HomeMy WebLinkAboutApplication-Permit.pdfGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT VNE. raw: =®Name C'F...f-RT`J."""..V-1-"- System Location (V r7t (C3fiijf t Pre ddress o U'hekr. IV w) si&Lt Permit ° '4 Assessor's Parcel No. 1=1 -01L%C'1J- 54( This does not constitute a building or use permit. Phone (-4 ©` ovi Legal Description of Assessor's Parcel No. (lt 111-0N -0C)-914 SYSTEM DESIGN l) r7 '; Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date - p + Inspector I3912 ACJ Jd (m7i t -tivumka sus; rig (;, bR�d G d Q 00-41PiaJ c 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" off surface Absorption Area Absorption Area Type and/or Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements Other Date H'7 2-7 -6 /7 Inspector ` + LI ` j,✓k,� RETAIN WITH RECEIPT RECORD 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 1, Petty Offense ($500.00 fine —6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT OWNER - faC INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Crakia ADDRESS Tib CR t6 "?-4 C\ -e_ CONTRACTORR,T Talo r Con,iroci- cs (1 ADDRESS t4140 'iiiccor'1-`Rd Rick c0 PHONE01ic)go41- (20gg PHONE (W)(995 -5a PERMIT REQUEST FOR (>0) 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 R t 1-rI P. , C C) Size of Lot / 0 ' Legal Description or Address ) s (q c 2 k. o WASTES TYPE: (') DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER—DESCRIBE BUILDING OR SERVICE TYPE:5,-1W C, ►n'1©!� R(' Number of Bedrooms 3 Number of Persons (i) Garbage Grinder ()4Automatic Washer ( Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL,. SPR NG ( ) STREAM OR CREEK A✓ If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? 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 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: SEPTIC TANK VAULT PRIVY PIT PRIVY CHEMICAL TOILET( ) ( ) ( ) AERATION PLANT COMPOSTING TOILET ( ) INCINERATION TOILET VAULT RECYCLING, POTABLE USE RECYCLING, OTHER USE OTHER -DESCRIBE FINAL DISPOSAL BY: X 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? AD 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: Pvi 3 3.�.,1AV 31.) %LIS— 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 misrepresentationmay_ result in the denial of the application or revocation off any permit granted based upon said application andin legal action forpenjury as provided.... by law. y.gned , LbO Date PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 as 4 \ 2 oa) 337.6 NAM -v` ' , TANK e p�pldVP\PROX WATER SEPT STORA PROPOSED `frit" APPROXCE ����y5 IX, 1\ 411-- HOUSE 9' APPROX 26 46 BARN LSAT 183.6' DR 0 133.31 FOUND NAIL it 30.00' ACCESS ,F UM. ESA!? 15.00' 45' 2.01' S89°25 45' AREA NORTH CTY. RD. R.O.W. FENCE 37.092* ACRES N89°46 '15"E FENCEAREA SO0.2UTX47± OF CTB RD. go.w. ACRES 56 56' 755.96' 16. 1' N89°44'10"E FOUND REBAR & CAP ILLI 9I ,00.00N S89°44'49" W 133.71' Oen 387.6' A 902.39' 498.3' APPROX. SEDC APPROX WATER STORAGE TANK PPROX. PROPOSED HOUSE 2 469.5' SHED SILO 30.00' ACCESS & UTIL ESMT. 539.6' AREA NORTH CTY. RD. R.O.W. FENCE 37.092± ACRES AREA SOUTH OF CTY. RD. R.O.W. FENCE 0.247± ACRES FOUND NAIL & WASHER JILL IN ROAD CS1/16 NOTICE; ACCORDING TO COLORADO LAW YOU MUST COMMENCE ANY LEGAL ACTON BASED UPON ANY DEFECT IN THIS SURVEY WITHIN THREE YEARS AFTER YOU FIRST DISCOVERED SUCH DEFECT. IN NO EVENT, MAY AN ACTION BASED UPON ANY DEFECT IN THIS SURVEY BE COMMENCED MORE THAN TEN YEARS FROM THE DATE OF THE CERTIFICATION SHOWN HEREON. S89°25' 45" W N89°46 15"E COUNTY RD. 210 MILE POND ROAD 654.6' liarS'A T BARN 756;56' 755.96' 983.8' -r.