County Subdivision Ordinance, the attached Statement(s) of Taxes
Due, issued by the Weld County Treasurer, are evidence of the status as of this date of all
property taxes; special assessments and prior tax liens attached to this (these) account(s).
Signe
me
Current year's taxes are due but not delinquent
Date: 3 ��—
1 PAGE OF DOCUMENT
INCLUDED IN PAPER FILE.
REMAINDER RETAINED
ELECTRONICALLY IN TYLER.
DEPARTMENT OF PLANNING SERVICES
RECORDED EXEMPTION
ADMINISTRATIVE REVIEW
PLANNER: Ryder Reddick HEARING DATE: May 24, 2017
CASE NUMBER: SUBX17-0009
APPLICANT: Robert E. Benson
APPLICANT ADDRESS: 25203 County Road 47, Greeley, CO 80631
REQUEST: Subdivision Exemption for a Property Line Adjustment
LEGAL DESCRIPTION: Being a part of the SE4 SE4 of Section 26, T5N, R65W of the 6th P.M., Weld
County, CO
PARCEL NUMBERS: 0961-26-0-00-027 & 0961-26-0-00-028
PARCEL SIZE: SE Lot 1 Before:
SE Lot 2 Before:
ZONE DISTRICT: A (Agricultural)
WATER SOURCE:
+/- 0.55 acres
+/- 0.95 acres
SE Lot 1 After:
SE Lot 2 After:
+/- 0.70
+/- 0.80
Lot 1 Before: CWCWD Tap #1207 Lot 1 After: CWCWD Tap #1207
Lot 2 Before: CWCWD Tap #1207 Lot 2 After: New CWCWD Tap
SEWER SOURCE: Lot A: Before & After: Septic Permit #SP -1700068
Lot B: Before & After: Septic Permit #G-19850091
Description: In this case, the applicant is seeking to adjust the parcel boundaries between two adjacent
parcels which are in same ownership and are legal lots that were created by warranty deed
through metes and bounds descriptions prior to August 30th 1972. The lots created have held
the same legal description since July 18, 1966 per recorded warranty deed (Reception
#1493072). The applicant is seeking to do a minor adjustment to the lot boundaries between
the parcels because currently the lot line running between the two parcels is running directly
through the middle of the garage associated with the 25169 County Road 47 home site. The
lot line will be moved north so that all structures on both parcels meet all minimum offset and
setback requirements. Both lots are also under the 1 acre net minimum lot size requirement
for subdivision exemption parcels (that have public water taps) to be created per the Weld
County Code Section 24-8-40.L.
The Department of Planning Services staff has reviewed this request and recommends that this
request be Denied for the following reasons:
Section 24-8-40.L of the Weld County Code, states:
The minimum size of any lot proposed with a public water supply is not less than one (1) acre net.
The minimum size of any lot proposed with a well as the water supply is not less than two and one-
half (2%) acres net. Minimum lot sizes do not apply in zone districts which allow smaller lots or where
exempted by the Board of County Commissioners. The minimum lot size does not apply to
subdivision exemption lots created for the temporary use of a parcel for public utility facilities or
telecommunication antenna tower facilities.
S U BX 17-0009
Page 1 of 5
2017-1636
Suc51n -fit
Both lots that are proposed to be adjusted per this application request are recognized as legal
buildable lots. Both lots while on public water were each still created under the minimum 1 acre net
lot size requirement for a subdivision exemption lot, therefore any adjustments through the
subdivision exemption process would create lots that don't meet the minimum exemption standard
under 24-8-40.L, The application per section 24-8-40.L of the Weld County Code must be referred
to the Board of County Commissioners where they can waive the minimum lot size requirement.
Should the Board of County Commissioners approve this request, the Department recommends
the following conditions be attached:
1 Prior to recording the plat:
A. The applicant shall submit a sketch of the existing septic system in relation to the proposed lot
line to the Weld County Department of Public Health and Environment. Evidence of approval
from the Department of Public Health and Environment shall be submitted to the Department of
Planning Services by the applicant.
B. The applicant shall address the requirements (concerns) of Central Weld County Water District,
as stated in the referral response dated April 7, 2017. Provide written confirmation from the
Central Weld County Water District that a new second water tap has been purchased and is
active on site providing separate water service to each individual lot. Written evidence shall be
submitted in writing to the Weld County Department of Planning Services.
C. The Subdivision Exemption Lot shall comply with the less than thirty-five (35) acre maximum lot
size required by Section 24-8-10.8 of the Weld County Code.
D. 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.
2. Items to be included on the plat:
A. The plat shall be titled: Subdivision Exemption No. 0961-26-04 UBX17-0009
B. All approved accesses shall be clearly shown on the plat and labeled with the approved access
permit number (AP17-00209). The applicant shall contact the Weld County Department of Public
Works to determine if a culvert is necessary at any approved road access point.
C. County Road 47 is a paved road and is designated on the Weld County Road Classification Plan
as a local road, which requires 60 feet of right-of-way at full buildout. The applicant shall verify
and delineate on the plat the existing right-of-way and the documents creating the existing right-
of-way. If the existing right-of-way cannot be verified it shall be dedicated. All setbacks shall be
measured from the edge of right-of-way. This road is maintained by Weld County.
D. Setback radiuses for existing oil and gas tank batteries and wellheads shall be indicated on the
plat per the setback requirements of 23-3-50. E of the Weld County Code.
E, All recorded easements and rights -of -way shall be delineated on the plat by book and page
number or reception number.
Thin fnllnwinn nntaie aharII hn nlnr cad nn the nI t:
• • • • •• • • •• • • • T 7�Y chi! • • Y Y lIF�1r1YY f� 7F■ . fl TY �,/ . ti1 \
1) This Subdivision Exemption is for adjustment of property lines between two contiguous
parcels.
SUB 17-0000
Page 2 of 5
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.
* N o 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 2012 International Building Code, shall
be constructed within a 200 -foot radius of any tank battery or within a 150 -foot radius
of any wellhead or within a twenty -five-foot radius of any plugged or abandoned oil and
gas well. Any construction within a two -hundred -foot radius of any tank battery or one -
hundred -fifty -foot radius of any wellhead shall require a variance from the terms of this
Chapter in accordance with Subsection 23-6-10.C of this Code.
3) Any future structures or uses on site must obtain the appropriate zoning and building
permits.
4) The property owner shall control noxious weeds on the site.
5) The historical flow patterns and runoff amounts will be maintained on the site.
6) 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.
7) Building Permits issued on the proposed lots will be required to adhere to the fee
structure of the Weld County Road Impact Program.
8) Building Permits issued on the proposed lots, will be required to adhere to the fee
structure of the County Facility Fee and Drainage Impact Fees.
9) Potential Purchasers are hereby notified that the proposed Subdivision Exemption is
located within the A -P (Airport) Overlay District.
10) RIGHT TO EXTRACT MINERAL RESOURCES STATEMENT: Weld County has some
of the most abundant mineral resources, including, but not limited to, sand and gravel,
oil, natural gas, and coal. Under title 34 of the Colorado Revised Statutes, minerals are
vital resources because (a) the state's commercial mineral deposits are essential to
the state's !conomy; (b) the populous counties of the state face a critical shortage of
such deposits; and (c) such deposits should be extracted according to a rational plan,
calculated to avoid waste of such deposits and cause the least practicable disruption
of the ecology and quality of life of the citizens of the populous counties of the state.
Mineral resource locations are widespread throughout the County and person moving
into these areas must recognize the various impacts associated with this development.
