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Home My WebLink About02021 • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N: 2021 109 0th Street <iUlte 303 Assessor's Parcel No. Glenwood Spring',Oql 81601 Phone (303) di 4212 I This does not constitute 1 INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. ii PROPERTY Owner's Name Dale & Julie Ne Present Address 227 R. 3rd Rifle Phone 625-9246 System Location County Road 216, $SEt8 c5 t* Legal Description of Assessor's Parcel No. I ' SYSTEM DESIGN p 6 P} t) n Septic Tank Capacity (gallon) Other j M DE el 2 0 Percolation Rate (minutes/i Number of Bedrooms (or other f t" Q 1 R o c1.44, e ?c a e /r' /J/ ' i Required Absorption Area - See Attached 2 'Si z I E r es S. 0, 2. , ' Special Setback Requirements: co 7 P 1"+, j 7 t R q. r o v ,, 2 7 P; c2 C p S ' rd 7 ' C o +t t i � c T Y2 ry 1 6 /, e c e S f ' Date 7 — g 4 r' Inspector /—bryr C).lc , t cnt FINAL SYSTEM INSPECTION AND APPROVAL (as installed) / Call for Inspection (24 hours notice) Before Covering Installation System Installer C2?. 4) ,.QAt .4_A 1 Septic Tank Capacity / . 0 3 Septic Tank Manufacturer or Trade Name C ;i 1 i • Septic Tank Access within 8" of surface L- Absorption Area / p / X 0 lj I V J l a p`t''f L �nr �J p 0j I. Absorption Area Type and /or Manufacturer or Trade Name a -I n -c �� er '1 _ r f �C _I-2c e' � Adequate compliance with County and State regulations/requirements /---" y ! P Other Date I "' 79 Inspector — Sr . _ ' RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE 4 •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- C 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 (5500.00 fine — 8 months In Jail or both). Applicant: Green Copy Department: Pink Copy Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by � County Official: - -- OWNER )A7.F e \I)/ iG /1/6-1/..1" 0—° ADDRESS 7 f • � � C3' C PHONE 425 - 9.2 4 1 C CONTRACTOR_ & R I ADDRESS - r7. PHONE 9nr/�9 PERMIT REQUEST FOR: (v- 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: County 6 jP2e A Near what City of Town .4) S,cr ) Acih - Lot Size 6.9 / ac Legal Description `ICE Yo i .. a. 7// X / , ei / S 4 c� . S - Z300 65 / e4 f)-/.�) 4t7.-21 �G Ad WASTEt / / TYPE : ( ✓j Dwel l ing ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Si, lst6 14'7 r -- 2 - As ) /ft, Number of bedrooms 3 Mamba of persons • 3 ( ) Garbage grinder (utomatic washer (4 SOURCE AND TYPE OF WATER SUPPLY: ( 1 71;11 ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: 5 If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: _ Depth to first Ground Water Table: 70 Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: / Was an effort made to connect to community system? 4 /n TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( ✓)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? n Paae SOLL.P('RCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) 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 purposes of the evaluation of the application; and the issuance of the permi'tis'subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements 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. 1 further under- stand 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 per - jury as provided by 1 w. Date 3 99, Signed C— /. /l!.L PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY • /9.crio.o9L` / La sr; / sNc U L3 \ 1711 u � ly � is Page 3 PLOT PLAN AND DESIGN FEATURES: Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, water course, stream, dry gulch and show location of proposed system by direction and distance from dwelling or other fixed reference object, and additional submissions in support of this application such as data, plans, specifications, statements and comnitments. Page 4 • • • "EXHIBIT A" 5 "7; '7QJ r -i64? A Parcel of land situate in the NEt of the SW14 of the SW34, Section 5, Township 6 South, Range 92 Heat of the 6th P.H., said land also lying Northerly of the Northerly line of Document No. 218779 as described and recorded, in the Clerk and Recorder's Office, of Garfield County, Colorado and more particularly described as follows; Beginning at the corner common to Sections 5, 6, 7 and 8 of said Township and Range; • _ .. - _ thence N. 45.51'37' E. a distance of 2850.73 feet, all bearings herein being relative to the West line of Section 5, being N. 00 °43'00' W.; • thence along an existing fence N. 88 6 09'02' E., a distance of _ - ' 327.65 feet; thence S. 89•54 E. a distance of 277.70 feet; thence S. 10.23 E. a distance of 37.14 feet; thence S. 00 °24'08" E. a distance of 660.00 feet; thence S. 89 °35'52' W. and along the Southerly line of the Zelenka Minor Subdivision Exemption, recorded as Document No. 310242 in the Garfield County Recorder's Office, a distance of 1351.59 feet to the . . - Southwest corner of said Zelenka Minor Subdivision Exemption; • thence S. 44•34'00" W. a distance of 5.37 feet to the True Point of Beginning; • thence S. 00 °42'30' E. and along the Westerly line of Tract 54 of the Antlers Orchard Development, a distance of 447.89 feet to a point on the Northerly line of that real property described in Document No. 218779 in the Garfield County Recorder's office; • thence S. 81 °22'00" W. and following said Northerly line a _ - distance of 64.37 feet; thence S. 85 °31'00" W. and continuing along said Northerly line a distance of 524.82 feet; thence N. 89 °54'00" W. and continuing along said Northerly line a distance of 11.48 feet; thence S. 80 °49'00" W. and continuing along said Northerly line a distance of 20.00 feet; • thence S. 78 °40 W. and continuing along said Northerly line a distance of 44.36 feet to a point on the West line of the NE14 • of the SWk of the SW14 of Section 5; thence along said West line N. 00 °42'45" W. a distance of 141.57 feet; ' - thence leaving said West line, N. 18 °45 E., a distance of ` <.�.. : :.._�• l.,'., - - 209.69 feet; thence N. 00 °57'33" E. a distance of 165.37 feet; thence N. 89 °34 E. a distance of 587.07 feet; thence N. 44 •34'00" E. a distance of 0.76 feet more or less to the Point of Beginning. • COUNTY OF GARFIELD STATE OF COLORADO •