HomeMy WebLinkAboutApplication- Permiti>a CD!'"
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
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PROPERTY ,i�1I r}�/�� l^� jet' ' 1
Owner's Name 1 CJ 7� ,ten de"). Present Address ±43 L0 Phone (a40 — 1775
System Location t/✓ r l n' I e-nZ C S
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Permit N° 3872
Assessor's Parcel No.
This does not constitute
a building or use permit.
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 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 ./ 9fr` /�
Date / -06/ Inspector Ry geta /� 6Qt'w1 eL1 t.p e.41
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).
White -APPLICANT Yellow -DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER eetta t &Nulai /+
ADDRESS Po Bax y33tq-,c ?(Ls" a
CONTRACTOR ice( (k4t u,vbXt ce
ADDRESS 10t5 S 30 6.0 l,w4o t4r7%,tccss, Co PHONE 00-177S
S
K(‘fi`t
PHONE 7 6- J5115
PERMIT REQUEST FOR (1/ 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 S.1 1+ Size of Lot b ' 4( A
Legal Description or Address D3 (O '�. ~r 1. Rent. z.. La Ore,
WASTES TYPE: (DWELLING
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER -DESCRIBE
( ) TRANSIENT USE
BUILDING OR SERVICE TYPE:
Number of Bedrooms T Number of Persons "r
(Garbage Grinder (Automatic Washer Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: p J� (
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: - 1L'I (/0J
Was an effort made to connect to the Community System? iUO
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
51 kL b
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(>4 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:
(f 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? Pc,
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: Gime ,- _it &ct Q. llllb
Name, address andephone of RPE responsible for design of the system: np13-GU 6r r ✓lR'1 ��
(.�rajd JthC*ort coCa RhO-ac3,'F!?5c
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 QA:1
PLEASE DRAW r CCURATE MAP TO YOUR PROPERTY!!
Campb 11� unctionEner.
phone (9711) 243-4174
far 243-0318
ADDRESS: 336 LeFrenza - Silt
PERC TEST DATA
Sheet 1 of 2
Ref.
No.
1
Perc Hole
Depth
32714")
34714')
32714")
156714 "J
7fat 10.27 aa. Ths 1129 aa.
kadth, tial a.&at tm1
15.5
17.875
16.625
13.5
15.5
18.625
0
Elapsed
7Yme
60
.75
60
16.625
15.5
0
60
2
60
Perc Rate
(min/in)
n.8.
80
n.a.
30
CHECK LIST
Pere < 60 %" es
Perc >57 yea
Slope>30% no
Water Table<51
.__Iill_
Bedrock <5'
Floodplain nn
On Site Water n9
Repair Area treoal°rr
G.W.T. (ft) >9 ft
B.S.W.T. (ft) >9 ft
F
E
1
T
0
1
2
3
4
5 — #1
6
7
8
Soil Conditions / Horizons
ted Soil,Ftactured/lointed Pattern)
(Indicate: Bedrock, Groundnter Table, Ss
r-12' Top Soil Brown Loam
\
12'-28' Sand & Gravel
9-
10-
11-
12-
13
14
9 \ 28'-48' Silt
/3 \ 48 -72' Silty Loam w/Shale gips
s.‘‘‘ 1�
vaRE
28-48' Sandy Loam/Loam
Tested By:
PA
11.1.1..
Date: 2/27/2004
ADDRESS: 366 LaFrenaa Silt
PEW TEST DATA Well
Sheet 2 of 2
Concrete Foundation
0
IRRIGATED FIELD
Underground Irrigati
467,82'
DRIVE
#3-=
rT#4
Test Pit
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Campbell
Engineering
RECEIVED
SEP 1 0 2004
GARFIELD COUNTY
BUILDING & PLANNING
P.O. Box 1593 Grand Junction, CO 81502
(970) 243-4174 fax 243-031 gcampbel@gj.net
CERTIFICATION OF COMPLETION
I hereby certify that the septic tank/ absorption bed installed at 336 LaFenz,Silt, CO., has
been completed according to the plans and specifications and that the installation meets the
requirements of the Garfield County Sewage Disposal Systems Regulations.
9012/.;
tt I. �3 zefto 0 -
Gary W. Campbell P.E.
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