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Home My WebLink About02041 1 1' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT ' Permit N: 2 0 4 A j 109 Sth Street Suite 903 A is Parcel No. I Glenwood Springs, Colorado 61601 03 9 S /3 /- • ♦ , • Phone (903) 945.8212 ' '' k This does not constitute ,, r" r.. ' a building pr use permit. INDIVIDUAL SEWAGE DISPOSAL PERMIT 1 ) PROPERTY ' l y . Curtin A. Trautman 1020 L(atacm Ct. 4 7. o - S. 928 -0794 Owner's Name Present Address Phone System Location 0050 Lariett Lane, Teller Springs, Lot 17, Carbondale Legal Description of Assessor's Parcel No. i SYSTEM DESIGN 1 i 4 000 Septic TTaannk CaCappaacity (gallon) �n -� , j'`_' Other / / q r elation Rate 1 Inures /inch Numbiiof Bedrooms (or other) 4 i Required Absorption Area - See Attached __ Special Setback Requirements: Date /"',,�e 0- Inspector . Env , ( )A,,.Ptu FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ' i Call for Inspection (24 hours notice) Before Covering Installation 1 I System Installer r Ci . ' �'f /;� a Septic Tank Capacity ilJ3() »)rPyyfr Septic Tank Manufacturer or Trade Name o f Septic Tank Access within 8" of surface Ai [ r1 f Absorption Area / F '/ . ,,1 X i G. , it x i^ ^ S - //c) ! j .0 J Absorption Area Type and /or Manufacturer or Trade Name t.4.2�.__f_4 f / Adequate compliance with County and State regulations/requirements 1. Other Date �� 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 c sr 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 sew 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 (5500.00 fine — 6 months in )all or both). — - -- -- Applicant: Green Copy Department: Pink Copy Application. ".` INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by Official: OWNER Qt vTi 5 4. '1 tot ,„ S fS•V's ADDRESS /O 20 ran-t» * PHONE 9� 0- 079 V / CONTRACTOR_ ADDRESS _ PHONE PERMIT REQUEST FOR: (44-46 ( ) 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: County �CaAd Near what City of Town ed%) 1- tlh -.¢ik Lot Size cv l tJ Legal Description % P7 b1..6 4 �tti /a Ol7S"o G4.F L2n Uv WASTES TYPE: ( ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe ////� BUILDING OR SERVICE TYPE: )/,r _l, f& N �✓tA _. Number of bedrooms tj V Number`df persons 0 (arbage grinder (4 was Her ( dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: /�friv2 I If supplied by community water, give name or supplier: 4(t-nwd- ovA4 �da� /2i, -i �/ GROUND CONDITIONS: Depth to bedrock: C1....11,000K c(2 CO-P. QS /L NO Teo c K Depth to first Ground Water Table: _ Percent ground slope: cW/kZ • ' r A- /-6O _ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: D S /I/f ,fa _ Was an effort made to connect to community system? in.n TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( 1eptic Tank ( ) Aeration Plant ( ) Vault 2 (Vault Privy ( ) Composting Toilet ( ) Recycling, potable use o ( ) 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 ( ) Other - Describe: — — -. WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? Na. • • • SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) 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 Mo. Nance, 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 purposes of the evaluation of the application; and the issuance of the permft subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements 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 under- stand 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 per- jury as provided by law. Date Signed /; ; • , i ■_J ._ PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY IG• 6 � ' NC r — j prf} j /0, ce- Pnnp 1 tz" 4 7 N_ S TELLER SPRINGS 6. LOT SETBACKS ARE: 25 FT. FRONT 25 FT. BACK 10 FT. SIDE 7. LAND USE SUMMARY: EXISTING ZONE: AGRICULTURAL /RESIDENTIAL -RURAL DENSITY. ROAD R.O.W. IS 1.953 ACRES MORE OR LESS. OPEN SPACE IS 31.409 ACRES MORE OR LESS. TOTAL LOTS IS 141.904 ACRES MORE OR LESS TOTAL DEVELOPMENT IS 175.266 ACRES MORE OR LESS. TOTAL NUMBER OF LOTS 21. 8. EASEMENT HOLDERS OF RECORD: MOUNTAIN STATES TELEPHONE S TELEGRAPH COMPANY 931 14TH STREET DENVER, CO 80202 ROCKY MOUNTAIN NATURAL GAS CO. 2517 GRAND AVENUE GLENWOOD SPRINGS, CO 81601 GARFIELD COUNTY (ROAD 109) 109 8T11 STREET GLENWOOD SPRINGS, CO 81601 9. THE 60 FT. GAS, TELEPHONE AND WATER EASEMENT IS AN ENLARGEMENT OF AN EXISTING 50 FT. GAS EASEMENT. ROCKY MOUNTAIN NATURAL GAS WILL ALLOW THE TELEPHONE AND WATER LINES TO PARALLEL THE EXISTING GAS LINE, HOWEVER, THEY SHALL BE LOCATED ON THE EAST SIDE OF THE PIPELINE AND SHALL BE NO CLOSER THAN 15 FT. TO THE PIPELINE. 10. PRIOR TO ANY EXCAVATIONS, ALL UTILITY COMPANIES SHALL BE NOTIFIED FOR A FIELD LOCATION OF THEIR RESPECTIVE UTILITY. 11. 15 FT. UTILITY EASEMENT ON ALL LOT LINES AND EXTERIOR BOUNDARY LINES, 7.5 FT. EACH SIDE OF COMMON LINES UNLESS OTHERWISE NOTED. 12. DEBRIS FLOW HAZARDS MAY EXIST ON LOTS 1, 2, 3, AND 4. STRUCTURAL HAZARD MITIGATION MEASURES ON THESE LOTS SHALL BE DESIGNED AND CERTIFIED BY A QUALIFIED ENGINEERING GEOLOGIST AND ALL IMPROVEMENTS \ • • • • • • ,, r ti • • • D ° a 0 �'. 4 � • • • • • • • • .� \ \' � ,BusJossTcoiipoa *n 1 1 a division of TJ i ' terriationai PACIFIC INLAND OPERATIQMS -+ WESTERN SLOPE SALES OFFICE 201 Centennial Street • SOB 107E • Glenwood Springs, CQ 81605. DAVID SACK ..: Taohnicat Representative 6 stiivorii 27.5 /i2 ¢ 7 2qA 22P ).3 - / 924, / E0100/1/ I /c)9,9 _ 4/: / ra bbh t 30 h �f lv 70 /:I el 07 ,/`safe( g /�;_ 6o ' t &jts V tzs • _ JOB NAME: JOB # LOCATION: —__ SHEET SALESMAN: _ BY _ ___— DATE: __ — PLOT PLAN AND DESIGN FEATURES: Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, water course, stream, dry gulch and show location of proposed system by direction and distance from dwelling or other fixed reference object, and additional submissions in support of this application such as data, plans, specifications, statements and commitments. Page 4 • • • / r • • • . o • • 4 ?,/' • • • • v c - c , ti..; �\ CO 1. • ` i