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Home My WebLink About20142337.tiff l *it Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 5 Phone: ((970)) 3 304-64 Fax: (970) 304-6411 VADc www.co.weld.co.us COLORADO Statement of Existing Septic Permit Application Number: SE-0701071 Status: Recorded App Type: Health\Residential\Statement of Existing\na Applied: 11/16/2007 Applicant Name: REETESH SARAF COULSON INVESTMENT HOLDINGS LLC alta 1205 W ELIZABETH ST PMB#134 FORT COLLINS, CO 80521 Owner Name: COULSON INVESTMENT HOLDINGS LLC Parcel#: 080335400021-R7142797 Legal Desc: S2 SE4 35 6 65 EXC BEG AT SW COR OF SEC 35 THENCE NOOD06'E 1324.24'TO NW COR S2 SE' S89D41'E 440.10' S01 D49'E 624.66'588O29'E 427.62' S07D12'W 696.53' TO A PT ON S LN SE4 THENCE N89D39'W 802.45'TPOB (3R) SITUS: WELD 0 Site Address: 22785 CR 62 GREELEY, CO 80631 Additional Info: Work Description: HOUSE App Specific Info: 1/2 Bathrooms 0 3/4 Bathrooms 0 Absorption Bed Size 800 Absorption Trench Size 0 Basement Plumbing Yes Full Bathrooms 1 Location Description 22785 CR 62, GREELEY Number of Bedrooms 2 Number of Persons 2 Private Water Supply Public Water Supply Yes Septic Tank Size 1000 Tank Material CONCRETE Year Installed UNKN t Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 60631 Phone: (970) 304-6415 5 Fax: (970) 304-6411 www.co.weld.co.us COLORADO Statement of Existing Septic Permit NOTICE The property ownerlagent has certified by Notary Seal that the above described septic system is in fact installed as described,and exits at this lime on the parcel identified above by the parcel number and/or legal description,and further states that the system IS/IS NOT in good working order and to the best of his/her knowledge 15 f IS NOT failing to function properly. The property ownerlagent further understands that any falsification or misrepresentation may result in the revocation of any permit granted based upon this information hereby submitted and inlegal action for perjury as provided by law. The Statement of Existing Record relies on information the property owner or hisiher representative provides,under oath,indicating current status of the system and representing to the best of his/her knowledge that the sytem IS/IS NOT failing to function properly.Issuance of the Statement of Existing Permit for any system does not constitute assumption that the site was evaluated or inspected during any phase of construction by this Department to meet regulations. X �� 1 l • &Frei- Envir nm Health Specialist Date • • WELD COUNTY DEPARTMENT OF PUBLIC SOE# 010/017/ 418(tHEALTH AND ENVIRONMENT ORG PERMIT# x- 1555 N. 17T" AVENUE REPAIR GREELEY, COLORADO 80631 LOAN # VIED PHONE: (970)304-6415 ISDS # Ot7010(p1/ FAX: (970) 304-6411 STATEMENT OF EXISTING FOR SEPTIC SYSTEM COLORADO (PLEASE FILL OUT IN BLACK INK ONLY) PARCEL NO. 000 33544 0002 1 PROPERTY OWNER CDUL5ot.1 VFSiMt WOI-DiNCS PHONE NO. F{1Q 1 231 6321 MAILING ADDRESS 1205 w Eii3H par iN ST 94g Th&'1 f. Cots-INS CO g( 2 City State Zip DESCRIPTION OF BUILDING(ex. house, mobile/modular home,shop, office) Ifx IV= SITE/LOCATION ADDRESS 22385 WILD (oU . '1 2J`i+p , ( R?& F y I CD SO1 City State Zip LEGAL DESCRIPTION PT Ea. PT $6' SECTION 2)S TOWNSHIP 4, 14 RANGE W SUBDIVISION LOT BLOCK FILING CENCUS TRACT LOT SIZE/ACRES S(,• Sb COMMERCIAL. YES /R\ RESIDENTIAL YE /NO NUMBER OF PERSONS/b-C-11 BASEMENT PLUM YES / O BEDROOMS 2- BATHROOMS - FULL._ _ 3/4 1/2 WATER SUPPLY - PUBLIC YE /NO NAME tjnin*4 L3T-U) (oot-f UPt 1)15-2-g PRIVATE YES/NO WELL YES/NO CISTERN YES/NO WELL/CISTERN/4 SYSTEM SIZE: Septic tank material is constructed of t•pairrko: and has ID on gallons capacity. FIELD: Trench square feet or Bed SOD square feet YEAR INSTALLED__________ You are required to draw a diagram of the system on the reverse side of this form in black ink only and indicate