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Home My WebLink About041563 -I(40 -o b GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Owner's Name J 'r` �I K 1st, System Location Present Address Sc rvv) a11FcRiiiCSS Permit 4 156 Assessor's Parcel No. This does not constitute a building or use permit. Phone ! /- 735 Legal Description of Assessor's Parcel No SYSTEM DESIGN /coo 5 &IRs -;73 -OO -036 Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or 321 (r.ta-.-eL 3 8G d but Required Absorption Area - See Attached Special Setback Requirements: Date Inspector other) -.9t H-4' 4-4-p % ' -a/ 5 e 33 Q V - or V2-- 1) FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer tad Septic Tank Capacity /Ooo Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface y�1� s3 -�-/' ^�� 6/i/f) Absorption Area Type and/or Manufacturer or Trade Name j &L442 -1- I/ Absorption Area Adequate compliance with County and State regulations/requirements Other n / 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 Cully complied with County zoning and building requirements. Con- nection to or use with any dwelling or structures not approved by the Building and Zoning off ice 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 materiel variation from the terms or specifications contained in the application of permit commits a Class 1, Petty Offense ($500.00 fine — 6 months in jail or both). INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER A ADDRESS Z 115 rd f 17 CONTRACTOR( • K0 CR_ ADDRESS i?c (3oK CeJI S v� CIS r PHONE_ q5-_ -7355 'MUNE PERMIT REQUEST FOR (4) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PROPOSED FACILITY• Near what City of Town lakrlh.co4 J1,9ftSize of Lot C, �A ``13 crz S Legal Description or Address 2 1 h (n u -vl- j P rl i 1 7 l -Q v \'occI S p r i v i ciS WASTES TYPE: 06 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER -DESCRIBE BUILDING OR SERVICE TYPE: 3o,\g1{ i'r'1i Iv knot W/Septrc Number of Bedrooms 3 ( Number of Persons z ($) Garbage Grinder ( Automatic Washer (y6) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (y) 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: ( K) 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? LJ b 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 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 permit granted based upon said application and in legal action for perjury as provided by law. Signed 76O 6 Date 311410 l/ PLEASE DRAW AN ACCURATE AP TO YOUR PROPERTY!! 3 Designate North Arrow y L y 0 L ti zo 0 g �z w 0 0 A _c c y ca > o -c 0 it o J , ▪ W l 3 3 0 o A y v O` 09 v v OV N 0 ca V y �� N ct 0 3 tt o c.. C- f C 00 y C v r; o -0 v 0 e) 3 7 Ir y y 0 V .."--9-1/U'D TO "o C!NJ[ 1 y v 0 y . C y L.' .01) C _ x y \ of CO E _ Vs 0 et Q 0 V - y --15,0 C -.0 3 c %' 0 0 3.1 ca 4.n .-r Loc County Road (Note the Road Number and Name) 1 1 Sik -'lan Sitiwtedth Secti7f6S R 89 W of GahICounij, Cokrado kb p SC4l E : I INC! Thst Prop at Page is To NW Corner NE1/4SW1/4 Sec 27 NO2'55'54"E 1755.29' Notes 1) AT CLIENT REQUEST, THIS SOLE PURPOSE OF THIS SITE PLAN 15 TO SHOW A PROPOSED BUILDING AND CERTAIN EXISTING SITE FEATURES SPECIFINO VISIBLEEDTIBY TIES,E SUBSURFACED UTIILIOTHER TIES, APPARENT EAG OSEMENTS DITCHES, ETC. WAS TO BE A PART OF THIS WORK. 2) NOTICE' ACCORDING TO COLORADO LAW, YOU MUST COMMENCE ANY LEGAL ACTION BASED UPON ANY DEFECT IN THIS SURVEY WITHIN THREE (3) YEARS AFTER YOU DISCOVER SUCH DEFECT IN NO EVENT MAY ANY ACTION BASED UPON ANY DEFECT IN THIS CERTIFICATE BE COMMENCED MORE THAN TEN (10) YEARS FROM THE DATE OF CERTIFICATION SHOWN HEREON. 3) RIVER CITY SURVEYS WILL NOT BE RESPONSIBLE FOR ANY CHANGES MADE TO THIS DOCUMENT AFTER IT LEAVES OUR POSSESSION ANY COPY, FACSIMILE, ETC., OF THIS DOCUMENT MUST BE COMPARED TO THE ORIGINAL SIGNED, SEALED AND DATED DOCUMENT TO INSURE THE ACCURACY OF THE INFORMATION SHOWN ON ANY SUCH COPY, AND TO INSURE THAT NO SUCH CHANGES HAVE BEEN MADE Surveyor's Certificate 1, THE UNDERSIGNED, BEING A REGISTERED PROFESSIONAL LAI, LICENSED IN THE STATE OF COLORADO, DO HEREBY CERTIFY r DATE, December 7, 2005, THIS SITE PLAN WAS PREPARED BY SURVEYS, L.L.C. FOR AL NELSON, UNDER MY DIRECT SUPERVI1 CHECKING AND THAT THIS DOCUMENT 15 TRUE AND CORRECT' OF MY KNOWLEDGE AND BELIEF. THIS MAP WAS PREPARED WTHOUT BENEFIT OF A CURRENT TI COMMITMENT NOT SURVEYOR OR RIVER CITYSURVEYSSLL.TITLE C OF THE PROPERTY DETERMINE OWNERSHIP, COMPATIBILITY WITH ADJOINING PARCF EASEMENTS OR ENCUMBRANCES OF RECORD AFFECTING THIS David A. Cooper Colo. Reg. P.L S. # 29030 For, and on Behalf of River City Surveys, L.L.C. he RM Go Jx laeggr _ -- No, 117 Goun�y goad51102400 No, X� arty Described in Book 526 64 afthe Garfield CourrtyKecored5 YW 314.64' ID SURVEYOR, THAT ON THIS Y RIVER CITY SION AND TO THE BEST PTLE Y THIS ( SHOWN TO !LS, OR PARCEL. NOO°09'09"E 34759' N0t 5105'W NOO°30'YTW 134.55' _ 1141/' K'Y Siig p �Gt o°v ac ie ° `f' IS 491602 Qn et -4 P i7 FREP4RED FOR: Al Nelson - phone 970-945-6019 fax 970-945-6022 jcb # 1067 thin by : o. coop plotted .. 12/2/2005 08.22 AM s est# 1 of 1 1067 Al Nelson Site Plan Four Mile Property Sec 27 dwg