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Home My WebLink About02916 t .w GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2316 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 Tim & Teri Burns Present Address 1653 E. 12th, Rifle P 625 -0936 System Location County Wad 325, Rifle Legal Description of Assessor's Parcel No. /LOCK - Le &Ck FrEI O "t `Zd (D - z'I°387 SYSTEM DESIGN ti v Mr r S 31 11 C H A rrc dex. 06 0 r � ') -� s a 9� I 1 r r StJ t, f q /LEFIC A ES `SO -- E!9 100 Q Septic Tank Capacity (gallon) Other fr r-AI ( �- V 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 O/(.4) - Septic Tank Capacity , C 0 �/t/ ay - {�Q,{�r P/SD Septic Tank Manufacturer or Trade Name •' • " °'� Septic Tank Access within 8" 8" of surface 4 —. 7 % Absorption Area j P P Absorption Area Type and /or Manufacturer or Trade Name L - -- A - AI/11 Adequate compliance with County and State regulations/requirements L" Other , ,/ Date `/ ./ 2 7- / p tS Inspector 4:LernY1 &94/ 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 1, Petty Offense ($500.00 fine — 6 months in jail or both). __ - White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER Tin T�2t r�t,rzataS ADDRESS Piacicm C- amusing 1?owD E S 2: Co PHONE 6 -e93>o CONTRACTOR Ow+v ADDRESS 155 !-• 12a- m (, , PHONE 6zS -0436 PERMIT REQUEST FOR QQ 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 I i c s — Z u L-1. ea,K Size of Lot tdO Alcae Legal Description or Address PIkul-et, C (t n u iury 8m►th cs s ea Fr r . WASTES TYPE: (X) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: i?ESt DtrtiryA L._ Number of Bedrooms 3 Number of Persons .3 ()Q Garbage Grinder ()() Automatic Washer (X) Dishwasher SOIJRCE AND TYPE OF WATER SUPPLY: (A) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: uta uotnr. — rrrnttrr, Was an effort made to connect to the Community System? k5ovc, hYA-t ut'Bta_ A site plan is required to he submitted that indicates the following MTNIMTJM 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 WITL, NOT BE ISSUED WITHOUT A SITE PLAN. GROI JND CONDITIONS: Depth to first Ground Water Table uu lctloou,tJ Percent Ground Slope Fut WM Vi..a -r 7 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (X) SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) MT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAL DISPOSAL BY: - ro tsE 1 r EA Peer_ , r.,s7 ( ZQ ABSORPTION TRENCH, BED OR MT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? PFRCOJ.ATION TEST RESIILT$; (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 Date = 2 � J ` PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 • «\ E 3. t f ) e /' / ; 2 >/ ; r ® « 0 \ r • \ cz 0 r \ ( 7 o } a $ t $ o \ sv sw Q. ( � / s is q 5 \ Po / \ / * ® CD 0 \ \\ 99 \ w /: \ ° \{ _ — - - / / / }a 2 0- ITV al ':< k k t o , CIO CD \ ¢ \ _� ® CD c t / �7 // � | • • LEGAL DESCRIPTION l:nuu• vibe pn ,wr,. Mrown xx Parcel C County Rd. 125 R lEle, CO R3S50 A PARCEL OF LAND SITUATED IN THE E AND KI/2E1/1 AF SECTION 35, TOWNSHIP 6 SOUTH, RANGE 94 WEST OF THE 6771 PRINCIPAL MERIDIAN, GARFIELD COUNTY, COLORADO BEING, MORE PARTICULARLY DESCRIBED AS FOLLONS: BEGINNING AT A POINT BEING A REAAR AND RED PLASTIC CAP L.S. NO. 26950 WHENCE THE SOUTH 1/16 CORNER OF THE 3E1 /4 OF SAID SECTION 35 BEING A REAAR AND ALUMINUM CAP L.S. N0. 2695o SEARS S. 00017'19" N, 666.27 FttT AND THE NORTHEAST CORNER_OF SAID SECTION 2 AND SOUTHEAST CORNER OF SAID SECTION 35 BEING A MBAR B.L.M. ALUMINUM CAP PROPERLY HARHEU BEARS N. °9o17'211" E. 1333.81 FEET; THENCE S. 99034 N. 2662.27 FELT TO A RERAN AND RED PLASTIC CAP L.S. NO. 26950; THENCE N. 00026'07" E. 653.57 FEET TO THE CENTER 1/16 CORNER OF THE SOUTHWEST 1/4 OF SAID SECTION 35 MEING A REAR AND ALUMINUM CAP L.S. NO. 26950: THENCE N. 69017'40" F. 2660.79 FEET TO THE CENTER 1/16 CORNER OF THE SE1 /4 OF SAID SECTION 35 BEING A MAR AND ALUMINUM CAP L.S. NO. 26950; THENCE S. 00017 W. 666.27 FEET TO THE POINT OF BEGINNING. ohm: , C.. R eA •, v00ard _._. Wr 72i t ? „ L� 1� z - 2� � Maxine R. Hugga iwrc, 1 � /"..... `,o ‘\� 0 CENTER SEC. 35, T. 6 S., R. 9 N W. • - . - ..._..`. • % %$l... _............ _. .. . li a u peat_ . 11 i 1 1 4 t 1 1` 1 26 y - ik ‘t . • ..?:..\ I t8 11 • �\ coos 1 11 1I {� WELL • . 4 " 11 (\Cups° • �� N i 1 ` 1 f` G • :ten .. -° \\.\ leia ` g • I11. A 11 7 it . II q �1 ' 11 , I 10 9 i 0 .: -- , % _ =4...--,____0 4 SEC. as o z 11 • 11 ; \ • Cdr- *el, • o N � ; I' o 1-12) 3 A in o � X6 r > ; �JOL.D II-1 r 1 �( 7d C, v , 1 /T V) /„.• - w CI R A& 1 le ** MILE TO PU•LIC LANDS I r m zo r 3 3 . .. .. . . .v ao & ra b I ND RTH S ITE PLAN __ TM -TiRI 541016 60,0 A aro6o IV LEww"- P /FtD ■ sone.. r 4. ' um' MIM ! Cn o - 75 ' ' i M PR � av ,,/ 3 O / , 7- s ° V u 7 V