location,length, width, and distance from the dwelling. The undersigned property owner hereby certifies that the above described septic system is in fact installed, as described, and gists at this time on the parcel of ground identified by the above legal description and further states that the syste is is not in good working order and to the best of his/her knowledge i is not failing to function properly. I further understand that any falsification or misrepresentation may result in revocation of any permit granted based upon this information hereby submitted and in legal action for perjury as provided by law. DATE OWNER Subscribed and sworn to before me this /(/O day of 30VP AE E_ , 20t31 \' By -ee'k sky, Witness my hand and official seal. My commiss. .expire �V — //' �// DATE NO . UBLIC STATEMENT OF EXISTING REVIEWED B )j' ,� HCNA^T my PURbOIICN 11 stale at Colorado ENVIRONMENTAL HEALTH SPECIALm • e rn I a d t 3 d Er O O. c ,5„ ma. O /\) r •0 ti ahi 2-; -cc_42 ea r 8 8r e gilrict tr. Weld County Environmental Health Services Department (st 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970)304-6415 5 Fax: (970)304-6411 hiDe COLORADO RECEIPT • November 16, 2007 Application Number: SE-0701071 App Type: Health\Residential\Statement of Existing The Owner Name: COULSON INVESTMENT HOLDINGS LLC 1205 W ELIZABETH ST PMB#134 FORT COLLINS, CO 80521 Site Address: 22785 CR 62 GREELEY, CO 80631 Rcpt# Pmt Type Pmt Method Ref# Pmt Date Amount Cashier Comments EHS-0700413 Paid Check 1001 11/16/2007 $ 10.00 MSWAIN Total Payments: $ 10.00 . -- --- -_ _. Sl�n's Saa itation,.Inc . ) )4i �aft� . { WORK ORDER • Cusianer# ty Wwtflc4et# -,, BM To: Date Ordaed: // f— 7 ? 'i (�o,-ii so:, 1•t v d ',.c 1•,y: ordered p Tema:O D P O Number . Pixies' S thertnberd , )r Tine'ttr I ,•I , ( ) ' Time Out .I TaNc# Trmvet Time: a twtMbess � �`:L. 7 �:i..��Cy1 6 aZ Route' r Phoee'lumb[r ;4 _ `k\, -e, p 1 • •HT z�3S ( Baan Vat I. 11 D t i Sentor Disc 1 : • Tot a4Due $ 0-b≤, I : •,y • Jut Oesc l awfulness:b Tonic . , ' yi. `1O o d c c:h L\'. I cr j 1 Cam/ G:C to jC. •I ;STI!lincrOrdoi.Job Please Ptbd Name Here l iob done are COD.., arena bnper accepting champ&xzui slit '1 H cuages nabt be dewed through the ol%oe&salt I , 3 iii . I ,: DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N 17TH AVE GREELEY, CO 80631631 WEBSITE: www.co.weld_co.us I ADMINISTRATION (970) 304-6410 FAX (970) 304-6412 PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420 O FAX (970) 304-6416 ENVIRONMENTAL HEALTH SERVICES (970) 304-6415 COLORADO FAX(970) 304-6411 November 30,2007 Coulson Investment Holdings LLC 1205 West Elizabeth Street, PMB#134 Fort Collins,Colorado 80521 RE: Coulson Investment Holdings LLC ISDS No.: 0701064 Permit No.: SE-0701071 On November 28, 2007, an evaluation of the existing individual septic disposal system at: 22785 County Road 62,Greeley; Section 35,Township 06 North,Range 65 West, was conducted by Stephen J. Wiatrowski,an Environmental Health Specialist of this department. The existing individual septic disposal system is of sufficient size and capacity to adequately handle the proposed load. This evaluation is based on a final treatment capacity for a 2 bedroom residence. Be advised,neither the County of Weld nor any of its agents or employees undertake or assume any liability to the owner of the above property,to any purchaser of the above property or to any lending agency making a loan on the above property or in the report. This inspection was conducted for the purpose of determining compliance with current regulations and for detecting health hazards observable at the time of inspection. This does not constitute a warranty that the system is without flaw or that it will continue to function in the future. Inspections requested during periods of snow cover and high soil saturation may be of