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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 26 9 3
109 8th Street Suite 303 Assessor's Parcel No.
I Glenwood Springs, Colorado 81601
Phone (303) 845.8212 1 }
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This does not constitute '
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. i
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PROPERTY
SUM - ` •
Berry & Da aAe Barry P.O. ,A
Box 671, lt t .÷.,,c 625 -4876
Owner's Name \ Present Address Phone
,ygaj_ County Road 233, Antlers Orchard, Lot 44, Silt
System Location
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN ^ �Y • • 1? SO Septic Tank Capacity (gallon) aaAa8$8ac 17 Oth r / -
/ /Al a. P ercolation Rate (mirLutes/inch) , Number of Bed r s ( rot e) 4 /I af< /3.5 '
1 f A7 w 20 ale # c. E Aar r ° /�} " rr� vxoya Q.40/544 4_ a '•�ceecyo ass
fi e' Required Absorption Area - See Attache r 4 F7l- T/ TAA'j 3 Vu / Ts 6/ y ` / 3 5 2
.f' k1 I> (CDs tess c/ 3 uA7i�3J3 l t
Special Setback Requirements: T N PI k l t A T t .4:,..., .C-{4 r 3 r✓r . dl1._O
Date / O /4 ' 9 G , . Inspector rY
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ..
Call for Inspection (24 hours notice) Before Covering Installation
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System Installer_ - F X C A t ' 0 7- / A i (t
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Septic Tank Capacity 1 S" O Lft
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t c d
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Septic Tank Manufacturer or Trade N: me. ‘ ° 1�T" t A k f Y 1
Septic Tenk Access within 8" of surface.:
Pee: 0 C O c ` `�
et Absorp)ion Area 60 •
Absorption Area Type and /or Manufacturer or Trade Name / /1/4l r f L 7 n 5C/ t2 1
Adequate compliance with County and State regulations/requirements
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Other p, -
Date ( I "" 1 5 -f 6' Inspector - 4 ��
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 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 ($500.00 tine —6
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER __— _. DIAWE Ain JAMES (3ARRy
ADDRESS p 0. Ro?( A71 511.% CC) eV/45a PHONE 4, a 4 1876,
CONTRACTOR. R K EKCATJAn mr-, Rnf K 1Nk)E Y
ADDRESS / Orin a a a a o R e v i n Mon)72osP Rigel PHONE 6 0 2 -4. °r
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).
1.00ATION OF PROPOSED FACTT,ITY;
Near what City of Town S1(_. I Size of Lot AD ACRES
—neacr qq RS Siloam) bat) 7 ' A-.urcERS ee w4Rp 0r=.00.00mENT (»nim»rs
Legal Description or Address rows/ me Ate ,flrr'i�Po bo r;arng ocourr nrcw nsor 370ii
WASTES TYPE: (>4 DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: 51 'OGLE FRm
Number of Bedrooms FOUR Number of Persons FOUR_
Garbage Grinder Automatic Washer c Dishwasher
SOT JRCE AND TYPE OF WATER SIMPLY: 1)Q WELL ( ) SPRING ( STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Te00
Was an effort made to connect to the Community System? /
A site plan is required to be submitted that indicates the following MINIMIJM 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 to Property Lines: 10 feet
YOUR INDIVIDUAL, SEWAGE DISPOSAL SYSTEM PERMIT WILT, NOT BE ISSUED
WITHOUT A SITE PI, AN.
GROI IND CONDITIONS:
Depth to first Ground Water Table /0 / ( r*n c i,,A7tz
Percent Ground Slope 0.05 rr /i'r
2
/0.3 - //:Ga
g w. J 8 T . 3
/ " tu ao tfl'V
N o as,.
01-1-
fr
ems x.33
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4 Sta
.�Jn_ 1rn �,.�, �a Be . g7 4/ 4 -- /1 .�_
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TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
¢Q SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) NT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE
FINAL DISPOSAL BY:
N) ABSORPTION 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? t0C)
PERCOLATION TEST REST .TS; (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 {nd
additional tests and reports as may be required by the local health department to be made and furnished by th�j
applicant or by the local health department for purposed of the evaluation of the application; and the issuance f 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 9im0,l" -inrzt2 Date . 30.' .7!v
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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66865
1 SITE PLAN
5_ NT& BARRY
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11 1 2 13 14
N 4 ACRES ...- — \\\
TRACT 21 2
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TRAC1 21 —16 J
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SOUTH ACRES ii `�
TRACT 21 \\ ROADS
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SEI /4SE1/4MN1/4 S N.
.- ....... .... ... — 2 F.I.
' (-' 2.5 F.I. 4 Silt Project
2.5 F.I. ` - J ( t.3 4 Silt Project
BLS ARC LOTS 5
CHARD swoIVIsl• 3 i7 36
5.5 Silt Projec
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2.5 F.I. 8 F.I. 2 F.I.
4 4 4 5 SE1/4NV1/45C1/4
S. S. Silt Project .
15 FT.110V
ROAD•LASEMENT
2.5 F .I. 2.5 F.I. 5 F.I.
4 Silt Project 4 Silt Project
53 I 52 51
5.5 Silt Projec
�1@l UNDER CONTRACT
60 51 62 EXHIBIT / A
UNDER CONTRACT �T "k J