HomeMy WebLinkAbout1.00 Application7w
z. vv..:. '' y"
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N:3 5 7 4
109 8th Street Suite 303 A ssessor's Parcel No.
I.
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212 i
This does not constitute
j INDIVIDUAL SEWAGE DISPOSAL PERMIT a buildin¢ or use permit.
PROPERTY
Cb 11 -L
Owner's Name! rt Pp f Sio Present Address 1- - -per — , af.-.:1'7P Phone 9U k-- Y - ,1 2
System Location
1
r"Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
f J2 Q (,4 Septic Tank Capacity (gallon)Other
1 Percolation Rate (minutes /inch) Number of Bedrooms (or other) ' 9 D.R. (. 6. }6 "ua74
o34 sc.FT - I`ock Lt* cH rco i
Required Absorption Area - See Attached LW 35.Ft - L. AAC N C11.1“Sl4) - 22 110+05- - '' rn',CArC At
Special Setback Requirements:
r 27 OurT L Jr t6
SW 31 u.ru • 73 F-0 2v 3 r
Date Inspector I. ) ,4 r
r
Y FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
l 1
System Installer
1
Septic Tank Capacity I'"-' /)
Septic Tank Manufacturer or Trade Name C wx-1.
iY
r Septic Tank Access within 8" of surface
S q. iAbsorptionAre
Absorption Area Type and /or Manufacturer or Trade Name 7 1 - 34 W 11 t i ft Br Aid)i
R
Adequate compliance with County and State regulations /requirements Z!
Other
n , \ /'(
i
Date 1h' i O/Inspector N D'
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
1
CONDITIONS:f
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter i
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 - P
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 materialvariationfromthetermsorspecificationscontainedintheapplicationofpermitcommitsaClassI, Petty Offense ($500.00 fine — 6
t months in jail or both).i
White - APPLICANT Yellow - DEPARTMENT 1
i
r
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
X 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:
4 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? Ain
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 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) 440/421 Date //
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
3
GARFIELD COUNTY BUILDING AND SANITATION DEPAK J Ml:::N I
108 Eighth Street, Suite 401
Glenwood Springs, Colorado 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Permit
Assessor's Parcel No.
Th is does not constitute
a bu ilding or use permi t.
owner's Name WA a.st.fl/ OtJ!Zt>PresentAddress ~Z(;?L cit ZZb Phone ~Ill-796'7
System Location ________________________________ _
Legal Descripjion of Assessor's Parcel No. _-lZ~/-""'Z-S"j~-....;O=-....... Z~--'Z....:....ii&.::.....:0::::;.......1.Z...,-~O~Y _______ _
SYSTEM DESIGN
I Z $:AP Septic Tank Capacity (gallon)
I
_____ Oth er
. 3 '3 Percolation Rate (minutes/inch) Number of Bedrooms (or other) __ 1..1-..-____ . _
Requi redAbsorptionArea-SeeAttached /3'S-Sf. r~ /Al m.t';Vc# r 62! R--'fs
SpecialSetbackRequirements: 88Z .St(1 ~T /N B'$'J?-/--7<f' cf-?-.s
Date 7-ZS -,/k ln~pector ,;::1lin /A//Lsad
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer ______________________________ _
Septic Tank Capacity -J..L.::.;~=-0=------------------------
Septic Tank Manufacturer or Trade Name _iair;..i..~ .. ~-1<4-~~--""'~~-==~~-------------
Septic Tank Access within 8" of surface ~~-¥A:..;:-~--------------------
Absorption Area ---=~:;.;;..""'-::...o. ;..:;.:;..--"'"--------------------------
Absorption Area Type and/or Manufacturer or Trade Name ~ o/ r 6:Z. ~
Adequate compliance with County and State regulations/requirements ---'¢;..yf--------------
Other~-------------------------------------~---
Date C /JI. ·16. 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 Sew age
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. Connection 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 permi t 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 applica tion of
permit commi ts a Class 1, Petty Offense ($500.00 tine - 6 months in jail or both).
