HomeMy WebLinkAboutApplication- PermitSbidr
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY 1I /
Owner's Name 1 1B_ (1
System Location
Legal Description of Assessor's Parcel No
SYSTEM DESIGN
Permit
4061
Assessor's Parcel No.
This does not constitute
a building or use permit.
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��Pres�eennttt Address 11 l� S - cf it?4, ' t f tt4�p� Phone
Ion [44 ✓l9. %fRAmiekP.Sili
X393-�y�+- ozs-c 9
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer t2 --as( 1,14-1-1-4 COY � b1_INrr,4+ r
Septic Tank Capacity 'o
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
Other
Date L Z -CJ c/o Inspector l'i'lt, -
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).
c INDIVIDUALS SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER tte)2 � ►tc („ QAV117 ✓EaA.0 ?)
ADDRESS II WI CI.4Pia'P (0 T . f s,rel1/4I &IPHONE � ZS Z I00 A'
CONTRACTOR }grin I I G lti • 4( CO
ADDRESS I l' •GI, ' N6 ' ' PHONE 92S.2(00)Z
A,{m ttryrp/.r0.g RD 113. Ca.rlxx+da(e t PAct1l... sin . oZ40
PERMIT REQUEST FOR (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 C.�joncia(e
Legal Description or Address IOf 4 . West g m ei* C
WASTES TYPE: (WDWELLING
Size of Lot al .(0 +5 ACMS
5tbdi»»s10i Cxl rft e(d W . 0 IL (e4e
( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER—DESCRIBE
BUILDING OR SERVICE TYPE:
Number of Bedrooms
�J1
3 4D be E'if'j il-pksti Number of Perso
(tic Garbage Grinder (4<utomatic Washer
SOURCE AND TYPE OF WATER SUPPLY: (U)WELL
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 4' mites
( t)Ifishwasher
( ) SPRING
( ) STREAM OR CREEK
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:
Septic Tank to Well:
Leach Field to Irrigation Ditches, Stream or Water Course:
Septic System (septic tank & disposal field) to Property Lines:
100 feet
50 feet
50 feet
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 I 0 ^' i ( Q u/O
2
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( V 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 Pe" C.0 die -x''' [ CCUNt'L-f
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? N0
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.
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Signed pca' (C' 3(4 \/14r. Date
PLEASE DRAW AN ACCURATE O YOUR PROPERTY!!
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Ff 20 06 07:28a
PINNRCLE DESIGN
870-704-0215
February 20, 2006 PINNACLE DESI N
CONSULTING GROUP, INC.
0805 BUCK POINT ROAD
CARBONDALE, COLORADO 81623
Mr. Tim Holiday
Garfield County Building Department
108 8th Street Suite 201
Glenwood Springs CO 81601
RE: BROWN RESIDENCE - ISDS
LOT 4 RIM ROCK SUBDIVISION
GARFIELD COUNTY COLORADO
Dear Tim:
RECEIVE)
FEB 2 4 2006
BARFIELD COUNTY
DING & PLANNING
Pursuant to the subject residence, I had the opportunity to inspect the septic systc m
during installation. I observed the placement of the drain field, septic tank and associal3d
piping. To the best of my knowledge, the septic system was installed in accordance w ith
Garfield County standards and specifications.
Please feel free to give me a call if you have any questions.
ani ' Brucker, PE
PINNACLE DESIGN
CONSULTING GROUP, INC.
HES/heb
P.1