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Home My WebLink About02293 ,.. - GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit I 22 9 3 4 4 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 , Phone (303) 945 -8212 t M r This does not constitute t INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. i e PROPERTY f M Owner's Name Queetar Pipeline Present Address P.O. Box 1240. Rifle Phone_ 625'4017 i System Location 0611 Cjunty Road 264. Rifle } ;Legal Description of Assessor's Parcel No. l SYSTEM DESIGN iv 1 7 1-4 Septic Tank Capacity (gallon) Other {{ /it ma-A: i M T • / ,. -(n.. ..- rid Percolation Rate (minutes /inch) Number Bedrooms (or other) 2 ' J."- f/ b • Required Absorption Area -See Attached f!' / r P " o i -t -A t P a - A fl 04 ) -: x / � / a , kit { y C1 -. '� f �t. Y .7« ] '0l nr D)-'<rT,or t Special Setback Requirements: -, /^ f^ -° z . G] l y //�� , � i Date ,7 - ' %</ f`fj Inspector 4—±-7„). (9 f c n+- .... FINAL SYSTEM INSPECTION AND APPROVAL (as installed) '' . Call for Inspection (24 hours notice) Before Covering Installation • System Installer W AL-tilt - s (tuft j1J i • Septic Tank Capacity f X/ S 2t. 1 )f 7 4 Septic Tank Manufacturer or Trade Name 6E-Y i J a Septic Tank Access within 8" of surface 1 . - i f ') a Absorption Area 3 7L2 Absorption Area Type and /or Manufacturer or Trade Name IMC r/.rRri TfA) a 4 �xc.- • Adequate compliance with County and State regulations/requirements YES ? '' Other Date 4' .. '•- Inspector L1-4_, - -/.L!'L rr//� .r'* .% _ p !!"" RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE t, i *CONDITIONS: I. t 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter p 25, Article 10 C.R.S. 1973, Revised 1984. M ,t 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- i nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a r. r requirement of the permit and cause for both legal action and revocation of the permit. p 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material P 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). • ' i { Applicant: Green Copy Department: Pink Copy ". R Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by OWNER. (ve5�e! R, ? �V Q County Official " .ODRESS � 01 � O � .\ . (etc PHONE lq,1S • 101"1 CONTRACTOR ��, �� \ e_ ADDRESS PHONE PERMIT REQUEST FOR: ( ) New Installation ( ) Alteration (y) 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 (\N✓ Near what City of Town Lot Size Legal Description -ee \ )(-14-r \ ()I,P13 ki2 a 9, WASTES TYPE: ()( ) Dwelling ( ) ransient Use ( `f) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms D Number of persons LA ( ) Garbage grinder ( ) Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek X C• Give depth of all wells within 180 feet of system: I If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: p ) 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: V .) 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? 1 • DUE 5.1HR /RIFLE TEL 1 303 625 2940 � ul 06,94 1515 No.003 P.03 ,,,...,.... .,,..," ...�.°..,..�. . A IGlll. ULSCRhI'1ION - PARCEL A i parcel of land located in the NW! of Section 18. T.6 S., R.93 W. and in the NE! of Section 13, :,6 S., R.94 W. of the 6th Principal Meridian, Garfield County, Colorado, being more particularly leccrll,ed as follows: Commencing of the Northwest corner of said Section 18; thence 5.20 e iictance of 254.89 feet to the True Point of Beginning of Parcel "A "; thence N.88 ° 53'E. b distant 176,15 feet; thence 5.07 °16'W, a distance of 442.93 feet; thence S.O9 ° 22'E. a distance of 1;'p.H3 feet; thence S.20`53'E. a distance of 488.78 feet to a point on the Northerly right -of -way ,f old U.S. Highway 6; thence N,88 °28'W. along said right -of -way a distance of 316.02 feet; then - .untinuing along Said right -of -way of old U.S. Highway 6 S,R8 °23'W, a distance of 86.69 feet; tlionce leaving the said Northerly right -of -way of old U.S. Highway 6 N.01 °37'W, a distance of '02.64 feet; thence N.88 "23'C. a distance of 54.92 feet; thence N.01 °37'W. a distance of 120.0 Beet; thence S,88'23'W. a distance of 108.45 feet; thence N.09 "17'C. a distance of 279.12 feet; !hent.a N.57 "31'E. a distance of 148.36 feet; thence N.04 °33'W. a distance of 250,16 feet to the !rue Point of Beginning containing 5.64 acres more or less. • IL PRRCOI.ATION TRST REMIT .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. _ _ me, address and telephone of RPE who made soil absorption tests: :me, 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 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 perniit granted based upon said application and in legal action for perjury as provided by law. 7 / / /?Y Signed e,,JG- 442 Date d I't) Kovic a'[ pi.EASE DRAW AN ACMIRATE MAP TO YOUR PROPERTY - 4 il2 ,2A x , X 7 ctrl, ) • • D 0 k .' o • A P.O.B. . PARCEL R ° 1 11.8 15$ E. a. .o UNDEVELOPED a P.O.B. PARCEL "B" a . .� y!' 1..5646416 8 %> • - - N.47 '1Xj * PARCEL :;: »;" , ",; � o n � � 5.64 Acres • " e t" - U UNDEVELOPED ,, t. P C EL 11 ,: 1 2,00 1 T . 41,* b 't; "" L Iot°NC v AD, r. ' t.; N 16°6047 .. ' 661.94 as. N T ILCH ' WATLN WW 0 u ., t ail �..�� n Is N. 88 25'E 381. w • a 506.42' • 54.82' • P.O.B. PARCEL, 11 PARCEL °C11 Pesai 1 2 2.002 ,A,s7wite.40 imp wou _ WOOD TRAILER 1 Ip p 0� (RAMC 1* 4 ° M ' NOON LIONt roll o N PMOPOSEO /' mr TI.11 WATER SERVICE 4 . - _ 0 1 E -- M'MTRR �VE z WATER VALVt C t • N;. ,t., v f1i 'i , sr a k : I ; ; 3520' r S. 88° 23' W. 443.69' N. OLD U.S. HIGHWAY 6 4 •. 0*00 g ' " OAS com PE NY cOMPRE880R afry-y- PANel'aGg )81i/IL1 1403 .2., d ■ nit l it i pci yi p s * fr r MOUNT Al