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Home My WebLink About03928. "'"""' :~~·!'· . ' f ~ .. ' .. ' ' > I •· aJ GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street SuHe 303 Glenwood Springs, Colorado 81601 Phone(303)945-8212 r i INDIVIDUAL SEWAGE DISPOSAL PERMIT ! PROPERTY ' • Permit N: 3928 Assessor's Parcel No. ' This does not constitute a buildlng or use permit. I, •J Owner's Name :Bof [,( ( ~ I ~ C 1e r .+ Present Address ~'f !fw ~ ~ t iJ. y ~ System Location )fyq~ lli4-{o<f ;)<{ fh..(o.c"'~ Cc i/b ~£7 Phone c)f5-<to~ ; : Legal Deacrlption of Assessor's Parcel No. d-. l/ 01-I I '-( -0 0 -I 7 / Lot J Tur I.A c. h, 1 SYSTEM DESIGN EX€fviflr 0 I'\ • • ' IOOQ ; Septic Tank Capacity (gallon) __ J~l(~--Percolation Rate (minutes/inch) Required Absorption Area -See Attached Special Setback Requirements: ______ ,Qther Number of Bedrooms (or other) 3 )?! ~ ~~ ' 2'1~ fob( ii. w. &_,£ 35 ~ Otb) f "'1 'f &\., 4 l--/U-(2 '/ "J oat•~~5_· ·_.Q,._-~0_4_/ _____ inspector _ __,fJ'--"-'"'W,'"'--~<h=-~'"-1--:~/A..c'-'-'~a...,_,_/""f _________ _ ' ' FINAL SYSTEM INSPECTION AND APPROVAL (as installed) :, Call for Inspection (24 hours notice) Before Covering Installation l '· \ I ' I ' Septic Tank Access within 8" of surface -~11!:,::C ___________________________ _ ') (J _ __,__... t Absorption Area ___ J~~t,.~=~..:vv-~----~ ~-·~'··~<.~A _________________________ _ Absorption Area Type and/or Manufacturer or Trade Name _y,.i".·,t,"'-"-1(,.,' ''"Jt'-"''-'-' _,i."'j--''L) "='----'-J.-+l_-_i(..:D=:.,. _________ _ c Other _____ ~-------------------------------------- Date _J(.,19-'-". lllL\-lk_,.(;J{ILJ, ____ Inspector ---1-£,,_,)l.A.{J. 4'1. t"-, .+'-d-· '-+,)1..__' ·~'· -""a-+A-"---------- 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.RS. 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 1 i i I • I • l ' i • INDMDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER "4&~e-r t' Po/et.le.fl ADDRESS ~'t9'f ~ {,,,-,;').'f~HONE 77tJ-,)/() -031 CONTRACTOR cYAK J,ttµ t"JoutY1/fd t!t?@fL'v1:..~N ADDRESS 8L( U 47 (.. K:J.'ffo/r~tfvfir PHONE 9?t3-#,1-57JJ'f PERMITREQUESTFOR ~NEWINSTALLATION ()ALTERATION ( )REPAIR Attach separate sheets or repoh 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: NearwhatCityofTown d;tf,ttC.H v"'fl!E_ Legal Description or Address <l 't''l'f 16.y C.,x H WASTES TYPE: ~DWELLING Size of Lot 35:/1-crtE 5 1%1'/Jc.. I/~ rl?.. . (!_ 0. 217~~:<> I ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ()OTHER-DESCRIBE _______________ ~ BUILDINGORSERVICETYPE: f?A.Nu EAL:1'VR1£ o JkML Number of Bedrooms ~ Number of Persons 5 ~ .,_ ( ) Garbage Grinder ('(J Automatic Washer 94 Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: fo .v/\J Qr j??,<19 C../1-c.fT'l!.. DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: kb r""nl.Jt 7 Was an effort made to connect to the Community System? IV (J v-/!ff/"' A site plan is required to be submitted that indicates the followine 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 TabJe,_-L"'--'L,_I __________________ _ Percent Ground Slope __ -<£..,,£..6"------------------------ , TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ~ SEPTIC TANK ( ) AERATION PLANT ( ) VAULT VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PITPRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET( ) OTHER-DESCRIBE FINAL DISPOSAL BY: 7'3 ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRA TION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER-DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? fl-/6 PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes. ____ _,per inch in hole No. I Minutes er inch in hole No. 3 -----~ Minutes. ____ per inch in hole No. 2 Minutes er inch in hole No. Name, address and telephone ofRPE who made soil absorption tests: --------,..------- Name, address and telephone ofRPE 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. Signol ~~ D"° 'f-1'-t>¥ PLEASE ~A'CCUKATE TOYOUR PROPERTY!! --... !!!! l!i -Iii -11!8 =Ill ="'i -m a. !!!! .. q II Iii _ ..... ;;;.• -··1 =Iii . -Ill So ~. _ ..... -•co _, .. -G iiiii tD a:: -.. ,., =N -R ... -D !!!!!! ·-- ' ' ' C-€ 1/16 COFlfER SEC. 11 rOlfiO UMIM.IM CAP U.S. S.L. , ·CADASTRAL SURVCY - ' ~ • 0 0 Exhibit B B .L .IV1 . 1982 S89 '38'10 "E z 8" NATURAL GAS PIPELINE (APPARENT EASE/o/ENT) NOTE: EASEMENT OESCRIBED IN AGREEMENT FIECOllDED IN SOOK 730 A T PAGE 287 IS . FOR A NON-SPECIFIED LOCATION IN SECTION 12 Lot 2 7.330 Ac . w tol[o ~I._ 01 . (Tl (J) • (Tl 0" ~ (\) z 1z 010 5~ r.:i r.:i {/) C/l f', u.