Often times, mineral resource sites are fixed to their geographical and geophysical
locations. Moreover, these resources are protected property rights and mineral owners
should be afforded the opportunity to extract the mineral resource.
11) WELD COUNTY'S RIGHT TO FARM: Weld County is one of the most productive
agricultural counties in the United States, typically ranking in the top ten counties in the
country in total market value of agricultural products sold. The rural areas of Weld
County may be open and spacious, but they are intensively used for agriculture.
SUBX17-0009
Page 3 of 5
Persons moving into a rural area must recognize and accept there are drawbacks,
including conflicts with long-standing agricultural practices and a lower level of services
than in town. Along with the drawbacks come the incentives which attract urban
dwellers to relocate to rural areas: open views, spaciousness, wildlife, lack of city noise
and congestion, and the rural atmosphere and way of life. Without neighboring farms,
those features which attract urban dwellers to rural Weld County would quickly be gone
forever.
Agricultural users of the land should not be expected to change their long-established
agricultural practices to accommodate the intrusions of urban users into a rural area.
Well -run agricultural activities will generate off -site impacts, including noise from
tractors and equipment; slow -moving farm vehicles on rural roads; dust from animal
pens, field work, harvest and gravel roads; odor from animal confinement, silage and
manure; smoke from ditch burning; flies and mosquitoes; hunting and trapping
activities; shooting sports, legal hazing of nuisance wildlife; and the use of pesticides
and fertilizers in the fields, including the use of aerial spraying. It is common practice
for agricultural producers to utilize an accumulation of agricultural machinery and
supplies to assist in their agricultural operations. A concentration of miscellaneous
agricultural materials often produces a visual disparity between rural and urban areas
of the County. Section 35-3.5-102, C.R.S., provides that an agricultural operation
shall not be found to be a public or private nuisance if the agricultural operation
alleged to be a nuisance employs methods or practices that are commonly or
reasonably associated with agricultural production.
Water has been, and continues to be, the lifeline for the agricultural community. It is
unrealistic to assume that ditches and reservoirs may simply be moved "out of the
way" of residential development. When moving to the County, property owners and
residents must realize they cannot take water from irrigation ditches, lakes, or other
structures, unless they have an adjudicated right to the water.
Weld County covers a land area of approximately four thousand (4,000) square miles
in size (twice the size of the State of Delaware) with more than three thousand seven
hundred (3,700) miles of state and county roads outside of municipalities. The sheer
ra...r algal .rr IS. .JYa rrr 1L .4 =ME Spa ..r l� LE Jim man Sim “Ma y.J ilr�l�IS. Si mEa. ..a :la L r.-
1 I I GZL 1 I I LUUc U1 LI IC Cl I CO Ltd LSO OCI V GU OLI GL\. I ICO G Va I ICILOIC I 'Galati I LsC3. LCW CI I I JI LeC I i CI I I
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.
4 Additional Information.
A. A Weld County septic permit is required for any proposed home. The septic system shall be
installed according to the Weld County Onsite Wastewater Treatment System regulations.
SUB 17-0 009
Page 4 of 5
Topographic or physical features of the proposed lots, such as ravines, ditches, streams etc.
may limit the area available for a new or replacement septic system. Prior to recording the
plat the Weld County Department of Public Health and Environment recommends that the
applicant review the Weld County Code pertaining to septic systems to assure that any
installed septic system will comply with all setback requirements found in the Code. In the
event the proposed lot is not of sufficient size to allow the installation of a septic system the
lot may need to be enlarged.
The West Greeley Conservation District has provided information regarding the soils on the
site. The applicant shall review the information and use it to positively manage on site soils.
5 The plat shall be prepared in accordance with the requirements of Section 24-8-60 of the Weld County
Code. The applicant shall submit an electronic copy (PDF) of the plat for preliminary approval to the
Department of Planning Services. Upon approval of the plat, 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 County Clerk and Recorder by the Department of Planning Services. The
Mylar plat and additional requirements shall be recorded within sixty (60) days from the date the
administrative review was signed. The applicant shall be responsible for paying the recording fee.
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 Board of County Commissioners
resolution was signed a $5200 recording continuance charge shall added for each additional 3 month
period.
7 The Department of Planning Services respectfully requests the surveyor provide a digital copy of this
Recorded Exemption. Acceptable CAD formats are .dwg, .dxf, and .dgn (Microstation); acceptable
GIB formats are ArcView shapefiles, Arc Info Coverages and Arc Info Export files format type is .eO0.
The preferred format for Images is .tif (Group 4) . (Group 6 is not acceptable) . This digital file may be
sent to mapsco.weld.co.us. The Department of Planning Services respectfully requests the
surveyor provide a digital copy of this Recorded Exemption. Acceptable format is a projected ESRI
shapefile (.shp, .shx, .dbf, .prj) with a defined coordinate system (i.e., NAD 1983 UTM Zone 13N,
WGS 1984: NAD 1983 HARN State Plane Colorado North FIPS 0501 (US Feet).... etc.). This digital
file may be sent to mapsco.weld.co.us.
3, If the exemption plat has not been recorded within sixty (60) days from the date the administrative
review was signed, or Board of County Commissioners resolution, or if an applicant is unwilling or
unable to meet any of the conditions within sixty (60) days of approval, the application will be
forwarded to the Board of County Commissioners with a staff recommendation for denial. The
Director of Planning Services may grant an extension of time, for good cause shown, upon a written
request by the applicant.
By r-1Lrt
`Rider Reddick, Planner I
BUBX17-0009
Page 5 of 5
Date: May 5, 2017
March 24, 2017
DEPARTMENT OF PLANNING SERVICES
1555 N 17th AVE
GREELEY, CO 80631
WEBSITE: www.co.weld.co.us
E-MAIL: rreddick@weldgov.com
PHONE: (970) 353-6100, Ext. 3527
FAX: (970) 304-6498
ROBERT E BENSON
25203 COUNTY ROAD 47
GREELEY, CO 806319769
Subject: SUBX17-0009 - Lot Line Adjustment between two parcels
On parcel(s) of land described as:
12839-N PT SE4 SECTION 26 T5N R65W of the 6th P.M., Weld County, Colorado.
12839J PT SE4 SECTION 26 T5N R65W of the 6th P.M., Weld County, Colorado.
Dear Applicants:
Your application and related materials for the request described above are complete and in order at this
time. I will schedule a meeting with you at the end of the review period to discuss the referral
comments received by our office.
It is the policy of Weld County to refer an application of this nature to any town or municipality lying
within three miles of the property in question or if the property under consideration is located within
the comprehensive planning area of a town or municipality. Therefore, our office has forwarded a
copy of the submitted materials to the following Planning Departments for their review and
comments:
Greeley at Phone Number 970-350-9780
Kersey at Phone Number 970-353-1681
It is recommended that you contact the listed Planning Departments for information regarding their
process and to answer any questions that might arise with respect to your application.
If you have any questions concerning this matter, please call.
Respectfully,
Ryder Reddick
Planner
March 24, 2017
DEPARTMENT OF PLANNING SERVICES
1555 N 17th AVE
GREELEY, CO 80631
WEBSITE: www.co.weld.co.us
E-MAIL: rreddick@weldgov.com
PHONE: (970) 353-6100, Ext. 3527
FAX: (970) 304-6498
ROBERT E BENSON
25203 COUNTY ROAD 47
GREELEY, CO 806319769
Subject: SUBX17-0009 - Lot Line Adjustment between two parcels
On parcel(s) of land described as:
12839-N PT SE4 SECTION 26 T5N R65W of the 6th P.M., Weld County, Colorado.
12839J PT SE4 SECTION 26 T5N R65W of the 6th P.M., Weld County, Colorado.
