HomeMy WebLinkAboutApplication- Permit•
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Sptings, Colorado 81601
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Nama f I 0,-R \GYom+ Present Address 7 lection( nn V Phone ciu1 n -g
a71 Ccbinanchetd``1%. 1\\-Eu.CiCk% t
System Location ' l� �� �►'`i�� �% � �1�/., 1/Y' ,/n �/) 1n� 1,
Legal Description of Assessor s Parcel No t 3 �' lr d l'-f��._. ` J I t ) ` Ar Q -TL �V w.(�Y'r
Permit N!° r 3669
Assessor's Pajel No.
Fr
This does not constitute
a building or use permit.
•
"TEM DESIGN
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date C. 2 3.02-
95OpMni
Inspector 1 1 W1
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer ecirre 0)n Ctn (i/1.Y'
Septic Tank Capacity
/75'D
TVS r 1 t4PFo I S "
(-M to r a -4.7r
A. S.
ti (,0 pC-Rc
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
Adequate compliance with County and State regulations/requirements V
Other e
Date s' Ca Inspector ' 6v%,- 4554"e,
RETAIN WITH RECEIPT RECDS AT CONSTR TION SITE �j �! 7 -ZS Y��
OP
*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).
White - APPLICANT Yellow - DEPARTMENT
' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER 13»,a.a, SG a -r / rcdirr e
ADDRESS 97/ Coma -Ai c_htiro Tr PHONE 9)4-OdOd
CONTRACTOR
ADDRESS PHONE
Rs,/ace 0/1 Sys'ori
PERMIT REQUEST FOR (4 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 /Yf 4/ r fie
Legal Description or Address L ori 3k'f /3/cc-/C
WASTES TYPE:
Size of LotX I/O'
,Elk Creck 5e,h 0.5, n
(DWELLING
( ) COMMERCIAL OR INDUSTRIAL
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: Port and h&tnl
(
TRANSIENT USE
NON-DOMESTIC WASTES
S%nalc/ Alt /t fibrrl e OA"' `Fbnn
Number of Bedrooms 9 Number of Persons 3
( ) Dishwasher
( ) SPRING ( ) STREAM OR CREEK
Ocvn of M.cc/ 6.5 tie
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 2Inic va i.na/✓r�
Was an effort made to connect to the Community System? We
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
( ) Garbage Grinder ( ) Automatic Washer
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL
If supplied by Community Water, give name of supplier:
2
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( �) 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? WO!
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
/3, c Lr �JLGt/ f
Date . S//%/61
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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County Road (Note the Road Number and Name)
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4
July 24, 2002
Garfield County Building & Planning
109 Eighth Street, Third Floor
Glenwood Springs, CO 81601
Re: 1SDS for Schwarz Residence
HCE Job No. 2011104'39
To Whom It May Concern:
RECEIVED
JUL 2 6 2002
GARFIELD COUNTY
BUILDING & PLANNING
On July 24, 2002, High Country Engineering personnel observed the construction of the
ISDS for the Schwarz Residence located at 0271 Comanchero Trail in Garfield County,
Colorado. One 1250 -gallon septic tank and a drywell absorption field had been installed.
The 4'0 precast concrete drywell had an absorption depth of 8 -feet and was backfilled
around with a 10' x 30' bed of crushed stone. The sewer and effluent lines were being
installed. No additional backfilling had taken place. The installation of the system was in
conformance with the intent of the design. If you have any questions, or need additional
information, please contact us.
Sincerely,
HIGH COUNTRY ENGINE •-! G, INC.
Roge r Neal, P.E.
Project Manager
RDN/djw
Cc: Brian Schwarz
1517 Blake Avenue, Suite 101
Glenwood Springs, CO 81601
Telephone (970) 945-8676 - Fax (970) 945-2555
14 Inverness Drive East Suite D-136
Englewood, CO 80112
Telephone (303) 925-0544 - Fax (303) 925-0547
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