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Home My WebLink About04403GARFIELD 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—NCci a DIL -t.St 5 Present AddressPV (TM- Pc\'3 System Location RC46 J w R.> x' 4. tom- \ o109 Permit 4 4 0 3 Assessor's Parcel No. This does not constitute a building or use permit. Phone G C? Legal Description of Assessor's Parcel No CIO N-3 SYSTEM DESIGN 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. 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 fine --- 6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER CV 7/ t QraS Gsr1 ADDRESS 7/7 61e, f).. •4 /a° PHONE 970 — /O--'/4/6 CONTRACTOR Pre $i' /f 4,P 5.5! 5 ADDRESS Sec 1,14,1" / PHONE PERMIT REQUEST FOR (X) 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 /Q .01,7 0°5 /T% of Proud e G.A2i''1- Size of Lot Au Legal Description or Address Sec 414.1-a / WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES (y) OTHER—DESCRIBE "'Nor re boipo 41� ifrp/ogee 14,v3snr BUILDING OR SERVICE TYPE: fiirg.14. Number of Bedrooms Number of Persons ( ) Garbage Grinder ( Automatic Washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: LA)etl wn. mw. wie54 C6,/ ettr J Ieof by 441e5__ waw s.9/ ' DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /ra -- /,S --oz.* le 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: Septic Tank to Well: Leach Field to Irrigation Ditches, Stream or Water Course: 100 feet 50 feet 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 ,Vc Percent Ground Slope Na 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: SEPTIC TANK ( ) AERATION PLANT (>4) VAULT VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE CHEMICAL TOILET( ) OTHER -DESCRIBE FINAL DISPOSAL BY: ( ) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND OTHER -DESCRIBE //a&led /0 4)&54 weer. .e• ,Fay; / 4.7 (4 WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF TI -IE STATE? A/O PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes ,44t per inch in hole No. 1 Minutes Alei per inch in hole No. 3 Minutes f/ot per inch in hole No. 2 Minutes A/4 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 maybe 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 evaluatin g the same for purposes of issuing the permit applied for herein. 1 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. Date .►/ 10/ 2 a PLEASE DRAW AN ACCURATE AT TO YOUR PROPERTY!! See ,¢ e,4 » / 3 Designate North Arrow Your Neighbor's Name & Address Your Pot - Shape to Fit (Na Scale) See Ageke,d, 04.00`"GD) Locate well, al/ streams, irrigation ditchs, and any water courses. Draw in your House, septic tank & system, detached garages, and driveway. If a change of location is necessary, you must submit a corrected drawing, before a Certificate of Occupation wilt be issued. Your Neighbor's Name & Andress County .Road (Note the Road Number and Name) cCK c1% -i mintowgdoa<voi lac 0, jSCALE: 1 = 60 DATE: 01-16-07 Drawn 8y. D.R.B. evised: 02-16-07 D. .B. 03-01-07 D.R.B. ' Rd: 03-01-07 D.R.B. ",11/sefitIFCreP11Istobo located a min. of 100' Rom the Well i rari 1 e V'tekc2":C"' EnCana OIL & GAS (USA) INC. LOCATION LAYOUT FOR WELL PAD J22A 596 SECTION 22 T5S, R96W, 6th P.M. f\yit NW 1/4 SE 1/4 Il,r Proposed Acces Rocs• OA' FIGURE #1 Topsail Stodlpfte F-31.1' El. 307.2' C-19.4'. 81m. P11) 1 Apox.�� Top of - l �,hIM Cut ope�i L la '�,Mg OMMI11111 1% i RESERW pa 1ret Pit Capacity W/2' of Freeboard 1 = 4360 Obis. Total P11 Volume 1530 �. Yds ,,! 0 STRUC 1VERS �h E7. 339.8' NOTES.. 1 MM�n7hMHiwW aua. i rr Eley. Ungraded Ground At Loa Stake = 6,5,36.0' RNISHEO GRADE ELEV. AT LOC. STAKE = 6,538,Y 5 Existing Drainage I 1 \ APP A APPROX. WELL OIS7UR8ANCE _ 1'3.518 ACRES ACCESS ROAD DIS7UR9ANCE _ 0.028 ACRES TorA1. _ X3.546 ACRES UINTAH ENGINEERING & LAND SURVEYING 85 So. 200 East * Vernal, Utah 84078 • (435) 788-1017 f, .r f c2 Driving Instructions to the J22A Well Pad: From the intersection of Main St. and CR 215 in Parachute, Colorado, drive Northwesterly on CR 215 for 10.3 miles to the Encana automatic guard gate. Turn left just past the automatic guard gate and proceed 0.6 mile to a 'Y' and take left turn on West Fork Road. Continue Northwesterly 2.1 miles and tum left on Light Gulch Road. Continue 0,5 miles to the J22 Well Pad and proceed Westerly 0.4 Miles to the J 22A Location. Well Location: Lat.: 39° 35' 59" N Long.: 108° 09' 12" W r y t : Parachute 3 0 EnCana Oil & Gas (USA) Inc. J22A Well Pad NW 1/4 SE 1/4 Section 22, ? 5S, R96W, 6th P.M. Garfield County, Colorado NrCit uRvr 908 Mein Street Evanston, Wyoming 82930 Mono No. (307) 780 x545 -LEGEND - Existing Road • Site Location DATE: May 3, 2007 SCALE: As Shown PROJECT NO.: 03-04-55 Topo A SHEET 1 OF 1