questionable value to potential buyers due to adverse conditions. Evaluations based on Statements of Existing(S.O.E.)relies on information the property owner provides, under oath, indicating current status of the system and representing to the best of his/her knowledge the system is not failing to function properly. If we can be of any further assistance,please contact our office at(970) 304-6415. Sincerely, Stephen J. Wiatrowski Environmental Health Specialist Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, 80631 Phone: ((970)) 3 304-6411 5 • Fax: (970) 304-6411 WARt 461At .co.weld.co.us COLORADO ISDS Field Inspection Form Application Number: ISDS-0701064 Applied: 11/16/2007 App Type: HealthlResidentiallISDS\na Applicant Name: REETESH SARAF COULSON INVESTMENT HOLDINGS LLC 1205 W ELIZABETH ST PMB#134 FORT COLLINS, CO 80521 Owner Name: COULSON INVESTMENT HOLDINGS LLC Parcel#: 080335400021-R7142797 Legal Desc: S2 SE4 35 6 65 EXC BEG AT SW COR OF SEC 35 THENCE NOOD06'E 1324.24'TO NW COR S2 SEd 589D41'E 440.10' S01D4VE 624.66' 588D29'E 427.62' 507012'W 696.53'TO A PT ON S LN SE4 THENCE N89D39'W 802.45'TPOB (3R) SITUS: WELD 0 Site Address: 22785 CR 62 GREELEY, CO 80631 _ Percolation Rate 1 D Limiting Zone ) P, ft —in Description % Ground Slope ---- Direction Soil Suitable (Y/N) y Engineering Design Required (Y/N) N,.` In 100 Year Flood Plain (YIN) The septic system identified aboveS�d2�of sufficient size to accomodate the proposed alteration(s) indicated below to the structure(s)served by t is system. ENS ISDS Reseach: Absorption Bed Size 800 Absorption Trench Size 0 Engineering Design No Other Public Water Supply Utility Private Water Supply Private Water Supply Permit Reference Number Public Water Supply Yes Public Water Supply Utility NWCWD Research Comments Septic Permit Recorded Yes Septic Permit Reference Number SE-0701071 Septic Search Yes Septic Tank Size 1000 Year Installed UNKN 4 Weld County Environmental Health Services department rap 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 64155 Fax: (970) 304-6411 ' www.co.weld.co.us COLORADO ISDS Field Inspection Form EHS ISDS Current Flow: Current Flow 1/2 Bathrooms 0 Current Flow 3/4 Bathrooms 0 Current Flow Basement Plumbing Yes Current Flow Comments Current Flow Description HOUSE Current Flow Full Bathrooms 1 Current Flow Number of Bedrooms 2 Current Flow Number of Persons 2 EHS ISDS Research Changes: Additions 1/2 Bathrooms Additions 3/4 Bathrooms ' Additions Basement Plumbing Additions Description RECORDED EXEMPTION Additions Full Bathrooms Additions Number of Bedrooms Additions Number of Persons • EHS ISDS Proposed Total: Addition Comments • Proposed Basement Plumbing Yes Proposed Total 1/2 Bathrooms 0 Proposed Total 3/4 Bathrooms 0 Proposed Total Full Bathrooms 1 Proposed Total Number of Bedrooms 2 Proposed Total Number of Persons 2 EHS Inspection Corrections: Approved Corrections Comment Field Area Undersized By Field Undersized By Increase Field Area To Tank Construction Tank Undersized By The existing septic system is REQUIRED/ RECOMMENDED to have the following alterations made to accomodate the proposed alterations to the structure(s) served. NOTICE This permit is granted temporarily to allow construction to commence.This permit may be revoked or suspended by the Weld County Department of Public Health and Environment for reasons set forth in the Weld County Individual Sewage Disposal System Regulations including failure to meet any term or condition imposed theron during temporary or final approval.The issuance of this permit does not constitute assumption by the department or its employees of liability for the failure or inadequacy of the sewage disposal system.Ibltt permit Is non-transferable and non-refundable.Before issuing final approval of this permit the Weld County Department of Public Health