HomeMy WebLinkAboutApplicationGARFIELD COUNTY SEPTIC PERMIT APPLICATION
108 8th Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 888-868-5306
www, rarfield-countv.com
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Parc, INIo: (tt}is inforjn on is available at the assessors off 97(, 45-91't4) / '
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Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description
. ?5 S v; J; 0 s - / ? /14; I.4. -r oLt.1
- ' SANL-
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Lot Size: Lot No: (-N Block No: Subd,! Exem 'tion:
o ch II1■bP
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Owner: (property owner) Oa.
449'kair : %cI
Mailing Address 9' yy t
Ph:
9&-b)93
Ph:
Alt Ph:
/7- s�27
Alt Ph:
1 s 0A -CS 1
Mailing Address '
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�.
Contractor:
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Engineer:
Mailing Address
Ph:
Alt Ph:
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PERMIT REQUEST FOR:
X) New Installation ( ) Alteration ( ) Repair
( )Transient Use ( )Commercial or industrial ( )Non- Domestic wastes
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WASTE TYPE: (Dwelling
( )Other - Describe
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BUILDING OR SERVICE TYPE: ' - i I s -
Number of bedrooms
' h % - t I v t ' It . • fl
Garbage Grinder ( )Yes *)No
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SOURCE & TYPE OF WATER SUPPLY: ( )WELL ()SPRING ( )STREAM OR CREEK ( }CISTERN
If supplied by COMMUNITY WATER, give name of supplier.
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DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System?
/ > /h i t—ro—f
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
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GROUND CONDITIONS:
Depth to 1st Ground Water Table Percent Ground Slope
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TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:
x)Septic Tank ( )Aeration Plant ( )Vault ( )Vault Privy ( )Composting Toilet
( }Recycling, Potable Use ( )Recycling, other use ( )Pit Privy ( }Incineration Toilet ( }Chemical Toilet
( }Other- Describe
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FINAL DISPOSAL BY:
(}Absorption trench, Bed or Pit ( )Underground
( )Wastewater pond ( )Other-
Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter
Describe
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Will effluent be discharged directly into waters of the state? ( )YES Ai4NO
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PERCOLATION TEST RESULT: (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
No._
Minutes per inch in hole No.2 Minutes per inch in hole
Name, address & telephone of RPE who made soil
Name, address & telephone of RPE responsible
absorption test:
for design of the system:
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 fumished 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 legal tion four perju - provided bylaw. Q 4 "Y// to
fret
OWNERS SIGNATURE IA/, L L..>,eM ,'t4iI* s' DATE
c; 13511:. -
STAFF USE ONLY
Permit Fee:
Perk Fee:
Septic Permit #:
56P
Building &
APPROVAL
/co
Total fees:
/73 '-
Building Permit #
Issue Date:
•11—N-210
)(/,‘) 2 2oiD
DATE
1Z)/ 0/A/
This
(970) 945-2233
FAX # (970) 945-2300
LNg IS.d P*e&u tef 9irc.
