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Home My WebLink About02371, r. t l // GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 Blh Street Suite 303 Glenwood Springe, Colorado 91801 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPl!RTY Permit N~ 2371 Aaaeseor'• Parcel No. This does not constitute a building or use permit. Owner's Name_K_e_n_n_e_t_h_M_._Go_o_d ____ Present Addrell _P_. O_. _B_o_x_l_8_5_4__:''-R_i_f_l_e_::,_C_O_ Phone._9_2_8_-_1_0_9_3 __ Syotem Locatlon ______ 0_9_4~8_C_ou_n_t~y~Ro_a_d_2_5_1~,_R_i_f_l_e _________________ _ Legal Description of Assessor's Parcel No.----------------------------------- SYSTEM DESIGN ______ Septic Tank Capacity (gallon) ______ Other Percolation Rate (mlnut8Sl'lnch) fi;Num;er of :roo~(=~ •oth 1 ekr) ~1 -;l J -~€ I/" 9 Required Absorption Area -See Attached ~ f,:)ff/V lfC/~ -f"O r fL ~ Special Setback Requirements: ~ {J.) Date Inspector tUJ ~ oJ I), ~S ' 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-------------------------------------------- Oate _____________ lnspector ___________________________ _ RETAIN WITH RECEIPT RECOROS 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 shaH 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). Applicant: Green Copy Department: Pink Copy r • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPIJCATIQN Application Approval By County Official OWNER /4z4et-L ri1 Caa£ ADDRESS_,..,...-r,~--;--:,..--.--:,..--,.,~----:----..---- CONTRACTOR ' PHONE'fzf:Y/v l/s o. - ADDRESS ,· PHO PERMIT REQUEST FOR: )<{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). I.OCATION OF P&OPOSE?Jf ~µxrv : County _.a...;..r;;,..c;/_.b:--4;',e,~,{;"'4/~----------- Near what City or To~n ./L_f::_./6!:._ Lot Siz.e &, :fQ &,,vi"' r Lega!Description+,1"4--.......... ~-a"""'"'c~h.'-'-------------------------- ~Dwelling f )Commercial or Institutional ( ) Transient Use ( ) Non-domestic Wastes WASTES TYPE : ( ) Other -Describe __________________ _ BUILDING OR SERVICE TYPE: _.,c.t.p...~.C....------------------ Number of bedrooms Number of persons_-L--------- ( ) Garbage grinder ( ) Automatic Washer ( ) Dishwasher SOURCE ANP TYPE OF WATER SJ JPPI,Y· ( ~ell ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: ---"~~-"~+..&.:.~~~,,..."----.L/-"'fi"""'7:i...k.,,___?1<'5::...e""-"O'"J-"T"c~l~-- If supplied by community water, give name of suppliec -~;z;"'""'Y;L"-,.oo4"':;z;------------- GROI JND CONDITIONS: Depth to bedrock: IQ -r &.£-:.. Depth to first Ground Water Table: £:,i «w< PC? •f'r ?: .... k...,_..c..., Percent ground slope:_A--.:=_,_f-_~::::.....Z"L--,cr-""%""---------------r---------- DISTANCE TO NEAREST COMMUNITY SEWER SYST.P~ .... · _3..c..Len::.u...'/<-.iz;c.--5"----------- Was an effort made to connect to community system? 4-4""~""'"'/&--:_,_"---------------- TI'!~ O~IVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ~ ~ptic Tank ( ) Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use ( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use ( ) Chemical Toilet ( ) Other -Describe: _______________ _ FINAL ~POSAL BY: )4'.:'" 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? L../1...,/():.....1>'------ ' • SOU. PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer) 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 purposes 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 adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements 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. PLEASE DRAW AN ACCURATE MAP TO VoUR )>ROPERTY ,, • Pl ill PI .AN AND DESIGN FEATI JRES . Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, water course, stream, dry gulch and show location of proposed system by direction and distance from dwelling or other fixed reference object, and additional submissions in support of this application such as data, plans, specifications statements and commitments. 5 ' .. ·•. ; . • '.ength deter- 11fned from 1erc test ·esults lack fill 2'+ 1 ' eepage Bed n Other (lit" to ?1 ... 11 Lo" 2 TOP ' TYPE OF SYSTEM TO BE CONSTRUCTED Clean Gravel Required Unless Otherwise Approved) 6 11 Gravel under pipe 1---·- *Size determined from perc test results SIDE VIEW ....,__ Backfil 1 ~--t--4" solid pipe to tan' 4" hay or straw t'JI~--Gravel ~~Wt'H---Concrete ring~ or cinder bloc~s 1' of gravel in bottom Drywell