and Environment reserves the right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval is contingent upon the final inspection of the completed system by the Weld County Department of Public Health and X b <<•asro2 Envi n I Health Specialist Date 10 in 2 i d m 3. a 5 a a Z Di O 0 C n 'O Pt et to�a�[I A n 8 Lid iI r) ND r------- rat 0 Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970)304-6415 Fax: (970)3046411 hiDe COLORADO RECEIPT November 16, 2007 Application Number: ISDS-0701064 App Type: Health\Residential\ISDSIna Owner Name: COULSON INVESTMENT HOLDINGS LLC 1205 W ELIZABETH ST PMB#134 FORT COLLINS, CO 80521 Site Address: 22785 CR 62 GREELEY, CO 80631 Rcpt# Pmt Type Pint Method Ref# Pmt Date Amount Cashier Comments EHS-0700414 Paid Check 11/16/2007 $ 150.00 MSWAIN Total Payments: $ 150.00 ISDS NO: 09010629 DATE RECEIVED: lgi is/07 RECEIVED BY: 5 FEE: 150 .OO INDIVIDUAL SEWAGE DISPOSAL SYSTEM EVALUATION SITE ADDRESS OR LOCATION: 227 S W CZ h2, G'ZZtE(_E`I , C 0 8 063 PARCEL NO: 0 g 21354 COD 2 I THIS CAN BE OBTAINED FROM THE ASSESOR'S OFFICE AT (970)353-3845 EXT 3650 OWNER: C OIILSOM I nJ V(`SIFAEN i let i nl(DS 11C.- PHONE: QlO 231 6 339 MAILING ADDRESS: (Z.lY W Eu ZASE H S i , PNl64134 , fi, (cu-14, ({l 80$2( CITY STATE ZIP APPLICANT NAME: (n t Sort ),r aJcSSIn4c,4l NX-0/t•I S L_LiC APPLICANT ADDRESS: AS figaJC e2 I e S1n S Q (At (IF DIFFERENT FROM OWNER)CITY STATE ZIP PHONE: ALT#: FAX: 120 255 2695 LEGAL DESCRIPTION: PT;S2 PT:SELI SEC: 35 TWN: ( N RNG: (-5 w SUBDIVISION: LOT: BLK: FLG: WATER SOURCE: Nge-ru Inlet n (n„N ny f,JF1Tr DtS'R (T ACRES: Sb ORIGINAL OWNER OF SEPTIC SYSTEM: (7—)t )L5Dn/ Fl ll_r PERMIT NO: 1,Jp VI 5 rJ 1 LE SOE: ESI NO DESCRIPTION OF STRUCTURE CURRENT FLOW: ADDITIONS: PROPOSED TOTAL: DESCRIPTION: J,(SiDcA DIAL T1 t�l PERSONS: Tw fl (z) a BEDROOMS: MAID (a) o` BATHROOMS: UNF; C') BASEMENT PLUMBING: `ie,S I e.5 NEITHER THE COUNTY OF WELD NOR ANY OF ITS AGENTS OR EMPLOYEES UNDERTAKE OR ASSUME ANY LIABILITY TO THE OWNER OF THE ABOVE PROPERTY,TO ANY PURCHASER OF THE ABOVE PROPERTY OR TO ANY LENDING AGENCY MAKING A LOAN ON THE ABOVE PROPERTY OR IN THE REPORT. 07/19/2313 12:44 970-335-0997 NORTH hiFMn WATER PACE 03/03 90AR0 OF DIRECTORS P�H iY NORTH WELD COUNTY WATER DISTRICT • O FC lr2325 TR39• LUCERNE C000846 CtUR1Es AOl4ZIGER GENE STELE 7e s DON POSSELT,METRIC?MANAGER v GARY SILPSON _ P.D.BOX 56• 6U3:9]0.a66ae2n•FAX:9io-395OSST TODD DEAN rye `wane r'�P ROBERT ARNBRECHT reaw.nwcwdarg • ma twawrenstcwd.mg NORTH WELD COUNTYWATER DIBrnICr ASSIGNMENT 44L(Tap or Account No ` FOR VALUE RECEIVED I/WE herby sue,transfer and as'gn to: a Water Tap with a Pleat Investment Class of 1 •and a Wafer Class of 1 an lr•(a9r ma/or Weld County,Colorado. • INFRASTRUCTURE It is understood that this tap with a bent Investment Class of_ t a maximum amount of 2731 thou��onssshshall be delivered annually within the water year. If amount is exceeded Weld on an annual n wWater y�er basis, apply any appropriate fires,fees or stuchargeS, by riat • WATER RIGHTS It is further understood that this tap wrth a Water Class of S__,a mardmum amount of 22$ thousand D�llons hall all be delivered annually within the water year. If this amount is exceed Weld County Water eon an annual water ar r bat apply any appropriate fines,fees or surcharges.as determined by North It is understood that these taps were purchased for the attached described lands and may not be trarsferied to other lands,without express written consent in addition to the below consent of the NORTH WELD COUNTY to effectuate WATER DlStuCT.I/we further authorize the s rotary of said District to do any and:all bergs necessary this transfer en the books and records of said District the normal Operating pressure range for the Shove I dress is 54 psi we understand thatsure may be as great as psi. Therefore, I/w to r Psi 