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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Colorectal 81601
Phone {970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Permit 4 4 0 4
Assessor's Parcel No.
This does not constitute
a building or use permit.
Owner's Name Enovid Ot i -am Present Address PAN Ci rClit6V. Phone N3.54 -i -51s-
System Location P - �� s • t�-
Legal Description of Assessor's Parcel No ra� lJ
SYSTEM DESIGN
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
Other
Date inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
25, Article 10 G.R.S. 1973, Revised 1984.
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con-
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a
requirement of the permit and cause for both legal action and revocation of the permit.
3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense (8500.00 fine —6
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER £,Canet, a 1 $ Gas (Lisle
ADDRESS 717 Golitr .LS'" Sc.;4e laa PHONE 47a -ate �6o
CONTRACTOR P4 #ets0„ 1 17h ,e; , msi , dr, ,�t�,�_._ Fitz;1
ADDRESS PHONE
PERMIT REQUEST FOR NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable
building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY:
Near what City of Town/p,a,, )" N0 r4 o4- Panae lw a.1S) Size of Lot IA/A.
Legal Description or Address See #444e t7 wt e,.1 -
WASTES TYPE ( ) DWELLING
( ) TRANSIENT USE
{ ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
(>Q OTHER -DESCRIBE A',tor !ern► id? 5 la to
BUILDING OR SERVICE TYPE: 417 -EA
Number of Bedrooms 9
( ) Garbage Grinder ()Q Automatic Washer
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL
Number of Persons /j,
( ) Dishwasher
( ) SPRING
( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: 4r4e5 We&Aer sere. ees
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /Q - / „,/rS
40411 ,MSc&.
Was an effort made to connect to the Community System? yrs
A site plan is required to be submitted that indicates the following MINIMUM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System (septic tank & disposal field) to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
Depth to first Ground Water Table ///at
Percent Ground Slope /ick
2
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( ) SEPTIC TANK ( ) AERATION PLANT (X VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET( )
FINAL DISPOSAL BY:
OTHER -DESCRIBE
ABSORPTION TRENCH, BED OR PIT
UNDERGROUND DISPERSAL
ABOVE GROUND DISPERSAL
OTHER -DESCRIBE
(
(
(
) EVAPOTRANSPIRATION
) SAND FILTER
) WASTEWATER POND
by mou,t4A ) west' /o it;, -41, g eJ -rec: J
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? R/e,
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test)
Minutes Alk per inch in hole No. 1 Minutes Aick per inch in hole No. 3
Minutes #t4& per inch in hole No. 2 Minutes ivek per inch in hole No.
Name, address and telephone of RPE who made soil absorption tests:
Name, address and telephone of RPE responsible for design of the system:
Applicant acknowledges that the completeness of the application is conditional upon such further mandatory and
additional tests and reports as may be required by the local health department to be made and furnished by the applicant
or by the local health department for purposed of the evaluation of the application; and the issuance of the permit is
subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations made,
information and reports submitted herewith and required to be submitted by the applicant are or will be represented to
be true and correct to the best of my knowledge and belief and are designed to be relied on by the local department of
health in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any
falsification or misrepresentation may result in the denial of the application or revocation of any permit granted based
upon said application and in legal action for perjury as provided by law.
Signed - ----- Date i/ 1 o j z 0 ,, 7
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!?
3
Designate North Arrow
Your Neighbor's
Name & Address
Your Plot - Shape to Fit
(No Scale)
See 444ackv &ev +
Your Neighbor's
Name & Address
Locate well, all streams, irrigation ditchs, and any water courses. Draw in your house,
septic tank & system, detached garages, and driveway.
If a change of location is necessary, you must submit a corrected drawing, before a
Certificate of Occupation will be issued.
County Road (Note the Road Number and Name)
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D 28 Weil Pad
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Driving Instructions to the D 28 Well Pad:
From the intersection of Main St. and CR 215 in Parachute,
Colorado, drive Northwesterly on CR 215 for 10.3 miles to the
Encana automatic guard gate. Proceed Northeasterly 0.2 mile to
a 'Y' and turn right. Continue Northeasterly 0.3 mile to a'Y', tum
right on East Fork Road and proceed Easterly 2.3 miles, turn left
on well road and proceed 0.15 Westerly mile to the well pad.
Well Pad Location:
Lat.; 39° 35' 18.804" N
Long.: 108° 03' 58.021" W
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EnCana Oil & Gas (USA) Inc.
D 28 Well Pad
NW 1/4 NW 1/4 Section 28,
T5S, R95W, 6th P.M.
Garfield County, Colorado
AiZU
SURVEYING
900 Main Sime!
Evanston, Wywminp 82930
Phare No, (307) 789.4545
—LEGEND -
Existing Road
Site Location
DATE: Jan. 16, 2007
SCALE: As Shown
PROJECT NO.: 06-04-55
Topo
A
SHEET
1
OF1
SCALE: 1" 50'
DATE: 01-31-07
Drawn By: O.R.S.
Revised: 02-27--07 ma.
Revised: 04-11-07 D.R.B.
EnCana OIL & GAS (USA) INC.
LOCATION LAYOUT FOR
WELL PAD D28 595
SECTION 28, T5S, R95W, 6th P.M.
NW 1/4 NW 1/4
Exlsting Stockpile .;
Existing Stockpile
1 FIGURE #11
Slope
UIN7 AFI ENGINEERING & LAND SURVEYING
85 5o. 200 East • Vernal., Utah 84078 • (486) 788-1017