HomeMy WebLinkAbout03619\
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
~ PROPERTY
N"-Permlt 3619
Assessor's Parcel No.
This does not constitute
a building or use permit.
7 ll bt . , '»--i ~"(\~r D:t ie-r/'l't::lr,.011 n & / G/i, /
Ow.!)er's Namer U Daf Cl (\ 1 Present Address t'• 0 ' :->X 'T~ C 'of a fe ~ l> J$Phone (o ;g. ;;){,{,5
(..(~~LliV4>r'.")) /,;i3 c I ' /) I nl. '/f ·;
System Location ).. s . -<' 17Q r Sf r I ')S /Hl I'\("' M. 51 (,, 8 b 5' ;}__
Legal Description of Assessor's Parcel No. Lat().. ( eJar 5ftf,'1'jS .f0,..c~ SuhJr'111~1'()A
SY.§JEM DESIGN
1l .... ;· t. I oO 0 4' ~.~~c Tank Capacity (gallon) ,, ______ ,Qt her
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-~/~5'~--Percolation Rate (minutes/inch) Number of Bedrooms (or other) 2 l) .[!
Required Absorption Area • See Attached '"2.~2 57 f:"; / 5 Ul#1J -fqf:-1.JC H
Date /l-O·O / Inspector _,_'*""''.;'-:-'~+~u.1'2-~l'-'/\'--/-B_14_1+-r_r._~_·_'B_14' _____ _
Special Setback Requirements:
, FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
:
System lnstaller _ __..,Q.....,L,_)"~""'~'-·~-------------------------------
Septic Tank Capacity·_,/_,0'-'0"'0"'-'<=;~4L...------'C_..af,~lc=~=-=..,_ ________________ _
Septic Tank Manufacturer or Trade Name ------------------------------
Septic Tank Access within 8" of surface -+_,..~),,,_ _________________________ _
Absorption Area _____________________________________ _
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Absorption Area Type and/or Manufacturer or Trade Name 15 -· 2-1 o Irtt1'-LMffm) 1t' lf2.8<ctt{J
Adequate compliance with County and State regulations/requirements_L~~l~)~-------2-'-·-~/Lf),=H:J""'...,c,_,;"-t_.M=.. __
Other ________________ .._~~-~~i""~~-+------------------
Date i ,~ ·02 Inspector t.'\C-VQ:Liiv
RETAIN WITH RECEIPT REco't2s 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. 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).
While. APPLICANT Yellow. DEPARTMENT
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INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICA'hON •
OWNER DA;v ,//f,,13B.~0 t. t-+ /1,A.,?c,,., hot<v>r~?.
/ r: C'. w~7 vJ..,A_, c,,., q1?<?tJ ADDRESS 0 3> V C , »t-z.-aa&"-" ~T, PHO
CONTRACTOR a.,_.l&il2 ~' 1> All (97o) l!J>-2-/t 'Y) (6~)<16?-/oJ'?
ADDRESS Sp~ PHONE (t1?c)J6/P-2-66s )cbr,r
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PERMIT REQUEST FOR <,'>Q NEW INSTALLATION ( ) ALTERATION ( )REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable
building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY:
NearwhatCityofTown ~Fl e-SizeofLot 5,. J <?'CteJ·
"l? N"" .,.,J IJl '7y, SCG. ) II)
Legal Description or Address _,/c..:2_~_'2 __ S-'' •:_G.::.:ll:>::.=A~-=~Jr"'-"""~s.;..· -.,;"~/'Q.J=<-"-'o..ll.L-""----':....7::....::;,SLL>i..i!.3.BL;---"-=-7":.;..£....:.."1,
51< T. t-o dl/ 52-
WASTES TYPE: 9<1 DWELLING J ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER-DESCRIBE _______________ _
BUILDING OR SERVICE TYPE: /&3-z... '.:':>, C@A'i, S f'f?t µ(, .J 7?-A>.d/H fap ,,
Number of Bedrooms ~ Number of Persons __ :2 ____ _
( ) Garbage Grinder .°'(Automatic Washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: 0() WELL ( ) STREAM OR CREEK ( ~:::G
If supplied by Community Water, give name of supplier: __ ~/~•Vd_,~------------
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: _ __..g>'--"/'1"""""'"1-" _M ______ _
Was an effort made to connect to the Community System? _____ -<-.._,o"-----------
A site plan is required to be submitted that indicates the following MINIMUM distances;
Leach Field to Well; 100 feet
Septic Tank to Well; 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course; 50 feet
Septic System to Property Lines; 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
Depth to~st Ground Water Table -~ S ~ Vo / 7Z ffGJl €\.' c ni
:,tl/'{..i 14.u:J.u>>-...... 3-Percent ound Slope __________ ~_-__ ,.., ________________ _
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TYPE OI·"if.lo1VIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
.,,
,J <>O SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POT ABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET
FINAL DISPOSAL BY:
( ) OTHER-DESCRIBE. ___________ _
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ABSORPTION TRENCH, BED OR PIT
UNDERGROUND DISPERSAL
ABOVE GROUND DISPERSAL
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( )
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EV APOTRANSPIRATION
SAND FILTER
WASTEWATER POND
() OTHER•DESCRIBE~----------------------------~
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ___ )y,__o __ _
PERCOLATION TEST RESULIS: (To be completed by Registered Professional Engineer, ifthe Engineer does the
Percolation Test)
Minutes. ____ _yer inch in hole No. 1 Minutes ______ per inch in hole NO. 3
Minutes er inch in hole No. 2 Minutes per inch in hole NO. _
Name, address and telephone ofRPE who made soil absorption tests: ______________ _
Name, address and telephone ofRPE responsible for design of the system:. _____________ _
Applicant acknowledges that the completeness of the application is conditional upon such further mandatory and
additional tests 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 pennit 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 pennit applied for herein. I further understand that any
falsification or misrepresentation may result in the denial of the application or revocation of any pennit granted based
upon said application and in legal action for perjury as provided by law.
