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Home My WebLink About04034Pai sv cc a-119'05 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 Na - • '�� Le,4" System Location Permit A r'a Parcel No. This does not constitute a building or use permit. 0/1950 �% / 7 / 963- 9a5// resent Addres. `_ /(D / /7Phone Legal Description of Assessor's Parcel No SYSTEM DESIGN / 7C'L% /9(0q (Jtici 6. 6o±5 i 3"/5- lYUU -DO -IS" Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) 4 87Z /i Special Setback Requirements: 53 Date / " ` (i Inspector /� 74-;/- 4 Required Absorption Area - See Attached FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer L .. 1 S Septic Tank Capacity /-CAL OC Septic Tank Manufacturer or Trade Name 29/41 Septic Tank Access within 8" of surface Absorption Area /J Y !, (! 4)8474-4,-.? 5 S Absorption Area Type and/or Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements `r7-'-) Other Date (c /G C r 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 aviolation 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). Whore- APPI Ir smsr valve, ncoeotficur INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER 5(10-4 n on., C6\Sc E ADDRESS LtCt LC ItA t u .t PHONE qu t -gas I CONTRACTOR 0 Wmkt,� ADDRESS PHONE 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 to LA 1.1x0 C � Size of Lot c) • .Q n �s Legal Description or Address tel" " 1L.7 (3-S. WASTES TYPE: (161 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER—DESCRIBE BUILDING OR SERVICE, 4 `TYPE: S / F g �s Number of Bedrooms Number of Persons 3 (x) Garbage Grinder (i«) Automatic Washer ( Dishwasher SOURCE AND TYPE OF WATER SUPPLY: 1) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: S ovn,(z-) Was an effort made to connect to the Community System? 1,11A 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 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (4 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: 6,21 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? 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 Dateo3- ('®S PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! a INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER 570 A ADDRESS 0995 II Z /G 7 PHONE CONTRACTOR Ocumt-,C ADDRESS /ZG9 £44/c/ DX. esdelez,,oWe PHONE 943- `/25/ ex 321- Z587 PERMIT REQUEST FOR QO 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 G/PN�J�j ii.5 5 Size of Lot 2 • Z /wee s Legal Description or Address 6 y9 5 40,0)17 SCO/. /G 7 WASTES TYPE: 00 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER—DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms Number of Persons (X) Garbage Grinder ()() Automatic Washer 00 Dishwasher SOURCE AND TYPE OF WATER SUPPLY: QO WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 7 Was an effort made to connect to the Community System? Kp 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 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (7O 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: ( ) 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? /'JO 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 Date PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 0 0 z a Q t1 N os cu ▪ L N ect A 3� N 4 • '9 ti N O C O y U O U .`a L vi A 0 0.Ep cti 00 0 j 3 H cd 0 ej Uv AO o o ` cd o y U U pq 0• y C4� IS - vi r 0 J U t4 Q 0 O V1 N ^--• - W —y 0 C) - 00 N C 3 ,c N U U • F, O " ..a 0 riTh M 00 82o00N Jo' FA SKr'; SIT H PLI A PARCEL OF LAND SITUATED IN LOT 21, SEC. 1, GARFIELD COUNTY, COLO r 70.44' I oksTa.t tttav RPa. A 0475 CO RD 167 ADDRESS APPARENT N89°22'00"E 274.— rl APPROX. TOP OF RIVER BANK (STING SINGLE ORY WOOD N ' 433 T COV 83.22' CONC 215.0' APPROX. TOP OF SLOPE 0 32.0' 8.5' 34.0' m 17 4.0' a PROPOSED HOUSE 52.1' x t C O NOISE: AOCONNB TOC MOULD LAW YOU MUST CGNIN i ANY (HMI ACNOI BASED UPOM ANY DEFECT IONS SURVEY NTNN *MEE YEARS AFTER IOU ABT DEOX EPFD 9301 DEFECT. N MO E'CIT. MAY M ACTION BASED UPON MISE DEFECT N TNS SUDSY BE COBEICED MOTE 114411 TEN YEARS FROM TE DATE OF THE CEDIRCATIW SNOW HIMONT S89°22'00"W UTIL POLE PROPERTY DESCRIPTION A PARCEL OF LAND SITUATED IN LOT 21, SECTION 1, TOWNSHIP 7 SOUTH, RANGE 89 WEST OF THE 6 LYING EASTERLY OF A LINE IN THE ROARING FORK RIVER, AND WESTERLY OF A ROAD AS CONSTRUCT IN PLACE, SAID PARCEL OF LAND IS DESCRIBED AS FOLLOWS: BEGINNING AT A POINT IN SAID RIVER WHENCE THE NORTHWEST CORNER OF LOT 9, OF SAID SECTION BEARS NORTH 00'38"00" WEST 2838.64 FEET; THENCE NORTH 89'22"00" EAST 518.50 FEET TO A POINT ON THE WESTERLY LINE OF SAID ROAD; THENCE SOUTH 28'31"50" EAST 192.36 FEET ALONG THE WESTERLY LINE OF SAID ROAD; THENCE SOUTH 89°22"00" WEST 608.50 FEET TO A POINT IN SAIL RIVER; THENCE NORTH 00'38'00' WEST 170.00 FEET ALONG SAID RIVER TO THE POINT OF BEGINNING. COUNTY OF GARFIELD, STATE OF COLORADO SURV . 7S., R. 89W. OF THE 6TH P.M. ADO 'VZ 6L S`151.9 -ate ‘tii .v.r1O ., , o1)‹. 3FD5 = 120 0 t\ C CAPE..1.Dt...m u.a ?Fac- ar•-5'- .--10) t.n.•...1 ?vc_ llf)s.1 a �ti ,.�,J—Cw,..AC flan. ).tJ 6.044-p E 1 /PLF C/. -'r..../ f401SE SEwssK l�,�r� 518.50'x H P.M., D AND 1 608.50' 40 0 FOUND REBAR & CAP 15.04 40.00' PROPOSED GARAGE m 0 2 f x 28.00' 20 GRAPHIC SCALE 40 80 160 ( IN FEET) 1 inch = 40 ft. FOUND REBAR & CAP SITE PLAN CERTIFICATE I, BRIAN A. STEINWINDER , BEING A REGISTERED LAND SURVEYOR IN THE STATE OF COLORADO, DO HEREBY CEe - w T THIS SITE PLAN WAS MADE UNDER MY SUPERVISION AND 15 TRUE AND CORRECT TO N. To®88$i 1/4,1 BELIEF AND KNOWLEDGE. P N°C6 ():2' y . -070 BRIM{ :STEINWINDtd1W.S. 31944 DATE 01 ♦..••�°•aJ\ti JOB NO 0411/ek A �I L �t BY 30. NO.: 04110 DATE: 1/13/05 DWG. BY: 1(13 REY: REV: THE SEXTON SURVEY COMPANY 128 WEST 3RD STREET RIFLE, COLORADO 81850 970-825-3711 OR 945-4700 FENSKE SITE PLAN SURVEY 1 of 1