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HomeMy WebLinkAboutApplicationGarfield County Community Development Department 108 8`h Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-countv.com ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION TYPE OF CONSTRUCTION ❑ New Installation WASTE TYPE 0 Dwelling 0 Other Describe ❑ Alteration 0 Transient Use 0 Comm/Industrial R• epair 0 • Non -Domestic INVOLVED PARTIES Property Owner: Sirfa ert/ g Mailing Address: 0c) .W.4rIeon IA/ to/ 1.41. Contractor: Phone:(17o ) c(4'6 -63S AA/ P Mailing Address: Engineer: Phone: Mailing Address: PROJECT NAME AND LOCATION Job Address:th (St- fr12---11:A© Assessor's Parcel Number: Sub. Lot Block Building or Service Type: _ #Bedrooms: Garbage Grinder_ Distance to Nearest Community Sewer System: Z. IAA -I _ Was an effort made to connect to the Community Sewer System: Type of OWTS Septic Tank 0 Aeration Plant 0 Vault 0 Vault Privy 0 Composting Toilet 0 Recycling 0 Pit Privy 0 Incineration Toilet O Recycling, Potable Use O Chemical Toilet 0 Other Ground Conditions Depth to 1. Ground water table Percent Ground Slope Final Disposal by Water Source & Type rill) Absorption trench, Bed or Pit 0 Underground Dispersal ❑ Evapotranspiration ❑ Wastewater Pond 0 Sand Filter ❑ Other ❑ Well 0 Spring 0 Stream or Creek 0 Cistern Community Water System Name r 0 Above Ground Dispersal Effluent Will Effluent be discharged directly into waters of the State? 0 Yes , SNo CERTIFICATION 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 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 action for perjury as provided by law. I hereby acknowledge that I have read and understand the Notice and Certification above as well as have provides tFye require information which is correct and accurate to the best of my knowledge. Property Owner Print and Sign 1,2-12-1y Date OFFICIAL USE ONLY Special Conditions: Permit Fee: Perk Fee: Total Fees:} Fees Paid: c` f Building Permit Septic Permit: i.1 Issue Dae: Zt 11 I/114 Balance Due: z� .r �� �� / /L BLDG DIV: L. APPROOF DATE • 4 6b v�sa�J FLIP -It 4 IMPROVEMENT LOCA770" CERTIFICATE A TRACT OF LAND SITUATED IN THE NE//1 sw1/4 OF SECTION 20 T.6 8., R89 W. OF THE 6TH P.M CARFIELD COUNTY, COLORADO PROPERTY DESCRIPTION A partel of land situated in the NE1/4 SW1/4 of Section 2, Township 6 South, Range 89 West of the Sixth Principal Meridian, County of Garfield State of Colorado; said parcel being more particu(ary described as follows: Beginning at a point in the center of No Name Creek whence the Northwest comer of said NE1/4 SWI/4 bears N.46:74'30.W. 697.72 feet; thence 11.2031'00'E 177.53 feet to a point on the Southerly right—of—way of interstate Highway No. 70; thence 57535'00'E along said right—of—way 97.55 feet; thence S.1353'00.W. 92.00 feet; thence S37'04'00'W. 114.00 feet to a point in the center of said creek thence N.56' 00'00'W. along said centerline 18.96 feet; thence N.61D7'OO'W. along said creek 57.32 feet to the point of beginning; said parte! containing 0.420 acres, more or less. Together with a right--of—way or easement for do purposes along the roadway and bridge as now constructed and in use from Highway 6 & 24. as it formerly existed as a means of ingress and egress to and from said property. (Property Descr►pt►on from Warranty Deed recorded in Book 449 Page 314.) NW CORNER NE1/4 SW1/4 SECTION 2 am. 6' sr - 39 -67/7y- 97. r 97.5 0.920 Ac. 2'- 0086 HIDEAWAY LANE ni POKER PO ,� INF 4j FOUND REBAR & CAP C.S. if 3317 R cif''/y• 9'A''�O•• /1,114..s. 00* Ca N 56'00'OO' W 18.96' 13'x26' BRIDGE UPDATE IMPROVEMENT LOCATION CERTIFICATE I HEREBY CERTIFY THAT THIS UPDATE IMPROVEMENT LOCATION CERTIFICATE WAS PREPARED BY SCARROW & WALKER, INC. MESA NATIONAL BANK FROM AN IMPROVEMENT LOCATION CERTIFICATE PREPARED BY SCARROW AND WALKER, INC. DATED FEBRUARY 11, 1991, THAT IT IS NOT A LAND SURVEY PLAT OR IMPROVEMENT SURVEY PLAT, AND THAT IT IS NOT TO RE RELIED UPON FOR THE ESTABLISHMENT OF FENCE, BUILDING, Of? OTHER FUTURE IMPROVEMENT LINES. I FURTHER CERTIFY THAT THE IMPROVEMENTS ON THE ABOVE DESCRIBED PARCEL ON THIS DATE, JUNE 24. 19P3, EXCEPT UTILITY CONNECTIONS, ARE ENTIRELY WITHIN THE BOUNDARIES OF THE PARCEL, EXCEPT AS SHOWN, THAT THERE ARE NO ENCROACHMENTS UPON THE DESCRIBED PREMISES BY IMPROVEMENTS ON ANY ADJOINING PREMISES, EXCEPT AS INDICATED, AND THAT THERE IS NO APPARENT EVIDENCE OR SIGN OF ANY EASEMENT CROSSING 01? BURDENING ANY PART OF SAID PARCEL, EXCEPT AS NOTED. THIS UPDATE IMPROVEMENT LOCATION CERTIFICATE DOES NOT CONSTITUTE A TITLE SEARCH BY SCARROW AND WALKER, INC, OR THIS LAND SURVEYOR TO DETERMINE OWNERSHIP OR EASEMENTS OF RECORD. ALL INFORMATION REGARDING OWNERSHIP, EASEMENTS AND OTHER ENCUMBRANCES OF RECORD WAS OBTAINED FROM, AND SUBJECT TO A TITLE COMMITMENT PROVIDED BY STEWART TITLE OF GLENWOOD SPRINGS, INC. TITLE INSURANCE COMMITMENT ORDER #930213 5 DATED MAY 2, , 1993. NOTE• LOT DIMENSIONS AND COURSES SHOWN REON ri D INFORMATION. BY: SAMUEL D. PHELPS Da TE COLORADO REGISTERED PROFESSIONAL LAND SURVEYOR 127613 FOR AND ON BEHALF OF SCARROW AND WALKER, INC. NOTICE ACCORDING TO COLORADO LAW YOU MUST COMMENCE ANY LEGAL ACTION BASED UPON ANY DEFECT IN THIS SURVEY WITHIN 3 YEARS AFTER YOU FIRST DISCOVER SUCH DEFECT. IN NO EVENT MAY ANY ACTION BASED UPON ANY DEFECT IN THIS SURVEY BE COMMENCED MORE THAN TR YEARS FROM THE DATE OF CERTIFICATION SHOWN HEREON. SCARRO, & 1PALIlE14 INC. 8H COLORADO AVE GLENWOOD SPRINGS, COLORADO DATE: FEBRUARY 11, 1991 DWN BY: DAC CKD BY SCALE: 1 !NCH = 30 FEET JOB NO. 90.274