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HomeMy WebLinkAbout02763 • 17 1 -J • •r .. - % r . • , GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 276 3 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945-8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Vavid & Amy Skinner Present Address 618 Surrey Rd., Carbondal,R 963 -0269 System Location 16706 Highway 82, Carbondale Legal Description of Assessor's Parcel No. M1 keg Ch efi,r0 _ �/ SYSTEM DESIGN >r/ e, J k-S - y ° j P "rd / MS 3/ea. 6 Pr -awrica_ c26. 1 4-J d Septic Tank Capacity (gallon) Other —0 Pa �O 7.03 a 4 + ercolation Rgte (minpts//inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: / Date /c2-' /4 r// Inspector ��� ` v-a? FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ' Call for Inspection (24 hours notice) Before Covering Installation System Installer © w tf ate-1._ Septic Tank Capacity ( 2 ' Septic Tank Manufacturer or Trade Name C V Io t L A t-i Q Septic Tank Access within 8" of surface C S Absorption Area 3 1 E Ar e / / 5 f * 2 . CI F r >! AFT) 7 n '9 p Absorption Area Type and /or Manufacturer or Trade Name I hi F i r. t n A 7 r ?l?,.< Adequate compliance with County and State regulations/requirements t r S Other Date " — ' e - 4 -7 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 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 Ina manner which involves a knowing and material variation from the terms or specif ications 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 INDIVIDI ;Al. SEW.AGF DI SPOSAL SYSTEM APPLICATION OWNER be vIC1 ctvd Avv:y 'ktvirit2( -- ADDRESS � u % > k,rYB 2G5 COr iie PilgfcPHONE 0 CONTRACTOR 11i61viC S}:i'r• _ ADDRESS S Mg, PHONE 6 )11:5- C V U� PERMIT REQUEST FOR (}A) 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 CO i UI) t'k:JO J!'• Size of Lot 10 ; I S 5 4 14- Legal Description or Address WASTES TYPE. (10 DWELLING !� ( ) COMMERCIAL OR INDUSTRIAL • it° � .1. ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: RCSiCiel )trCt.I >j3' 6 ✓ ' 3 Number of Bedrooms (A Garbage Grinder (1() Automatic Washer 1 ,-- SOURCE AND TYPE OF WATER SUPPLY: (X) WELL ( ) SP If supplied by Community Water, give name of supplier: NI') DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: t Was an effort made to connect to the Community System? 6�• A site elan is rewired 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 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 2 . INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPI,ICATION OWNER David DIVd Amy S�IVIif;;f ADDRESS (OIS Sta,rre Rd. Carbovidgle,Go LIVA PHONE g �� - 02r>a9 CONTRACTOR David S rier ADDRESS SIRM{ PHONE g1,3 - °2 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: Near what City of Town COI b())1C10 Size of Lot 101 ) 1 1 5 s4. ft. Legal Description or Address WASTES TYPE: (2( ) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON- DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: RGS1dev)7 Number of Bedrooms Number of Persons 9 (X) Garbage Grinder (,X) Automatic Washer (10 Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (X) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: NA DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: t/' l` vvt t ICS Was an effort made to connect to the Community System? NO 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 to Property Lines: 10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOIJT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope, 2 • l r TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (>c) 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? PERCOLATION TEST RFSI11,TS: (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 n-- Date 3'-vZO - 9 7 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 N ch. oo ' 1 • . J W o n v M U r.... 4 M se , h� c,C h lb 0d � C z °� V n F 0 v \, o E` - L a c >•i z ►u rc 4 -'1 � 5 _ � � O VI M .._:�� '� 0 3 r. t —fit �� 3 3 d h s Y 1 - — �\ Ca 3 - ° ° al p > . b. U y K, o ` ° ° V . m U v. �- c' v ti V . m Dp E 1- I 3 ` IN c u c V V , V = 7 0 3 c E — U N a l z V I ' y v >, O a • �; v E �' E ti F i >- ) o t/ � N ›/1 g U G ` v 1 z : 1 : op c w cd t5 E • V •- ° 7,3 y V 3' a o c4 Co I ____ - - -_- t 0 0 o o 4.. Z .• 32 ,- o o Y/"4 `` d • >' ti N K C x 0 y 0 7 x v U xv oA , 0 Q c z ` W • 0 >.Zin € a w`, y" . Attachedl and rrw: -, a part of biewart In uuaIUnty wn.p , I .,., Continuation of Schedule A -No. 4 BOOUO9OI "4rr 20;3 A Parcel of land situated in Government Lots 3 and 6, Section • ' 32, Township 7 South, Range 87 West of the 6th P.M., Garfield County, Colorado, more particularly described as follow*': Beginning at the Witness Corner for the Northwest Corner of said Section 32, a rock found in place; thence S. 59 °39'21" E. 2798.33 feet to the True Point of Beginning; thence N. 88 °20'00" W. 302.19 feet; thence N. 01 °40'00 E. 316.35 feet; thence S. 88 °20'00" E. 294.07 feet; thence S. 10 °10'40" W. 240.64 feet; thence S. 57 °07'42" W. 13.27 feet; thence S. 35 °59'32" E. 89.47 feet to the True Point of Beginning. TOGETHER with a 20 foot access easement lying parallel with and to the West of the following described line: Beginning at the Witness Corner for the Northwest Corner of said Section 32, a rock found in place; thence' S. 54 °26'21" E. 3013.63 feet to the Northerly right -of- way line of State Highway 82, the True Point of Beginning; thence N. 01 °37'00" E. 277.84 feet; thence N. 35 °59'32" W. 75.64 feet to a point of termination from which the Witness Corner to the Northwest Corner of Section 32, bears N. 59 °39'21" W. 2798.33 feet. EXCEPTING from said easement that portion conveyed to the Colorado Department of Highways, by Deed recorded August 5, 1983 in Book 632 at Page 251 as Reception No. 344456. COUNTY OF GARFIELD STATE OF COLORADO • Page 2A • 1 -/ t > Nw 242 s'o(s No'sc '' •"4 .c 'ir /, €. r I . Hd a ; • uI 3 • V 1 M r g x 3 'o 31a )4� h w t 1 < f / y ec CC ` M ti� + � _i- o K ti n 0 vl Cc n •^ 'tt C - i M M vl Mb ' e ta 4 •_ I., v c V .o CC J /� C o • o c - -I... 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