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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit IN -0
109 8th Street Suite 303
Glenwood Springs, Colorado 81801
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
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3973
Assessor's Parcel No.
This does not constitute
a building or use permit.
PROPERTY /
Owner's Name /4u bbard, 7 (,''IPresent Address 1/3 0.4/Zlee. [///� S /LoPhone�70 "'
– ,8 32 0
System Location IOO� ,{�Q� j0 , r Si a8145 -D,
Legal Description of Assessor's Parcel No
SYSTEM DESIGN
?33 -00 -on
/OD() Septic Tank Capacity (gallon) Other /�' {w,1/i�
/ Percolation Rate (minutes/inch) Number of B Brooms (or oth ) �� `"
Required Absorption Area - See Attached
Special Setback Requirements:
Date
90
Inspector /07,6V•L-""–"'-1
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer Act --11 / try,n-'-
Septic Tank Capacity / 2 57)
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area IAL,OI1�?>7
F
Absorption Area Type and/or Manufacturer or Trade Name c �7 a int
Adequate compliance with County and State regulations/requirements C/
2,1s) ZQ8
Other
Date _ i) VInspector Qc'� (.r 7/ (-!�
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 C.R.S. 1973, Revised 1984.
2. This permit is valid only for coitnection to structures which have fully complied with County zoning and building requirements. Con-
nection to or use with any dwelf'igg or structures not approved by the Building and Zoning office shall automatically be a violation or a
requirement of the permit and dllyse for both legal action and revocation of the permit.
3. Any person who constructs,alters, Ctinstalls 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 ($500.00 fine — 6
months in jail or both).
While - APPLICANT Velbw - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER-1—CX\ , j lA D'bnx s� t _ ���
ADDRESS 1 t3 a t.Ja.1z *4, . Ocrety pt. S,w9� 1PHONE q7 -b nc
CONTRACTOR \ O aa C ySd`7Q(v& Cq,o) 4.1g 3860 ce«
ADDRESS l 3a Wat z. l'°e aithweelspeMse.asIbol PHONE tqm peso Kowie
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 6 1 1 Size of Lot .5 I .10 Acre
Legal Description or Address 1 P 321 'RI. 5' to(oraret 11 (0 Seet-ol-fr
► r,
WASTES TYPE: kf DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER -DESCRIBE
BUILDING OR SERVICE TYPE: (1c 1 e CG,.;
Number of Bedrooms �J
Number oftons ons 1
( Garbage Grinder ('4 Automatic Washer (Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: N) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: LL,Annu3
Was an effort made to connect to the Community System? N) .
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
Percent Ground Slope
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
CHEMICAL TOILET( ) OTHER -DESCRIBE
FINAL DISPOSAL BY:
kABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER -DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? )i/o
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test)
Minutes per inch in hole No. 1 Minutes per inch in hole No. 3
Minutes per inch in hole No. 2 Minutes 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 correctto 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 S1 -i Date 3b- / / tea*{
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! ((!
EXHIBIT "A"
LEGAL DESCRIPTION
A parcel of land situated in the S1/2SW 114 of Section 23 and in the N1/2NW 114 of Section 26, an in Township
7 South, Range 92 West of the Sixth Principal Meridian, County of Garfield, State of Colorado, lying Southerly
and Westerly of County Road right-of-way fences, said parcel of land is described as follows:
Beginning at a point whence a rock corner found in place and properly marked for the Southwest Corner of
said Section 26 bears: South 09°47'12' West 5304.86 feet; thence North 21622'07" East 1464.15 feet, more or
less to a point in saki County Road right-of-way fence; thence along said County Road right-of-way fences
South 71'19'06" East 30.98 feet; thence South 68'49'32" East 34.77 feet; thence South 88'28'37" East 175.06
feet; thence North 74'50640" East 75.48 feet; thence South 89'24'29" East 876.22 feet; thence South
50'01'12" East 16.81 feet; thence South 001329" West 1217.33 feet; thence leaving said right-of-way fence
South 8913'15" West 815.85 feet along a lane; thence South 32'5033" West 163.46 feet; thence South
48'04'58" West 35.07 feet; thence South 64'0226" West 99.84 feet; thence North 8r03'42" West 184.49
feet; thence North 80'34'46" West 523.56 feet, more or Tess, to the POINT OF BEGINNING.
EXCEPTING THEREFROM that parcel conveyed to Marvin J. Layman and Cynthia J. Layman in deed
recorded October 17, 1978 in Book 516 at Page 835.
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