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Home My WebLink About04543GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 401 4 5 4 3 �olzoGlenwood Springs, Colorado 81601 Permit Phone (970) 945-8212 Assessor's Parcel No. 1 l INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Thisdoes not con9tit6te a building or use permit.? Owner's Name'BA " 1 �q 7 Present s S AAddresYR �1 2 PhonQ 1`-( 1 -2_2M J System Location'C�t? 9 I l.ss p 1 1 10 �1 t Legal Description of Assessor's Parcel No. —11 i /- L4'�up-�� - l h -° l i 74 SYSTEM DESIGN YCMoVe.a i2 3a •oS 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 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 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. 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 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 GARFIELD COUNTY SEPTIC PERMIT APPLICATION 108 8th Street, Suite 401, Glenwood Springs, Co 81601 Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003 www-earfietd-countv.c in USE ONLY Permi Parcel No: (this information is available at the assessors office 970-945-9134) 2177-262-00-956 2 Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description Section 27 T6S R93W 6TH P.M. 3 Lot Size: Lot No: Block -No: Subd./ Exemption: 1480 Acres NA 00 NA 4 Owner: (property owner) Bureau of Land Management Mailing Address 50629 Highway 6 & 24 Glenwood Springs, -CO 81601 Ph: 970.947.2800 Alt Ph: NA . 5 Contractor: Mountain West 09 Field Services Mailing Address 864 20 RD /if Fruita, CO 81521 Ph: 970.858.8859 Alt Ph: NA 6 Engineer: Christopher F. Hale Mountain Cross Engineering Mailing Address 8261/2 Grand Avenue Glenwood Springs, G.O.&160.1.- Ph: - 970.945:5544- Alt Ph: NA' 7 PERMIT REQUEST FOR: (D+) New Installation ( ) Alteration ( ) Repair 8 WASTE TYPE: ODwelling ( )Transient Use (. )Commercial or industrial )Non- Domestic wastes ( )Other — Describe 9 BUILDING OR SERVICE TYPE: Number of bedrooms Garbage Grinder Cres ( )No 10 SOURCE & TYPE OF WATER SUPPLY: ( )WELL ( )SPRING ( )STREAM OR CREEK ( )CISTERN If supplied by COMMUNITY WATER, give name of supplier: vault and Ham System. Water received from CBPHE certified water hauler. 11 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was effort made to connect to the Community System? an YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN 12 GROUND CONDITIONS: Depth to 1s' Ground Water Table Percent Ground Slope 13 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED: ( )Septic Tank ( )Aeration Plant (Vault ( )Vault Privy . (' )CompostingToilet ( )Recycling, Potable Use ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet ( )Other- Describe 14 FINAL DISPOSAL BY: ( )Absorption trench, Bed or Pit ( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter ( )Wastewater ([Other- Describe Water Hauled to municipality pond 15 Will effluent be discharged directly into waters of the state? ( )YES LINO 16 PERCOLATION TEST RESULT: (to be completed by Registered Professional EngineeydtlheEngineerdoesthePercolatiiorrlestl.. 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 & telephone of RPE who made soil absorption test: .. Name, address & 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 test 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-0rwillberepresented4obe-rue andcorrect-othebest of my knowledgeand.beliet.. and are .r . •-e 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 unders =nd tha - falsifica ton or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application and I al actio . r alas provided by law. G _-- 17 OW ERS '�!= " �- uA AT USE ONLY Permi Fee: ..- 00 Perk Fee:Total fees: Building Permit #: Septic Permit . 1-614:3�7 Issue D te: 15 Ca B ding & PI 1 ning De APPRIVAL DATE Woo Rifle Ea t 87 Proposed Location Well Pad (H27MW) EnCana Oil Gas Inc. 7u -sem .GeastreSarmeyieg g%. \ (435) 781-2501 80 one Vernal Ave. Vernet, wee 84078 = Legend = ®® Existing Road Well Pad (H27NW) SEC. 27, T6S, R93W, 6th P.M. Approximate Location of PIPET-IIt (not verified by survey) S /L U Plater u ano Q. DZ21 iled x [Frac rart 0 Directional Trailer Waste Water—.ft Fresh Water—CI 19 a n Waste Ha Frestp n 1, Kenneth Scott Thompson, a registered Professional Land Surveyor In the State of Colorado, do hereby state that the Survey shown hereon was prepared under my supervision and has been prepared solely for the purpose of depicting the location of Improvements on the site shown as surveyed on October 8, 2008. 'This statement Is not a guaranty, either expressed or Implied. 1"=100' 0 100 Surface Disturbance Area Proposed 5.621 acres Actual 5.4c14 acres RIVERCITY Z.,„„C 0 N 11 LTANTS 744 Horizon Ct. Suits 130 Grand Junction CO 81506 970-241-4722 Drawn:kst I Ghecked:dot lOct 15, 20081 5:\PROJEGTS\1086 EnCana\002 H2"INWW2"INWasbulltpro Proposed Location Well Pad (H27NW) ;Slcri nq EnCana 0116 -Gas Inc Well Pad (H27NW) SEC. 27, T6S, R93W, 6th P.M. 4#dSena.i Oft. / \ (435) 181.2501 180 NaN Verna! Ave. Verna, Utah 34078 — Legend Existing Road SHEET 10 OF 11 Proposed Access 32700' Proposed Location Well Pad (1127NW) Weil Ped (N27NW) Tie In at EnCana Oil&GasInc. Well Pad (H27NW) SEC. 27, T6S, R93W, 6th P.M. i r AAt-Seca* dSew ray gee. (438)787.25ol 180 North Vernet Ave. Vernal. Utah 84078 — Legend = ------= Existing Road ------ Proposed Access 02- .—, em Proposed Gas Line