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Home My WebLink AboutApplication- PermitGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT p��s PROPERTY S»ou) lira 53 Vi /1a untie S us.ot1-1'4e�'+ Owner's Name resent Address gbfaD64u5Aej<ty* Permit N° 3157 Assessor's Parcel No. This does not constitute a building or use permit. Phone 9a 9�. C}oq ‘if.piwoc,cp AltCerf bola G . 379'. 9 System Location Legal Description. of Assessor's Parcel No SYSTEM DESIGN 1 F b D 0 Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: 1 Date ' Inspector 6s 7 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) CaII for Inspection (24 hours notice) Before Covering Installation System Installer 0 (...i., H E,y Septic Tank Capacity 1200 Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surMace Absorption Area COPCC AN( D Gv Absorption Area Type and/or Manufacturer or Trade Name 6 s. ,ol ec V Adequate compliance with County and State regulations/requirements Other (L O Date 1 j { � { � 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 -8 months In jail or both). White - APPLICANT Yellow - DEPARTMENT • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER //L £ L o0 ge-ei r 5,44 — D/9 -0 -EL cvi r ADDRESS (-48 Cieffiait0 fi PHONE q 2-3 -1/ /371%51- CONTRACTOR ad r) Cte ADDRESS Sq/11 PHONE PERMIT REQUEST FOR SEW INSTALLATION ( ) 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: Near what City of Town Ca dc'' c, Legal Description or Address 1 /5, /6 a"a S/ 8/014 WASTES TYPE:(, DWELLING Size of Lot /Z567 11 17"://- 3 7�/ 3, Tew41fr re t ( C0 -0/07 -on ,6oY`-p-cf) trj (40/0 ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Si7+�t �A/ilrly 5 -7 -roc Bu, tr Number of Bedrooms ( ) Garbage Grinder Number of Persons (464 Automatic Washer 64 Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK Car -6.5m a q fe Gva- j v If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? IMT ;MAk ifl Stera K K A site plan is required to be submitted that indicates the following MINIMUM distances: Leach Field to Well: 100 feet Septic Tank to Well: 50 feet Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet Septic System to Property Lines: 10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope £ 2 1 TYPE O.INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: t}--- 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? /JD PERCOLATION TEST RESULTS: (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. Name, 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 purposed 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 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. Signed Date PL DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 ACCORDING TO COLORADO LAN YOU WST CODE AMY LE ACTION IAs IRDN AMT DEFECT 1N TNts 'METNINONTREE f AFTER YOU FIR T DIICD GOON Oi CT. IN 116 WY ANY ACTION RAZED UPON ANY DEFECT IN 1S SURVEY RE MO THAN TER YE i FROM TIE CF TEE CERTIFICATION RND*I HEREON. FOs.1ND REBAR & CAP MARKED L S. 5447 0 0 z I(1 4 6V(K i 05 1 SET REBAR & CAP MAR ED L.5 t4III IMPROV. S!NGLESTOR'f FRAME fil!I�LINC� 89` OC'E 5C T.,EP ANOUT ai'' ARE SEPTI SYSTEM PROH!BITED WEST OF THIS Drct- LINE 1 / N 89°22 00'W 152 50 �7 -MENT SURVEY x Tr