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Home My WebLink About04359GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT Assessor's Parcel No. This does not constitute a building or use permit. PROPERTY Owner's Name � �J �?k�(i+� lit 1��Pres!entAddress Y7�fc-oZ(t� Si(`—G' Y�Phone N72 ,y ( D System Location - (( C 2 (V `-� i / �1y Co o 16�>,).,, tJG�j�f,r Legal Description of Assessor's Parcel No IR(- 6{°A -60-2-F3 007' %n SYSTEM DESIGN X660 Septic Tank Capacity (gallon) Other 1/0 Percolation Rate (minutes/inch) Number of Bedrooms (o other 6/1/1/4r -10b. Required Absorption Area - See Attached Special Setback Requirements: Date Inspector "A- , ,si ~!JA NV' (y "P.; CA Chea _ p 9,4`t � -. FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer {( `"iS� r `A"" `a, A,✓�'I .! Septic Tank Capacity TV) L-1 Septic Tank Manufacturer or Trade Name ` 0 OP. Septic Tank Access within 8" of surface l�"^ Absorption Area ` 5 iiVA,A,Ab (j,'� fJt �'�•.(/\ r Absorption Area Type and/or Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements 1 Other Date 0 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 ($500.00 fine — 6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER UQ l+p Li D. t l.)LA-1 /1 4%W ADDRESS ei I c'a/ry Ior. CONTRACTOR 6010 /c ADDRESS PHONE PHONE en a.4 y� PERMIT REQUEST FOR (X) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PROPOSED FACILITY: Near what City of Town S 1 I f Size of Lot 41 all 3 Qvt Legal Description or Address yei q t a.1 + £of 4 �- WASTES TYPE: 9() DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER—DESCRIBE BUILDING OR SERVICE TYPE: A i D. t4 Number of Bedrooms '3 (4 Garbage Grinder (c/) Automatic Washer Number of Persons (.7) Dishwasher a SOURCE AND TYPE OF WATER SUPPLY: (97) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? A site plan is required to be submitted that indicates the following MINIMUM distances: Leach Field to Well: 100 feet Septic Tank to Well: 50 feet Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet Septic System (septic tank & disposal field) to Property Lines: 10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ($) SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET( ) OTHER -DESCRIBE FINAL DISPOSAL BY: 9C) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER -DESCRIBE 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 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 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 fumished 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 permit granted based upon said application and in legal action for perjury as provided by law. Signed // 7. %O Date 7-024 ®--a 7 PLEASE DRAW AN ACCURATE MAP YOUR PROPERTY!! 3 \ % f + c SITE P. A".34.82' R=76.45, =26'05'46' .5 /8'28'49' E INSzwinem!PSCOAV r, r SIM 40 RIZ • A=7334' R=274.40' A=15.18'48" B=S 14'09'08" W 0' 200' 400' 600' U LEGAL DESCRIPTION LOT 2, WHITTINGTON SUBDIVISION EXEMPTION A tract of land situated in Lot 3 and the SE//4NWI/4 of Section 6, Township 6 56956'54'WI South, Range 91 West of the 6th P.M. being that tract of land descr/bed in Hook 112.42 425 at Page 288 and portions of those tracts of land described in Book 393 at Page 510 and Book 1067 at Page 654 in the Office of the Corfield County Clerk and Recorder said tract being more particularly described as follows: Beginning at a point on the westerly right of way of County Road No. 238 whence the South 1/4 Corner of Section 35 township 5 South, Ronge 91 West of the 6th P.M. beors N 65'28'06" 5 2135.22 feet; thence along said right of way S 353541" E 17.36 feet; thence along the am of a curve to the right having a length of 34.82 feet, a radius of 76.45 feet and a central angle of 26'0546'; the chord of which bears 5 18'2849" E 34.52 feet; thence S 05'25'56" E 34.20 feet: thence S 00'52'18" W 88.20 feet; thence S 10'55'06' W 80.51 feet; thence S 0739'34" W 87.04 feet; thence S 06'29'44" W 155.46 feet,- thence eet;thence along the arc of a curve to the right having a length o1 73.34 feet, o radius of 274.40 feet and a central angle of 15'18'48, the chord of which bears S 14'09'08" W 73.72 feet; thence 5 21'48'32" W 133.09 feet; thence 5 21'4708" W 721.94 feet; thence S 25'05'47" W 37.65 feet; thane S 25'54'07" W 148.49 feet; thence S 06'05'08" E 11.33 feet to the northerly boundary of that parcel of land described in Book 457 at Page 495; thence along said northerly boundary S 89'56'54" W 112.42 feet; thence departing said northerly boundary N 32'22'55" E 119.05 feet thence N 11'26'42" W 287.78 feet; thence N 19'50'8" W 183.22 feet: thence N 19'37'03" E 127.23 feet; thence N 47'03'19" E 739.77 feet; thence N 14'35'52" 5 216.39 feet; thence N 88'50'48" 5 174.23 feet; to the Point of Beginning having an area of 5.293 Acres more or less. I David C. Nicholson a licensed surveyor in the State of Colorado, certify that I have located the property lines for the property shown hereon and hove indicated the location of proposed improvements as directed by the property owner or the owner's representative as shown hereon. This certification applies to proposed impr• emnts and doe npt represent an Improvement Location Certificate or /m fj t-meilt Survey vid C. Nicholson L.S. 3458 ONIOE CREEK SURVEYORS INC. DAVID C. NICHOLSON Professional Land Surveyor LS. 34.585 0029 Calore00 River Road New Cando. Colorado (970) 8705632 (970)366-9306 SITE PLAN 4791 COUNTY ROAD 214 SILT, COLORADO DATE: 6/01/2007 PROJ. 6012007 WHITTINGTON SITE