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HomeMy WebLinkAbout02457 a ( ) b _ r. L..._, i. °"" 416 . 4 7.71 :{ ). f GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit IY_. 2 4 5 I j' 109 8th Street Suite 303 Assessor's Parcel No., Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 a o t 1 This does not constitute 4 INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. a PROPERTY : -; Owner's Name Eva Caprani Hansen Present Address 5682 CR 331, Silt Phone_ 876-5013 System Location 5882 County Road 331 ,, Silt s Legal Description of Assessor's Parcel No. ? , SYSTEM DESIGN t / %� t- (2 Septic Tank Capacity (gallon) Other // f /,, r , . / r_ n +- 'i Percolation Rate (minutes /inch) Number of Bedrooms (or other) 4 (. ' �` a r - C ) k 7 7 r P' (,r .41 4^. d t r 1: - / C {aX 67/ ' X J CI rr :., t k , Required Absorption Area -See Attached r 76 N ^y- t ') r r ,t y n' , / , r p Special Setback Requirements: V -'s'� I_ -�" F "� r / �. r Date it ..... r `..-.' Inspector _1 . - 'r - •tl f 4 4 1 ` ir FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation xi In L System. Installer Pe 1 S k I IC Septic Tank Capacity /naS a ! 4 f ' Septic Tank Manufacturer or Trade Name L7 /I �z'� -•t- , Septic Tank Access within 8" of surface 7t s _6 t> ' J Absorption Area _J x `' 1 Absorption Area Type and /or Manufacturer or Trade Name i t ' 4 )�' / a A, 3 t it S ' i' I ' Adequate compliance with County and State regulations /requirements 7 Rs R t t a Other lr . '/ i Date g1_. 9 -61.\s- Inspector V k. ,, AZr1. ,..L -.vr✓ 4 ( RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE t *CONDITIONS: R 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 off ice shall automatically be a violation or a requirement of the permit and cause for both legal action and revocation of the permit. / I' 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 ; r months in jail or both). 1 1 t t. Applicant: Green Copy Department: Pink Copy i:. • .. $_ -- Ol A INI?IYI1?UALSGWAGE_I?ISI'nSAi. SYSTIM_AP1'T,iCATION OWNER 4F$1 6t44'V/ JTffi EA/ ADDRESS ,5 �R 3 37. PHONE g7 57 "3 CONTRACTOR GEu/i gXCAdit /NC:- AnnRrSS 3/,7 C2 33/ , S /LT PHONE $7 -2302 PERMIT REQUEST FOR (X) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). 1, PROPOSED_L'ACILITY: COUNTY i,k -F/FLD Near what City or Town S /LT Lol I.ega1 nescrip1ion 7ity e jA. (a ' e cae d aae WAS'ItSTY.PE: QO Dwelling ( ) Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVIV. TYPE: 5 /NGLF 754#f /L Number of bedrooms: C ' ' Number of persons C o4/1E4./ri ( ) Garbage Grinder 2 - rEk ($) Automatic Washer ( ) Dishwasher / e.e) SOURCIL©ND TYP_EnILWATER_SLPP_LY_: fC) WELL ( ) SPRING ( ) STREAM OR REEK Give depth of all wells within 180 feet of system: /SS If supplied by communtiy water, give name of supplier: GROUND ( NDI11QNS: Depth to bedrock: Depth to first Ground w- teryTable: Percent Groind Slope: 1 /S "0 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: G Al/t 5 Was an effort made to connect to community system? TYPE OF INDIVIDIIAI. SEWAGE DISPOSAI. SYS'T'EM PROPOSED: Septic Tank ( ) Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use ( ) Pit Privy ( ) Incineration 'Toilet ( ) Recycling, other use ( ) Chemical 'Toilet ( ) Other - Describe: FINAI.. DISPOSAL BY: ( Absorption Trench, Bed or Pit ( Evapotranspiration () Underground Dispersal ( ) Sand Filler ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT RE DISCI IARGIJ) DIR FC'I'LY INTO WATERS OF THE STATE? Na PERCnLALION: EST_RESULTS: (To he completed by Registered Professional Engineer) I Minutes per inch in hole No. 1 Minutes per inch in Hole No. Minutes per inch in hole No. 2 Minutes per inch in Hole No. 3 Name, address and telephone of R PE who made soil absorption tests: Name, address and Telephone of It PE responsible for design of (he system: Applicant acknowledges That the completeness of the a ppliction 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 permit is subject to such terms and conditions as deemed necessary to inusre compliance with rules and regulations adopted tinder Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements make, 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 bre relied on by the local department of health in evluating the same fro purposes of issuing • Elie 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 per jury as pro ided by law. Signed ► / • 2 , q 94/1L2-- p er, /' 7/ Date P_LEASELRAW_AN_ACCURA7TIMAP_14 YQLICL'R PER"1,_ • • Q 5 2013441- : • l /t 1' �! _ __---- 31- vu- . -__ EXHIBIT A A parcel of land situated in the F4R1* of Section 10, Township 7 South, Rang+ 9? Sot of the lying Southerly of the Northerly li ne of maid Snotion 10i said ts parcel of Colorado. lid to desoribed as follovol toginning at • point on the Northerly line of said Seotion 10 whence an iron post with a brass cap found in place and properly Barked for the Witness point to the Quartos Corner common to Seotinne 3 and 19 in said Township and Range the bears: W foot; 20;1,2" Northerly line of 8eoticn hence ence S. g5 0 8'59" W. 580.44 feet alorg a fence as constructed and In planet thence S. 89 06'54" W. 298.10 feet along a fence ►e constructed and in plans, thane F. 00 ° 25'09" W. 572.83 feet along a fence as constructed and in place; thence Forth 5. feet, more or less to the point on the Northerly lint of said Section 10, the point of beginning, containing 4.32 acres, more or lest:. Together with all improvements thereon. Also the easements and right -of -use of Adkins Well 1o. 1 looated in Section 10, Township 7 South, Rangs West of the 6th Principal Meridian at a point whew* the Forth Quarter Corner of said Section 10 bean F. 10 59'45" West 2827.81 feet and 0.033 cubic foot per second of time for dooestio mss as adjudicated by decree recorded at Book 442 at Page 219 in the office of the Garfield County Clerk lad Recorder. Subject to precious n eervatlons of mineral rights except the undivided 1 /16th interest and subject to rights -of -way for road', dl:ches, pipelines and utility line. COUNTY OF GARFIELD STATE OF COLORADO PLQTPLAI,IANI) DESIG1•1_?EMBRES 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 commitments. SY . \\ 4.P\ t I ,,),,..% :k .)3i • i \i ‘ . ________ , ic i id, / . 1 4c1 o f � (l I VO��� I 7'9y ' A - I u t� c t N a .1'.-\C i\ 3 C 7 (.I 1 3W cto 4-01 `la/ A-"t 2 e) _" gr c a /1 _./ i s --t' 9 -_ b 3 t 1. 3 0 9 " 71'0 le z Jo = M S o /S' f i I ) 1 ) C .