HomeMy WebLinkAbout1.0 ApplicationGARFIELD COUNTY
Building & Planning Department
108 8th Street, Suite 401
Glenwood Springs, Colorado 81601
Telephone: 970.945.8212 Facsimile: 970.384.3470
www.garfield-county.com
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JUN 1 2 2u
GARFIELD COUNTY
BUILDING & PLANNING
Ca 'i c (c
GENERAL ADMINISTRATIVE PERMIT
GENERAL INFORMATION (Please print legibly)
Name of Property Owner: It011, - nPrj e v
> _I3 C Mailing Address: �-I A �,�t �?
y�� (9la) 9L/
City:elephone:
06u000.01 Jct j r 5 State: CoGo Zip
Code:
ISO) Cell: (lb) 37`. M)
1
> E-mail address: 5 -c;r'kk rk,S 1114.
arinfq; .( FAX: (jb) 99.5 /3:77.?
> Name of owner's Representative, if any, (Attorney,
Planner, Consultant, etc):
i i
,I
> Mailing Address: Telephone: (V )
City: State: Zip
Code:
Cell: ( )
_
E-mail address:
FAX: ( )
> Requested Use from Table 3.501 or 3-502:
• Of uid I ,Ar
StreetggAddress / General Location of Property:
Imp— C f p
1/3 Lou el -LI V c 0 T
Legal Description: La -V "1 CASG
Del Alai-y� (5i )190 r! :4, r
> Assessor's Parcel Number: 1._1__ 5-- a
> Existing Use: J;11q 1� - c.<01, 5;d%nr6_,--
- 0 j_ - Q Q 1-
Zone District: 0011 ReS4'40 I
7
Property Size (in acres)) X09
is
ter" %} S d :'
•
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Last Revised 12/29/08
/.7) %:,4 104C- •
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GENERAL APPLICABILITY & SUBMITTAL REQUIREMENTS
The following general application materials are required for all Administrative Review
Applications in Garfield County. To determine if the use you request requires an
Administrative Permit, refer to Table 3-501 and 3-502 of Article III. Application materials
and review standards that are specific to an individual use (Accessory Dwelling Unit,
Home Office, etc,) are detailed in Sections 3-301 of Article III and Section 7-801 of Article
VII of the Unified Land Use Resolution (ULUR) of 2008.
1. Submit a completed and signed Application Form, an application fee, and a signed
Agreement for Payment form.
2. Submit a narrative explaining the purpose of the application and supporting materials
that address the standards and criteria found in Articles Ill and VII of the Unified Land
Use Resolution of 2008.
3. Submit a copy of the deed showing ownership. Additionally, submit a letter from the
property owner(s) if the owner is being represented by another party other than
th )
he
owner. If the property is owned by a corporate entity (such as an LLC, LLLP, e
Please submit a copy of recorded "Statement of Authority" demonstrating that the
person signing the application has the authority to act ire that capacity for the entity.
4. Submit a vicinity map: An 8 1/2 x 11 vicinity map locating the parcel in the County. The
vicinity map shall clearly show the boundaries of the subject property and all property
within a 3 -mile radius of the subject property. The map shall be at a minimum scale of
1"=2000' showing the general
round�pographic acopyogrc relation of the f U S G S. quadranglee map
roposed
land use change to the surrounding area for which
may be used.
5. Submit a Site Plan which is required in Section 4-502(C)(3) of Article IV which shall be
scaled at 1 inch to 200 feet for properties exceeding 160 acres in size, or 1 inch to 100
feet for properties less than submit,0 more in size. The led verslonDirector
of all or part of quire, the
applicant may choose to the site plan.
The site plan shall include the following elements.
a) Legal description of the property.
b) Boundary lines, corner pins, and dimensions of the subject property, including land
survey data to identify the parcel with section corners, distance and bearing to
corners, quarter corners, township and range.
c) Existing and proposed topographic contours at vertical intervals sufficient to show
the topography affecting the development and storm drainage.
d) Significant on-site features including: natural and artificial drainage ways, wetland
areas, ditches, hydrologic features and aquatic habitat; geologic features and
hazards including slopes, alluvial fans, areas of subsidence, rock outcrops and
rockfall areas, radiological and seismic hazard areas, soil types and landslide
areas; vegetative cover; dams, reservoirs, excavations, and mines; and any other
off-site features of the same type that influence the development.
e) Existing and proposed parking areas, driveways, emergency turn -outs and
emergency turnarounds, sidewalks and paths, shown by location and dimension.
f) Existing and proposed roads, railroad tracks, irrigation ditches, fences and utility
lines on or adjacent to the parcel, shown by location and dimension.