White -APPLICANT Yellow · DEPARTMENT
c0tP
COLORADO POWER OF ATTORNEY FOR PROPERTY
OF
WARREN L. DODO
ALSO KNOWN AS WARREN LEROY DODO
AND WARREN DODO, PRINCIPAL
IMPORTANT INF'ORMATION:
This power of attorney aufhorizes another person (your agent) to make decisions concerning
your property for you (the Principal). Your agent will be able to make decisions and act with
respect to your property (including money) whether or not you are able to act for yourself. The
meaning of authorþ over subjects listed on this form is explained in the "Uniform Power of
Attorney Ac,t',Part 7 of Article 14 of Title 15, Colorado Revised Statutes (theooAet"). This
power of attorney will be subject to and interpreted under the Act and the default provisions of
the Act will apply unless you otherwise expressly provide below.
This power of attorney does not authoúze the agent to make health care decisions for you.
You should select one or more persons you trust to serve as your agent. Unless you specify
otherwise, generally the agent's authority will continue until you die or revoke the power of
attorney or the agent resigns or is unable to act for you.
Your agent is entitled to reasonable compensation unless you state otherwise in the special
instructions
This form provides for designation of one or more agents. If you wish to name more than one
agent, you may name one or more co-agents and/or one or more agents to serve in succession.
Co-agents shall be required to act together unless you specify otherwise below.
If at any time, there is no agent or sucoessor agent able and willing to act for you, your power of
attorney will end.
This power of attorney becomes effective immediately unless you state otherwise in the special
instructions. You may revoke this power of attomey in the future by giving notice as required in
the Act.
If you have questions about the power of attorney or the authority you are granting to your
agent, you should seek legal advice before signing this form.
r. pESrqNATroN oF AGENT(S)
I, Warren L. Dodo, also known as 'lryarren Leroy Dodo and Warren Dodo (the
Principal), name the following persons as my co-agents:
Name of first oo-agent: Michael \il. Dodo
Name of second co-agent: Scot J. I)odero
Page I of5
STATEMEI{T OF AUTHORITY
NAME OF ENTITY: The name of the entity to which this Statement relates is the
Warren L. Dodo Revocable Trust.
TYPE OF ENTITY: The entity is a Revocable Trust dated October 16,2013, formed under the
laws of the State of Colorado
MAILING ADDRESS: The mailing address for the entity is 111 County Road 247,
New Castle, Colorado 81647.
AUTHORIZED PERSON: The name and position of the person authorized to execute
instruments conveying, encumbering or otherwise affecting title to real property on behalf of the
entity is as follows:
Name
Warren L. Dodo
Scot J. Dodero
Position
Co-Trustee
Co-Trustee
After recording return to: Kerst & Strautman P.C.
823 Blake Avenue, Suite 202, Glenwood Springs, CO 81601
LIMITATIONS: None.
AUTHORITY: All of the above-named persons must execute instruments conveying,
encumbering or otherwise affecting title to real property on behalf of the entity.
Dated October 16,2013
Warren L. Dodo, Co-Trustee
Scot J.Co-Trustee
STATE OF COLORADO
COUNTY OF GARFIELD
The foregoing instrument was acknowledged before me this 16th day of October,2013,
by Warren L. Dodo as Co-Trustee.
WITNES and official seal
{vu¡l¿-t-arwv'tn,
Notary Public
My Commission expires:1-1->ot6
STATE OF COLORADO
COLINTY OF GARFIELD
The foregoing instrument was acknowledged before me this 16th day of October,2013,
by Scot J. Dodero as Co-Trustee.
V/ITNESS my hand and official seal.
{vuh.t*tt -lruvwùu'
Notary Public
My Commission expires:T1-Aot6
After recording return to: Kerst & Strautman P.C.
823 Blake Avenue, Suite 202, Glenwood Springs, CO 81601
)
)
)
ss.
ss.
)
)
)
B
A &
aI
TA
Aì]
ÂlJ B
a
I
N All preceding subjects; I grant the agent general authority over all the
subjeots listed in A through M above as if I had initialed each of subjects
A through M.
