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Home My WebLink About04402.777 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Assessor's Parcel No. This does not constitute a building or use permit. Owner's !Name\Cc' , 1‘07a Present Address a A C \5- \ C.\ACAE Phone r a� System Location" -7 Legal Description of Assessor's Parcel No SYSTEM DESIGN t-cA / 9 9s Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (0 f Required Absorption Area - See Attached lf" a' b Special Setback Requirements: Date other) Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System installer ✓ 2 ./(,-TV/ /ice ' Sty 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 compile ce with County and State regulations/requirements / Othe Date f (at/a`.I inspector 6' is 2111/.1( e f 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. 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 1, Petty Offense ($500.00 fine 6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER E, C a(.a COi I 6 -as CUs') ADDRESS a 7 C . (,).‘ d2oad a, S Sc.: 44 /co PHONE q 70 - to -96/6 CONTRACTOR Pet 44ed-sr „ f71 ADDRESS See PHONE PERMIT REQUEST FOR 04 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: Near what City of Town 10,,,:Ies /U. oie Par8c 1%k it- 6,12= a 1S Size of Lot Legal Description or Address WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( OTHER -DESCRIBE ,rii.Not 1 ewip&ry £ p) ,ee 140u Mr" BUILDING OR SERVICE TYPE: (1 T 1I Number of Bedrooms 9 Number of Persons /5"-- ( ) Garbage Grinder (y) Automatic Washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (A WELL , ( ) SPRING ( ) STREAM OR CREEK fru.-Ys If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:io-- Was an effort made to connect to the Community System? ye -5 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 (septic tank & disposal field) to Property Lines: 10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table /13/4 Percent Ground Slope 7l//q 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( ) SEPTIC TANK ( ) AERATION PLANT (Xl. VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE. ( ) CHEMICAL TOILET( ) OTHER -DESCRIBE FINAL DISPOSAL BY: ( ) ABSORPTION TRENCH, BED OR PIT ( ) UNDERGROUND DISPERSAL ( ) ABOVE GROUND DISPERSAL ( ( ) EVAPOTRANSPIRATION ) SAND FILTER ( ) WASTEWATER POND (`X) OTHER -DESCRIBE #a 449 &,e, - a. Tr e c1 A- 4iN e •fir. GA -L. WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes A!t per inch in hole No. 1 Minutes \Jc per inch in hole No. 2 Minutes Minutes Name, address and telephone of RPE who made soil absorption tests: per inch in hole No. 3 per inch in hole No. Name, address and 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 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 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. 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 as provided by law. Signed 4 4 +- --- Date 1 1) PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 Designate North Arrow Your Neighbor's Name & Address .See Your Plot - Shape to Fit (No Scale) 4-14-ack et-- 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 County Road (Note the Road Number and Name) etic c:lwpwin601wpdocsipiottoc 'I If qg L PROPOSED LOCATION: D19A 595 MAN CAMP INNING DIRECTIONS TO D19A 595 MAN CAMP PROCEED IN A NORTHWESTERLY. THEN NORTHEASTERLY DIRECTION PROM PARACHUTE, COLORADO APPROXIMATELY 10.6 MILES TO WE JUNCTION OF THIS ROAD 040 04 EXISTING ROAD TO THE NORTHWEST; TURN LEFT AND PROCEED IN A NORTHWESTERLY, THEN NORTHERLY, THEN NORTHEASTERLY DIREcroN APPROXIMATELY 24 MILES 10 DIE JUNCTION OF THIS ROAD 040 04 EXISTING ROAD 10 1111 EAST:, TURN RIGHT MD PROCEED 18 04 EASTERLY WITECTION APPROXIMATELY 0.2 MILESTO THE BEGINNING 01 181 PROPOSED ACCESS ROAD TO THE SOUTH; FOLLOW ROAD FLAGS W A SOUTHERLY DIRECTION APPROXIMATELY 20XY TO THE EXISTING LOCATION. TOTAL DISTANCE FROM PARACHUTE COLORADO TO THE EXISTING 100010815 APPROXIMATELY 13.6 MILK MAN CAMP LOCATION: LATITUDE 39 36' 19.22' LONGITUDE 1115 06' I ELEVATION 6.039' EGEND: PR()POS F. 11 LOC:AT I ON Uintah Engineering & Land Surveying South 200 East Verna1, Utah 84078 (438) 789-1017 "" VAX (435) 789-1813 EnCana OIL & GAS (USA) INC. DOA 595 MAN CAMP SECTION 19, T5S, R95W, 6th P.M. NW 1/4 NW 1/4 (Lot 2) 0 P 0 6 .1Z, A P U 1 C 1 7 1 9 07 Ni . P DAT YEAH SCALE: 1:100.000)DRAWN BY: .L.G. TREVISED: 0049-00 (0 co IQi) (51-1aC,.1 N EnCana OIL & GAS (USA) INC. LOCATION LAYOUT FOR WELL PAD C27A 595 SECTION 27, T5S, R95W, 6th P.M. NE 1/4 NW 1/4 SCALE: 1" = 50' DATE: 01-29-07 Drawn By: D.R.B. Revised: 02--28-07 D.R.B. LEGEND: 1 — OVERFLOW 2 — SEWER TANK 3 — LIFT STA 770N 4 — SEWER LINE 5 -- WA TER TANK 6 — FREEZE—A' 7 — STORAGE F — GENERA FOR 9 — FUEL 10 — TRANSFORMER FIGURE ,#91 UINTAH ENGINEERING & LAND SURVEYING 85 So, 200 East • Vemat, Utah 84078 • (495) 769--f017