HomeMy WebLinkAbout02914 A is Parcel No. Permit 2 914
Buffalo Ranch LLC
CHARGES Owner's Name
Percolation Test $100.00 Ict 60, Block 5, Aspen Crystal
(includes final inspection) Address at System Location
VHY EStatO6, CBYbQ'1dRlE
Permit Processing Fee $50.00 Amount Paid $150.00
Check X Date Paid February 13, 1998
Cash
Money Order Cashier S. Archuleta
ALL CHECKS ARE TO BE MADE PAYABLE TO GARFIELD COUNTY TREASURER
Wlie- APPLICANT Yellow- DEPARTMENT
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 91 4
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name. Buffalo Ranch ILC P resent A ddress P.O. Box 221 Carbcndale Phone_ 947 -5184
System Location Lot 60, Block 5, Aspen Crystal River Estates, Carbcndale
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 ti
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 Chap ter
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 (8500.00 fine —6
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
INNDIVIDOAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER' .... &AT? _ 12h-Lc L L LC
ADDRESS Mks?! z2I PHONE / 9q -5/g
CONTRACTOR of tifv / (A'ail t — p 1, /L
ADDRESS rPB , zz) 6�vino& C k PHONE 9/ / 7 -
PERMIT REQUEST FOR ((/J 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 e � 60 L Size of Lot f 3 � / cJe
Legal Description or Address LS Co f 3 46 s, R.'t �shL
WASTES TYPE: (DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: l25iL4
Numbyr of Bedrooms 3 Number of Persons 3
((arbage Grinder (( Automatic asher (i�Uishwasher
SOIJRCE AND TYPE OF WATER SIMPLY: (WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: ,d M /c5
Was an effort made to connect to the Community System? 4/0
A site plan is required to be submitted that indicates the following MINIMIJM 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.
GROIJND CONDITIONS -
Depth to first Ground Water Table
Percent Ground Slope gi J�
7
. -. ,� . if •
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TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(( SEPTIC TANK ( A" RATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET ( OCHER - DESCRIBE
FINAL DISPOSAL BY:
(0 ABSORPTION TRENCH, BED OR PI r ( ) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE
WILL EFFLUENT BE DISCI IARGED DIRE( TLY INTO WATERS OF THE STATE? WC)
PERCOLATION TEST RESI JUTS (To be ce'npleted by Registered Professional Engineer, if the Engineer does
the Percolation Test)
Minutes per inch in hole I` o. 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.
' c ( flo /Z 1 - 1 -
Signed 4/ 9JJA/ 4"- Date f Z / �cF
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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