To the extent that the authority under any of the provisions of such sections or as set forth in
the provisions above are similar or overlap, the broadest authority controls. Except as
expressly limited by the following provisions of this po\iler of attorney, my agent may do all
acts I could do.
UI. GRANT OF'SPECIF'IC AUTHORITY (OPTIONAL)
My agent MAY NOT do any of the following specific acts for me TINLESS I have
INITIALED the specific authority listed below:
(CAUTION: Granting any of the following will give your agent the authority to take
actions that could significantly reduce your property or change how your property is
distributed at your deáttr. INITIAL ONLY the specific authority you WANT tò give your
agent.)
Create, amend, revoke, or terminate an intervivos trust
Make agift., subject to the limitations of the "Uniform Power of Attorney
Act" set forth in section L5-14-74A, Colorado Revised Statutes, and any
special instructions in this po\ryer of attorney
Create or change rights of survivorship
Create or change a beneficiary designation
Authorize another person to exercise the authorþ granted under this
power of attorney
\Maive the Principal's right to be a beneficiary of a joint and survivor
annuþ, including a survivor benefit under a retirement plan
Exercise fiduciary po\¡'lers that the Principal has authority to delegate
Disclaim, refuse, or release an interest in property or a power of
appointment
Ifthe subject ofestates, trusts, and other beneficial interests is authorized
above in item H of the preceding Section, exercise a general power of
appointment for the benefit of the Principal
If the making of a gift is specifically authorized hereunder, exercise a
general pov'ler of appointment to make gifts for the benefit of persons
other than the Principal, subject to the gifting authority and limitations of
the agent hereunder
Exercise powers, rights, or authority as a partner, member, or manager of a
partnership, limited liability company, or other entity that the Principal
may exercise on behalf of the entity
All preceding authorities above.
Mtr-
1.
IL.
3.
4.
6.
7.
8.
9.
10.
11,
T2,@
Page 3 of5
IX. F.AILURE TO RECOGNIZE AGENT'S AUTHORITY¡ COTJNTERPARTS AND
PHOTOCOPIES. My agent is authorized to take legal action on behalf of me or my estate
for any damages that may result from a third party's refusal to rely on the representations of
my agent or to recognize the authority herein granted to my agent or faihue to permit my
agent to exercise any power granted by this instrument. This Power of Attorney is executed
in two (2) counterparts. Each execute.d counterpart and any photographic copy of this Power
of Attorney shall have the force and effect of the original.
X. SIGNATURE AND ACKNO\ilLEDGEMENT
Date: October 29,2015
Warren L. Dodo, also known as
Warren Leroy Dodo and Warren Dodoo
Principal
Address:4701 CountyRoad226
New Castle, Colorado 81647
STATE OF COLORADO
COLINTY OF GARFIELD
The foregoing instrument was acknowledged before me this 29ú day of Qctober, 2015, by'TVarren L. Dodo, also known as'Warren Leroy Dodo and Warren Dodo, Principal.
Witness my hand and official seal.
)
)
)
ss.
H E R E F R E
NOTARY PU B Llc
8TATE OF
NOTARY ID
COLORADO
# 201 14041 306
Notary Public
Page 5 ofS
f"ry fi ii !' lt ü
td,*çil,l+¡,' [ ilrlfi !Ì¡fi f*r¡] tllt¡' I hr¡ f I tri H,,¡ ffiReception#: 79øø96OBlf il2î1O 12:;4.49 p'yi Jean Êlberico1 of 2 pec Êe":316 co Doè-Fäe,ôlıb'oãirr;er-l couNly a,..)
STATEMENT OF AUTHOR¡TY
NAME OF ENTITY: The name of the entity to which this Statement relates is the Scot J.
Dodero Trust.
TYPE OF ENTITY: The entity is a revocable trust dated August 6,2010 formed under
the laws of the State of Colorado.
MAILING DRESS : The mailing address for the entity is 111 County Road 247,
New Castle, Colorado 81647.