Uses and grantees of all existing and proposed easements and rights-of-way on or
adjacent to the parcel, shown by location and dimension.
h) Area of the individual parcels, and the total square feet of existing buildings,
driveways and parking area.
i) Zone district in which the site is located.
j) Location and dimension of all structures, existing and proposed, and distance of
structures from property lines.
g)
(k.)) Elevation drawings showing existing grade, finished grade, and height of the
t proposed structures above existing grade.
I) Description of the proposed wastewater treatment system, including location and
size of leach field, sewer service lines, and treatment facilities to serve the
proposed use.
m) Description of the source and capacity of the water supply, including location and
size of well(s) and/or water lines to serve the proposed use.
n) Location and size of signs for the purpose of identification, advertising and traffic
control.
o) Additional information that may be reasonably requested by the Director to enable
an adequate evaluation of the proposal.
6. Submit a copy of the Pre -Application Conference form from the original Pre -Application
Conference.
7. Submit 3 copies of this completed application and all the required submittal materials to
the Building and Planning Department. Staff will request additional copies once the
application has been deemed technically complete.
11. Administrative Review Process
The following section outlines and describes the Adminisl rative Review process for the
variety of uses that are governed by the Board of County Commissioners by the Unified
Land Use Resolution of 2008 (ULUR). Please refer to Se3tion 4-401 of Article IV in the
regulations themselves for a higher level of detail. [The following process is required for
applications for land use changes that are subject to Administrative Review as defined in
Table 3-501 or 3-502 in Article 111.]
A. Outline of Process. The Administrative Review process shall consist of the following
procedures which are more fully described in Sections 4-401 and 4-104 of Article IV:
1. Pre-Application Conference (Section 4--103(A))
2. Application (4-103 (B))
3. Determination of Completeness (4-103 (C))
4. Evaluation by the Director/Staff Review (4-103 (E))
5. Decision by Director
I have read the statements above and have provided the required attached information
which is corre t - id accurate to the best of my knowledge.
(Signature of Property Owner)
I.
6 �L��
GARFIELD COUNTY
BUILDING AND PLANNING DEPARTMENT
FEE SCHEDULE
Garfield County, pursuant to Board of County Commissioners ("Board") Resolution No.
98-09, has established a fee structure ("Base Fee") for the processing of each type of
subdivision and land use applications.
The Base Fee is an estimate of the average number of hours of staff time devoted to
an application, multiplied by an hourly rate for the personnel involved. The Board
recognized that the subdivision and land use application processing time will vary and
that an applicant should pay for the total cost of the review which may require
additional billing. Hourly rates based on the hourly salary, and fringe benefits costs of
the respective positions combined with an hourly overhead cost for the office will be
used to establish the actual cost of County staff time devoted to the review of a
particular project.
Actual staff time spent will be charged against the Base Fee. After the Base Fee has
been expended, the applicant will be billed based on actual staff hours accrued. Any
billing shall be paid in full prior to final consideration of any land use permit, zoning
amendment or subdivision plan. If an applicant has previously failed to pay application
fees as required, no new or additional applications will be accepted for processing until
the outstanding fees are paid.
Checks, including the appropriate Base Fee set forth below, must be submitted with
each land use application, and made payable to the Garfield County Treasurer.
Applications will not be accepted without the required application fee. Base Fees are
non-refundable in full, unless a written request for withdraw from the applicant is
submitted prior the initial review of the application materiel's.
Applications must include a Payment Agreement Form ("Agreement") set forth below.
The Agreement establishes the applicant as being responsible for payment of all costs
associated with processing the application. The Agreement must be signed by the
party responsible for payment and submitted with the application in order for it to be
accepted.
The following Base Fees shall be received by the County at the time of submittal of
any procedural application to which such fees relate. Such Base Fees shall be in
addition to and exclusive of any cost for publication or cost of consulting service
determined necessary by the Board for the consideration of any application or
additional County staff time or expense not covered by the Base Fee, which have not
otherwise been paid by the applicant to the County prior to final action upon the
application tendered to the County.
