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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit I♦` 2 4 7 4
109 8th Street Suite 303 Assessor's Parcel No. g:t
Glenwood Springs, Colorado 81601 ..
Phone (303) 945 -8212 1f '
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This does not constitute 1}
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. 3
PROPERTY {
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Owner's Name Glenn MCCuen Present Address 434 Midland, New Castle Phone_ 984 -23859
System Location Cnnnty Rnad 941, Nam CAB r 1e . )'
Legal Description of Assessor's Parcel No. I`,
SYSTEM DESIGN
Septic Tank Capacity (gallon) Other .
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- ' Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 p
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Required Absorption Area - See Attached
Special Setback Requirements:
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Date f - - ' ` - / ` � Inspector ' .. - . -' � � t , " Ai c t
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FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation i i
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System Installer_' .. rte' /,' • . - .,• .0 b $8
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Septic Tank Capacity{ >j It.t, 6
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Septic Tank Manufacturer or Trade Name - . • t h
Septic Tank Access within 8" of surface • - < '
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Absorption Area S
Absorption Area Type and /or Manufacturer or Trade Name f - . . -
Adequate compliance with County and State regulations /requirements Vc <
Other '
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Date Inspector u
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RETAIN WITH RECEIPT RECORDS AT CONSTRUOT / ION SITE � '�
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•CONDITIONS: C 1
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. 1'
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- i t
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a j
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 i y
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine —6
months in jail or both).
Applicant: Green Copy Department: Pink Copy pp 4
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INDIYIDUALSBWAGG_DISPOSALSYSTEM APPIJCATTON
OWN F.12 al., m �CuJ
ADDRESS PHONE 9P-/- Z 3 8S
CONTRACTOR G(e Mfai-e-
ADDRESS sio- -t- PHONE
PERMIT REQUEST FOR ( ) NEW INSTALLATION (.ALTERATION () REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area,
habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes
(See page 4). /1 r
LOCATION QL PIWP_OS MlILIT_Y: COUNTY (atr%e
Near what City or Town /vM p t � (` a Lot ('v.✓4 tot. 2v3 frli%iv 4 C.ioe4
Legal Description hem A r4 itAerr
WASTL''STYPE: ( ( ) Transient Use
( ) Commercial or Industrial ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: Macy ranG Shi /e 444‘t /y .
Number of bedrooms: 3 Number of persons 4'
04 Garbage Grinder p,c Automatic Washer (>0 Dishwasher
SOURCE AND TYJ EDF_WATEILSUPPLY: 14 WELL () SPRING () STREAM OR CREEK
Give depth of all wells within 180 feet of system: NO`S w / KO'
If supplied by communtiy water, give name of supplier: N/i1-
GROUND CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table:
Percent Ground Slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 7,4]e5
Was an effort made to connect to community system? A f'm n•( DA 44/1 y$rt'
TYPE O�F �INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(vf aeptic Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
( ) Chemical Toilet ( ) Other - Describe:
FINAI. DISPOSAL BY:
¥(✓r Absorption 'french, Bed or Pit ( ) Evapotranspiration
() Under round Dispersal ( ) Sand Filter
Above Ground Dispersal ( ) Wastewater Pond
) Other - Describe: $# 4e PT4I4ir,ro tq,er flame /r»/a Onto eireenst Oro)
WILL EFFLUENT BE 1)150 !ARCED DIRECTLY INTO WATERS OF THE STATE? f'O
4* OwrKn At TO YR7iFy T7l09T ferenOrleMo 4a K1 WeICi/ wica nref;ViRK
ext9rsior is iN t4nC 9no9 ItronitfrWc Pic. V- co e Are w,)"&
err Quin.er pitrlinst :
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I ERCCLAT14NJFESTRLSIILTS: (To be completed by Registered Professional Engineer)
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 thecompleteness of the appliction 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 purposes of the evaluation of the application; and the
issuance of the permit is subject to such terms and conditions as deemed necessary to innsre compliance with
rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby
certifies that all statements make, 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 bre relied on by the local department of health in evluating the same fro 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.
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Signed �- Date /A A
PLEAS D WAN_ACCURATI MAP_T2Y IUtPRCP_EICX
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PLOT P1 ,ANANI1DESIGFLEEA"LIIRES
Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings,
properly lines, subsoil drains, lake, water course, stream, dry gulch and show location of proposed system by
direction and distance from dwelling or other fixed reference object, and additional submissions in support
of this application such as data, plans, specifications statements and commitments.
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A PARCEL OF LAND BEING PART OF HOMESTEAD ENTRY SURVEY NO. 53,
SITUATED IN TOWNSHIP 4 SOUTH, RANGE 91 WEST OF THE SIXTH
PRINCIPAL MERIDIAN, MORE PARTICULARLY DESCRIBED AS FOLLOWS :
BEGINNING AT A STONE CORNER PROPERLY MARKED AS CORNER NO. 1 OF
H.E.S. NO. 53, THE TRUE POINT OF BEGINNING;
THENCE ALONG THE WESTERLY BOUNDARY LINE OF H.E.S. NO. 53, N. 16
DEGREES 41'41" E. 432.63 FEET;
THENCE LEAVING SAID BOUNDARY LINE S. 80 DEGREES 41'27"
E. 826.33 FEET TO THE EASTERLY BOUNDARY LINE OF H.E.S. NO. 53;
THENCE ALONG THE EASTERLY BOUNDARY LINE, S. 01 DEGREES 47'27"
E. 530.08 FEET TO CORNER NO. 9 OF H.E.S. NO. 53;
THENCE N. 75 DEGREES 24'00" W. 988.20 FEET TO CORNER NO. 1 OF
H.E.S. NO. 53, THE TRUE POINT OF BEGINNING.
