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Home My WebLink About04405ka).-Dq- � 56 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 9454212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY b1)-- i0 -WW, Permit 4405 Assessor's Parcel No. This does not constitute a building or use permit. Owner's Name Th 1CemG ( i --GM Present Address + r `s i , c a PhoneMS' .\1-.5F5 System Location 6- l S t'' R` IMP -LA Legal Description of Assessor's Parcel No M:35- �� `-��' 3 SYSTEM DESIGN Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer /��,.,,��}} Tank Capacity 4I'i� 14,a - Septic 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 0 Other , „." Date ~ �``� D 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. 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 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER £,ruCtt A dr`oras (t.5►i) ADDRESS ?217 9n r lead alarm , &d e leo PHONE q20-,) 5;-gote CONTRACTORke Bim; ht: vSc. r- ANtrso,✓ I S t ADDRESS PHONE PERMIT REQUEST FOR (). 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 TownA2,n; lrs #Vo pat2uktde 6.4 a 1S— Size of Lot_ Legal Description or Address Sce Aga ch �+tr•�f % WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( y-}- OTHER—DESCRIBE 4VAtor je mfare (.employee 44ws:4g BUILDING OR SERVICE TYPE: g Number of Bedrooms 9 Number of Persons ( ) Garbage Grinder ( Automatic Washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (X) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: At 4esr waw Serv. c es 1.10-1. led these, co."ly 'rl DISTANCE TO NEAREST .COMMUNITY SEWER SYSTEM: /D --/5./: tes Was an effort made to connect to the Community System? y95 A site plan is required to be submitted that indicates the followin ' 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 Percent Ground Slope Vet 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( ) SEPTIC TANK ( ) AERATION PLANT (70 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 ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ()e) OTHER -DESCRIBE Mated l' y Opcviv Valu s�p�C; G WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? f?/p, PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes ,V per inch in hole No. 1 Minutes /U per inch in hole No. 3 Minutes /1/o per inch in hole No. 2 Minutes A et per inch in hole No. Name, address and telephone of RPE who made soil absorption tests: 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. I further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any peunit granted based upon said application and in legal action for perjury as provided by law. Signed . - ..--• 014/40--- - Date 1/ i (z 7 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 Designate North Arrow Your Neighbor's Name & Address Your Plot - Shape to Fit (No Scale) _Se 4-4ict c edi: 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) eric clwpwin6O1wpdocskploi.Ioc l a� ATTACHMENT 1 • I \"-\_,:- • Driving Instructions to the 1(22 Weil Pad: From the intersection of Main St. and CR 215 in Parachute, Colorado, drive Northwesterly on CR 215 for 10.3 miles to the Encana automatic guard gate. Tum left just past the automatic guard gate and proceed 0.6 mile to a `Y' and take left turn on West Fork Road. Continue Northwesterly 2.1 miles and tum left on Light Gulch Road, continue 0.9 mile to the Well Pad. Well Pad location: Lat.: 39" 35 57.167" N Long.: 108° 09' 31.067" W 0 if EnCana Oil & Gas (USA) Inc. K22 Well Pad NE 1/4 SW 1/4 Section 22, T5S, R96W, 6th RM Garfield County, Colorado air CR SURVEYfNG WWI Street rmsu PIXY NO. (son 789-4845 —LEGEND— Existing LEGEND— Existing Rood Site Location DATE: Jan.17, 2007 SCALE: As Shown PROJECT NO.: 06-04-55 Topo A SHEET 9 OFI ATTACHMENT 2 SCALE: 1' - 50' OATE: 01-31-07 MOM By. O.R.6. Ravined: 02-27-07 O.R.O. Revised; 03--01-07 O.R.O. RevSeed: 04-11-07 O.R.B.. EnCana OIL & GAS (USA) INC. LOCATION LAYOUT FOR WELL PAD KZZ 590 SECTION 22, T55, R96W, 6th P.M. NE 1/4 SW 1/4 / FIGURE #11 LEGEND.' T - oI4RFLOW 2 - 5EiiE7i' TANK J-IJPTSTAIK.W 4 -- SEWER UNE 5 -- WATER TANK 6 - FRE'E2E'R 7 - STORAGE" 8 -- GENERATOR? 9 - f't/ix TO - TRANSFORMER 1 wiia• ,8168 WON* •14910 WF050. •WE158 W36• •M715C F12B. .W►i40 111098• •Wii38 W1090' • 111180-21 UrNTAl ENOv wERING a LAND &IJWErjNG 86 so. 870 dRue • Vernal, Ut0A 85078 • (455) 745—t0ly [ co kr) MI 1 1111 11 1111111111