Dear Applicants:
Your application and related materials for the request described above are complete and in order at this
time. I will schedule a meeting with you at the end of the review period to discuss the referral
comments received by our office.
It is the policy of Weld County to refer an application of this nature to any town or municipality lying
within three miles of the property in question or if the property under consideration is located within
the comprehensive planning area of a town or municipality. Therefore, our office has forwarded a
copy of the submitted materials to the following Planning Departments for their review and
comments:
Greeley at Phone Number 970-350-9780
Kersey at Phone Number 970-353-1681
It is recommended that you contact the listed Planning Departments for information regarding their
process and to answer any questions that might arise with respect to your application.
If you have any questions concerning this matter, please call.
Respectfully,
Ryder Reddick
Planner
Submit by Email
Weld County Referral
March 24, 2017
The Weld County Department of Planning Services has received the following item for review:
Applicant: ROBERT E BENSON
Please Reply By: April 21, 2017
Project: Lot Line Adjustment between two parcels
Case Number: SUBX17-0009
Planner: Ryder Reddick
Location: Approximately 0.15 miles north from the intersection of CR 52 and west of and adjacent to
CR 47
Parcel Number: 096126000028-R3923686 Legal: 12839-N PT SE4 SECTION 26 T5N R65W of the 6th
P.M., Weld County, Colorado.
Parcel Number: 096126000027-R3923586 Legal: 12839J PT SE4 SECTION 26 T5N R65W of the 6th
P.M., Weld County, Colorado.
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.
P
We have reviewed the request and find that it does / does not comply with our Comprehensive
Plan because:
We have reviewed the request and find no conflicts with our interests.
See attached letter.
Signature
Agency
BPascoe
Zoning Compliance
Date
03/24/2017
Weld County Planning Dept. 1555 N 17th Ave, Greeley, CO. 80631 (970) 353-6100 ext,3540 (970) 304-6498 fax
Submit by Email
Weld County Referral
March 24, 2017
The Weld County Department of Planning Services has received the following item for review:
Applicant: ROBERT E BENSON
Please Reply By: April 21, 2017
Project: Lot Line Adjustment between two parcels
Case Number: SUBX17-0009
Planner: Ryder Reddick
Location: Approximately 0.15 miles north from the intersection of CR 52 and west of and adjacent to
CR 47
Parcel Number: 096126000028-R3923686 Legal: 12839-N PT SE4 SECTION 26 T5N R65W of the 6th
P.M., Weld County, Colorado.
Parcel Number: 096126000027-R3923586 Legal: 12839J PT SE4 SECTION 26 T5N R65W of the 6th
P.M., Weld County, Colorado.
The application is submitted to you for review and recommendation. Any comments or
recommendation you consider relevant to this request would be appreciated. Please reply by the
above listed date so that we may give full consideration to your recommendation. Any response not
received before or on this date may be deemed to be a positive response to the Department of Planning
Services. If you have any further questions regarding the application, please call the Planner
associated with the request Please note that new information may be added to applications
under review during the review process. If you desire to examine or obtain this additional
information, please call the Department of Planning Services.
O We have reviewed the request and find that it does / does not comply with our Comprehensive
LIan because:
We have reviewed the request and find no conflicts with our interests.
O See attached letter.
Signature
Agency
Date
Weld County Planning Dept. 1555 N 17th Ave. Greeley, CO. 80631 (970) 353-6100 ext.3540 (970) 304-6498 fax
MEMORANDUM
TO: Diana Aungst, Planning Services
DATE: 4/3/2017
FROM: Hayley Balzano, E.I., Development Engineer
SUBJECT: SUBX17-0006 State of Colorado
The Weld County Department of Planning Services -Engineering has reviewed this proposal. Staff
comments made during this phase of the application process may not be all-inclusive, as other issues may
arise during the remaining application process.
COMMENTS:
Parcel(s): 096716100001
The project proposes: Subdivision Exemption for Telecomm Tower
Approximate Access Location: County Road 69 north of County Road 50
Geologic Hazard Area:
This area IS NOT in a Geologic Hazard Area.
Floodplain:
This area IS NOT in a FEMA regulatory floodplain.
DEVELOPMENT STANDARDS (NOTES ON THE SITE MAP)
1. The historical flow patterns and runoff amounts will be maintained on the site. (Department
of Planning Services -Engineer)
MEMORANDUM
TO: Ryder Reddick, Planning Services
DATE: April 11th, 2017
FROM: Morgan Gabbert, Public Works
SUBJECT: SUBX17-0009 Benson
The Weld County Department of Public Works has reviewed this proposal. Staff comments made during
this phase of the application process may not be all-inclusive, as other issues may arise during the
remaining application process.
COMMENTS:
Parcel(s): 096126000028 & 096126000027.
The project proposes to: do a lot line adjustment between two parcels.
Approximate Access Location: on CR 47 north of CR 52
Roads:
County Road 47 is a paved road and is designated on the Weld County Road Classification Plan as a local
road, which requires 60 feet of right-of-way at full buildout. The applicant shall verify and delineate on the
site map the future and existing right-of-way and the documents creating the existing right of way. If the
existing right of way cannot be verified it shall be dedicated. All setbacks shall be measured from the edge
of future right-of-way. This road is maintained by Weld County.
Access:
An access permit has been approved for the access to the site (AP17-00209).
AP17-00209 Special Requirements or Comments:
"Parcel 096126000028 & 096126000027. Utilize existing access points on CR 47 (4 -Residential) located
approx. 840 ft., 925 ft., 995 ft., & 1100 ft. North of CR 52."
Entrance gates (if applicable) must be set back a minimum of 100 feet from edge of road shoulder to allow
a truck with trailer or RV to pull completely off of the roadway and open the gate. In no case shall any
vehicle(s) stopped to open a gate be allowed to create a safety issue for roadway users.
When feasible, there shall be no net increase in the number of accesses to a public road. Contact Public
Works to discuss your access.
CONDITIONS OF APPROVAL:
A. The plat shall be amended to delineate the following:
1. County Road 47 is a paved road and is designated on the Weld County Road Classification
Plan as a local road, which requires 60 feet of right-of-way at full buildout. The applicant
shall verify and delineate on the plat the existing right-of-way and the documents creating
the existing right-of-way. If the existing right of way cannot be verified it shall be dedicated.
All setbacks shall be measured from the edge of right-of-way. This road is maintained by
Weld County. (Department of Public Works)
2. Show and label the approved access point(s) and access permit number(s) on the plat
(AP17-00209). (Department of Public Works)
DEVELOPMENT STANDARDS (NOTES ON THE SITE MAP)
1. The property owner shall control noxious weeds on the site. (Department of Public Works)
•.''�.�86i �u
r1
couNTY
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 North 17th Avenue, Greeley, CO 80631 www,weldhealth,org
Memorandum
To: Ryder Reddick, WC Planning
From: Ben Frissell, Environmental Health Services
Date: April 19, 2017
Re: SUBX17-0009
Applicant: Benson
Environmental Health Services has reviewed this proposal for a property line
adjustment. The line adjustment is between neighboring properties at 25169 WCR 47
(parcel number 096126000027) and 25203 WCR 47 (parcel number 096126000028).
There is an existing residence on each of the parcels. Currently water is provided to
both properties via Central Weld County Water District (tap #1207), however, a new tap
will be needed for address 25169 (parcel 096126000027) as indicated in the CWCWD
referral letter. Both residences are serviced by existing on -site wastewater systems.
Property 25169 WCR 47 is serviced by permit SP -1700068 and property 25203 WCR
47 is serviced by permit G-19850091.
