HomeMy WebLinkAbout02913 A is Parcel No. Permit 2913
CHARGES Owner's Name Buffalo Ranch LLC •
Percolation Test $100.00 LDt 22, Block 6, Aspen
(includes final inspection) Address at System Locat
Crystal River Estates, CaY'bcndale
Permit Processing Fee $50.00 Amount Paid $150.00
Check X Date Paid February 13, 1998
Cash g, chu] eta
Money Order Cashier
ALL CHECKS ARE TO BE MADE PAYABLE TO GARFIELD COUNTY TREASURER
While - APPLICANT Yellow - DEPARTMENT
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6 ,9166i5
EXPiRt
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 913
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 Buffalo Ranch LLC Present Address . P.O. BOX 221 Carbondale phone_ 947 -5184
System Location Lot 22 , Block 6, Aspen Crystal River Estates, Carbondale
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3
Required Absorption Area - See Attached
Special Setback Requirements:
Date Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer_
Septic Tank Capacity
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area
Absorption Area Type and /or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
Other
Date 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 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
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
0.4•Ut t L L �_
OWNER I.) �Q ADDRESS Po. Dc't Z7 C4ee jo,c t-e t/4 L3 PHONE 9q7 -sre
CONTRACTOR :17 w PA*ec-H LU—
ADDRESS ?b.C5 6X Zig Cgv43o4o PHONE ?
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).
LOCATION OF PROPOSED FACILITY:
Near what City of Town 0 11DON Size of Lot .39 7
Legal Description or Address t-or ZZ , got eft A A5f tech Cavr At 2ro e2 esr/a rES
WASTES TYPE: (,4 DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: PL=S"en r'.it r
Number of Bedrooms Number of Persons 3
( 4 .)--Garbage Grinder (vt Automatic Washer (`)' Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (>4, WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Z ,W I c-
Was an effort made to connect to the Community System?
A site plan is required to be submitted th i 's I • t • h • I win INI u ‘• t n e •
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 DE ISSUED
WITHOUT A SITE PLAN.
GROIJNI) CONDITIONS:
Depth to first Ground Water Table Percent Ground Slope —1 /6
2
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
b q SEPTIC TANK ( ) A ERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE
FINAL DISPOSAL BY:
(X11 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 REST TITS: (To be completed by Registered Professional Engineer, if the Engineer does
the Percolation Test)
Minutes per inch in hole PIo, I Minutes per inch in hole NO. 3
Minutes per inch in Bole 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 hest 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 otany
permit granted based upon said application and in legal action for perjury as provided by law.
LG.
Signed _ Date Z 9e
C fwr /ur- /N1e.s.it- LL
PLEASE D ACCUPATE MAP TO YOUR PROPERTY!!
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VERY GEL ILE OOWNSLQPE
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,REQUIRED BUILDING SET BACKS I
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1 \ �� , FRU u3D SEPTIC SYSICn
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NOTE: .
BUILDER WILL MAINTAIN A MINIMUM SEPARATION
. OF 100 BETWEEN THE. SEPTIC SYSTEM AND THE .
WELL.
BELL COUNTR 1 HOMES PROJECT SITE PLAN
P.O. BOX 229 L0T22. BLOCK 6
NEW CASTLE. CO 81647 ASPEN CRYSTAL RIVER ESTATES
(9701 984 -3500 GARFIELD COUNTY. COLORADO
JANUARY 21. 1 : J98 PREPARED FOR: BUFFALO RANCH. LLC