AUTHORIZED PERSON: The name and position of the person authorized to execute
instruments conveying, encumbering or otherwise affecting title to real property on behalf
of the entity is:
Name
Scot J. Dodero
Position
Trustee
2010
Scot J.ro, Trustee
After recording return to: Dan Kerst, P.C.
823 Blake Ave., Ste. 202, Glenwood Springs, CO I I ó0 I
LIMITATIONS:
Dated this
None
4, il day of
4
oiÐKu)DERO,SCOIEKNMUP.20ToBTñtr 1Uril,SJDX)CX
llll fili I'l$rtHl,Hl{ 114'rt Í*1ç i*rtr?l+lf l*tjiH'l id,*þf ,å Hi i!;Recept.r.on{t: 79ØØ9â
ABI 17 i201D 12.C:: 4l FT ..1êar, Êì.bêricc2 oi 2 itec LÉe.1.6 iî 3.r: Fee !.fn GÊRFIEI__D !ìOu¡tt't ;û
STATE OF COLORADO
COUNTY OF GARFIELD
SS
)
)
)
Tþe foregoing
this n//,. day of
Dodero Trust.
m was subscribed, sworn to and acknowledged before me
2010, by Scot J. Dodero as Trustee of the Scot J
Pub
After recording retum to: Dan Kerst, P,C-
823 Blake Ave., Ste. 202, Glenwood Springs, CO 81601
WITNESS my hand and
My Commission expires:
t! Corl'r'nr'o'ì E¡ilr6 0f{Unût4
LAURIE
SPAKANIK
O:DKWDIRo.sc-olÞKtrñISf -:0l0STW-¡\6H-sJD-ü)CX
l[lf i f
'f iüffid- lt{ '[ ru¡q lrÅ tr|4r,'l Hh'lhtr I i*,'ri, l.H',å ffi l r
t iReceptionts: ?gØØ97Agl l7l2A1O 12 04:4:ì pt4 Jean ÞIber icoror ¿ hec ¡e*.S,'l .ii Dcc tree.0.0(.r GlìfìtrIFLD C,?:il.jry C0
day
STATEMENT OF AUTHORITY
NAME OF ENTITY: The name of the entity to which this Statement relates is the
Kimberly A. Aaberg-Dodero Trust.
the laws of the State of Colorado.
MAILING ADDRESS: The mai ling address for the entity is 1 1 1 County Road 247,
New Castle, Colorado 81647
AUTHOR¡JZED PERSON: The name and position of the person authorized to execute
instruments conveying, encumbering or othenruise affecting title to real property on behalf
of the entity is:
Name Position
Kimberly A. Aaberg-Dodero Trustee
LIMITATIONS; None.
J.e-
Dated this
Kim
2010.
Dod stee
After recording retum to: Dan Kerst, P.C.
823 Blãke Ave., Ste.202, Glenúood Springs, CO8160l
O:ÐKWDERO.SCOI&KISNN!P-]o¡o$Tln:,\(trH-KAA¡),lXEX
l il nT.I l'ill r [J] r lËi¡,FJrr I hrfi tt*ff f*C { l ilT';Ltr l ilt
"*,
Hi "å B l l i l
Receptionli: 79ØØ97
ûA!17 l20 l0 i2 Cri.49 Pl'l Jean Alberico2 ol 2 9ec tree 31ê.0C Dot-. tree 0.ltì GÊRrjlE*L) C0t])l'i/ CC
STATE OF COLORADO
COUNTY OF GARFIELD
e foregoing was subscribed, sworn to and acknowledged before me
,2010, by Kimberly A. Aaberg-Dodero as Trustee of
SS
)
)
)
ínstrument
fruou¿*this day of
the Kimberly A. Aaberg-Þodero Trust.