The Environmental Health Services Division has no objections, but recommends the
following conditions:
Prior to recording the plat:
1. 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. Lot lines may need to be adjusted if this
cannot be accomplished with the boundaries proposed.
2. Evidence of an adequate water service will need to be provided for the existing
home site located at 25169 WCR 47 (parcel number 096126000027). Central
Weld County Water District issues all taps for their public water supply in this
area. Please contact Central Weld County Water District and provide
documentation from the District that an adequate dedicated water source is
provided for the site.
3. 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
Health Administration
Vital Records
Icic: 9/0 304 6410
Fax: 9/0-301-64 I'2
Public Health &
Clinical Services
lobo: 9:0 :304 6420
Fax: 9,10-304-64I6
Environmental Health
Services
Tele: 970-304-6415
Fux: 970-304-6411
Communication,
Education & Planning
Tele: 970-304-6470
Fox. 970-304-6452
Emergency Preparedness
& Response
Tele: 970-304-6470
Fax: 970-304-6462
Public Health
septic system will comply with all setback requirements found in the Code. In the
event the proposed lot is not of sufficient size to allow the installation of a septic
system the lot may need to be enlarged.
Submit by Email
Weld County Referral
March 24, 2017
The Weld County Department of Planning Services has received the following item for review:
Applicant: ROBERT E BENSON
Please Reply By: April 21, 2017
Project: Lot Line Adjustment between two parcels
Case Number: SUBX17-0009
Planner: Ryder Reddick
Location: Approximately 0.15 miles north from the intersection of CR 52 and west of and adjacent to
CR 47
Parcel Number: 096126000028-R3923686 Legal: 12839-N PT SE4 SECTION 26 T5N R65W of the 6th
P.M., Weld County, Colorado.
Parcel Number: 096126000027-R3923586 Legal: 12839J PT SE4 SECTION 26 T5N R65W of the 6th
P.M., Weld County, Colorado.
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.
n
F -
We have reviewed the request and find that it does / does not comply with our Comprehensive
Plan because:
We have reviewed the request and find no conflicts with our interests.
See attached letter.
Signature
Agency
Kathy Naibauer
Central Weld County Water District
Date
4/7/17
Weld County Planning Dept. 1555 N 17th Ave, Greeley, CO. 80631 (970) 353-6100 ext,3540 (970) 304-6498 fax
CENTRAL WELD COUNTY WATER DISTRICT
April 7, 2017
Ryder Reddick
Weld County
Department of Planning Services
Dear Mr. Reddick,
Thank you for referring project SUBX17-0009 to Central Weld County Water District (CWCWD) for
review.
As stated in the letter from CWCWD, dated May 16, 20I6 and submitted with the application, water service
for both parcels is currently being provided by tap #1207. Tap #1207 is designated for use on parcel
096126000028. Because the tap holder was offering both parcels for sale during 2016, CWCWD agreed to
allow the connection to both parcels to remain on a temporary basis, until the property became divided or
ownership changed. Because the applicant states that the purpose of the exemption application is to be able to
sell the properties separately, it is appropriate at this point that the connection to parcel 096126000027 be
severed and water service be provided through an additional tap purchase or with the use of a well. Once
ownership of either parcel changes, parcel 096126000027 will not be eligible for water service through
tap 1207. The District requests that Weld County Planning consider requiring proof of a separate water
source for parcel 096126000027 prior to approval of SUBX17-0009. Having this requirement will help
ensure that the existing home on the property doesn't transfer ownership without a water source.
If the applicant wishes to pursue purchase of a second tap, appropriate fees and documents can be submitted
to the District for a water study. If the applicant wishes to pursue a well permit through the Division of Water
Resources, current District policy will allow for generation of a non -opposition letter, also with submission of
the appropriate fees and documents to our office. The applicant is encouraged to contact our office to arrange
for a CWCWD staff member to verify disconnection of service to the second parcel, at which time the
District can provide Weld County Planning with confirmation of the disconnect and any documentation
associated with a new tap purchase.
All requirements of Central Weld County Water District, Northern Colorado Water Conservancy District and
the U.S. Bureau of Reclamation must be satisfied prior to installation of a new tap for water service at parcel
096126000028.
If you should need anything further, please contact the District.
Thank you,
oejc
t)r��4_9�
Kathy Naibauer
Central Weld County Water District
970-352-1284
2235 2nd Avenue • Greeley, Colorado 80631 • Phone (970) 352-1284 • Fax (970) 353-5865
Submit by Email
Weld County Referral
March 24, 2017
The Weld County Department of Planning Services has received the following item for review:
Applicant: ROBERT it BENSON
Please Reply By: April 21, 2017
Project: Lot Line Adjustment between two parcels
Case Number: SUBX17-0009
Planner: Ryder Reddick
Location: Approximately D.15 miles north from the intersection of CR 52 and west of and adjacent to
CR 47
Parcel Number; 096126000028-R3923686 Legal: 12839-N PT SE4 SECTION 26 T5N R65W of the 6th
P.M., Weld County, Colorado.
Parcel Number: 096126001}027-R3923586 Legal: 12839J PT SE4 SECTION 26 T5N R65W of the 6th
P,M„ Weld County, Colorado.
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 lo applications
under review during the review process. If you desire to examine or obtain this additional
information, please call the Department of Planning Services.
O
We have reviewed the request and tied that it does/does trot comply with our Comprehensive
Plan because:
We have reviewed the request and find co conflicts with our interests.
See attached letter.
Signature A
Agency
;i. 7
t,�„ Fr�v++lion D SrRICT
iM r,
Dale 'v ' & �` D
Weld County Planning Dept, 1555 N 17tha Ave, Creerey, CO. 80tia1 {97Uf 353.6100 ext.35v0 (970) 30-1-64 98 fax
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West Greeley Conservation District
(970) 356-8097
Below is a list of the soils and their limitations according to the USDA. Weld County Soil Survey.
MapSymbol
Soil Name Soil Texture
69 Valent Sand
70 Valent Sand
Shallow
Excavations
Dwellings Dweitings with Small Septic Tank Prime Farm
without basements Commercial Absorption Land (if
r°lE:rr; Slight Slight Slight Slight No
tin 4!t r+, Slight Slight Slight No
Addltianal Comments
Ttir Wrest Grerlcy ConseTuntiprY District recommend, th,rt tltc.1pplicant does an on Site soil,. Eest prior to any construction. For ,r morn complete ,oils dt•scriptipn consult the Weld County Soil Stnwey or
contact our office it {9701 35b -E3097. If you or the appli€:ant have any qutr.trons pteasr: Eeet flee to call our offuce.
WEST GREELEY
CONSERVATIN
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Produced by the West Greeley Conservation District
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110C10 -EL
Certificate of Conveyance
State of Colorado
County of Weld
Weld County
Department of Planning
Services
STEWART TITLE OF COLORADO hereby certifies it has made a careful search of its
record, 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:
12839-N PT SE4 26 5 65 BEG 918'N & 30'W SE COR W208.6' N200.2' E208.6' S200.2' TO BEG
CONVEYANCES (if none appear, so state):
Reception No.: 1493072
Reception No.: 1588458
Reception No.: 1613 834
Reception No.: 1721487
Reception No.: 2228021
Reception No.:
Reception No.:
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 or an opinion of Title, nor a
guarantee Title, and the liability of STEWART TITLE OF COLORADO is hereby
limited to the fee paid for this certificate.
In Witness Whereof, STEWART TITLE OF COLORADO has caused this certificate to
be signed by its property officer this 20 day of March, A.D., 2017, at 8:45 a.m.
