HomeMy WebLinkAboutApplication-Permit.pdfGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Phone (970) 945-8212 Permit
Assessor's Parcel No, This does not constitute a building or use permit. OWQer's Name ['be. \J Ion !) '':'1\, Present Address Box 363G{;, 'I'\OU" ,15;, r,< Phone Ql0-~'S S--CQIS 'd-,
System Location '33 ! \ cl d..I::' 11:::(-::1 fCiC\f\"C3\e Legal Description of Assessor's Parcel No. -<.11L:.'c.'K-'',"-----'I_IO,,''-._. ",d:..:O",--_c..:::·):..~-,6"::.) ______________________
_ SYSTEM DESIGN _.;.).cCl",-,D.L.>.D,--Septic Tank Capacity (gallon) _ -,d: L' _:("')'-_ Percolation Rate (minutes/inch) ~equired Absorption Area ~ See Attached ______ ,Other "2. Number
of Bedrooms (or other) _-"...)==-__ I, 2545$ ~, ~O(I< ~,e\ J Lh. 'J ill ~ ~ck , 5b" [~ G p~ J Date_1-,---,\-,q~.-",o_1_ ___ lnsp,ectof·+1hf2:\),-,IL""iJ,,,~<-,AW'.~~..:..::..:~._ .Q.._.cJ.._J
__________ !.i i/' .,//", ; Special Setback Requirements: FINAL SYSTEM INSPECTION AND APPROVAL (~S inhlalled) '. j I. Call for Inspection (24 hours notice) Before Cov~ring Installation
System Installer X<l S f5,A'NfMv, Septic Tank Capacity ~.t-. //0 r; 0 . ~ ..... f .J..I rf Septic Tank Manufacturer or Trade Name _,;;;;d",,,"a<U""1LjC""'-=--""-,,~=::,·-!.":::>,,,,,"i-_L/~Cd.7~G=O,,
,-_----_____ ~ _ _ Septic Tank Access within 8" of surface .:./lA-,;;~",;z1!._. ___________________________ _ 1/, Absorption Area _L-"1-"{."-=-"'~'J6t""=""_. ~.ku='2-""~"-"<dZ."'d=,.L'=.'_
__________________ _ /i /. " /.!. >d1i Absorption Area Type andlor Manufacturer or Trade Name .JlX.,;&A•i...,•. u&!&,2,"'' ~",,'-.::.i''-.;'u7_ __________________ Adequate compliance
with County and State regUlationS/reqUirementS-f(1"t:;..~•c . ::Y:,,' ___________________ Other _________________ ~---~----"A--------------I/,(" Date _..L;f""vC.. " ",;.,I_S_·_' D__7
____ Inspector ~;f'.lI:L/!c!{2~A.=.J(...1t4_r·-'7 ...!-·:..,7Le..::....::. ., :.c;_.. , "'_,,_-____________ RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE -CONDITIONS: 1. AI! installation
must comply with all requirement~"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 systel"fl 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 OWNER c..~ev.~a-n. St...,je o;{ CO,"I",,, f1t fJ/v:."h.. et.CiI."M. u.5,1I. 7"c, ADDRESS PI') ~ 3{;,'!>t>rR, 14D"<;~' -re",«> 77';>;'PHONE
170-?-'f'S-<J7?-2... CONTRACTOR 1115/2 CtJt7>rh-....C/{'Ik.. ADDRESS ;)'17<; Hwy 6t>O,fl.0rvt:Sci ('0 'i)/S'o5' PHONE ,,/7tJ -?-4S-"Io3')Y;IZ_ I ' PERMIT REQUEST FOR ()<) 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_'-f....:..r..'. A.. ..=d==..:f<.""'-'='----,.--r ______S
ize of Lot '5' 3M ,S /lcjo.es. Legal Description or Address 5u ~2J Gil d. (;-!Para.. C. WASTES TYPE: (A DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( )OTHER-DESCRIBE ______________________________ _ BUILDING OR SERVICE TYPE:--LH.L-'~O"':"':'-= ______________ ~ ________________ __ Number of Bedrooms ___ "'3"'-________ Number ofPersons_-<2~~
_ ( ) Garbage Grinder ( ) Automatic Washer SOURCE AND TYPE OF WATER SUPPLY: ()4 WELL If supplied by Community Water, give name of supplier: ~ Dishwasher ( ) SPRING ( ) STREAM OR CREEK
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: ___1! .::.....!fYi--'--'.:/..:...I!.""-? __________ Was an effort made to connect to the Community System? ______________ _ 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 (septic tank & disposal field) 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 ___________________________ _ 'S-~~O~ C"-tOgD $180 2
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ()C) SEPTIC TANK ( ) VAULT PRIVY ( ) PITPRIVY ( ) AERATION PLANT () VAULT ( ) COMPOSTING TOILET () RECYCLING, POTABLE USE ( ) INCINERATION
TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET( ) OTHER-DESCRIBE, ______________ _ FINAL DISPOSAL BY: ~ ABSORPTION TRENCH, BED OR PIT ( ) UNDERGROUND DISPERSAL ( ) ABOVE GROUND
DISPERSAL ( ) EVAPOTRANSPIRATION ( ) SAND FILTER ( ) WASTEWATER POND ( ) OTHER-DESCRIBE _______________________ _ WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? i\lo
PERCOLATION TEST RESULTS: (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 ofRPE who made soil absorption tests: _____________ _ Name, address and telephone
ofRPE 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 regnlations 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 peIjury as provided by law. Signed ~-:~2J1 11.-Date 7-?-'7 -0 '/PLEASE DRAW AN ACCURA
T", 1l"nP TO YOUR PROPERTY!! 3
Designate North Arrow Your Neighbor's Name & Address Your Plot -Shape to Fit (No Scale) 5c.e-;+-4cL1. Locate well, all streams, irrigation ditchs, and any water courses. Draw in your
house, septic tank & system, detached garages, and driveway. If a change of location is necessary, you must submit a corrected drawing, before a Certificate of Occupation will be issued.
