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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit
4478
108 Eighth SSuite 201 Assessor's ParcelM hu
Glenwood Spriringss,, Goloradof 81601 /�
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
This does not constitute
a building or use permit.
PROPERTY -}_J*0 N,L SthOreDI
Owner's Namef a 11-dI ff l/tn 1C{acrI e Present Add ress4 .4 �Ch`r-�U�d0 Phon4/' LAM ss"q
System Location 1 f l ` (1,1 atm lye 6 �jS�� ?till--
J1�" !�, I/
Legal Description of Assessor's Parcel No. _ 1 (: ,I 1 ` 1 VI 1 1 1 C, I v`� 1 I L
SYSTEM DESIGN
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch)/X1 Number of BedroomsQ(or other)
Required Absorption Area - See Attached /y�o✓C{��,.+¢pG�� �`""' e zet7n et
Special Setback Requirements: '" / t W to-C-aoer
Date Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity
Septic Tank Manufacturer or Trade Name
92%,J flsr . , 200 7
Septic Tank Access within 8" of surface (ter
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
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
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 I, Petty Offense ($500.00 fine —6
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
GARFIELD COUNTY SEPTIC PERMIT APPLICATION
108 8th Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003
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Permit Fee:j
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Parcel No: is informafion is available at the assessors office 970945 134)
2
Job Address: (if an address has not been assigned, pleasepro iddeCr, c or Street Name & City) or and legal description
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3
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Lot Size Lot No: Block No: Subd.l Exemption:
Building & Plannin: • :. t:`y
0 41
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APPROVAL
4
Owner: (property owner)
CLe)ce Westc.lrw�40,
Mailing Address
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Contractor O /
Mailing Ad¢yt
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Alt Ph:
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Engineer. �/7
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PERMIT REQUEST FOR: ' -3 (' New Installation OAlteration ( ) Repair
8
WASTE TYPE: ( welling ( )Transient Use ( )Commercial or industrial )Non- Domestic wastes
Describe
( )Other-
OR SERVICE TYPE:
9
BUILDING
Number of bedrooms Garbage Grinder ( Yes ()No
10
SOURCE & TYPE OF WATER SUPPLY: ( ELL ( )SPRING ( )STREAM OR CREEK ( )CISTERN
WATER, of supplier:
If supplied by COMMUNITY give name
SEWER SYSTEM:
11
DISTANCE TO NEAREST COMMUNITY
Community System?
Was an effort made to connect to the
YOUR
INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
12
GROUND CONDITIONS:
Water Table Percent Ground Slope
Depth tor Ground
13
TYP F INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:
( eptic Tank ( )Aeration Plant ( )Vault ( )Vault Privy ( )Composting Toilet
( )Recycling, Potable Use ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet
)Other- Describe
14
(
FINAL DISPOSAL BY:
( )Absorption trench, Bed or Pit ( nderground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter
Describe
( )Wastewater pond ( )Other- /
15
Will effluent be discharged directly into waters of the state? ( )YES NO
16
PERCOLATION TEST RESULT: (to be completed by Registered Professional Engineer, if the Engineer does the Percolation Test)
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.
test:
Name, address & telephone of RPE who made soil absorption
for design of the system:
Name, address & telephone of RPE responsible
17
Applicant acknowledges
the local health
issuance of
reports submitted
and are desig
understa.te�.1any
and le
that the completeness of the application is conditional upon such further mandatory and additional test and reports as may be required by
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
the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations made, information and
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
•d 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
�rfi•.ti. or i�representation may result in the denial of the application or revocation of any permit granted based upon said application
for luas..-i1,. • • ; / —022/ � --.Or
OWNERRSS SIGNATURE DATE
Permit Fee:j
v
Perk Fee:
''~
Total fees:CC,Build+ting
Permit
100-11
Septic Permit #:
L11 -1---M
Issue Date:
i126)IOF34
Building & Plannin: • :. t:`y
0 41
or
040
APPROVAL
DATE
Jul 10 2008 3:46PM HP LASERJET FAX
JUL-B-2008 08101 FROM:WESTERMAN 13126645838 T0:19708765893 P.1'1
CIVOL ENOINEtrOING
November 20, 2007
Garfield County Building Department
108 Sal Street
Suite 401
Glenwood Springs, CO 81601
Re: Westerman ISDS -
HCE Job No. 2051602.00
To Whom it may concern:
LAND SURVEYING
The 'following letter is to confirm the Engineer's acceptance of the constructed individual
sewage disposal system for the Westerman residence located up 4 mile in Garfield County,
Colorado.
The design included a 1,250 gallon septic tank, and 105 Quick 4 infiltrator units. These units
were installed at the location and configuration shown on the drawings.
The system.. has been completed with the intent of the original design.
Please contact me at High Country Engineering, Inc. if you have any questions or need
additional information.
Sincerely,
HIGH COUNTRY ENGINEERING, INC.
ger Neal
rincipal 'Engineer
1517tIakcAvonue,sufte lot
Olenwocd Sprints, CO 81601
Telephone (970)9453676 - fax (970) 045.2S55
14 Inv4maw Drive Gaut Suite F -I 20
Englewood. CO ROI 11
Telephone (303) 925.0544- Fuz (302)025-0547
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