Effective date of search: 3/10/2017
STEWART TITLE OF COLORADO
BY; r/ -�
Authorized Signature
Recorded al _, B 1277 REC 02228021 09/21/90 16:17 5.00 1/001
AR222a(121 F 0750 MARY ANN FEUERSTEIN CLERIC & RECORDER WELD CO, CO
.GWafrarity‘Deed
THIS DEED re a conveyance u( the real properly described below including any Improeernenie and other appurtenances (the
properly ) horn tire indlvlduall5) corptratinr(s} partrerih'p(s),orotherenIllyIlea)nomadbelowasGRANTORtotilelndrvodue'(r)
0' entity -0W named below es GRANTEE
1 he GRANTOR hereby sells end conveys the property to the GRANTEE and She GRANTOR warrant' the ode tp the properly.
eCcepl for I i) the hen 01 the general property lases For the year Oliva deed which the GRANTEE wul pay (2i any eeeemenla and
nghlsrolway shown of record l5! any patent reservalions and eacepnons (9) any outstanding mineral mleres'S shown or record (5)
any protective covenant' and reslnctionn enown of record and (Et any add,tlonat mailers shown below under-Add,llonal Warranty
Er ce phone
The Specific Terms of This Deed Are:
rig
poc
>re�
7
5 o
?V
i
Gr■nlor,
(Grve namnlbl and FIecatal of residence 1' the spnJS0 al the nwrer re altldr IS pining Milli Deea In weals name,51e90 ngn15 dealdy
grantors 0S hue0and art) role I
ROBERT E. BENSON
25203 Weld County Road 47
Greeley, Colorado 80631
(Giro nemelel non aporeallnl Ilelemenl ul arrehrlab inLn.dll'9 '+"nl.rn,n rg'd or erreel naelber S '9onrred
ROBERT E. BENSON AND KATHLEEN ANN BENSON
25203 Weld County Road 47
Greeley, Colorado 80631
FarR1 at CO^OWRONTip: 111 noes ale l*0 or men' q,JrImes named Ines r I he ecneldered to lane as leninla In co•nmun'.mess Ire won10 •n
lo'l`l !mill:. ar wards or the yan'h meamr'Ir all, altar in the apace new*:
In Joint Tenancy
Property Drecripllont Ilnciode r,nmly are sin Is
A parcel of land in the SE 1/4 of Section 26, Township 5 North, Range 65
West of the 6th P.M., Weld County, Colorado, more particularly described
as follows: Beginning 918 feet North of and 30 feet West of the
Southeast Corner of Section 26; thence West 208.6 feet; thence North
parallel to the East line of said Section, 200,2 feet; thence East
208.6 feet; thence South parallel to the road 200.2 feet to the
Tnie Point of Beginning.
P:operlyAddrier 25203 hold County Road 47, Greeley, Colorado 80631
Con alderdlon: I me statement b1 a arll,er arneenl,a epbonal Idecunle' pn5"rrnll'+1,' loi Irks d0na 0 l nn c'rvl'nrn I, lcm 'h ti l aw+ynr re'0
derld 101 ac a ii,n ,r u- -sae Ih s cnr rl'yn'''re in nbsohiree 1 ,0 ,n+a tlncondll'anal I
CONVENIENCE DEED
R lions -Restrictions: lnl^e rRANTuaI^lenlls:•1,'r'.r'sr any'ni'nl sl „' Inc n,uperry 0' li i.e .,I, ,. •.rl ^,',.a ,.., „i.hANlrin
'901' Chm, the ii3OAN'GE S ngrl .• u'r e'sprviy mane dhN nn".11, '•'I. ,I '
Additional Warranty Exceptions: II'rswne dress al troll DP ny 591.10'01 "•n1 erne, Matters not ors' I ,rna, ,
E eecJled nr the Ca:inter on _--Septernher 13_ 'n .—�
elenarure Clauai fps Corparahee, Paelnennlp or M.,Glalien: tI gnasura-Ctw1a ler Indmeealpt
_
Name or Grenror Col earal,on. Parine'eh,p al AS90e'at,05 r&irt —V. Penson
By
it,
STATE OF COLORADO
COUNTY OF FIELD
The loregemy ,gNlumenl wee ecsno..le ngue
a,' Robert E. Benson
WITNESS my rand and on,c'al seal
my commissioneepen: 11/23/93
S TAT h OF
COUNTY OF
TO. ,mago'ng .nelrumenr was acenow,aope. nel0re me In,.
By'
;'name lnSinduatGrenrorpl or if Grerlor'OCu,poranan Perrnershipo' Am:merlon lher'denldySignerfas praallsrnl arr,ce p,esleer'l andeecrelary or
aes.sra,i1 reGrelary d' co'daral,an or as partneri') 0$ fI'Ina'anlp 0109 aurhorued n iembe,IJI of easocainse I
day of September
Notary Prr
vie L. Loomis
day of
6,0010•
r9 90
WITNE£5 my nand Ind 011,[111 seer
My rarnmlealaa .spiral:
an
19
Meters Peelle
• 1541 UPDATE LEGAL FORMS
PO Boa Sera • Greeley Colorado B0ed2
(757! 711•'7(0
MO. eel
BOOK
JUN ...............M1!w... 9 1977
�q
Y� Recorded at ................�.............v cluck M,, ........_...... .....;..-..._.......,...,..... _....... 1721467 Reception hFo,,. ANN FEII[RSTi i1� .....R
warder.
has DEED, Made this 27th day of Nay , 1977 ,
between -SHARON 0. BENSON, a single person
of the County of Weld , and state' of
Colorado, of the first part, and
-r ROBERT E. B N DN a single person ------
i17d W ffCWli,V7
of the County of We.id d and state of
Colorado, of the second part, -
WITNESSETH, That the said part y of the first part, for and in consideration of the sum of
m Other good and valuable consideration and the sum of $1.00 DOLLARS,
tri to the said part y of the first part in hand paid by the said part y of the second part, the receipt whereof
5b is hereby confessed and acknowledged, ha a remised, released, sold, conveyed and QUIT CLAIMED, and by
4-4 these proaenta do e5 remise, release, sell, convey and QUIT CLAIM unto the said part y of the second part,
p and to h Dire, successors and assigns, forever, all the right, title, interest, claim and demand which the said
o part Y of the first part ha S in and to the following described lot or parcel of lend situate, lying and
being in the County of We i d and State of Colorado, to wit:
PARCEL 1:
A parcel of land in the Southeast Quarter (SE/ii) of Section 26, Township 5 North,
Range 65 West of the 6th P.M., more particularly described as follows: Beginning
• 801 feet North of and 30 feet West of the Southeast corner of Section 26, thence
• West 208.6 feet; thence North parallel to the East line of Section 117 feet;
thence East 208.6 feet; thence South parallel to the road 117 feet to the true
point of beginning, Weld County, Colorado; and,
Y1
PARCEL 2;
A parcel of land in the Southeast Quarter (SE/4) of Section 26, Township 5 North,
Range 65 West of the 6th P.M., Weld County, Colorado, more particularly described
as follows:
Beginning 918 feet North of and 30 feet West of the Southeast Corner of Section 2
Thence West 208.6 feet;
Thence North parallel to the east line of Section, 200.2 feet;
Thence East 208.6 feet;
Thence South parallel to the road 200,2 feet to the True Point of Beginning.
TO HAVE AND TO HOLD the same, together with all and singular the appurtenances and privileges thereunto
belonging or in anywise thereunto appertaining, and all the estate, right, title, interest and claim whatsoever, of the
said part y of the first part, either in law or equity, to the only proper use, benefit and behoof of the said
party of the second part, h i s heirs and assigns forever.
