HomeMy WebLinkAboutApplication- Permit•
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Name e 3 o Retain
Permit
4095
Assessor's Parcel No.
alas- aSa-oo -/03
This does not constitute
a building or use permit.
Sf -Pavnbork rt r`��-s ea -
Present Address %D S • �-iPC i fl steit'205 Phone ! ID -W 1`I- /).19•b‘
soYS'�
System Location 0/0qS CAC. !!l���nnn ) ` J / I3e ua casf (eam ( c ? Uo 7
Legal Description of Assessor's Parcel No. pCkrCe 1 133 J ).`; a- Oo -103
SYSTEM DESIGN I
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date Inspector
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" of surface
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
Other
Date /1- I OS
Inspector &/ Dc r t c S w ai+e - I? t '' 3%/I o
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 ($500.00 tine — 6
months in jail or both).
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNEk CRA-WCJ+ LLC-
ADDRESS CQ00 5.1-4 !J1)C.0 I In Sit 20S nA PQHONE -0 pi q `"71p 0
CONTRACTOR MGW?ol3 (DIJSTR 017013 ) -TX C•
ADDRESS
Co. 84-11
PERMIT REQUEST FOR ( ) NEW INSTALLATION
HONE 770- T71- 994y
ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable
building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY:
Near what City of Town Neu) CiLS1 Size of Lot_ 143 ± A-Uzts
sdru £as+4e. J Co .
Legal Description or Address 2011 S dAZ24S
WASTES TYPE:
(}i DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER—DESCRIBE
BUILDING OR SERVICE TYPE: Fiwp/o yee (4OLI5a(4 Kevinocde( dty)
Number of Bedrooms 3 Number of Persons
( ) Garbage Grinder
( ) Automatic Washer ( ) Dishwasher
( A at Veru )
SOURCE AND TYPE OF WATER SUPPLY: (Q WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: / m
Was an effort made to connect to the Community System? 40
A site plan is required to be submitted that indicates the following MINIMUM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System (septic tank & disposal field) to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
Depth to first Ground Water Table
Percent Ground Slope
2
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
($j 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:
()1( ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL rr ( ) WASTEWATER POND
( ) OTHER -DESCRIBE
AM( 1JCa iu-Pd1di:re) J-%lS- WLcD jz f
I0 CA 0-eLe, +0 sic C)
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? MO
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.
3
Name, address and telephone of RPE who made soil absorption tests:
5E -e- Ek)6rfdleek2 S tporr
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
Date 7/3 /6(
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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Pit 23
NATO PRDJECT 1
2995 CR 245, NEW CASTLE D
AS&IILT DRAWING
NAT 7. 2004
SCALE I'=20' A.7RTw
2 rows of 6 standard
Infiltrators For a total
of 12 urvts
BOUNDARIES
UNLIMITED INC.
Consulting Engineers
November 7, 2005
Garfield County Building & Planning
108 8th Street, Ste. 201
Glenwood Springs, CO 81601
Re: ISDS for 2095 County Road 245, New Castle, Garfield County, Colorado
BUI Project: Moulton ISDS
To Whom It May Concem:
On November 4, 2005, Boundaries Unlimited Inc. personnel observed the expansion
of the ISDS for 2095 County Road 245, New Castle, in Garfield County, Colorado.
An additional 10 standard Infiltrator units had been installed in a trench configuration
and interconnected to the existing chambers. No backfilling had taken place. The
contractor was advised to install tank risers to bring the tank lids to the surface.
Other than that, the system was installed in conformance with the intent of the
design. If you have any questions, or need additional information, please feel free to
contact me at 945-5252.
Sincerely,
BOUNDARIES UNLIMIT
Deric J. Walter, P.E.
Project Manager
Cc: Cole Moulton via fax: 970.871.9964
923 Cooper Avenue 1 Suite 102 1 Glenwood Springs 1 Colorado 81601 Ph 970.945.5252 Fax 970.384.2833
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C. DWEWNG-20'
D. PROPERTY UNES/IRRIGATION LATERALS.. 10'
E. SEPTIC TANKA6
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STANDARD INFILTRATOR TRENCH DETAIL
Garfield County, Colorado
2095 County Road 245, New Castle
Individual Sewage Disposal System
Expanded System for a 3 Bedroom Residence
1
Cole Moulton
970.8719964
QQ�IIlA$$rl6S Drs. ww
nllmltedY nc
ComiklN 4 CN9 Freemen CH PAH
933 Caopr Avenue. 3u. DATE. 10/18/0;
6Nnw0W Spnn0. CO 190
We: 970946.9393 991 970.3841
NO.
DATE
REVISION
BY