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Home My WebLink About03922' i ~ • • . I Jj' >lo. J GARFIELD COUNl!Y BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81801 Phone (303) 945-8212 Permit N: 3922 Assessor's Parcel No. i INDIVIDUAL SEWAGE DISPOSAL PERMIT This does not constitute a building or use permit. I PROPERTY ·, '.} j Owner's Name~=!..U~~d>'-f.::J.M~-?;P~ '" i •'' -· ' ' ·' " • •. < I I j I ~ • • " i , I • I ' j 1 • ' ' ' i Legal Description of Assessor·s Parcel No. ----.-------.~-----,~~~m'"""-7/'--'-J__,,7 __ _,,3,._S=-,,,3--_,,;CJ?=-""'-----l.J--'--'g..L!_7 ___ _ · 3-:z_f P~ -"'-..::ot-c. <=Jo + , ~". ~ . .;.<a&-t. ~ SYSTEM P£$IGN1 tT~ "\ ' ~/ _cD_O ___ Septic Tank Capacity (gallon) ______ Oth8r ~ ______ Percolation Rate (minutes/inch) Number of Bedrooms (oi other) -~!; __ _ Required Ab~rption Area • See Attached \ ,.,,\..-·-.. Speci\al Setback Requirements: Date _____________ Inspector ___________________________ _ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer ________________________________________ _ Septic Tank Capacity~/~,~~·_:S_u_\ _________ _,~_,_,.UL(.,,.__1L~==~'"""l<---''--S...,./"'-"'lffktf/c==.L..--------- Septic Tank Manufacturer or Trade Name-------------·------------------- Septic Tank Access within 8" of surface ----~-------------------~,,._ _____ _ :/ s A *~J ""· Absorption Area --------~-"i'.,,_ ______ ~~'-''L~-jL=---~frti_._~'\XQ_.'--'~~rti11~~--''~ I:_,___·~""---- """ Absorption Area Type and/or Manufacturer or Trade Name-------------------------- Adequate compliance with County and State regulations/requirements _____________________ _ Other ________________ ~~""°',.,.._ _____ ~-------------------Date~4'~·~2~S~·-D_•~/ _____ lnspector:i:.C!,J ':I A.1JOC1M""iA J,::,p;( /b~cj 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 • .. ' ., • I I ' • • I l, •• ;,1~. .:... __ r "' ' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION 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: NearwhatCityo.Town Q.~ ~ SizeofLot~ b LegalDescriptionorAddress #ii(J;A.~t 0,) '6f1:ti 1 (\) 'tLLeR)/ PAW'.~()(-@~ WASTES TYPE: p0 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ()OTHER-DESCRIBE _______________ _ BUILDINGORSERVICETYPE: ~~(.e .c~.l k=f<\\'wJ," l Number of Bedrooms -~~---------N.umber of Persons _ _,·~....J---- ( ) Garbage Grinder K) Automatic Washer SOURCE AND TYPE OF WATER SUPPLY: K> WELL If supplied by Community Water, give name of supplier: e)J Dishwasher ( ) SPRING 'ND ( ) STREAM OR CREEK ,? DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_~\ l~)__ip~J>.+..._,0 ______ _ Was an effort made to connect to the Community System? --------------- A site plan is required to be submitted that indicates the followini= 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 INDMDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: ' Depth to first Ground Water Table. __ -'.-"J="C:'-'--"---':+--L----------------- Percent Ground Slope __________________________ _ ,. ... TYPE OF INDNIDUAL SEW AGE DISPOSAL SYSTEM PROPOSED: % SEPTIC TANK ( ) AERATION PLANT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) CHEMICAL TOILET( ) OTHER-DESCRIBE FINAL DISPOSAL BY: ~ ABSORPTION TRENCH, BED OR PIT 9 J.·kERGROUND DISPERSAL ( ) ABOVE GROUND DISPERSAL ( ) ( ) ( ) ( ) VAULT RECYCLING, POTABLE USE RECYCLING, OTHER USE EV APOTRANSPIRA TION SAND FILTER WASTEWATER POND ( ) OTHER-DESCRIBE _______________________ _ WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?~NJ>~- PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe Engineer does the Percolation Test) Minutes ____ _,,er inch in hole No. I Minutes _____ per inch in hole No. 3 Minutes ____ per inch in hole No. 2 Minutes er 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 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· .\.,~A._WL -Date $:.;)C, =NI PLEAS~ ACCURATE MAP TO YOUR PROPERTY___.....!!'---"''-"'--......... t------- I • )\)o..,."\>i---+ Designate North Arrow Your Neighbor's I Name&Addr ess I ¥ I Your Plot -Shape to Fit 5..;1'-1.~ - c:V ~l ;;..P~ r,,; _.,.ff!J.._ 1~ ~ ~- \ ~i/n I j>? --. -., Locate well, all streams, irrigation ditchs, and any water courses. Draw in your house, septic tank & system, detached garages, and driveway. If a change oflocation is necessary, you must submit a corrected drawing, before a Certificate of Occupation will be issued. County Road (Note the Road Number and Name) enc c·\wpwm60\Wpdoca\plot.loc L3A) \ ~81\ ~our Neighbor's ame & Address CHURCH & Associates, Inc. June 25, 2004 Gary Wallace P.O. Box 201 Rifle, Colorado 81650 ENGINEERS & GEOLOGISTS Subject: OWS Installation Observation, Proposed Residence I 065 Gage Road -Garfield County, Colorado Job No. 16464 Mr. Wallace, As requested, we observed the installation of the onsite wastewater system for the subject site on June 22, 2004. The system was de~igned under our Job No. 16464, with a final revision date of June 8, 2004. The system includes the installation of a I 000-gallon, two-compartment, plastic septic tank and nine gravelless chamber-trenches. Six trenches had one row of 11 chambers each, one trench had 9 chambers, one had eight chambers, and one had five chambers for a total of 88 Infiltrator™ EQ-36 chambers and 1404. 9 tt2 of infiltrative area. An as-built drawing is included as Figure 1. The observed components of the OWS were installed in general conformance with our design. Our instal- lation observations do not imply a guarantee or warranty of materials or workmanship. Sincerely, CHURCH & Associates, Inc. Eric R. Burns Field Technician EOC/erb 2 copies sent Reviewed by Copy to Garfield County Building and Sanitation Department Attn: Andy Scwhaller 108 8th Street, Suite 20 I Glenwood Springs, CO 81601 DENVER 4501 Wedsw-Boulevard Wheat Ridge, CO 80033 303.483.9317 Fax: 303.483.9321 www.geo-church.com Toll Frea-1.877.248.3123 1 065 GAGE ROAD SCALE GARFIELD COUNlY, COLORADO 1" = 30' 3-BEDROOM RESIDENCE CONCRETE DISTRIBUTION BOX (FLOW LEVELERS TO BE INSTALLED) 4" PVC HEADERS JOB NO. 16464 4" SEWER LINE WITH CLEANOUT DRIVEWAY ----. 1000-GALLON, TWO-COMPARTMENT, PLASTIC SEPTIC TANK 4" PVC EFFLUENT LINE 1404.9 SF OF INFILTRATIVE AREA IN 9 GRAVELLESS CHAMBERS-TRENCHES. A TOT AL OF 88 INFIL TRATOR(TM) EQ-36 CHAMBERS WERE INSTALLED AS-BUil T DRAWING OBSERVATION/ VENT PIPES FIGURE 1