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Home My WebLink About03929t 4 6 } t iJ ,D. Gro '513/0(11 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N: 3929 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Pprings, Colorado 81601 Ph a (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT B D%kn9WATV K i w Owner's Name, _.� `b+�'`�-. Present Address � System location � Legal Description of Assessor's Parcel No. d Y SYSTEM DESIGN i 1 3 s 4 75n0 Septic Tank Capacity (gallon) 31 Percolation Rate (minutestinch) Required Absorption Area - See Attached Special Setback Requirements: Date TC) 9� Inspectoi This does not constitute a building or use permit. e�Cas P� one $16 1 Cu 5f 1� �cf l qa-i (91-o-73-oa Number of Bedrooms (9r other) � �� //9� X e15 G/J S tiq m 252 "/ja,X1S 1--71--� FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Septic Tank Cal Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface - Absorption Area r n Absorption Area Type and/or Manufacturer or Trade Namet-J Adequate compliance with County and State regulationstrequirements yOfff� Other Date �'�ZJ –�� ('� Inspect k RETAIN WITH RECEIPT RECORDS AT CO RUCTION SITE l *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. Anyperson who constructs, alters, orinstallsan individual sewage disposal system in amannerwhich involvesa 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 • 1 I]► VN ,V R ! • AL, : CONTRACTOR ADDRESS PHONE PERMIT REQUEST FOR ()e_1_ 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 �P w C :: t t4& Size of Lot ° S Legal Description or WASTES TYPE: BUILDING OR SERVICE DWELLING ( ) COMMERCIAL OR INDUSTRIAL ( ) OTHER—DESCRIBE ( ) TRANSIENT USE ( ) NON-DOMESTIC WASTES Number of Bedrooms .11 %J Number of Persons — ()4 Garbage Grinder (Automatic Washer V,) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: M WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 1.kA\°VLo1a v\ Was an effort made to connect to the Community System? KU A site plan is required to be submitted that indicates the following MINIMUM distances: Leach Field to Well: Septic Tank to Well: 100 feet 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 fust Ground Water Table Percent Ground Slope TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 11>4 SEPTIC TANK ( ) VAULT PRIVY ( ) PIT PRIVY ( ) CHEMICAL TOILET( FINAL DISPOSAL BY: ( ) AERATION PLANT ( ) COMPOSTING TOILET ( ) INCINERATION TOILET OTHER -DESCRIBE ABSORPTION TRENCH, BED OR PIT UNDERGROUND DISPERSAL ABOVE GROUND DISPERSAL OTHER -DESCRIBE ( ) VAULT ( ) RECYCLING, POTABLE USE ( ) RECYCLING, OTHER USE ( ) EVAPOTRANSPIRATION ( ) SAND FILTER ( ) WASTEWATER POND WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 01) 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 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 �Q�`c�A� . 1y Date �-b • 6 k ek-O0 PLEASE DRAW AN ACCURATE TO YOUR PROPERTY!! MapQuest: Maps: print MAPQVEST PAWffZ A Send To Printer Back to Map Page I of 1 0245 County Road 335 NBook a Hotel: New Castle CO 81647-9635 US Save up to 70% on Notes: .C_�� -�T Orbitz Savers Nationwide! ..�� .._.� ^" "`... �?... - Eook-Nowa ............. S �O4 Morning Star or $ z zCDChatln Ave 9? Orchard Ave »� a ih: Grand Ave_ Ralsy Rd of 6 9Hmf amilmTd so n% Or -% 4.% Rn Saco Rd OZ 020M k%mQueatcam. Inc.:02000 Gtr. him At raIns resenmM t� 5m11;ge¢t W I ftp i�°ORityi,A.\ soerleaota Peach VaW Rd i a This map Is Informational only. No representation Is made or warranty given as to its content. User assumes all risk of use. MapQuest and Its suppliers assume no responsiMity for any foss or delay resu" from such use. �—D-A�,• g ---1 011*04— ® 2004 MapQuest.com, Inc. All rights reserved. http://www.mapquest.com/maps/printadp?mapdata=sUDba/o252fBv9J8jIflaT7s5dz5 V FbTrJ... 2/5/2004 \ \ / � � 7! \� 2; � ¢ : — � N `f¥ ƒtj 66 - � �-- � -- \ %_» _ƒ/\ � 7! \� 2; � ¢ : M �_y1 R=470.00 �G a _(185¢'26 o�i L_ 72.66 o = F ^_ e."t & Css i.5. full Parcel T -l] Parcel 7-E 6.26 Acs �1 a9j Cz.a vh Parcel 7-F 43005 29 �.=242.53 a.s. is a m S77-23'57 32.42 t w.a d 1 —1 ed.2 a Coo rpausc „f ai � 7 3 95 n OWU Q69 �J' L Enforgement of Nouse area Scaie t' = 40` pRoRERTY DESCRIPT19% parcel 7-=_, a A, u W nor Subdivision, Garfield Cour:ty, Colorado, and atsc addressed as 0245 County Road M, New Castle, Colorado 8:547. g61P7°IilEEtc`7 i_uCr",F€flii CERTIFICATE 1 hereby certify that this Improvement Location Certificate was prepared for U.S.A. i;ortearve Cor oration, that it is not a land survey plat or i�prcvempnt survey plat, and that it is not to be relied upon for the establishnoent of fence, buindinn ar other future imnroverrent Tines. 1 further certify that the immvements on the above described parcel on tris date, Septerber 8, 19,02, except utility connections, are entirely within the b3undar:es of the parcel, except as shown, that there are no encroachments upon the described premises by improvements on any adjoining Premises, except as indicated, and that there is no apparent evidence or sign of any easement crossing or burdening any part of said Marcel, except as noted. l'.idford L. CoctSauph P.Sc,