HomeMy WebLinkAboutApplication-Permit.pdfProject Address 5250 CR 342 SILT, CO Owner Information Gartield County Building & Planning Department 108 8th Street Suite 401 Glenwood Springs, CO 81601· Phone: (970)945-8212 Fax: (970)384-3470
Parcel No, 245510400043 Address Phillip Danielson po box 331 New Castle CO Subdivision Issue Date: 4/1612010 Phone Pennit "yne: Septic Permit Work. Classification: New Penni! Status!
final Expires: 01/01/2999 Section Township Range 10 8 92 Cell (970)876-2335 Contractor!s) Phone Primary Contractor Required Inspections: OWNER Yes ''''''p"IIo"",II, 1 (888)868-5306 Proposed
Construction I Details $ 0.00 Inspection IVR Single family residence. Valuation: Total Sq Feet: 0 final I 125 Perc Test 615 FEES DUE FEES PAID Fee Amount Inv Total Pay type Amt Paid
Amt Due Percolation Test S100.00 Inv # SEPT-4-10-20169 Septic Fee · New $73.00 $ 173.00 Check # 1286 $100.00 Total: $173.00 Check # 5149 $73.00 $ 0.00 IMPORTANT: APPLICATION IS HEREBY
MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: Applicant Copy 1. Final inspection of the work
authorized by this permit is required. A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings, structures and remodeling work. I This permit/pian review
expires by lime limitation and becomes null and void If the work authorized by the permit Is not commenced within 180 days from the date of permit Issuance or If the permit Is not obtained
within 180 days from the dale of plan submittal. This pennlt expires and becomes null and void If any work authorlzed by this pennlil. suspended or abandoned for 180 consecutive days
or If no progressive work h .. been verified by passing .. required County Inspectlon for I period of 180 consecutive day •. Wednesday, August 24, 2011 1
I 2 3 4 5 6 7 8 9 10 II 12 t3 14 15 16 17 GARFIELD COUNTY SEPTIC PERMIT APPLICATION 108 81h Street, Suite 401, Glenwood Springs, Co 81601 Phone: 970-945-82 12 /Fax: 970-384-3470 /Inspection
Line: 970-384-5003 www.l!flr nIe Id-count '.com Pp~1 No: (this in,alion is aVaip~e al lhe assesscxs office 970-94S-91j) , • arc<.1 'ur'j WI'»" S.,L. IVISI(lV) £",''''(>;101'') Job Address:
(if an address has not been assigned, please provide Cr, Hw(or Street Name & City) or and legal description S:J.. ,0 cR. 3'-/1-. Lol Size: Lot No: Block No: Subd.! Exemption: 1'3 + ACy-rS
O .. mer: (property ,,,,,er) Mailing Address Ph: lfj,;/J,p OaVl;-elsoVi fO, /3",x :331 '70-9(1'1-b 2. flo p~~raclor: ,!lIP Do >1"-( ) SCI j/\ 'P_.;J,,g AdB;~'I I '3 '3) Ph: "f10-'/[/L)
-{/~rfO Engineer: Mailing Address Ph: PERMIT REQUEST FOR: (><j New Installation ( ) Alteration AItPh: All Ph: AltPh: ( ) Repair WASTE TYPE: (><jDwelling ( )Transient Use ( )Commercial
or industrial ( )Non· Domestic wastes ( )Other -Descnbe BUILDING OR SERVICE TYPE: J> f" R. Number of bedrooms 'i. Garbage Grinder ( )Yes ~No SOURCE & TYPE OF WATER SUPPLY: (>IlWELL (
)SPRING ( )STREAM OR CREEK ( )CISTERN If supplied by COMMUNITY WATER, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: t:!.~ ",e. Was an effort made to connect to the
Community System? YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN GROUND CONDITIONS: Depth 10 1" Ground Water Table Percent Ground Slope TYPE OF
INDIVIDUAL SEWAGE DISPOSAL SYSTEM (lSDS) PROPOSED: (XSeptic Tank ( )Aeralion Plant ( )Vault ( )Vault Pnvy ( )Composting Toilet ( )Recycling, Potable Use i iOlher. Descnbe ( )Recycling,
other use ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet FINAL DISPOSAL BY: I)(lAbsorption trench, Bed or Pit ( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiralion
( )Sand filter ( )Waslewaler pond ( )Other· Descnbe Will effluent be discharged directly into waters of the stale? ( )YES ()()NO PERCOLATION TEST RESULT: 110 be comPeled by Regislered
Professionaf Engineer, Wth e Engineer does ,he Perrota'ion Tesll Minules 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._
Name, address & telephone of RPE who made soil absorption test: Name, address & lelephone of RPE responsible for design of the system: Applicant acknowledges that the completeness of
the applicalion is conditional upon such further mandatory and additional test and reports as may be required by the local health department to be made and fumished by the applicant
or by the local health department for purposed of the evalualion 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 regulalions made, information and reports submitted herewith and required to be submitted by Ihe applicant are or will be represented to be true and correcl
to the best of my knowledge and belief and are designed to be relied on by Ihe local departmenl of health in evalualing the same for purposes of issuing Ihe permil applied for herein.