- SOO°OO'OO' E 16.51' THE SEXTON SURVEY COMPANY 128 WEST 3RD STREET RIFLE, COLORADO 81650 970-625-3711 OR 945-4700 OLINDA Ul'!VEY THE NE1/4SW1/4 AND PART OF TH/' NWI/4SE1/4 OF S FC. 1, T.63., R. 93W. OF THF 6TH P. M., COUNTY OF CARFIELD, STATE OF COLORADO GRAPHIC SCALE 100 0 50 100 2001 400 { IN FEET } 1 inch = 100 ft. PROPERTY DESCRIPTION CRAW BROTHERS PROPERTY DESCRIPTION: A PARCEL OF LAND SITUATED IN FART OF SECTION 1, TOWNSHIP 6 SOUTH, RANGE 93 WEST OF THE 6TH P.M., BEING NORTH OF COUNTY ROAD 210 (MILE POND ROAD) BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT A POINT ON THE SOUTHERLY LINE OF SAID NW1/4SE1/4 AND THE CENTERLINE OF AN EXISTING GRAVEL DRIVE; WHENCE THE CS'4e OF SAID SECTION 1 A NAIL AND WASHER S.89°47'08" 133.31 FEET; THENCE ALONG SAID DRIVE N.02°40'46"W. 1176.75 FEET; THENCE LEAVING SAID DRIVE N.49°18'35"E. 63.94 FEET; THENCE N.01°00' 22"W. 102.99 FEET; THENCE S.89°44'49" W. 133.71 FEET; THENCE N00°22'46"W. 659.77 FEET TO THE CNf46 OF SAID 1 A REBAR AND CAP P.L.S. 31143; THENCE N 89°44' 10" E. 902.39 FEET; THENCE S.00°00'00"E. 1963.91 FEET TO THE NORTHERLY RIGHT OF WAY FENCE OF SAID COUNTY ROAD; THENCE ALONG SAID FENCE S.89°46' 15"E. 755.96 FEET TO THE TRUE POINT OF BEGINNING OF SAID PROPERTY CONTAINS 37.339 ± AS DESCRIBED. TOGETHER WITH A 30.00 FOOT ACCESS AND UTILITY EASEMENT A 30.00 FOOT ACCESS AND UTILITY EASEMENT SITUATED IN PART OF SECTION 1, TOWNSHIP 6 SOUTH, RANGE 93 WEST OF THE 6TH P. M , BEING 15.00 FEET EACH SIDE OF THE FOLLOWING DESCRIBED CENTERLINE: BEGINNING AT A POINT ON THE SOUTHERLY LINE OF SAID NW1/4SE1/4 AND THE CENTERLINE OF AN EXISTING GRAVEL DRIVE WHENCE THE CS1/16 OF SAID SECTION 1 BEARS 589°47'08"W 133.31 FEET; THENCE ALONG SAID DRIVE NO2°39'54"W 1176.75 FEET TO THE POINT OF TERMINUS WHENCE SAID CW1/16 BEARS 503°49'25"W 1178.60 COUNTY OF GARFIELD STATE OF COLORADO NOTES: - SURVEY ORIENTATION IS THE CN1/16 LS 31143 & THE CS1/16 NAIL WITH REF. CAPS OF SEC. 1 AS SHOWN - EASEMENTS & ADDITIONAL INFORMATION SHOWN ARE FROM INDEPENDENT TITLE COMPANY ORDER NO. 00003313 - THIS DOES NOT REPRESENT A TITLE SEARCH BY THIS FIRM OR SURVEYOR. * - INDICATES FOUND REBAR AND CAP P.L.S. 31944 UNLESS OTHERWISE NOTED. 0 - INDICATES SET REBAR & CAP PLS 31944. ca)- INDICATES FOUND UTILITY POLE. E - INDICATES FOUND PHONE FED. - SUBJECT TO COUNTY ROAD RIGHT OF WAY SURVEYOR'S CERTIFICATE I, BRIAN A. STEINWINDER BEING A REGISTERED LAND SURVEYOR IN THE STATE OF COLORADO. DO HEREBY CERTIFY THAT THIS SITE PLAN SURVEY WAS PREPARED BY ME AND UNDER MY SUPERVISION FROM A SURVEY MADE BY ME AND UNDER MY SUPERVISION AND THAT BOTH THE SURVEY AND PLAT ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. C?RAD 149 ��t C3 ifr r ll•L�}ry.0� i • Bgar A 0. NO 'Lr7 P.L.S. 31944 DTE JO. NO.: 03034 -SITE DWG. BY. KS CK BY: BAS DATE: 04/02107 REV: 440/07 REV: THE NE1/4SW1/4 AND PART OF THE NW1/4SE1/4 OF SEC. 1, T.6 S., R.93W. OF THE 6TH P. M, COUNTY OF GARFIELD, STATE OF COLORADO CRA OUNDARY SURVEY 7 of 1 LINE TABLE LINE LENGTH BEARING L5 63.94 S49'18'35"W L6 10299 S01"00'22'E NOTES: - SURVEY ORIENTATION IS THE CN1/16 LS 31143 & THE CS1/16 NAIL WITH REF. CAPS OF SEC. 1 AS SHOWN - EASEMENTS & ADDITIONAL INFORMATION SHOWN ARE FROM INDEPENDENT TITLE COMPANY ORDER NO. 00003313 - THIS DOES NOT REPRESENT A TITLE SEARCH BY THIS FIRM OR SURVEYOR. * - INDICATES FOUND REBAR AND CAP P.L.S. 31944 UNLESS OTHERWISE NOTED. 0 - INDICATES SET REBAR & CAP PLS 31944. ca)- INDICATES FOUND UTILITY POLE. E - INDICATES FOUND PHONE FED. - SUBJECT TO COUNTY ROAD RIGHT OF WAY SURVEYOR'S CERTIFICATE I, BRIAN A. STEINWINDER BEING A REGISTERED LAND SURVEYOR IN THE STATE OF COLORADO. DO HEREBY CERTIFY THAT THIS SITE PLAN SURVEY WAS PREPARED BY ME AND UNDER MY SUPERVISION FROM A SURVEY MADE BY ME AND UNDER MY SUPERVISION AND THAT BOTH THE SURVEY AND PLAT ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. C?RAD 149 ��t C3 ifr r ll•L�}ry.0� i • Bgar A 0. NO 'Lr7 P.L.S. 31944 DTE JO. NO.: 03034 -SITE DWG. BY. KS CK BY: BAS DATE: 04/02107 REV: 440/07 REV: THE NE1/4SW1/4 AND PART OF THE NW1/4SE1/4 OF SEC. 1, T.6 S., R.93W. OF THE 6TH P. M, COUNTY OF GARFIELD, STATE OF COLORADO CRA OUNDARY SURVEY 7 of 1