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Home My WebLink AboutApplication- PermitGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81801 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY D Owner's Name r i,� Present Address0.0.••314C.) .O'314C.) permit N2 3 8 3 2 Assessor's Parcel No. This does not constitute a building or use permit. Phone 39Z-7100 100 System Location j nZ) tit -72a- O-- ` l �r, Legal Description of Assessor's Parcel No IWO3- gal -GO bi` SYSTEM DESIGN Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Reauirements: Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Septic Tank Capacity 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 - _ /� Inspector ��/y� ¼ni L ,5n'� P6 I[/ iv�`/OflL� RETAIN WITH RECEIPT RECS/RDS 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 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER 12A Pe We'•,c.,rger C4 0142, ADDRESS 3400 sc.). to .4141 -at 2actrl PHONE 528 — 72i524—' CONTRACTOR� 0‘...4 e-1% 3R0 igOO �e. i) / ADDRESS P. (9. &. 3 240 (wpr4 pt co eL6 3) PHONE PERMIT REQUEST FOR 04 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, sod percolation test boles, sol profiles in test holes (See page 4). LOCATION OF PROPOSED FACILITY Near what City of Town Do4SePo 1 Size of Lot C? .7 3 A c Legal Description or Address Leit, SeCk lb, arm 3 Sy Q Al hl oV O''' P N . Swee+r- r - Rd• WASTES TYPE: P4 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) ORTIER - DPD B BUILDING OR SERVICE TYPE CQ Maribor ofBe�drooms (da198tsJ `tnil &e��` el` 37 Number of Persons i klestir zper a4 Garbage Grinder *0 Automatic Washer 0.1 Dishwasher SOURCE AND TYPE OF WATERSUPPLY: WELL ( ) SPRING ( ) STREAM OR CREEK ff supplied by Community Water, give name of supplier DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: $ 0 ftLCS Was art effort made to connect to the community System? MO 4 site phut is reetasdared to be ea tted_that indicates flee *Howie MINMIUM distances: Lead Field to Well: IBS feet kptic Tank to Well: SO feet sack Field to Irrigation Ditches, Stream or Water Came: SO feet Iepflc System to Property Lines: ( septic tank &leach field},* feet (OUR INDIVIDUAL SEWAGE DiSPOSALSYSTEM PERMIT WILL NOT BE ISSUED WITHOUT SITE PLAN. 3IkOUND CONDMONS: 7epth to first Ground Water Table 100 FL 'ercent (mound Slope —0— Pwdtk,etcol- 2 08/05/02 16:37 TX/RX NO.1646 P.002 ■ TYPE OF •IN$MVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 014 SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CQIEIvIICAL TOILET ( ) OTHER - DESCRIBE FINAL DISPOSAL BY: ABSORPTION TRENCH, BID? OR TIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 410 PERCOLATION TEST RESULTS- (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes 8 per inch in hole No. 1 Minutes l2 per inch in hole NO. 3 address �1 01 per inch in hole No. 2 Mmata per inch in hole NO. Name, s Land - OY of RPE who made soil absorption tests: At" L, groc k , 176 RAFT at , Name, address and t - - RPE responsible for esign of system: ► ilk!? Applicant admawledges that the cam -deftness of the application is conditional upon such Rather mandatory and addhioml tests and imports as may be required by the local hakh 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 subnitted by the applicant are or will be represented to be true and sonnet to the beat 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 Sather understand that any rah cation or misrepresentation may result in the denial of the application or revocation of any parrot granted based ,upon said 4plication and in legal action for perjury as provided by law. Signed Date /0/2 2 / 2 ce 7 ?LEASE DRAW AN ACCURATE MAP TO YOURPROPERTY!! 3 08/05/02 16:37 TX/RX NO.1646 P.003 • 1 1 0 .,._.. _tea 1 xii r: acv 08/05/02 16:37 TX/RX NO.1646 P.004 c r ■ VLB Design-Buigl, LLC Professional Engineering Services April 6, 2004 Building & Community Development Garfield County 108 8"' Street, Suite 201 Glenwood Springs, CO 81601 Reference: POFFENBARGER RESIDENCE, BP# 8817 Physical: 3400 Sweetwater Road Garfield County, Colorado Mailing: P.O. Box 3240, Eagle, CO 81631 Dear Official: 876 (Mesa (Drive (P.O.B. 3644 Tek, CO 81631 970-328-0876 Please accept this letter as my Final Certification Letter verifying that the referenced ISDS system was installed under my direction and approval and meets the full intent, capacity and safeguards of the original design. Should you need additional information or clarification, please don't hesitate to call me. Ifincerely`, 11 Vern L. Brock, P.E. 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