HomeMy WebLinkAboutApplication- Permitti 03 fifi-'Soso jierliswergatt,4
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit NE 3 8 83
109 8th Street Suite 303
Glenwood Springs, Colorado 81801
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT'
Assessor's Parcel No.
This does not constitute
a building or use permit.
PROPERTY
A
Owner's Nam n� (j / Present Address 3o5R CQ b3 C ja �e Pho
System Location 3O f CA/&3 [ /otrkosdafr Q. g
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
ouci a3-6 o) qg
/00D 44 Septic Tan Capacity (gallon) Other
/5"7874c -par
Percolation Rate (minutes/inch) Number of Bedrooms (or o
Required Absorption Area - See Attached 7a Lk1C Nw / 7 414r7)
Special Setback Requirements:
Date /111---(03
--(J3
Inspector
`oLLP-L-T-
4 /00°' Calf d
_ .
Final
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er) 2 iee E.a. %l tp
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FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
20 umn-s Bhp 3rd
z4 ua4r-s7ti0 218
System Installer ;;
Septic Tank Capacity //:C//f.17
Septic Tank Manufacturer or Trade Name .--Cgs"'"'
Septic Tank Access within 8" of surface
r
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Absorption Area
Ciatdy
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
Other
Date ✓ � � Inspector '117 ✓
RETAIN WITH RECEIPT RECORDS AT CON TRUCTION 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 I, Petty Offense ($500.00 fine — 6
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
FROM : CEDAR RIDGE FARM
GARFIELD COUNTY
FAX N0. : 970 %3 1703 Nov. 13 2003 10:36RM P3
Page 2 of 9
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION C0,4 Lao vAc%2 k
/ OWNER ADDRESS
✓ PHONE q % 0 ` I1'- a (
• CONTRACTOR ADDRESS NIC (` C a1A st rur j -rn IA 4I SS Seclo u rQ C [ C
✓ PHONE 9 7O —•x/5/15'- f 1 trot Lod e
C
pERMIT REQUEST FOR: 'KNEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report eho iing entire area with respect to surrounding areas,
topography of area, habitable building, location of potable water walls, sod percolation test
holes, soil profiles in test holes (See page 4).
LOCAT(QN OF PROPOSED FACILITY:
✓ Neer what City or Town r a v •a o v.e.] t -.Q
/ Size of Lot / 6 3 a - r_ e 4
/ Legal Description or Address `?j O S" g l 0 c Q a to
wain
TYPE
$Dweang () Non -Domestic Wastes
(> Transthe () C;wmercial Or Industrial
letter:
r: Deeeribe:
BUILhrNQ OR SERVICE TYPE:
Number of Bedrooms .2
Number of Parsons - f 4istinisor , 4a4
/ CLGarbage Grinder frfAutomadc Waatrer () Dishwasher
SOURCE AND TYPE OF WATER SUPPLY -
SMELL () SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name Of supplier:
/ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
✓ Was an effort made to connect to the Community System? () Yes
(0740
http://www.gar8eld-county.com/buildiig_and_plamlurg/forma and documents html/ISDS.1... 11/12/03
•d 6S11 oN 11)31035 dH riVBQ:Q1 CCU •EI't�N
FROM : CEDAR RIDGE FARM FAX NO. : 970 963 1703
[
GARFIELD COUNTY
I• al „ • •1, I , • «,. a. ,•. ••• , •
Leach Reid to Well:
Septic Tank to Wet:
Leach Plaid to Irrigation DlMahn. Stream or Water Courts
Septic System to Property Linn:
Nov. 13 2003 10:37AM P4
Page 3 of 9
100 feet
60 feet
60 hist
10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL_4Q7 SE ISSUED
W1111011/ASITEPLEN.
GROUND GOND MONS.
Depth to first Ground Water go 9#wui
Table Percent Ground Slope: /a%
N,Q+ res' 6'/ov . #,;/..
