HomeMy WebLinkAboutApplication- PermitGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 416 6
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 9454212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Name /1 t' Q
System Location 7 y 0 76- Fid r 2
esent Address 7025
Legal Description of Assessor's Parcel No
SYSTEM DESIGN
Assessor's Parcel No.
This does not constitute
a building or use permit.
z Phone 125 ipa 0
ret_s_ceiii- arts-- Nit- do
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)r)
ki-PLvikft ll–( CY SFPik.
Required Absorption Area - See Attached
Special Setback Requirements:
Date
Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hoursunotice) Before Covering Installation rs
System Installer /` 06 /000
Septic Tank Capacity ace 2
Septic Tank Manufacturer or Trade Name Sit /T ►✓
Septic Tank Access within 8" of surface
Absorption Area p X S
Absorption Area Type and/or Manufacturer or Trade Name % d •;'7/1
Adequate compliance with County and State regulations/requirements Gl✓�G��
Other D�
Date 4 2. . c Inspector
RETAIN WITH RECEIPT RECORDS 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 materlat'
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).
J
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER O7,trta j nAktt A HD
ADDRESS .7O,1S \-L k1.- PHONE 9�5.606o
CONTRACTOR 67a0,1.el pt. a yr, 6, vy
ADDRESS P-Dnose i ttt C-) c,.) S
PHONE L/5- -.2/20
PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION EPAIR D")
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
Legal Description or Address 1()J S j ��-
WASTES TYPE:
Size of Lot .2 / 7 QC r�
( ) DWELLING ( ) TRANSIENT USE
COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER -DESCRIBE
WAIL,
BUILDING OR SERVICE TYPE:W
•
Number of Bedrooms Number of Persons
( ) Garbage Grinder ( ) Automatic Washer
( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: WELL ( ) SPRING ( ) STREAM OR CREEK
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?
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 (septic tank & disposal field) 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
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
pC) SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET( ) OTHER -DESCRIBE
FINALFIDISPOSAL 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? NO
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 egal action for perjury as provided by law.
Signed
PLEASE D
Date V—/7--
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CURATE MAP TO YOUR PROPERTY!!
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12-14-2005 01:30an Fran -MORRIS 1 FYRWALD
Garfield County Permits
108 84' Street, Ste. #201
Glenwood Springs, CO
81601
970-945-8212
To Whom It May Concern:
0700200106 7-060 P 002/002 F-367
December 14, 2005
As owners of the property at 7025 Highway 82, (location of Furniture Farmhouse,
Specialty Sports) Glenwood Springs, CO, Barnett-Fyrwald Holdings authorizes Roto
Rooter Plumbing to act as contractor to excavate and install a new leach field at the above
described address. Please provide Roto Rooter Plumbing with the proper permits
required for the above described repair.
FYRWALD EXEMPTION PLAT
ATED IN LOT 20 OF SEC. 1, T.7 S., R.89 W., LOT 1 IN ,
88 W. OF THE 6TH P.M., COUNTY OF GARFIELD, STATE
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MARKER FOUND
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