GARFIED COUNTY BUILDING AND PLANNING DEPARTMENT
BASE FEES
TYPE OF LAND USE ACTION
Vacating Public Roads & Rights -of -Way
Sketch Plan
Preliminary Pian / Conservation Subdivision
Preliminary Plan Amendment
Final Plat
Final Plat Amendment / Correction Plat
Combined Preliminary Plan and Final Plat
Minor Exemption / Amendment
Major Exemption / Amendment
Rural Land Development Option Exemption / Amendment
General Administrative Permit
Floodplain Development Permit
Pipeline Development Plan / Amendment
Small Temporary Employee Housing
Minor Temporary Employee Housing
Limited Impact Review / Amendment
Major Impact Review / Amendment
Rezoning: Text Amendment
Rezoning: Zone District Amendment
Planned Unit Development (PUD) / Amendment
Comprehensive Plan Amendment
Variance
Interpretation
Planning Staff Hourly Rate
■ Planning Director
• Senior Planner
• Planning Technician
• Secretary
BASE FEE
$400
$325
$675 + application agency
review fees and outside
consultant review fees, as
authorized pursuant to the
Regulations, such as the
Colorado Geologic Survey
$325
$200
$100
$1,075
$300 / $300
$400 / $300
$400 / $300
$250
$400
$400 / $300
$50
$250
$400 / $300
$525 / $400
$300
$450
$500 / $300
$450
$250
$250
$50.50
$40.50
$33.75
$30.00
County Surveyor Review Fee (includes review of Amended
Determined by Surveyor$
Plats, Final Plats, Exemption Plats)
$11 --1st page
Mylar Recording Fee $10 each additional page
Page 2
The following guidelines shall be used for the administration of the fee structure set
forth above:
1. All applications shall be submitted with a signed Agreement for Payment form set
forth below.
2. County staff shall keep accurate record of actual time rEquired for the processing
of each land use application, zoning amendment, or subdivision application. Any
additional billing will occur commensurate with the additional costs incurred by
the County as a result of having to take more time that that covered by the base
fee.
3. Any billings shall be paid prior to final consideration of any land use permit,
zoning amendment, or subdivision plan. All additional :,osts shall be paid to the
execution of the written resolution confirming action on the application.
4. Final Plats, Amended or Corrected Plats, Exemption Plats or Permits will not be
recorded or issued until all fees have been paid.
5. In the event that the Board determines that special expertise is needed to assist
them in the review of a land use permit, zoning amendment, or subdivision
application, such costs will be borne by the applicant and paid prior to the final
consideration of the application. All additional costs shall be paid prior to the
execution of the written resolution confirming action on the application.
6. If an application involves multiple reviews, the Applicant shall be charged the
highest Base Fee listed above.
7. Types of "Procedures" not listed in the above chart will be charged at an hourly
rate based on the pertinent planning staff rate listed above.
8. The Planning Director shall establish appropriate guidelines for the collection of
Additional Billings as required.
Page 3
GARFIELD COUNTY BUILDING AND PLANNING DEPARTMENT
PAYMENT AGREEMENT FORM
(Shall be submitted with application.)
GARFIELD COUNTY (hereinafter COUNTY) and WktitVI e
Property Owner (hereinafter OWNER) agree as follows:7
1. OWNER has submitted to COUNTY an application for { A, ADo
he-einafter, THE PROJECT).
2. OWNER understands and agrees that Garfield County Resolution No. 98-09, as
amended, establishes a fee schedule for each type of subdivision or land use review
applications, and the guidelines for the administration of the fere structure.
3. OWNER and COUNTY agree that because of the size, nature or scope of the
proposed project, it is not possible at this time to ascertai 1 the full extent of the costs
involved in processing the application. OWNER agrees to make payment of the Base Fee,
established for the PROJECT, and to thereafter permit additional costs to be billed to
OWNER. OWNER agrees to make additional payments upon notification by the COUNTY
when they are necessary as costs are incurred.