TYPE OF INDIVIDUAL SWAGE Dia SAL SY TEM PRO D•
Septic Tank () Aeration Plant ( ) Vault
() Vault Privy () Composting Toilet ( )Recycling/ Potable Use
() Pit Prwy () Incineration Toilet () Recycling/Other Use
() Chemical Toilet ()Other — Describe:
FINAL DISPOSAL BY:
$kAbsorptbn Trench, Bed Or Pit () Evapotranspiration
() Underground Dispersal () Sand Filter
() Above Ground Dispersal () Wastewater Pond
( ) Other — Describe:
WILL EFFLUENT BE D1SCFtABGED DIREC1tV INTO WATERS OF 114 S,&1gZ tie
FERCOLATQN TEST RESULTS: (To be completed by Registered Professional Engineer, If
the Engineer does the Percolation Teat)
Minutes /5 per inch M hole No. 1
Minutes /3 per Inch in hole No. 3
Minutes /0 per inch in hole No. 2 Minutes per inch in hole No. 4
http:thAvar.garfield-county.com/bvildirc_acd_plaooing/forme aad_docurnms_}xmVISDS.L.. II/12/03
r A ca!I•ou 1331039 dH Nv8g:D1 CON I cioN
,_FROM : CEDAR RIDGE FARM
&AEFIELU COUNTY
FAX NO. : 970 963 1703
RPE ,WHO MADEBOILASZNIMELTESIT
Name: 1-e4,tr edi (Sr ,
Address: * '° r� gra LP/r
Telephone: 92» 7fl(
No). 13 2003 10:37AM P5
Page 4 0f 9
. S > J ,. , tn, i e. Ila ni,
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RPE RE$PONSIRLE FOR DESIGN OF THESYSTELt
Name: ii-f'_oaeiee%. Xisaaarrila Vttry R,n dd. dh/e. t
2 Anse &.
Address! P.tl✓�Merrre 'Natal)
Telephone: 970 - «bi- /974
Applicant acknowledges the the completeness of the application Is conditional upon such
further mandatory and additional Oasts 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 wdh odes end regulations
made, information and reports submitted herewith and required to be submitted by the
applicant are or will be represented to be true and corred to the best of my knowledge and
belief and ere designed to be relied on by the local department of health in evaluating the
sane for purposes of issuing the permit applied for herein_ 1 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 es provided by law.
/ Signed: Piadvietek
✓ Date: Yv H .
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTYII
hap://www genera-camry.wm/buildmtsnd f/frnms antdocuments btml//SDS.t... 11/12/03
t 'd SSU 'mti 1931439 dH WM64:0i CON 1l'r°4
FROM : CEDAR RIDGE FARM
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•
FAX NO. : 970 963 1703 Nov. 13 2003 10'36AM P2
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PROPOSED TWO
BEDROOM RESIDENCE
PROPOSED DRAIN FIELDS
CARETAKER RESDENCE511E. CEDAR RIDGE RANCH 1 FIGURE 1
DRIVEWAY
APPROX&SA1E SCALE
HER WORTH—PAWLAK
403 348 GEOTECHNICAL. INC.
9 E 99t1 +'I
031030 di 000:11 I00/ dl•uN
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CEDAR RIDGE FARM FAX J. : 970 %3 1703
1
RECEIVED- ...
NOV 1 to 2003
H )IRWOR7H.
GHRF IELD COUNTY
ING & PLANNING
fo Ad` -f sdw `�' r
FAX TRANSMITTAL FORM
TO. Rkn ubh ron
COMPANY'
Nov. 13 2003 10:35AM P1
PAWLAK GEOTECHNICAL, INC,
240 kook Rod
P.O. Boo 1307
SIverraotvr, CO 110496
Photo: 970461-1909
Fa>r:
970-468-5891
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FAX NUMBER: /4174-943 - /763
FROM jean ernSgarn y ►
DATE: /!/r�/o3
MESSAGE:
J03 NUMBER: .1/43 AV/
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