IN WITNESS WHEREOF, The said party of the first part has hereunto set her hand
and seal the day and year first above written.
.,.ISEAL)
(Sharon 0, Benson)
Signed, Sealed and Delivered in the Presence of
STATE 01' COLORADO,
County of Weld
The foregoing instrument wee acknowledged before me this 27th day of Nay
1El77,by SHARON 0. BENSON, a single person
My commission expires
September 23
'1179 . Witness may hand and official seal.
(Robert C. 3osley'
tSEAL]
[SEAL}
.[SEAL]
[1-041 rp Pu Mlle.
No. Ella. QUIT CLAIM SEDn,—Ai ndfcrd Publishing. Co., 151..1•w Sloet &Creek, Denver, Colorado (5734%1 l•
G7
0.2
�f3c,t� 692 MAY 2 3 1973
I I f tar I WY 11 ANN SPC
Vile,' tar recta, lh.. _ day
oor ,,. Q ., h, 1). In . n .. ,........,n'e oe .............
Ita'tna,in YI,. . 1613834
Ill CoRDEfi-
z
p
U[� Eerbi i Made this
one thousand nine hundred and seventy three
23rd day of Nay
between
in the year of our Lord
ED KOONCE, AKA ELDEN D. KOONCE AND LYDIA K. KOONCE
of the County of 'Weld and State of Colorado, of the first part, and
E.
ROBERT BENSON KND SHARON D. DENSON
of the County of Weld and State of Colorado, of the second part;
FVitnesseth, That the said parties or the fire, part, for and in consideration of the sum of
Other Valuable Consideration and Ten (x'10.00) DOLLARS,
to the sold part iesof the first pert in hand paid by the add parties of the second part, the receipt whereof is hereby Can-
fetLsed end acknowledged, hevt granted, bargained, Bold and cmnvcycd, and by these preannts do grant, hL,rllahl, sell,
convey and confine, unto the said parting or the second part, not in tenancy in common but in joint tenancy, the snrcivor a1
them, their assigns and thee heirs and assigns of such survivor forever, all the following described lot or parcel of land
situate, lying and tieing in the Courtly of weld and Stale of Colorado, to -wit: A parcel of
lard in the Southeast f'uarter (SE1;,) of Section 26, Township 5 North, Range 65 West
of the 6th P. M., more particularly described ,3s follows: beginning "D1 fort North
of and 30 feet West of the .Southeast corner of Section 26, thence West 20:3.6 feet;
thence North parallel to the ,East line of Section 117 feet; thence East 20e.6 feet
Thence South parallel to the road 117 feet to the true point of beginning, Weld
County.-, Colorado, and A parcel of land in the Southeast C:uarter (3 11) of Section
Tarenty-six (26) Township Five (5) North, Range Sixty-five (65) West of the Sixth
(6th) P. M., Weld County, Colorado, more particularly described as follows:
Soginning 913 feet North of and 30 feet Wiest of the Southeast Corner of Section 26
Thence West 20`x.6 feet; Thence North parallel to the east line of Section, 200.2
feet; Thence East 205,6 feet; Thence South parallel to the road 200.2 feet to the
True Point of Beginning.
State Dbeurnentory Epp
pate t1 AY `2)117.4
Togethar with ell and singular the hereditament -1 and appurtenances thereunto belonging, or in anywise appertaining,
and the reverting and reversions, remainder and rcmalnJens, rents, imues end profits thereof; and all the estate, right, title,
interest, clam did d‘nttimid. whatauever of the acid parties of the first part, either in law or equity, of, in and to the above
hergninrrl premises, with au Iicre,lilnmonts and appurtenances.
To Have a td'to Hold the said premises above bargained and described, with the appurtenances, unto the said parties of
the ascend part, the survivor of them, their assigns and tine heirs and assigns of such survivor forever. And the Raid part lea
of the first part, for them selves their heirs, executers, and administrator', do covenant, ,;rant,
bargain and agree to and with the geld imrLies of the second part, the survivor of them, their assigns and the heirs ,cod asthma
of such survivor, that at the time of the enseulieg rind delivery of these presents, they are welt srizcd of L1n', premises
above conveyed, as of weed', stir.-. inrrfrrt, ahrniute rind indefen_sihlr• r.Lstr of ioliediunce, in law, in NV xirlhph„ and Ira VC
grind right, full power and l:nvlot out horny t❑ grant, lotrgnin, sell :,fnf eulrvey the rtmr in insnecr:tnd form :,fnn for i,'to I that
the :mrno err: free Ind steer from all furn)cr mid taller grants, hnrgnins, a ukec, liens, taxi;, so,,:+dments till iticuntflrtincs3 of
wilatcvcr kind or natureyoever, ',xctnlrt; The gr:neral tdxc:r for current your 1973 and
subsequent years; Reservations, Restrictions, Easements, Right —a —ways, Conditions
Rxceptions and Protective Covenants of Record if any.
nod the shove iIILrgained premises du the quiet and pcaernhle possession or the sill parl tea of the Peened part, the e;,rrivor of
there, their Ilei gas and the heirs aid lumiglls of such surelyur, outlast all and every ,)m utt or Femme' lawfully claiming or
to ollitiu the whole or uuy part thereof, the said part ies of the first part shall and will WARRANT AND FOREVER
DEFEND,
In Witness Whereof The raid parties of the first part ha 170 hereunto set
Real S the day and yrnr 11rret shove written.
Signer., Sealed and Delivered in the Presence of
their
hand y and
P4.,„ ..... ..................(SgAL)
fI-'Lr f gA- C L—_NEAL1
ti
The foregoing Instrument was acknowledged before me this 0291;„!i
oL__May_--_-- _ _-- .----___-- 19 .73_., by Ed Koonce, AKA Elden D. Koonce
Koonce
STATE OF COLORADO,
County of Weld, 4 ss.
Witness My Hand anti Official
7 °JZtober 23714
My Commission Expires .
Mailing Address for
Future Tax Notices ,.
a
Q
--T41L G. F. ,10r.CirL CO., I:CIIvLn.coLO.- .ece,hL
Q •
Ii1m' 666 . ,
r 2 . •-
APR
Filed for Heard 4he,.���ypy� .� A. D. rs. �...,, nt�..,.,.,,,,,o'eloak�u.
nea.oCon N........_:.. V 5th.'
F]Ei'tlTY,
OD
teit
e -f
NI
Fr
rrt
v, r
af4
rf
0
O
r
w
19th ' day of . April in the year of our Lewd
one'thousand nine hundred and seventy two , between'
TES MALTOS aril MARIA M. MATXT OS
of the County of
and State of�dp, of the first part, and
'Texas'
ELDEN D. COON'+ AND LYDIA I. X0'ONGE
of the County of Weld
and State of Colorado, ef.t,he aecand part;
Witnasseth', That the Bald perti,es of the first part, for and in consideration of the sum of TEN' •(
other DOLLARS,
to the said part ie !f the first; part in hand paid by the said parties of the second part, the receipt whereof is hereby con-
fessed and acknowledged have granted; bargained, sold and conveyed, and by these presents do grant, bargain, sell,
convey and confirm, unto tho said partite of the second pert, not in tenancy in common but in Joint tenancy, the survivor of
14
them, their eseigra and the heirs awl assigns or such survivor forever, alidhe following described lot • or parcel of laud
hire
situate, lying and being in the County of Mold w and State of Joloradn, to -wit:
A parcel of land in the Southeast Quarter (m*) of Section 26,
Township .5 North, Range 65 West of the 6th P.M., more particularly
described ap follows: beginning, 801 feet North of and 30 feet West
of the Southeast corner of Section 26; thence West 208.6 feet; theme•
North parallel to the East line of Section, 117 feet; thence East
208.6_feet; Thence South parallel to the road 117 feet to the true
point of beginning
State Documents Fee
„'Date 'AIP3..,a6--...