4. The Base Fee shall be in addition to and exclusive of any cost for publication or
cost of consulting service determined necessary by the Board of County Commissioners for
the consideration of an application or additional COUNTY staff time or expense not covered
by the Base Fee. if actual recorded costs exceed the initial Base Fee, OWNER shall pay
additional billings to COUNTY to reimburse the COUNTY for the processing of the
PROJECT mentioned above. OWNER acknowledges that 2iII billing shall be paid prior to
the final consideration by the COUNTY of any land use permit, zoning amendment, or
subdivision plan.
PROPERTY OWNER (OR AUTHORIZED REPRESENTATIVE)
Signature
Mailing Address:
Dec—,
Print Name
6- /I-6
Date
Page 4
PRE -APPLICATION CONFERENCE SUMMARY
GARFIELD COUNTY
Building & Planning Department
108 8th Street, Suite 401
Glenwood Springs, Colorado 81601
Telephone: 970.945.8212 Facsimile: 970.384.3.70
www.garfield-county.com
TAX PARCEL NUMBER : 2185-023-01-004 DATE: April 23, 2009
PROJECT: Casa Del Monte Subdivision (No Name)1136 CR 121)
OWNER: Whitney Dean 379-8890
PRACTICAL LOCATION: No Name
TYPE OF APPLICATION: Administrative Permit for Accessory Dwelling Unit
I. GENERAL PROJECT DESCRIPTION
Applicant seeks to construct an ADU on his parcel which is zone Residential Suburban.
Minimum lot size requirements have been met with > 1 a cre lot size. Lot fronts on a County
Road and a secondary street forms the eastern boundary of the lot. Front setbacks (25'
from Lot Line) apply to two sides of this lot as it fronts o i two streets.
Water is provided via a central system within the subdivision. No HOA currently exists but
the water system is maintained via a contract. Applicant must demonstrate that adequate
legal and physical water can be supplied for the ADU.
Existing septic system on the site needs to be increased in size in order to serve the ADU.
Applicant proposes to supply a Soo -gallon tank for the ADU while utilizing the existing leach
field. A professionally qualified engineer must provide information regarding the ISDS.
II. REGULATORY PROVISIONS APPLICANT IS REQUIRED YO ADDRESS
Garfield County Unified Land Use Resolution Sections:
Code section 3-304 specific to ADU
Code sections 4-101 through 4-104 for `process'
Code sections 4-501 A. and 4-502
Code - Article VII Divisions 1, 2, 3 and 7-801 (speci fic to ADU)
III. REVIEW PROCESS
A. Outline of Process. The Administrative Review process shall consist of
the following procedures:
1. Pre -Application Conference
2. Application
3. Determination of Completeness
4. Evaluation by the Director
5. Decision by Director
Public Hearing(s):
Referral Agencies:
None
Road and Bridge Department, County Attorney, Planning Engineer,
any other agency determined upon review of application
IV. APPLICQTION_REVIEW_FEES
Planning Review Fees: $25o.00
Referral Agency Fees: $
Total Deposit: $ 250.00 (additional hours are billed at hourly rate of $40.50/hr)
General Applicatian_Process ng
Planner reviews case for completeness and sends to referral agencies for comments. Case planner
contacts applicant and sets up a site visit. Staff reviews application to determine if it meets standards of
review. Case planner makes a recommendation of approval, approval with conditions, or denial to the
appropriate hearing body.
Disclaimer
The foregoing summary is advisory in nature only and is not binding on the County. The summary is
based on current zoning, which is subject to change in the future, and upon factual representations that
may or may not be accurate. This summary does not create a legal or vested right.
General Administrative Permit App.
Whit Dean
1136 County RD 129
Glenwood Springs, CO 81601
The purpose of the application is too build an ADU on the property,
(1136 C.R. 129, lot 4 Casa Del Monte subdivision). Zoning is residential
suburban. And the lot size is 1.04 acres. There is currently no existing
subdivision association.
The building will be 36x 28 (1008 sq. ft) and include decking off the
front and back to gain access to a 1 bedroom dwelling on the top level.
The bottom level will consist of garage space and storage.
There will be a bathroom and kitchen in the top level. I have
included septic plans, and a copy of a written letter from our water board.
Upon approval of the permit I have agreed with the board to buy another
share to meet and exceed my water demands from our co-op.
In the site plan I have a square placed where the building will be
located. The setbacks have been included and the building placed
accordingly. The height of the building is 24' with a median height off
grade at approximately 22'. The grade currently slopes from the east side
of the building downhill to the west dropping five feet. I have included
grading plans which show existing and proposed grade along with rock
walls to reinforce slope.