I further undersland that ,~~:sifi~4~r misrepresentation may result in Ihe denial of the application or revocalion of any permil granled based upon said application and leg~ f ,q;:z,
; ~ ovided by law. "" 1/";1. OWNERS SIGNATURE DATE STAFF USE ONLY Permit II: )1-Perk Fee: V~ ff{) ~'o tal fees: ~n ·()(J Septic Permit : \ ___ \C)2 \ Issue Date: AI'PROVAL DATE
ISDS FIELD REPORT # 1 PERMIT# 4-1 0-1 521 PARCEL # 2455 1 0400042 OWNERS NAME PHIL DANIELSON ADDRESS ____ ~5~2~5~0~C~R~3~4~2~ _________________________________ __ SYSTEM DESIGN # BEDROOMS
____-'3"'-''../...{2,"'-_____ _ GARBAGE D ISPOSAL (CIRCLE ONE) YES NO SEPTIC TANK CAPACITY (GALLO~OOO G'9Jz 50 GAL PERCOLAT I ON RATE (M I NUTES/I NC H) _2""",3C!I,-,N",C",H!£/..!M""'-!1N
'--______________ REQUIRED ABSORPTION AREA &0 tJ ..5~. ,r~ __ -,9,,-,0:c6= @QFr. (ROCKLEACHFIELD-FROMCHART) 453/302 SQ Fr. IN TRENCH 46/31 QUICK 4. 34" # UNITS (TYPE) 544/362 SQ Fr.
IN BED 60 /40 QUICK 4. 34" # UNITS (TYPE) DATE 4-22-10 REVISED 4/20/1 1 INSPECTOR MATT M PROVOST
GARFIELD COUNTY BUILDII~G AND SANITATION DEPARTMENT 108 Eighth Street, Suite 401 Glenwood Springs, Colorado B1601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Permit
....,. /S-c: I Assessor's Parcel No. This does not constitute a building or use permit. Owner's NamellWtELS'oAi Present Address S-z: S-CJ C£.31-'Z. Phone -----System Location __----'....5:=~"JL/Yl"__
L~~_ ___________________________ legal Description of Assessor's Parcel No. Z 1-.s-S-/t:'?-(/t7 CJ 1--z SYSTEM DESIGN ______ Septic Tank Capacity (gallon) Other _ -Z=~3~ __ Percolation
Rate (minutes/inch) Number of Bedrooms (or other) __ Z=-_ Required Absorption Area -See Attached Special Setback Requirements: Date ________________ lnspector __________________________
_ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation Septic Tank Capacity /c2C2 C GA c:... Septic Tank Manufacturer
or Trade Name Cc::>/~ .,,:(A@C o#cte~ Septic Tank Access within 8" of surface ____ --,Y,,;c.-'£"''''-~5'''''__. ________________________ _ Absorption Area GS'C!> St:? EC @c/< ~Ac/l mc..,l2
Absorption Area Type and/or Manufacturer or Trade Name ______________________ ___ Adequate compliance with County and State regulationsfrequirements ______________ . Other ___________________
~----------------------Date W' -/1-= -//Inspector prl kt.d~ 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 19B4. 2. This permit is valid only for connection to structures which have
fully complied with County zoning and building requirements. Connection 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 1, Petty Offense ($500.00 fine
-6 months in jailor both). . White -APPLICANT Yellow -DEPARTMENT