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HomeMy WebLinkAbout02233 - -. �.,.- „..n.— nw",C ron OTC --"•...,.+^. � s^ r .., r... ,.w„+m- .- ..,.. --.- ,-�- k, w „ _r' x\ 1c - --J I GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N . 2 2 3 3 109 8th Street Suite 903 A is Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 This does not constitute i INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY i , Owner's Name Bruce Hasper Present Ad P . O . Box 1382, Glenwood 876 -2423 Phone_ _ c'� '∎ . >1..h r -- ,.:,.,f rest 1,4 44 14 ,. System Location 0812 County Road 294, Rifle -y,,. re i; Legal Description of Assessor's Parcel No. SYSTEM DESIGN J 060 Septic Tank Capacity (gallon) Other r / .!r! / 40 Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 ( / 7 / r C) 9'07 nz a/10ck + LeAc 1) 13-ed b -''!SI X ' O X ' cep Required Absorption Area - See ittel ,•�/» x' N F T R 4 To !'� �- ,2 �• p e C S Serf y( Special Setback Requirements: C O if t /VC T© Pt o-r; pi e C C $ 4 ' 7 l Date 1/—.2 C 7/ / Inspector �-- 6 ,./..44 ..tn/ 0.1 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours.notice) Before Covering Installation , System Installer - Rs. la 6. /- iivre-,r Septic Tank Capacity /en Septic Tank Manufacturer or Trade Name Al O/C /s/( 41J Septic Tank Access within 8” of surface lJ, Absorption Area 9/ / Absorption Area Type and /or Manufacturer or Trade Name Re#. , /H/cw t`sl,3f 3 p ,.pa S 3 .fie-cr. Adequate compliance with County and State regulations/requirements W7 '5 Other - .c. Date 7- �" �' Inspector Ins 4.. \ P - -- TTTT / s'�'x'4� RETAIN WITH RECEIPT RECORDS AT ONSTRUCTION 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 1 variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 i months in jail or both). 1 'i Applicant: Green Copy Department: Pink Copy J Application ll.TDTVIDU SEWAGE. DISPOSAL. SYSTEM APPT.TCATION Approval 13y County Official OWNER i 1 r•t,c.e `t+rz. r / ADDRESS Po 13az 13 R Z Clo4,r woe-el Sfi PHONE & ZVz 7/ O :ONTRACTOR SC iA A . ADDRESS PHONE ERMIT REQUEST FOR: 06 New Installation () Alteration () Repair .ttach separate sheets or report showing entire area with respect to surrounding areas, topography of area, abitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes See page 4). .00ATION OF PROPOSED FACTT.ITY : County Ca-' ct el. 4 C Jear what City or Town i Lot Size / 2 ax 1-4-'" • .egal Description VASTES TYPE : (>4 Dwelling () Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe IUILDING OR SERVICE TYPE: - r 4 ^-t . t y lumber of bedrooms 3 Number of persons Garbage grinder ( ) Automatic Washer ()r) Dishwasher ;OURCE AND TYPE OF WATER SI JPPT,Y: ( ) well () spring ( ) stream or creek 3ive depth of all wells within 180 feet of system: f supplied by community water, give name of supplier: 2i •(- 1R01JND CONDITIONS: )epth to bedrock: )epth to first Ground Water Table: 'ercent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_Jn cP Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: QC) 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: 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? n 0 c • 011. PE.RM'.ATION TEST RESIN .TS: (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 No. lame, address and telephone of RPE who made soil absorption tests; lame, address and telephone of RPE responsible for design of the system; Cl-- ^ Q- ' 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 permit is 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 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. Date ' " 2S - `1 v Signed "- ~�� p1,EASE. DRAW AN ACCIJRATF MAP TO YO1 JR PROPERTY 7 ` 1 III i \ (n/ a t Y • . . - --�—.. / 0 • pi.nT 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. b 30 \ N 3, K �'po0 GAL SLPTIC1AN 6 27� 1 0 itB SORPT )0N TRNCHe v J • PROPERTY DESCRIPTION ORDER NO: 93021258 The s1/2 of all of the following described tract to wit: All that part of the W1 /2SE1 /4SW1 /4 Section 10 Township 6 South, Range 93 West of the 6th P.M. described as follows: Beginning at the Southwest Corner of the SE1 /4SW1 /4 of said Section 10; thence North 1290.00 feet to a point on the southerly boundary of a county road; thence East 285.11 feet along said county road; thence S. 06 degrees 51' W. 259.94 feet; thence S. 02 degrees 31' E. 333.09 feet; thence S. 29 degrees 34' E. 156.69 feet; thence S. 28 degrees 10' W. 85.02 feet; thence S. 03 degrees 25' E. 81.02 feet; thence S. 09 degrees 18' W. 199.51 feet; thence S. 24 degrees 45' W. 231.40 feet to a point on the southerly line of said Section 10; thence West 181.61 feet along the southerly line of Section 10 to the Southwest corner of said SE1 /4SW1 /4, the point of beginning. COUNTY OF GARFIELD STATE OF COLORADO I / S � /V -T . ty: z 3 9 33 q y 3 to � I y y ' l !d' 9 ' y y /i 9' [ 0 6-i-1 to "A Y 4 1 0 3 9.. 3 , 9.•2 3 , , (,/ 1 I a i 67pfO ° . " z / 3 4 - r 3 / ir 3 - /G ( / il .-t64 l4 h- 75 e.t.a .Q d % ° /3/ 7