Signed~ Date. __ -'-/;'-,'~/'---2-.-6--'-/_c:?.-'1 ___ _
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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Designate North Arrow
Your Neighbor's
Name & Address
,,.,_, ... ~" /~ i.-15-Y.AJ'''
)-' 0 -µ U-;. 7 '2
CA-it ~o;v~A!_ -f-,1 { 0
f?) ,,;;_>;
lot -Shape to Fit
(No Scale)
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Locate well, all streams, irrigation ditchs, and any water courses. Draw in your house,
septic tank & system, detached garages, and driveway.
If a change of location is necessary, you must submit a corrected drawing, before a
Certificate of Occupation will be issued.
Your Neighbor's
Name & Address
"f' 0: Jll1iL ""fSf LAv
J> 0 -eJ'}. lbZ7
Sy"'~'>, io
81 b:fl-
County Road (Note the Road Number and Name) G1.1 ;.,·\7 J?vP<"P / 3 q (wEST )J ,A-717 l"'I C1zt~)
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CEDAR SPRINGS RANCH SUBDIVISION EXEMPTION
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VICINITY MAP
•J·, 'OfJ" 2:SJPM BRAY & CO GLENWOOD • • ,. NO JD8D !. ·.· "'" ". ~ , I ' •'
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/EL!,, CONSTRUCTION AND TEST REPORT FOR OFFICE USE ONLY
,,11?'0F COLORADO, OFFICE OF THE STATE ENGINEER
, WELL PERMIT NUMBER 227745
Owner Name( a) : ,Cedar Springs Ranch LL C
Malling Address ; 702 N Traver Trail
I City, St Zip: Glenwood Springs, Co. B1601
Phone (970) 945-2236 APPROVAL# GWS31·9HJ3
3. ~LL LQCATIQN A~ llB!~LED; NW 1/4 NE 1/4 Sec. 14 Twp. 07S Range 93W
DISTANCES FROM SEC. LINES:
180 ft from North Sac line. end 1440 tt: from East Sec. line OR
SUBDIVISION : LOT BLOCK FILING( UNIT)
STREET ADDRESS AT WELL LOCATION:
4 GROUND SURFACE ELEVATION f t DRILLING METHOD Air Rotary
DATE COMPLETED 09114/00 Tl'O'l"AL OEPTH 103 ft. ; DEPTH COMPLETED 103 ft.
5. GEOLOGIC LOG 6. HOLE DIAM. llnl FROM Im TO tnl '
Oop!li Type of Material (Size. Color, and Type) 9.0 0 l!U
Dirt, 1,,111ys, \:lrlYBIS 6.!> 30 103
Oi40"103 Wasateh Formation '\·
7. PLAIN CASING
00("1) Kind WaU Size From (ti.) To(lt)
7.0 Steel 0.240 -1 31
5.5 PVC .250 23 30
5.5 PVC .250 40 103
PERF CASING : Screen Slot Size :
5.5 PVC .250 30 40
8, Filter Pack 9, Packer Placement
Material: Type:
WATER LOCATED : 3540 Size: Depth :
Interval·
REMARKS: 10. GROUTING RECORD :
"''"""' Amou'1t 0•""" lrrtDMI Pi.AC1trnont
cement 3 sks 16 gal 10.JO poured
, DISINFECTION• Type: HTH Amt Used: 2 oz_
WELL TEST DATA • [ J Check BoJC If Test Data is Submitted On Supplemental Form.
TESTING METHOD : Air Compressor
Static Level : 25 ft Date/Time Measured : 09/1412000 Production Rate : 15 gpm.
Pumping Level : Total ft Data/Time Measured : 09/14/2000 Test Length : 2 hrs.
Remarks :
, ,._ ~i!'dltlt ~moo. '-'tjn 111JIQ'-.a.tt. ooroM&e'l•noQ!J,lnc:J lt'dlhl"Jllt6 lrVt ~ 'trrf~ (P\..hu.111'1!~~24-4.-lQ.4 (l:J){•) CR!!_..,. ~li"OI affillM ~nb 1.1;1f"I~
pe?Jry ko'I h M~nd 111.o~nit ar.d ti! pLJmtw.ble 15 I da&I 1 ni~rNahlr.)
\~;~!nFf'9}0~ '. ~h?(ltg~?~~~c? Corp"'~' ~11 "" A11'?1 fhone : (970 ;, .. _ 1'" -927-4182 -
1me I Title {Please Type or Print) Signature Date 09/18/00
ravne Shelton I President