County Road (Note the Road Number and Name) eric c:\wp~in60\wpdocs\ploUoc l3A) , \, Your Neighbor's Name & Address
~ \ i=>~Oi=>Oe!O C!=!EV~ON \..I.e.A. INC. ~ANCl-I ,,~,llU r CHEVRON U.S.A. INC. LOT 9 (NEI/4 SEI/4) SECnON 8 1/4 CORNER FOUND 1982 BRASS CAP PLS 11577 SW1/4 NWI/4 SECnON 9 LEGAL DESCRIPnON:
LOT 8 (5£1/4 NE1/4). SECTION 8. SURVEYOR'S CERTIFICATE TOWNSHIP 6 SOUTH. RANGE 96 WEST. 6TH PM COUNTY OF GARFIELD STATE OF COLORADO NOTES; 1) CONTOUR INTERVAL ~ 2' COLORADO P.L. CON&Tf;2UCTION
IWf;2VEY'E>, INC. C:Z;C:Z;12 IWNf;2leE ell.. vt:::>. &11.. T, CO 61i!>E>2 oa1C:Z;-61i!> -E> 1E>l
'arcel Detail Page 1 of 4 Garfield County Assessor/Treasurer Parcel Detail Information Assessor/Treasurer Property Search I Assessor Subset Ouery I Assessor Sales Search Clerk & Recorder
Reception Search Basic Building Characteristics I Tax Information Parcel Detail I Value Detail I Sales Detail I Residential/Commercial Improvement Detail Land Detail I Photographs I
TaxArea II Account Number I Parcel Number I MillLevy I I 026 II R260138 I 2171M200008 I 36.682 I I I Owner Name and Mailing Address ICHEVRON USA INC I Ic/o CHEVRON TEXACO PROPERTY TAX
I IpOBOX285 I IHOUSTON, TX 77001 I Legal Description ISECT,TWN,RNG:18+96 DESC: SEC 4 A , ITR CONT 160.93AC EXCEPT A TR CONT I 14.25AC DESC: SEC 5 LOTS 14-19,21,23 I ISEC 6 LOTS 1-18,SW,
WI12SE DESC: I ISEC 7 W1I2NE, NW, SW, W1I2SE, LOT I 11-4 SEC 81-5,7 DESC: I 112,S1I2SW,NWSW, SESE, 13-15 SEC 17 1 11,2,4-14,15,17 DESC: ,17, NENE, 1 IEl/2SE, SEC 18 WI12NE, NW, SW, I
IW1I2SE, DESC: LOTS 1-4 SEC 20 I 11-3,6,7,NE, NWNW, SI/2NW, EI12SW I IDESC: SEC 21 LOTS 1-4 SEC 29 LOT 1 13,4, WI12NE, NENW AKA DESC: I IBITUMINITE 15, PT OF 16 1 ,I CONSOLIDATED #S
3-10,12,13 DESC: I, tI 11 ") J'-'f'\fV"1
IlIcel Detail IGRAND V ALLEY #S 1,2,7,8 MIDLAND #S I 11-5,GJ.N. #S DESC: 1 & 2 DESC: I IEXCEPT 28.87 AC. FOR CO. RD. 215 I IROW AND SLIDE PCL BK:0377 PG:Olll I IBK:0285 PG:0169 BK:0274
PG:0228 I IBK:0268 PG:0532 BK:0268 PG:0531 I IBK:1712 PG:493 RECPT:679272 BK:1687 I IPG:548 RECPT:674194 BK:1663 PG:206 I IRECPT:668724 BK:1663 PG:200 I IRECPT:668723 BK: 1655 PG: 178
I IRECPT:666845 BK:1218 PG:223 I IRECPT:572435 I Location I Physical Address: IITWN 5 RGE 96 SEC 34,35-I I Subdivision: I I Land Acres: 115320.05 I I Land Sq Ft: 110 I I Section II Township
" Range I I 18 1/6 II 96 I Property Tax Valuation Information I 1/Actual Value 1/Assessed Value I I Land: II I Improvements: II I Total: II liIp =====S,::a=le:=Da,;=te==::I . Sale Price:
I 107,52011 28,77011 136,29011 Basic Building Characteristics Number of Residential Buildings: 11 (Ab~> I Number of co~~ndiio Buildmgs: I: 31,1901 2,2901 33,4801 I I 'I Page 2 of4 ;1/11:
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