WITNESS my hand and
My Commission expires:
þr 0ffiil¡s'oi WçUW¿AU
bl
After recording rotugr to: Dan Kers!, P.Ç-
823 Blake Ave., Ste.202, Glenwood Springs, CO 8 I 601
t.
ryI"AURIE
SPAKANIK
OiDKWDlRO.SCþ f&KMlI,Ul',!O loSTMI-^ûr.&!r-D.æcX
STATEMENT OF AUTHORITY
Pursuant to C.R.S. 838-30-172, the undersigned executes this Statement ofAuthority on behalfof
Kimberly A Aaberq-Dodero Trust ¿ Trust (corporation, limited
liability company¡ general partnership, registered limited liability partnership, registered limited liability
limited partnership, limited partnership associat¡on, government agency, trust or other), an ent¡ty other
than an individual, capable of holding title to real property (the "Entity"), and states as follows:
The name of the Entity is Kimberlv A Aabero-Dodero Trust
and is formed under the laws of Colorado
The mailing address for the Entity ¡5 01 11 County Road 247, New Castle, CO 81647
The name and/or position of the person authorized to execute instruments conveying, encumbering, or
otherwise affectíng title to real property on behalf of the Entity ¡s Scot J Dodero
The limitations upon the authority of the person named above or holding the position described above
to bind the Entíty are as follows (if no limitations, insert "None")None
Other matters concerning the manner in which the Entity deals with any interest in real property are (if
no other matter, leave this section blank):
EXECUTED this _ day of 20
Signature:
Name (printed)Kimberly A Aaberg-Dodero
Title (if any)Trustee
STATE OF
)ss
COUNTY OF
The foregoing instrument was acknowledged before me this _ day of . 20-
by , on behalf of , â
Witness my hand and official seal.
My commission expires:
(Date)(Notary Public)
IsEAL]
Garfield County
CERTIFICATION OF MINERAL OWI\ER RESEARCH
This form is to be compteted ond submitted with øny opplication for a Land Use Chonge Permit.
Mineral interests may be severed from surface right interests in real property. C.R.S. S 24-65'5-L01,etseq,
requires notification to mineral owners when a landowner applies for an application for development from a
local government. As such, the landowner must research the current owners of mineral interests for the
property.
The Garfield County Land Use and Development Code of 2013 ("LUDC") Section 4-101-(EX1Xb)(4) requires
written notice to owners of mineral interests in the subject property in accordance with C.R.S. 5 24-65'5-LO1-,
et seq, "as such owners can be identified through the records in the office of the Clerk and Recorder or
Assessor, or through other means." This form is proof of applicant's compliance with the Colorado Revised
statutes and the LUDC.
The undersigned applicant certifies that mineral owners have been researched for the subject property as
required pursuant to C.R.S. E 24-65.5-10L, et seg, and Section 4-101 (El(1XbX4) of the Garfield County Land
Use and Development Code, as amended. As a result of that research, the undersigned applicant certifies
the foltowing (Pleose initial on the blank line next to the støtement that accurotely reflects the result ol
research):
-
I own the entire mineral estate relative to the subject property; or
5llù Å t,n"r.ls are owned by the parties listed below
The names and addresses of any and all mineral owners identified are provided below (attach additional pages
as necessary):
I acknowledge I reviewed C.R.S. S 24-65.5-10!, et seq, and I am in compliance with said statue and the
LUDC.
Name of MineralOwner Mailing Address of Mineral Owner
CO ß,ank P,n,ßãv ¿l;/^j,i*u . Kntt<r]',\- 1^a,*Ò1 - "J.q¿/Û'
¿*h,^r.ro,n L. Ðada Aø¿o(aÁle-.
// I /¡",tnfv RJ, ,Q qT
'í./p
, ^1 Th <-//ç, fH ' .J>l/-t¡ 7
Applicant'Date
Gørfield CounQ
CERTIFICATION OF' MINERAL OWNER RESEARCH
This form is to be campleted and submitted with any applicotion for a Lond lJse Chonge permit.
Mineral interests may be severed from surface right interests in real property. C.R.S. g 24-65.5-101 , et seq,
requires notification to mineral owners when a landowner applies for an application for development from a
local government. As such, the landowner must research the current owners of mineral interests for the
property.
