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Home My WebLink AboutApplication- PermitGARFIELD COUNTY BUILDING. AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY v1 t � Owner's Name i:� t �t MikJ\ ` 1�? Permit ° a;=. 0 Assessor's Parcel No. System Location laq ( i \y This does not constitute a building or use permit. Phoneii� %� Legal Description of Assessor's Parcel No, 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 J,.l,�r �t!:. � fs e (Jr 2).0 (-1;1 System Installer 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 compliance with County and State regulations/requirements Other /(.,.t .tn;, Gl tr± �"-f '� � ice`? Date 110 C / �,(2' 1 1 Inspector , . I /./( / 2 I SLP /r 'j 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!, Petty Offense ($500.00 fine — 6 months in jail or both), While - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER EA/ Ca.ve , 4; i 1 Gas (v,s`) ADDRESS »i7 Coi'.tfy Sys 54.; k too CONTRACTOR Prc b.; if (is e Coir 1)4,7'rs4^) /77 PHONE /70 d 5"5"- )GOIS ADDRESS PHONE PERMIT REQUEST FOR pe.) 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/fm:/ds /14,14, c j Pe' 4e, 6,4 aiS Size of Lot /Alt Legal Description or Address 5 ee. ,W. e,.l.pkie, 4 WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ("7C), OTHER -DESCRIBE "tot/Or 1 t,-1porg y /iloyee kac•S' BUILDING OR SERVICE TYPE: W. I 1. 1f . Number of Bedrooms Number of Persons g ( ) Garbage Grinder (Automatic Washer ( ),Dishwasher SOURCE AND TYPE OF WATER SUPPLY: N,) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: 4t4e c* wakAaf Se,v s ia^ we « ;r✓ Mesa - DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? 10—I5-.1:is A site i lan is re . uired 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 ttik Percent Ground Slope At 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( ) SEPTIC TANK ( ) AERATION PLANT (>4 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 OTHER -DESCRIBE , lte 4, .- .n E-Jr57.- 'o .ACie asu.t tea. WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 4/0 PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes /14( per inch in hole No. 1 Minutes r+/a per inch in hole No. 3 Minutes _ Nz per inch in hole No. 2 Minutes N' 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 ii,: 411—, Date 7 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 Designate North Arrow Your Neighbor's Name & Address See Your Piot - Shape to Fit (No Scale) 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) arie c:lwpwin60%wpdocs\plot.loc 1 a� PROPOSED LOCATION: 130A 595 MAN CAMP SEE TOPO "6" 1 DRIVING DIRECT/0145 TO I30A 595 MAN CAM PROCEED IN A NORTHWESTERLY, THEN NORTHEASTERLY DIRECTION PROM PARACHUTE. COLORADO APPROXIMATELY 11,1 NILES TO THE JUNCTION OF THIS ROAD AND AN EXISTING ROAD TO THE NORTHEAST; TURN RIGHT AND PROCEED 04A NORTHEASTERLY D1RCC1ION APPROXIMATELY 1.1 KIES TO THE BEOIHNINGOF THE PROPOSED ACCESS ROAD 10 THE NOOfl4WES1; FOLLOW ROAD FLAGS INA NORTHWESTERLY DIRECTION APPROXIMATELY 250' TO THE EXISTING LOCATION. TOTAL DISTANCE FROM PARACHUTE COLORADO TO THE EX15I1NG LOCATION *APPROXIMATELY f 2,2 MHS. MAN CAMP LOCATION: LATITUDE 39 34' 55,59' TONGTRIDE 106 05 33,07' ELEVATION 5955' 1 1I012a.V 131141.%V1 . - Ilk 4, LEGEND: 0 PROPOSED LOCATION Uintah Engineering & Land Surveying 85 Soutb 200 East Vernal. ILitah 84078 (435) 789-1017 "° FAX (435) 739-1813 EnCana OIL & GAS (USA) INC. 130A 595 MAN CAMP SECTION 30, TSS, R95W, 6th RM. NE 1/4 SE I/4 T() P(?G RA I H I C MAP 8 MOOT'II 4 DAY 05 YEAR SCALE: 1:100,000 DRAWN BY:ILL REVISED: 12-7-07 ATTACHMENT 2 sCAM r n 00' WE: 01--30-07 Nowt OF D.R.B. R.Wfl: Ox-Zl-07 0,1.1.0, I R 1M 4EGE14D: '.-.._,.ate.!...: EnC6lna OIL & OAS (USA) INC. LOCATION LAYOUT FOR t - OIEffflOW VW. PAD C28 395 2 -- soar TANI( SEC1IO14 28. '15S. 1195W 6th P.M. J - 107STANN NE 1/4 NW 1%4 4 - 3i IPWR L 5 - WAIE"R TAM 5 - FREEZER 7 - SrARAcc 8 -- G M-PAIQR 9-Frz ro - m kiv- P ME1 LFICURE #11 LT 17150e •Eme £411 00 °MAe 1 1 1 1 1 1 1 1 UIN1'AY BNGINSERTNG A: LAND SURVEYING 66 50. 606 mut • rimed:. Mk 04074 • {1961 754-iot7 1,4_1 LQ ( 0 N (' 1--- z 1- N) Q) N\ (k) QT) ill ME (c) CZ) IEuhIIlIIIIuI 111 1