HomeMy WebLinkAboutApplication- PermitGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 909
Glenwood Springs, Colorado 81601
Phone (303) 945.8212
? INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Name
�Qi �C t [ 51 W Present Ad?ress Q /d
System Location \,\I
Permit N` 37 9 0
Assessor's Parcel No.
This does not constitute
a building or use permit.
Phone It03 ' {'�
Legal Description of Assessor's Parcel No
SYSTEM DESIGN
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date
;23,Zcv3
FINAL. SYSTEM INSPECTION
Call for Inspection (24 hours n
System Installer
Inspector iy`'5, 1 11N1 by/2 (Ir\ E' E/Scd .
IND APPROVAL (as installed)
tice) Before Covering Installation
Septic Tank Capacity
Septic Tank Manufacturer or Trade Name
Septic Tank Access withir 8" of surface
Absorption Area
Absorption Area Type an or Manufacturer or Trade Name
Adequate compliance wit County and State regulations/req rements
Other
Date \ IIr Inspector
ETAIN 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 jail or both).
White - APPLICANT Yellow - DEPARTMENT
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OWNER
ADDRESS
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
St -if- b;fatt_c.`
\\ b Rib, 1014, CPAII
CONTRACTOR .SCFE WIVaey
ADDRESS 1/4#4.th=e04).44.444.1eoNx5xIt3
PERMIT REQUEST FOR NEW INSTALLATION
PHONE ok 63-1S1e
PHONEab3
( ) 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 l AR6e►ltia Ler Size of Lot lOciSS At
Legal Description or Address t \ b k Cc, Rfl l O (,
WASTES TYPE:
4 DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER —DESCRIBE
BUILDING OR SERVICE TYPE:
Number of Bedrooms
( ) Garbage Grinder
S
CSF DltltU
pa() Automatic Washer
Number of Persons
( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING
(o
( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: 0. ctj of C ARISOP)th Lr
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Ya r�•lr
Was an effort made to connect to the Community System? CT Oca't i1ossAR<E
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 0"7o
2
Y
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
SEPTIC TANK
VAULT PRIVY
PIT PRIVY
( ) AERATION PLANT
( ) COMPOSTING TOILET
( ) INCINERATION TOILET
VAULT
RECYCLING, POTABLE USE
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?
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 a a 4° -
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2OAD 106
DOPERTON
,COLORADO
i
TIMBERLINE ENGINEERING
P.O. BOX 631 CARBONDALE, CO. 81623
PHONE 970 963 9869 / FAX 970 963 9003
1
TIM/MILINE ENGINEERING
STRUCTURAL /CIVIL ENGINEERING • CONTRACTING *CERTIFIED ENERGY DESIGN PROFESSIONAL
July 23, 2003
Garfield County Building Department
109 8th Street, Suite 303
Glenwood Springs, CO 81601
Re: ISDS Installation
Wadley ISDS
1611 County Road 106
Carbondale, CO
Dear Building Official:
The installation of the ISDS system for the above project bas been completed and has been
installed in accordance with applicable county specifications.
The system installed system is larger than the 5 bedroom capacity that was originally designed.
The final configuration of the leach area is large enough to support 8 bedrooms. The final septic
tank of 2,000 gallons is large enough for 7 bedrooms.
Attached is the as -built drawing for the system.
If you have any questions, please call me at 963-9869.
Sincerely,
TIMBERLIN ENG EgglitcAro
01 ''a
David A. Powell, PFj i �" ca 1
Reg. No. 25851 %1 '.J r; s
4p'&
"frgl EBG���tQ
P.O. ]BOX 6311 CA]RJBONDALE, CO. 81623 PHONE 970 963 9869 / FAX 970 963 9003