The Garfield County Land Use and Development Code of 2oI3 ("LUDC") Section 4-i.01(E)(1)(b)(4) requires
written notice to owners of mineral interests in the subject properly in accordance with c.R.s. 5 24-65.5-101,
et seq, "as such owners can be identified through the records in the office of the Clerk and Recorder or
Assessor, or through other means." This form is proof of applicant's compliance with the Colorado Revised
Stetutes and the LUDC.
The undersigned applicant certifies that mineral owners have been researched for the subject property as
required pursuant to c.R.s. 5 24-65.5-10L, et seq, and Section 4-101 (Exlxb)(a) of the Garfield county Land
Use and Development Code, as amended. As a result of that research, the undersigned applicant cert¡f¡es
the following (Please initial on the blank line next to the stotement that accurately reflects the result of
research):
-
I own the entire mineralestate relative to the subject property; or
.ç5D X- t'n"ruls are owned by the parries tísted betow
The names and addresses of any and all mineral owners identified are provided below {attach additional pages
as necessary):
I acknowledge I reviewed C.R.S. S 24-65.5-10!, et seq, and I am in comptiance with said statue and the
LUDC.
3 o
Name of MineralOwner Mailing Address of Mineral OwnerC0 ßanK þ.i', xr,v i',j',;þ-/, .'i n Le ¡t., ti, \
ttTo:(.1,,; - :"q+'t'
lii {¡,¿<r¡furaJ/"dT
Ap Date
Form No
GWS.25
APPLICANT
OFFICE OF THE STATE ENGINEER
COLORADO DIVISION OF WATER RESOUR
81 I Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303) 866-35e1
d-FEVi\jn'rt'hi üü g,
WARREN DODO
& SCOT J DODERO
4701 COUNTY ROAD 226
NEW CASTLE, CO 81647.
(e70) 876-2264
WELL PERMIT NUMBER
DIV. 5 WD 39
231822
DES. BASIN MD
APPROVED WELL LOCATION
GARFIELD COUNTY
SW 114 NW 114 Section 7
Township 5 S Range 91 W S¡xth P.M.
DISTANCES FROM SECTION LINES
1350 Ft. from North Section Line
650 Ft. from West Section Line
UTM COORDINATES.Northing: Easting:CHANGE/EXP G
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF APPROVAL
1) Approved pursuant to CRS 37-92-602(3)(bXl¡XA) as the only well on a tract of land of 38.2 acres (40 acres all lying North of
Garfeld County Road 226, less County Road ROW) described as that portion of the SW 1/4, NW 1/4, Sec. 7, Twp. 5 South,
Rng. 9'1 West, 6th P.M., Garfìeld County, more particularly described on the attached exhibit A.
2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval
of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump lnstallation
Contractors in accordance with Rule 18.
3) Approved pursuant to CRS 37-92-602(3)(bxllXA) as the only well on a tract of land of 38.2 acres (40 acres all lying North of
Gar¡eld County Road226,less County Road ROW) described as the SW 1/4, NW 1/4, Sec. 7, Twp. 5 South, Rng. 91 West,
6ih P.M , Garfleld CounÇ. Physical well address is 4701 CounÇ Road 226, NewCastle, CO 81647.
4) Approved for a change in use and amendment of legal description for an existing well Permit no. 196547 (canceled). The
issuance of this permit hereby cancels Permit no. 196547.
S) The use of ground water from this well is limited to fire protection, ordinary household purposes inside not more than
three (3) single family dwellings, the watering of poultry, domestic animals and livestock on a farm or ranch and the
irrigation of not more than one (1) acre of home gardens and lawns.
6) The maximum pumping rate of this well shall not exceed 15 GPM.
7) The return ¡ow from the use of this well must be through an individual waste water disposal system of the
non-evaporative type where the water is returned to the same stream system in which the well is located.
B) This well shail be located not more than 200 feet from the location specified on this permit.
NOTE: Parcel Identification Number (PlN): 23-2127-121'00-019
NOTE: Assessor Tax Schedule Number: 200354 (totaling 597.480 acres)
þ.2--- 2*
a QA
",
PR O3No.9500521
Engineer
ecer
APPROVED
DMW