0033 MARAND ROAD
P.O. BOX 248
GLENWOOD SPRINGS, CO 81602
Email: sales@dodeonplpe.com
SOLD TO: BARNES
BARNES FAMILY CABINS, LLC -CDD
924 CLUBHOUSE DRIVE
NEW CASTLE, CO
Job Phase:
Customer P.O.: BILL BARNES
Ship Via: CUSTOMER PICKUP
FOB: Origin
81647
IMMO
INVOICE
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invoice I: 152486
Inv Date: 09/27/11
SHIP TO:
Counter By:
Salesian: SOR
Teras: NET
Batch No: 095384
WATER SUPPLY & DISTRIBUTION
SEWAGE COLLECTION & DISPOSAL
DRAINAGE & STABILIZATION
LAWN, TURF & AG. IRRIGATION
Order I: BARNES RES
Ship Date: 09/27/11
Page: 1
Dbl Ck'ds
Part Number Location Description
Qty Ord Qty Shp Oty BO 2 Price Amount
NORW540292
TUFTITE7NO2
BIOARC36CHAMBER
SEWP041035B
SNOFA04
SNDPNO4
BIDARC36ENDCAP
$1111904
SWOL404
SKDL204
SWDT04
ALUEP70QP
SLUE705Q
YO3A NORM 1500 GAL 1/3-2/362 AN PLUMB. SEPTIC
32A02 7 - HOLE TUF-TITE DISTRIBUTION BOX
Y04A BIODIFFUSER ARC 36 CHAMBER 34' X 60'
UYB 4' X 10' 3034 SDR -35 PIPE - BE
01005 4' PVC S/D FEMALE ADAPT (P14041
01005 4' PVC S/D NPT PLUG (P1154)
Y04A END CAP FOR BIODIFFUSER ARC 36 CHAMBER
01805 4' PVC S/D 90 ELL LONG TURN (P256)
01C05 4' PVC 8/D 45 ELL (P504)
01C05 4' PVC S/D 22 1/2 ELL (P1704)
01A05 4' PVC S/D TEE (P104)
13005 P-70 QUART PRIMER PURPLE
13004 705 QUART CEMENT MED BODY
1.00
1.00
20.00
100.00
3.00
3.00
6.00
4.00
4.00
4.00
4.00
1.00
1.00
1.00
1.00
20.00
100.00
3.00
3.00
6.00
4.00
4.00
4.00
4.00
1.00
1.00
et, zif.flo nurwbr
2,I b1SI
Received By:
Print Name:
Date Rec'd:
***THANK YOU FOR YOUR ORDER***
0.100 1,822.223
39.500
27.500
1.020
4.555
2.761
10.900
4.761
3.466
3.800
4.761
14.282
12.254
Sub -Total
Garfield County Tax
Colorado Sales Tax
Freight/Handling
1,640.00
39.50
550.00
102.00
13.67
8.28
65.40
19.04
13.86
15.20
19.04
14.28
12.25
2,512.52
25.12
72.87
PLEASE PAY THIS AMOUNT) $ 2,610.51
TERMS OF SALE AND WARRANTY ON REVERSE SIDE
White Copy = Master File Pink Copy = Mail to Customer Yellow Copy = Customer File Gold Copy = Customer/Delivery Receipt
PIPE • VALVES • PUMPS • FITTINGS
Found Stone Replaced
with 3" Aluminum Cop
and No. 6 Rebar
1/4
Sec. 26 Sec. 25
ro
VAN HOOSE
S 89'25'00 0_E 2649_38'_ W 1/16 Assumed Basis of Bearing — — — — _ _ —
--1324,69' Sec. 25 1324.69'
Found No. 5 Rebar & Cop
Solar County P.L.S 14111
$ 8 93126 W
S89'30'59"E 1320.80'
1318.83'
0
N
0
o,"
w
c
Reel
5 89'38'00" E
991.32'
1316.87'
737,17
5W 1/16 Corner
Found No. 5 Rebor
Replaced with 3"
65.41 Aluminum Cap
2541.56'
C 1/4
-Sac. 25 ('S(
1-
y
'W
O
14
0
1^ 0
and No. 6 Rebar S89'31'53"E 1320.76' "" .
up
-r
r—t3H_ 3C_ _--� ‘' CI 42
Iv
\\\
1(1Parcel 1
Moor Lees \`r3 ��¢j/y / ui
�) S1. 1\ N1/2,81@,8911/ 4 \�'y/L rs ^ �'/
V todon 25 .
1) � 3 ‘52.li
N 89'44'35" W 2'x / 2637.65 1318.82' 417.00
Siloll rW
o
V5/// PWi,, 612 Centerline 25' o
Waterline Easement �
dine e A � la
Enamen
�I�/ 61 .6 1/4 Soclion 25 /.//e
/ /Jj, -Al\ii. S 64-4 ‘, 4 1a.5 1/I
15. ' 5.0' i -O -A ON 12.5
1,1
I ' I Sec. 25
16 2633.75' 1// 006.94 Sec. 25 11/
,1
ii Sec. 36 1316.87 /I Sec. 36 ,
Ill IP
I'I
///'� Parcel3 ///~
W/89.88 Acme I� K1
I More or Lees /C
' N 1/2,N 1/2, NW 1/ 4 i
Section 38 >.
/1I us
M
1'I M
In
N 89'21'26" W 2638.35' ISI
796.62 w
71
' N' I/I Found No. 5 Rebar & Cap H
\ \`Tp Parcel 4 /Y Solar County P.L.S 14111 m
/ S 75'15'31" W 3.54' c
3994 Acres
\�\ Mon or Leet I'I v
\ 7y,^ S1/2,N1/2,NW1/4 ih
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