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Home My WebLink AboutApplication- Permit0405 IGO 1 INDIVIDUAL SEWAGE DISP SA PERMIT GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 401 Glenwood Springs, Colorado 81601 Phone (970) 945-8212 Permit 4 5 4 1 Assessor's Parcel No. This does not constitute a building or use permit. PROPERTY } Owner's Name �LIA PresentAddreseOJ2- 01 -9 --If Phonel141 -2zs c System Location Legal Description of Assessor's Parcel No. SYSTEM DESIGN 2177-2-L0L _'{ (Q ttmoved i 24 3o Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Required Absorption Area - See Attached Special Setback Requirements: Date Number of Bedrooms (or other) Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Septic Tank Capacity Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface Absorption Area Absorption Area Type and/or Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements Other Date Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION 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. Connection 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 1, Petty Offense ($500.00 fine - 6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT GARFIELD COUNTY SEPTIC PERMIT APPLICATION 108 8th Street, Suite 401, Glenwood Springs, Co 81601 Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003 aarfid ri-r�nnrv,nnm F USE ONLY Permit Fee: Parcel No: (this information is available at the assessors office 970-945-9134) 2177-262-00-956 2 Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description Section 27 T6S R93W 6TH P.M. 3 Lot Size: Lot No: Block No: — Subd./ Exemption: 1480 Acres NA 00 NA 4 Owner: (property owner) Bureau of Land Management M 06p 2 A d ess 6 & 24 Glenwood Springs, CO 81601 Ph: .970247.2800 . Alt Ph: NA 5 Contractor: Mountain West Oil Field Services Mailing Address 864 20 RD #F Fruita, CO 81521 Ph: 970.858.8859 Alt Ph: NA 6 Engineer: Christopher F. Hale Mountain Cross Engineering Mailing Address 8261/2 Grand Avenue GlenwoodSprings,.00.8160.1- Ph: . 970.945':5544 - Alt Ph: 7 PERMIT REQUEST FOR: (8) New Installation ( ) Alteration ( ) Repair 8 WASTE TYPE: (0)Dwelling ( )Transient Use ( )Commercial or industrial )Non- Domestic wastes ( )Other — Describe 9 BUILDING OR SERVICE TYPE: Number of bedrooms Garbage Grinder (0)Yes ( )No 10 SOURCE & TYPE OF WATER SUPPLY: ( )WELL ( )SPRING ( )STREAM OR CREEK ( )CISTERN If by COMMUNITY WATER, give name of supplier: Vault and Haul System - Water received from COPHE certified water hauler: ' supplied 11 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was made to connect to the Community System? an effort YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN 12 GROUND CONDITIONS: Depth to 1u Ground Water Table Percent Ground Slope 13 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED: ( )Seplic Tank ( )Aeration Plant ()Vault ( )VaultPrivy ( )CompostingToitet ( )Recycling, Potable Use ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet ( )Other- Describe 14 FINAL DISPOSAL BY: ( )Absorption trench, Bed or Pit ( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter ( )Wastewater (E)Other- Describe Water Hauled to municipality pond 15 Will effluent be discharged directly into waters of the state? ( )YES LINO 16 PERCOLATION TEST RESULT: (to be completed by Registered Professional€nginees,.ifdhe.€ngineer.does.the9ercolatbn.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 & telephone of RPE who made soil absorption test: Name, address & telephone of RPE responsible 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 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 applicantare.or will be represented.tobetrueandcorfecttathebestof my.knowledge and -belief and are de '.ned to be relied o .y the local department of health in evaluating the same for purposes of issuing the permit applied for herein. I further unders cnd t.Qa r fa --• . Pi or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application and l:+alalp orperjw.➢rovidedbylaw. 44/7/64OWN 17 SIGNATURE AT F USE ONLY Permit Fee: Perk Fee: Total fees: O Building Permit #: Mal 11-cl Di 3 Septic Permit #:'104 k Issue Date: V)--1 ir-)pb Buildi rg & Plam " g D: �� %2-1S-- OB . APPROV L -. DATE Approximate' Location of PIPELIIP (not verified by survey) x AA7d ranks 000 Mid ITrou¢h I Pits me3 0: X to b4h 7 y a 8 O Fuel Neste Water -47j Fresh Water Directional railer Meeting Rig Manager JRoOe Trailer Neste Wet i I / !I — 0 Portable stoilets CompanMan Trailer Waste Water Fresh Wates U1 s DI n n m I, Kenneth Scott Thompson, a registered Professional Land Surveyor In the State of Colorado, do hereby state that the Survey shown hereon was prepared under my supervision and has been prepared solely for the purpose of depicting the location of improvements on the site shown as surveyed on October 8, 2008. ?his statement Is not a guaranty, either expressed or Implied. 1"=100' 0 100 Surface Disturbance Area Proposed 5.627 acres Actual 5.4g4 acres RIvERCrnr 744 Horizon Ct. Sulfa 110 Grand Junction 72 CO - 970—CO1142 506 Drawn:kat I Ghecked,dat IOct 15, 2008 I S:IPROJECTS11086 Encana\002 H21NWW27NWasbulltpro Va ley Wes Rine Ex 181 GRAM10 Proposed Location Well Pad (H27NW) EnCctnct Oil es Gas Inc. SriSine 9,re.. (435) 781.2581 180 North Vernal Ave. Vernal, Utah 8407. = Legend = ® Existing Read Well Pad (H27NW) SEC. 27, TES, R93W, 6th P.M. SHEET OF 11 Proposed Location Well Pad (H27NW) EnCana Oil 6 -Gas Inc. .(lameSavargrtg 7rt. (435)181-2501 th Vernal Ave. Vernal. Utah 84078 Legend immommis Existing Road Well Pad (H27NW) SEC. 27, T6S, R93W, 6th P.M. SHE 10 OF 11 Proposed Access 42700' Proposed Location Well Pad (H27NW) Well Pad (H27NW) �Tle In at Existing:. Pipeline EnCana Oil & Gas Inc. Well Pad (H27NW) SEC. 27, T6S, R93W, 6th P.M. i 7u -sem c'.urdS4 verrwit fist (435) 781-2501 Vernal, Utah 84078 = Legend = Existing Road .__.__......_.__._ Proposed Access ®mins en, Proposed Gas Line