1t preventative nt operating pressure and/or release the pressure• if do agree install pceveve pre plumbing rrt devices oto my Water District'claims no liability. damage results from excessive pressures.North Weld County Initial of Buyer(s) our s t6is—day of 10-`— Intesdmmrywhe+BDfI/we have Bet my/our signatures 1/we further agree to pay any and all charges hereinafter levied by said District for said tape and to abide by all regulations adopted by said District Steepest 1 1 Seller Sayer S` — Yer Seller Bu c17.5(0 C-:_ ^ 3 ---- Current Mailing Adxtrcu Current Malting Address / ! 1 nli� - 5 — C�Siti- �� Sly Zip__ — - City State Zip City C 1 O zl9 U Z.�z1 phone Number Phone Number CONSENT OF ASSIGNMENT I, \-t. I\ VC:::_______ —' Manager of NORTI WELD COUn.,a WATER DISTR1Ct,herebYcmtsent m the stove eiptlnent of behalf of said IYleldck iO4-V (a 4 4 p i — Manager d d this dxumerrt T'lraae attaz a roDV of the p_oth t e buyer d sells must initfal aigva a my deed. xarrantv 07/19/2013 12:44 970-395-0991 NORTH WELD WATER PAGE 03/93 BOARD OF DIRECTORS P.r; Lys, NORTH WELD COUNTY WATER DISTRICT CHARLES AOHZI3ER $20250R S9• LUCERNE,0090949 SEISE STILLS _^ DAA-Ye1t u ^ t DON R08SELT,DISTRICT MANAGER (�I(_'{h5kL5'8'pT`l 6.r �" PO.e0X 5e•IRIS:870 3664020 • FAk 970.99E-0997 �/IG R1�09�'/Er`_.I'A,RNL9/,REPir FNAiGn O`� wwwnwewaars•small:weterenwoutoig AUG 222013 NORTH WELD COUNTY WATER DISTRICT ASSIGNMENT Tap ar Account 140. POR1jALUE RECEIVED I/WE hereby sell,transfer and assign to: • =i . I& II1Lk _'xtiI Irv1llG`,I14I .NT k16 i LA', a Water Tap with a Plant Investment pass of_1_,,and a Water Class of J ,in Lartmrer end/or Weld County,Colorado • INFRASTRUCTURE It Is understood that this tap with a latent investment Class ofd a maximum arrocnt of _thousand gallons shall be delivered annually within the water year. If this amount is exceeded on an annual water year basis,the Dlahict shall apply any appmprlate fines,fees or surcharges,as determined by North Weld County Water District. • WATER RIGHTS It la further understood that this tap with a Water Class of a ma:dmum animist ad 2 thousand gallons shall be delivered annually within the water year. If this amount is exceeded on ar annual water year basis,the District shall apply any appropriate fines,fees or surcharges,ea delimited by North Weld County Water District It is understood that these tape were purchased for the attached described lands and may not be transferred to other lands,without express written consent,In addidonto the below consent of the NORTH WELD COUNTY WATER DISTRICT.1/we further authorize the secretary of said Matt to do any and,aB things necessary to effectuate this transfer on the books and records of add District I/we understand thaR'the normal operating pressure range for the aimed listS&dress is 54 psi to a.psi-the maximum operating pressure may be as great as 7C psi. Therefor I/we agree to install preventative plumbing:devices to zestrift and/or nitwit the pressure. If da` fib' from'tremolve preecurea,No:3t Weld County Water'Distelel.6lalans no liabilty. 1`J1S5� Initial of Buyer(s) It� �7• In whereofl/we have seemy/oar signatures oar.;oar.;4I %a A y of 20 f ] . 1/we further agree to pay arty and ail charges hereinafter levied by said District for said taps and to abide by all regulations adopted by said District. AGreptedt l M ----- ), / 3 Seller Buyer Seller _.. - Buyer • 0. 13ot 2131 SD CwrentMalling Address - Current Mailing Address _D2T_ CULL IAJS, co X027 City Stets Zip City State Zip Gil o 7(17-2)x7 PhoneNumber Phone Number CONSENT or ASSIGNMENT I, A ve < < •hE • r Manager of NORTH p'E{.D COUNly WATER DLSTRICT,hereby consent to the shove Assil gnment of behalf of said District I // Manager Perth the buyer and seller must initial,sign and date this document, Please attach s copy of the warranty deed, Hello