....
so
Ktit
Together with all and singular the hereditament° and appurtenances thereunto belonging, or in anywise appertaining,
and the TeveTeion and reversions, remainder and remainders, rents, iaeuca and pronto thereof; and all the nst.tr, right, titles
interest, claim and demand whanteevec of the card parties of the first pert, either in law or equity, or, in and to the above
bargained proinieca, with the Iteredilamento and appurtenances. '
To Have and to Hold the said promises above bargained and described, with the appurtenances, unto the said particp of
the second part, tironurelvoratthem,theirassignsandthehelmand&signsofetrchsurvivorforever: And the saidportjSS
of the first part, teethom sohfes & theiriirira, exoeutnre, nod arlminintnaore, tin cnvennnt, gnmt,
bargain and ogre¢ to and with the amid pnrtiss of tiresecond part., tin -survivor of them, their ii4 ig,ia and the heirs COO aaligrie
of eueh survivor, that at the time dr the ensealing and delivery of these presents, they are well seined of the premises
above conveyed, as of good sine. perfect, absolute and indrfraribte ewtate ur inheritance, in law, in fee oirnplt, and lot y@
good right, lull power &Intl lawful authority to grnnt,hargnjrt,acll mid convey the tame iii ii iurreran,t form ufuresaht,and. that
Ilse aarrie are free and clear from all former and other grant.% barignina, sales, liens, taxer, aascolainate and ineu,nbrancra of
whatever kind ornetursseevtr, EXCEP : reservation xcent- ns_Y i conditions .in U. S. Patent] easements and rigi�t0ior way ence
record; laws, rules and regulations of Weld County and the State of
Colorado; and 1972 taxes, which have been pro. -rated;
And tits mbove bargained premises in the peiet and peaceable poaeossion of tho said parties of the second part, the survivor of '
them, their rssigne aud'tho heirs and awigna of such survivor, against all an3.every peraun or persona lawfully claiming or
to claim the whole or any part thereof, the said parti.SS ' of the first' part shall and will WARRANT AND POREVER
-DEFT IND. •
7n Witness Whherrof, The said parties of the first part haVe hereunto set their hands and '
'meal s the day and year fret above written.
Signed, Sealed and Delivered in the Presence of.
STATE OPI
County o/
t+r Apr .1922 —by 'Tomas Maltos and Maria M. Maltos
Y ✓--1ra' _ v'r (SEAL}
Mine 1'fe1toi (SEAL)
Witness i iy frond and 0fficleb
My Commission Expires
June 1, 1973
Mailing Address for •
1,uturo '3'vx Notices
The foregoing Instrument was acknowledged before me this ,day
yN1,'.,.,,F,..a.r .
Y '
Notary Public
) a'f' 4+}rr [ C.. k b '
Lam' P.E )1QUis
F. asset. N—n17C.PttbliC.8endCauaNrtatr#.1
WARRANTY DEED TO JOINT TENANTS —The c; r, ftorend, cd., onNVCn, COLorar Ci CAI -
f _
'5`7'x.
,?UL B1966 0.3 ` JL Rocord�.- �g 8 .« O�CIaC� 21.Reception h1o. 149 ! is,........ _. '. N ►SP0I ,_..., Recorders
io !E b, Made this
?It h , day of July in the
year of our Lord one thousand nine hundred and Sixty-six between
WILLIAM A. WYLIE
of the County of and State of Colorado, of the
first part, rod TOMAS MALTOS and MARIA.M. MALTOS
of the
second part:
WITNRBSETH: That the said party of khe first part, for and in consideration of the sum of
Other valuable consideration and Ten and no/100 DOLLARS,
to the said partY of the first part in hand paid by the sold parties of the second part, the receipt whereof is
hereby confessed and acknowledged, ha S granted, bargained, sold and conveyed, and by these presents doe 5
grant, bargain, sell, convey and confirm unto the said parties of the second part, to pass not In tenancy in common
but in joint tenancy, the survivor of them, their assigod and the heirs and assigns of such survivor forever, all the fol-
lowing described lot or parcel of land, situate, lying and being In the
-Cooney of Weld - and State of Colorado, to wit:
County of
Weld- - + and State of Colorado, of the
A parcel of land in the Southeast Quarter (SEA) of
Section 26, Township 5 North, Range 65 West of the
6th P.M. , Weld County, Colorado, more particularly
described as follows: Beginning 801 feet North of
and 30 feet West of the Southeast corner of Section
26; Thence West 208.6 feet; Thence North parallel to
the East line of Section, 117 feet; Thence East
208.6 feet; Thence South parallel to the road 117
feet to the true point of beginning.
TOGETHER with all and singular the hereditaments and appurtenances 'hereunto belonging, or in any wise
appertaining, and the reversion and reversions, remainder and remainders, rents, issues and profit& thereof; and
all the estate, right, title, interest, claim and demand whatsoever of the said party of the first part, either in
law or equity, of, in and to the above bargained premises, the hereditament& and appurtenances.
TO HAVE AND TO HOLD the said premises above bargained and described, with appurtenances, unto the
said parries of the second part, the survivor of them, their assigns, and the heirs and assigns, of ouch survivor for-
ever. And the said part! of the first part, for hiimiscif, his heirs, executors, and admloi&iraters, does
covenant, grant, bargain and egret in and with the said parties of the second part, the survivor of them, their
assigns and the heirs and assigns of such sur, Ivor, that at the time of the enreating and delivering of these presents,
he 1 s well seized of the premises above conveyed, as of good, sure, perfect, absolute and indefeasible estate
of inheritance, in law, in fee simple, and ha S good right, full power and lawful authority to grant, bargain,
sell and convey, the same in manner and form aforesaid, and that the same are free and clear from all former and
other grants, bargains, sales, liens, taxes, assessments and incumbrances of whatever kind or nature soove,i
Subject to the following matters as are shown by recorded
instrument: reservations, restrictions. covenants, conditions,
easements and rights -of -way and 1966 taxes payable in 1967.
and the above bargained premises in the quiet and peaceable possession of the said parties of the second part, the
survivor of them, their assigns and the heirs and assigns of such survivor, against all and every person or persons
lawfully claiming or to claim the whole or any part thereof, the said partY of the first part than and will
WARRANT AND FOREVER DEFEND.
IN WITNESS WHEREOF, the said party of the first part ha S hereunto set his hand and
seal the day and year first above written.
▪ Signed
�▪ �1�tIrII„
d Deliverie4rilStii4rrrcewtCe of
:ED0CUIIENTARY
':ILL'e'66iifllf NhdCi RA
_a fSTI In n7si
(SEAL)
tSI3AL)
(SEAL)
he foregoing instrument was acknowledged before me this_._SL 1a......_...day of
._ 19_6 6., by ,._MY 1 i
Witness My Hand and Officla] S
My Comntlaaton Expires ._ _Ls�_ _ 9 7 6
Notary Peelale.