1111111111110111111II IOI11I IIIl1
, "
1I 11111111
695708 04/07/2006 02:06P 61788 P26 M ALSDORF
1 of 1 R 6.00 D 40.50 GARFIELD COUNTY CO o'clock M. RECORDER..
neceNi.,un nu. By DEPUTY.
WARRANTY DEED (1 (u'
TIHSDEED, Made on this day of April 06, 2006 , between
ALLEN G. ORCUTT AND BARBARA F. ORCUTT
of the County of GARFIELD and State of COLORADO , of the Grantor(s), and
WHITNEY S. DEAN AND MEGAN A. DEAN
whose legal address is : 1136 129 ROAD GLENWOOD SPRINGS, CO 81601
of the County of GARFIELD and State of COLORADO , of the Grantee(s):
WITNESS, That the Grantor(s), for and in consideration of the sum of ($405,000.00 )
' *** Four Hundred Five Thousand and 00/100*** DOLLARS
the receipt and sufficiency of which is hereby acknowledged, has granted, bargained, sold and conveyed, and by these �>..
presents does grant, bargain, sell, convey and confirm unto the Grantee(s), their heirs and assigns forever,
not in tenancy in common but in joint tenancy, ell the real property, together with improvements, if any, situate,
lying and being in the County of GARFIELD and State of Colorado, described as follows:
LOT 4
CASA DEL MONTE SUBDIVISION, AS AMENDED
of
COUNTY OF GARFIELD
STATE OF COLORADO
also known as street number 1136 129 ROAD GLENWOOD SPRINGS CO 81601
TOGETHER with all and singular and hereditaments and appurtenances thereto belonging, or in anywise appertaining
and the reversion and reversions, remainder and remainders, rents, issues and profits thereof; and all the estate, right
title interest, claim and demand whatsoever of the Grantor(s), either in law or equity, of, in and to the above bargained
premises, with the hereditaments and appurtenances;
TO HAVE AND TO HOLD the said premises above bargained and described with appurtenances, unto the Grantee(s), g:
their heirs and assigns forever. The Grantor(s), for himself, his heirs and personal representatives, does covenant, grant,;
bargain, and agree to and with the Grantee(s), their heirs and assigns, that et the time of the enseoling end delivery
of these presents, he is well seized of the premises above conveyed, has good, sure, perfect, absolute and indefeasible
estate of inheritance, in law, in fee simple, and has good right, full power and lawful authority to grant, bargain,
sell and convey the same in manner and form es aforesaid, and that the same are free and ctear from all former and other E/
grants, bargains, sales, liens, taxes, assessments, encumbrances and restrictions of whatever kind or nature soever,
Subject to general taxes for the year 2006 and those apeclfi, axeeptione described by reference to recorded document. as
reflected in the Title Doaumenta accepted by Grantee(.) 1n accordance with section 8a (Title Review) of the Contract to
Buy and Sell Real Notate relating to the above described real property; distribution utility easements, (including cable
Tv), thane apeeifioally described rights of third parties not &hewn by the public reoorde of which Grantee(a) has actual
knowledge and which were accepted by Grantee(.) in aeoordanee with Section 8b (Natters not Shown by the Public Senor -do) g,
and Section 8o (survey Review) of the Cbntraot to Buy and sell Real Nstate relating to the above deooribed real property)
inclusion of the Property within any special tax dietriet; and, the benefit and burden° of any declaration and party wall
agreement., if any, and other
NONE
The Grantor(s) shall and will WARRANT AND FOREVER DEFEND the above bargained premises in the quiet and peaceable
possession of the Grantee(s), his heirs and assigns, against all end every person or persons lawfully claiming the whole
or any part thereof. The singular number shall include the plural, and the plural the singular, and the use of any gender €`
shall be applicable to all genders.
IN WITNESS WHEREOF the Grantor(s) has executed this deed on the date set forth above.
2
ALLEN G. ORCUTT
f�.
/r
By:
STATE OF COLORADO ) BARBARA F. ORCUTT
)ss. E'
County of GARFIELD ) FIEED
JESSICA ;
NOTARY PUBLIC
STATE OF COLORADO
My Commission Expires Aug. 2, 2007
The foregoing instrument was acknowledged before me on this day of Apr i1 06, 2006
by ALLEN G. ORCUTT AND BARBARA F. ORCUTT
My commission expires
Witness my hand and official seal.
