HomeMy WebLinkAboutApplication- Permit6o,0 (0117/DS
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Name Ede' 1✓IQrtr CCA. fel) l {q�
System Location /'J05'9 jk 8a CCIrhDrdctc
Legal Description of Assessor's Parcel No. – ; J -- " C or
Permit
4135
Assessor's Parcel No.
This does not constitute
a building or use permit
Present Address, / r7( tB VALA ` d Phony 1 ( 3 81.3
SYSTEM DESIGN
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Att
Special Setback Requirements
Date
FINAL SYSTEM INSPECTION AN OVAL. (as installed
Call for Inspec on (24 hours notice) efor Covering Install
System Ins Iler
Septic Tank Ca
city
Septic Tank Manufa:turer or Trade Name
Septic Tank cess wit n 8" of su
Absorption Area
Absorption Area Type and/or Manufactu 'f 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 (5500.00 fine -6
months in lad or both)
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER C.c. tk Jf
ADDRESS 17 6v 9 `i I{, n +� K S 2 (/ 2:10' C PHONE \110) G t 8- 2 8 1 3
CONTRACTOR rc( C
ADDRESS Z 9 L Hw' h S ! "cc f Ca-bo•n0,, I< PHONE (51 d) 10 q - 91 3o
PERMIT REQUEST FOR (x) NEW 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 E1 Size of Lot 2 A1 A c
Legal Description or Address 1-1 (a c1 `I { ♦, ,�. Z.
WASTES TYPE: (9 DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: Pe -es o "'^-L Ga --a <-
Number of Bedrooms A///i Number of Persons
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: 96 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
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (-;-cit , c t‘ e+
2
SEPTIC TANK
VAULT PRIVY
NT PRIVY
CHEMICAL TOILET( )
( ) AERATION PLANT ( ) VAULT
( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
OTHER -DESCRIBE
FINAL DISPOSAL BY:
(>0 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?
Al
PERCOLATION TEST RESULTS: (To be completed by
Registered Professional Engineer, if the Engineer does the Percolation Test)
Minutes
Minutes
per inch in hole No. 1
per inch in hole No. 2
Minutes per inch in hole NO. 3
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
C—n Date lZ17/li'O C
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
3
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7516
Garfield County
108 8th Street
Glenwood Springs, CO 81601
(970) 945-1377
January 10, 2006
RE: 17694 Highway 82, Carbondale, CO
To Whom It May Concern:
This letter is to inform Garfield County and its inspection representative that all of the uwder- s44
plumbing has been installed in accordance with IBC standards. If you have any questions
or concerns, please feel free to contact me.
Sincerely,
Brian Kurtz, P.E.
Kurtz & Associates Inc.
5012 County Road 154
Glenwood Springs, CO 81601
(970) 945-6305
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Jayano/\ d/V min6aEl 9002
December 20, 2006
To Garfield County Building Department, attn. Tim Holiday:
Due to financial limitation, I was unable to install a septic system at my property
located at 17694 HWY 82 in Carbondale, Co. I do not have any plans to install a septic
system in the future. In the event that I would plan on installing a septic system, I would
reapply for a permit and pay any fees at that time. I understand that this again would be
subject to Garfield County's approval and that the old permit is rendered void. Thank
you.
Caleb Edelman,
Homeowner
RECEIVED
DEC 2 0 2006
GARP IELD COUNTY
BUILDING & PLANNING