WARRANTY DEED --To Joint Tenants 4,4 �•-
I.,
. DEC1BBI[T
STATE OF COLORADO
HOLD TO LIGHT TO VIEW WATERMARK
STATE OF COLORADO
CERTIFICATE OF DEATH
STATE FILE NUMBER
/ 1. DT�cAcNr5 NAME (First, MAMA Lest)
K4tnl>:en Ann BENs+7D7 I
2 SEX
Female
5. DATE OF DEATH (Month, Day, Year)
plovl mbar is, 2002
a. TriDCIBL. OIJRIT}r
NUMBER
5a rIGE .Led
S-1t68al(Te-ars)
5b LBN.,ER I TEAR
5. L 4EIER 1 Ilk,
G_ RAT£ Cr 1915TH
Der.
7 HIrrTH,L6C), BClry anti Slain er Fer,.pn
Cddrl!ry)
481-66-3fl96
54
rnn, Buys
Hn Mine
?Maat'r, YE..)
.JU7Nr 3, 1953
Council Bluffs, IA
8 WAS PEC 1'7J NT E6 R IN
fi,
9a PLACE OF DEATH 12nss6 erlly wail
V AR 1EEt} H FlCf=.as
LI Yes (gi No
I2 53 Ai
LL Inpatient ❑ ER/Outpatient 0 3A
F
9Y rJ Nyrsreg Herne ❑ Residence ig Other (Speedy) fGSpip*
Be. F6t'.Fr? NAME 61 oar 810312Lar par zee-Ile/id gamily}
L365T}ih U of No. Colo. inpatient unit
BY. C+TY, TOWN, CR LCC&TTCH Or DEATH
S=celcv
Ed. COUNOr 07 DEATH
Weld
16e 6E.TT1 ri [7's usu,,I OGCJPsTICS
(f fee Ar+w or work dons during Fowl of working Me
De nor wan reread)
Nurse
104, KIND 0"r @V5NES UL]atSY --
Health Care
11 MESITA! STATUS married,
Neer hiamen. Widwred,
Diwre.ad fspc1eijr,
Ms-rra.ed
12 6PO:17611 . pr 01 ,Rwr rro.m
-Robert Benson
— - - --..
1J RaSCENCE-•5'rATE
Colorado
IYh, COuwrr
eld _
IR. Grv, TOWN DR LOCATION
Greatly
132 STFtr-f ANDNutr[i:ER
25203 Weld County Road 47
13e INSIDE
CITY
LIMITS?
❑Ye.
2N'
:BI ZIP CODE
$0531--
14 WAS DECE=DENT C: HI5132 Ii DPAdd1
'Spud'} 121 v, TO.— IT .4.4- .44.*Cuwrti
Wax ea*. Fvret•.o amen_ ern,)
N.1" 0Y41
sot,cF-
16 RACE —.lmenca.,'.ndlt rl
6Jso. wane. me.3Spee
White
13 DECEDENTS XD11GtiTLCNISpeti!yern”r PNshwl
ggrade au dalM! Efomeelaryvr aecsider3
0 nnouse , 2! Cetiege 1121neHrgn 18 1117,1
16
17 FAThEr2.NArAE par fierffc. Les{?
Ra er Qeap Rein el
I B I.LCTI.SR.»A1.FG rI',t Gtiuov.. tat trArAtnrll
IR(Anent
Joau Frieda Nmtien
10 tir•ORMAIiC1-NA Mc end le;eliemhrp re 2021821
B11is Benson
Husband
20a METF1aJ OP 1156PC9e11737
ElBurial. IR Cram ado n CrRareoYel from Slate
poonelon ❑ Other (Specify)
22a. PLACE OP DeFP tSi EON [mints eeernel eamarory. d2fN
° °' eel
Northern Colorado Crematory,
[Ot.,,,T ~IL,'- TOYED 51,11
Greeley, CO
B:42 II
2s DoT '�r'a �r[7 9F1ru
?.'ante 3}ny
November 18
TO BE COMPLETED ONLY BY CERTIFYING PHYSICIAN
216 IIAME AND ADDIYEs5 OF PAGI[YIY_
Northern Colorado Crematory
700 6th Street Greeley CO
DEPUTY
22n. UAIEE FILED 016111n, Bay, Year)
NoVEM ER 18, 2003
PIT 5OS31
2.e WAS CGRCSER NDTIIIF.D'
Tani Held ries o, No;
2003 6:42 PM Yes
10 BE COIIPLETED 6Y CORONER
Zit Tc 1.. b.sl,.1,i r856*0,. a,elaeeyFaMl.'htilee. rte!, u+e yy[., o1>i rise le
•
1,9 UA1E SIGNED IManu,, Day, Vas,}
77 a oC
Ili'"ma ea wlpa 8, 016.11. ioVwc ai�blllcl rn11111 IIl.1I 1 occuroe ai ,r•r
rilEY ,MI MAOLIIlI ADDRESS OF I: 2TIFI 8R.:;.EDII FR (1 AN,IPr.I1J
2H. DATE SIdEED IMam1,. Day, veer)
Thomas R. I.iBioger, MD 1900 16th Street
31. NAME OF ATTENDING PHYSICIAN IF OTHER THAN CERTIFIER (TypeiPrdrt)
Greeley, Colorado r. 00631
82. MANNER OF DEATH
1.xr+eaG�n
rl AFHu.nt in Lew-amala,
❑ 51.1 aide �y„'•,
❑ Xertidae
3Se DATE OF INJURY
(Month, Day, Year)
131 TIME OF
INJURY
338 rNJURT AT
WORIf7
❑Yee Crib
37o- OESwRISE HQ1A LNiURY OCCURRED
33e PI.AGEOF INJURY- Atharne, farm, street Laomry utfiee
oulldlnB,112. (Speoi[y3
551 LOCAn3N{Street and Number or Rune 52.4. iJcrneer. City. Oven}, SAID;
34 II1.nit_liir`c CAUSE EENTERONL1iONE CAUSE PER 1,IN FO,R ,{a1.) blear crold rnulle or dein;r.ng :old** 02 Repinei1611e—.r1
CONDMON5 1IF ANY
SAVE RISE CH TO DUE TO OR AS A CONSEQUENCE. OF
IMMEDIATE CAUSE
STATING THE
UNDERLYING CAUSE DUE TO OR AS A G=Dh'5F.OJENCE OF
LA57 (c)
.Nerd tr,+...n veld
...I ',enn
wit .. �dr
•r.tri-all men 171.1.
rear OTHER SIGNIFICANT CIh5O!:IONa`-Ceanrmn, oalniblr,nq ie death but not related le agues in
II PART I (e.g., alcohol abuse, obesity, smoker)
32 Ai.rTdi'51' 34 IF YES -were rmdengs emeleaeed
IYrp e1 Nei In drrcrmmalnp ender of dea!bB
No
THIS,1 T1 9 THAT THIS IS A TRUE AND CORRECT COPY OF THE OFFICIAL RECORD WHICH IS IN MY CUSTODY.
1� „',4\u7\yT11L1i I Fll.rlrrl
`J
45
1 914 ..
1 11 /• _ r`
'77�Fi
fir` ='•°jLillr, ..1 ftakuitkkA# +.id,zm.dlfwl+dd frA{kk0. auA
11n•..�:ri v.- ,Y -:.xeh r .F'e'LTTa7L7'rT
DATE ISSUED
DEC 0 2 2003
RONALD S. HYMAN
STATE REG{STRAR
Do not accept unless prepared on security paper with engraved border displaying the Colorado state
seal and signature of the Registrar. PENALTY BY LAW, Section 25-2-118, Colorado Revised
Statutes, 1982, if any person alters, uses, attempts to use or furnishes to another for deceptive use
any vital statistics record. NOT VALID IF PHOTOCOPIED.
ibpail:+WA+d Ab H-JosmAsv`8A-0 �0V1*§.
EI
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