�/ L.-6-.2
i der A__
Notary Public
Name and Address of Person Creating Newly Created legal De .tion ( 38-35-106.5, C.R.S.)
VAIL ENCINEERINC, LLC
P.O. Box 900'7
Avon, Goferodo 8'.620
PFiono 990.2'11.1033
May 28, 2009
Garfield County
Building and Planning Department
108 8th Street, Suite 401,
Glenwood Springs, Co 81601
RE: Individual Sewage Disposal System (ISDS)
Mr. Whit Dean is proposing to construct a Gambrel -Loft Barn located at 1136 County Road
129, Glenwood Springs, CO 81601. The proposed building will be comprised of a loft,
kitchen, (1) full bath and (1/2) bath.
Vail Engineering (VE) designed an expansion to his existing ISDS to accommodate this
proposed building. VE is proposing to install a separate 1000 gallon, 1 piece, concrete tank
from Copeland Concrete and an expanded absorption bed next to the existing system.
VE calculated the required absorption bed size per the Colorado Depattinent of Public
Health and Environment, Water Quality Control Division, State Board of Health, Guidelines
on Individual Sewage Disposal Systems, Pages 33 & 34. VE used the previous percolation
rate of 13 minutes (ISDS permit No. 1738) to calculate the additional required absorption
area. (See Attached)
MIN/MUM ABSORP770N AREA
A=Ox.fr
5
A = MINIMUM ABSORPTION AREA IN SF
0 = DESIGN FLOW OF SEWAGE /N GALLONS PER DAY
= PERGOLA TION RA TE IN MINUTES PER /NCH
O = A VER AGE 75 GALL ONS/PERSON/DA Y (MIN. 2 PEOPLE PER BEDROOM, MIN. 2 BEDROOMS)
O = 300 GALL ONS/GA Y
0 = MAXIMUM FLOW SHALL BE CONSIDERED 150 PERCENT OF AVERAGE DAILY FLOW
0 = 300 GALL ONS/GA Y x 150 PERCENT
Q 450 GALLONS/GAY
t 13 MINUTES
MINIMUM ABSORPTION AREA RI -CURED: 325 50. FT.
VE is proposing an expansion of the existing absorption bed with dimensions of 12 feet by
28 feet. This expansion will provide 336 SF which exceeds the minimum requirement and
shall match the existing drain field system that is currently in place at a depth of
approximately 4 feet.
Sincerely,
:l
Adam Vail, PE
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 61h Street Suite 303
Glenwood Springs, Colorado 61001
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT ! c° 1738
)x�t, SiUivFtn
Owner
System Location
This does not constitute
a budding or use permit.
1136 C. r. 129 tdo iklnk' (;),_cts I *cif .
Licensed Installer )2i19py Ozmst.
• Conditional Construction approval is hereby granted for a jPO 0 gallon
f� Septic Tank or Aerated treatment unit.
Absorption arca (or dispersal area) computed as follows: `
Perc rate of one inch in 13 minutes requires a minimum of 26 t7 sq ft of absorption area per bedroom.
Therefore the no. of bedrooms 3 G '.-"sq ft minimum requiremeit = a total of 76'0 ft of absorption area.
May we suggest:
_ iC '`i �l e E.' /_ i� i- i & ,X' `7 1>- X 3 r ! e.
/ l /r/%
Date Sy/ (9 /% `i Inspector /�t0-1 . )/ /'.%,i rem T, I
FINAL APPROVAL OF SYSTEM:
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to cover-
ing any part.
k Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
Proper materials and assembly.
() 1Trade name of septic tank or aerated treatment unit. �� ,I~7e =r l /a%J r r< r , / +•r I r ei
;21>c Adequate absorption (o• dispersal) area. f.2. 1 C0 �r �, t "t 1 L<, �1
i..' ` Adequate compliance with permit requirements.
1' Adequate compliance with County and State regulations/requirements.
Date
Other
f /
t l•; i,"L
/z.. / .,/,-f Inspector ,.L 0.1� V/ i"' 'L"l1..''l.- •.