COUNTY OF GARFIELD
STATE OF COLORADO
AND
A ROAD, UTILITY AND DRAINAGE EASEMENT EIGHTEEN (18) FEET WIDE,
BEING NINE (9) FEET ON EITHER SIDE OF THE FOLLOWING DESCRIBED
CENTER LINE:
BEGINNING AT A POINT WHENCE CORNER NO. 9 OF HOMESTEAD ENTRY
SURVEY NO. 53, TOWNSHIP 4 SOUTH, RANGE 91 WEST OF THE SIXTH
PRINCIPAL MERIDIAN BEARS S. 01 DEGREES 47'27" E. 158.50 FEET;
THENCE N. 41 DEGREES 49'00" W. 50.4 FEET;
THENCE N. 65 DEGREES 53' W. 103.0 FEET;
THENCE N. 72 DEGREES 37' W. 77.7 FEET;
THENCE N. 44 DEGREES 05' W. 35.8 FEET;
THENCE N. 00 DEGREES 07' E. 35.5 FEET;
THENCE N. 53 DEGREES 12' E. 139.9 FEET;
THENCE N. 36 DEGREES 57' E. 156.6 FEET, TO THE POINT OF ENDING.
COUNTY OF GARFIELD
STATE OF COLORADO
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415 '44 06142 Gillis'IE COUNTY P.1 /1
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• "_'GARFIELD' douNTVYIVILDINO AND SANITATION DEPARTMENT
2014 fans Awns
2 „ GhawoUd ktiRgh caetede $1101
$41402-11.410 . Kees (310)04$4241
I This does nab sarrtitua
• buntline pr use permit. I
' INDIVIDUAL RIEIMG9 DISPOSAL'P[RMIT -44 1374
trnna ' Wi11 i w kirberlr CewenS 9h •--
ter t t1a i , I i Pill Road Aoeraxtratel v . 4401* New Castle „
tde/ened InstalMt Owner •
',Conditipdd Cgnstnjctlon approver is hereby granted for 1 — 50 vanon ,
,_.....A.... Sane Tank or Aerated vestment unit.
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Ab,Mptlbn Nee for dispersai w computed as follows: i
Pete rate of one ire* In rs �-.. Minutes iaq0411 min � l r mUm n o y f p ` Ur � p, ' �yt1me t ft. Of ab ores pot bedroow. •
)�� iOrmf' Iasi y vie . I s 4.1 seer.
TMrs•�prf-tAe Oo?10 ' tr / -7 --S :i/' .
May we %h n SjeJ I4'�1+6i8@_n /ea- ..A ^ �' J � x a J`'�,..� �^ i
`."- Inspector EaE':r_L.z../11 "toistll,L' �.
i1Nti►(.APPROVAi SYSTEM:
## 1 reed to lie in compliance with the Sewage Dims* Laws until the aeeembied *Wove' it soved prior to covers
No rystera fhM 4e tweed •
BM any Part.
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or--- kpttc lank Wass for Inspection and cleaning within 12' 01 ground surface or a erated nee per ry above grouts
s yi f aa e. .
. �r iihatwiell and assembly. anal
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CAl n of septic tent(or aerated treatment unit, ✓ al
— Arbewote ehsorpflM (or disp■rul) arts. //p' , ' ' t j �► " C°'�q et S
i Adequate comaienee with permit requlttmentt. .
' tr. Nine.
WOvott Compliance with County and Stele regulations/requirements. . -
Dote , I f Other
,",. .— InspaatOr
RETAIN WITH RECEIPT RECOROSAT CONSTRUCTION SITE •
"CONDITIONS: +
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1. Alt imieue tOn re OoPlY with all tegvbaetelt of the County Individual Sewage Disposes Regulations. edeasud putsuent it ate
thorny, rented in 6644 4. CM 1993, amended 66.3.1 CRS 1963.
2. This permit it veld only for connection to structures which nave fully complied .with County zoning end bonding requirerntnts.
COnMOt1On to Oi us} with env Walling or structure not spprOVed by the Bonding and toning office shall automottselly be t wo* •
00010 0 requlraineft -of the prrmit Ind cause for bath Ifgal getion and revocation of the permit. •
3. Section III; 3.24 raprr7res any person who constructs. alers ea insults in in0ividuat sewage dltoosal system Ina manner which in-
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1 . i• 4„ ' . vetiltion Nom the terms Or sptcitic *Dons container] in she sppliolNOf oof f• permtt commits /Class 1. Esirigi
j, 41 A/. { 11 r . ' NN Fort Ndto 7671 � ° ± N . ° � f . ( p l � a
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