HomeMy WebLinkAboutApplication- PermitGAR E D CISlicY BUILDING AND SANITATION DEPARTMENT Permit N° 3841
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
MIDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Assessor's Parcel No.
a3 R5 -[a Y -o (—o68
This does not constitute
a building or use permit.
Owner's Name Kt46 Iv ' € tligt '-"r/�/Pyreessenntt Addressj65 N. t 1 St C ~ k hone 9‘i-- 0 f 0�
System Location /18954, CAM C�/� t0oo J'frii'(�I�yy/� G8140
Legal Description of Assessor's Parcel No. 491-2 ��("^ Ser/ SJak
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 ---f-�
Date Fa • 20- UV Inspector / i%9'I k/irk £i..
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
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INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER Si as LgscxM 'eat
45 N. 077' sr c 4a 7ALy9'Ld do. rifiloNEssEciag
CONTRACTOR 19g//E cZ9, b/4 etae-7740W, Znvc
ADDRESS506,nas kSVAE,4re 6/24544400143 H ONE 9633 J41S
eo. 9/bA3
PERMIT REQUEST FOR OIKEW 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: 7 Lam,--Soxrn4.s —SksA' ',s,aA/
Near what City of Town 4eN400OA .S,A�rs Cd Size of Lot 17, Pica-cdteo_
Legal Description or Address for ND. 8 / Fd tJ.tl�S S(SbJ/%/�S/DN
WASTES TYPE: (DWELLING ( ) TRANSIENT USE $66 C'R
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER—DESCRIBE
BUILDING OR SERVICE TYPE: %Q$, Irv//t.y AcS OENGc
Number of Bedrooms 7 Number of Persons '/
(vr Garbage Grinder (rcAutomatic Washer (�hwasher
JR[= gait TYPEOF( ) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /Sf/'4i
Was an effort made to connect to the Community System? N/4
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
r�
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(1 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?
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: l7vvy&.r JI cn e G
T l 3 -Bost; 63 j Cc(rbpoA dtk Co 8l be3
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 t ��— Date 7e Zs —03
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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TIMBERLINE ENGINEERING
P.O. BOX 631 CARBONDALE, CO. 81623
PHONE 970 963 9869 / FAX 970 963 9003
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Timberline Engineering
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9-70 963 9003
ERS. NE ENGINEERING
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STRUCTURAL/CARL ENGINEERING • CONTRACTING *CERTIFIED ENERGY DESIGN PROIFESSIONAL
February 20, 2004
Garfield County Building Department (via Facsimile to 384 3470)
109 8th Street, Suite 303
Glenwood Springs, CO 81601
Re: ISDS Installation
Kuhl ISDS
Lot 8, Teller Springs
Carbondale, CO
Dear Building Official:
The installation of the ISDS system for the above project has been completed and has been
installed in accordance with applicable county specifications.
If you have any questions, please call me at 963-9869.
Sincerely,
TIMBERLINE E
David A. Powe
Reg. No. 25851
RECEIVED
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0 2004
`''4k} IE4_, CUUNTY
BUILDING & PLANNING
P.O. BOX 631 CARBO?WALE, CO. 81623 PHONE 970 963 9869 / FAX 970 963 9003