RETAIN WITH RECEIPT RECORDS tt CONSTRUCTION SITE I
*CONDITIONS:
1. All installation must comply with all requirements of the Colorado Stale Board c1 Hearth 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. Connection to or use with any dwelling or structures not approved by the Building and Zoning office shall
automatically be a violation of a requirement of the permit and cause tor bo:h legal action and revocation of the permit.
3. Any person who constructs, alters, cr installs en Individual sewage disposal system In a manner which involves a knowing
and materiel variation from the terms or speclficatlonscontained in the applIcarion of permit commits a Class I, Petty Offense
($500,00 tine -- B months in jail or both.).
Applicant: Green Copy Department: Pink :opy
GARFIELD COUNTY SEPTIC PERMIT APPLICATION
108 8th Strcct, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 ! Fax: 970-384-3470 / Inspection Line: 970-384-5003
nny,gxrtield-county.com.
1
Parcel No: (this information is available at the assessors office 9 ?0.945-9134)
2
Job Address: (if an address has not been assigned, please
/$6 Coe,.+ -/r, gagt> I L
provide Cr, Hwy or Street Name & City) or and legal description
LU �l Co )
Subd./ Exemption:
r.
. T'�
�L/..--/k l oaa .,-*5;
3
Lot Size: ' / Lot No:� Block No:
/d7 iG
4
Owner: (property owner)
la.//fii--s� 1..44
Mailing Address
( (:reo eounf7�/ Z!oA> l2A7
*G&fie--/APSa...�44 $ co erGot
Mailing Address
Ph:
4170 94'' 1378
Ph:
Alt Ph:
Alt Ph:
5
Contractor:
6
Engineer.
VAI(- Eilernigge4a6
Mailing Address
12A1301r 0007 Azu«L Go $20(10
Ph:
?D Z9/ �o�
((4.. Alteration
Alt Ph:
,� —
( ) Repair
7
PERMIT REQUEST FOR: (>4- New Installation
t3
WASTE TYPE: (g)Dwelling i )Transient Use ( )Commercial or industrial ( )Non- Domestic wastes
- Describe
( )other
9
OR SERVICE TYPE: 6•AM.81Z,EI- -- L -AF%
Garbage Grinder ( )Yes ( )No
BUILDING
Number of bedroom:; /
10
SOURCE & TYPE OF WATER SUPPLY:
If supplied by COMMUNITY WATER, give name
( )WELL ( )SPRING ( )STREAM OR CREEK ( )CISTERN
of supplier: _
11
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System?
_ —___ .._ ..... . ........ ..r les.,i dr—es 1A/1T1 1 !NI IT A L' ITC 01 Ant
12
YOUR INDIVIDUAL SEWAGE DISPOSA
GROUND CONDITIONS:
Depth to 1s' Ground Water Table Percent Ground Slope /Pf®
13
14
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:
(Septic Tank ( )Aeration Plant ( )Vault ( )Vault Privy ( )Composting Toilet
( )Recycling, Potable Use ( )Recycling, other. r.se ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet
( )other- Describe__
FINAL DISPOSAL BY:Sand filter
OAbsorption trench, Bed or Pit ( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )
( )Wastewater pond ( )Other- D :scribe
15
WiII effluent be discharged directly Into waters of the state? ( )YES (>4N0
16
17
PERCOLATION TEST RESULT: (to be completed by R;gistered Professional Engineer, if the Engineer does the Percolation Test)
Minutes /.3 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 & telephone of RPE who made soil absorption test:
Name, address & telephone of RPE responsible for design of the system:. VAI. -I 44-1 6ages- $007 4J v 44. O BI (�2ra
Applicant acknowledges that the completeness of the application is conditional upon such further mandatory and additional test 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 ccnditions 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 legal action for perjury as provided by law.
OWNERS SIGNATURE
DATE
Permit Fee:
Perk Fee:
STAFF USE ONLY
Total fees:
Building Permit #:
Septic Permit #:
Issue Date:
Building & Planning Dept:
APPROVAL
DATE
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TOP VILW
Eric & Roslynn Pedersen
0045 Casa Del Monte Court
Glenwood Springs, CO 81601
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0066 Casa Del Monte Court
Glenwood Springs, CO 81601
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Glenwood Springs, CO 81601
v/ Greg & Soon Jeung
1188CR129 l�
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y t Dog & Judy Eggleston
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Glenwood Springs, CO 81601