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Home My WebLink About02956. -"~'. ~-~·-~~-~"-c""""•~M:_c-.-c-c,c·-cc-y,c-- - - --~~.·~~T~ -;~~~\--~---.-·,--:-.,,.,.,:-,c: ~ ---,.! :~.i.,~.: ,•;;.. · .. -.. ' ·-··t·· . ,... ,,. ·,. ; \t =--.... . ·~·fl.· ~,.,.~~ .. ~/ -'-•:: t~ (, ' . GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit · 2956 · ' . 109 8th Street Suite 303 Assessor's Parcel.No. Glenwood Springs, Colorado 81601 Phone (308) 945·8212 ~ ~./:---~e/~ ~l'f'f? This does not constlt c/-t-'.elle fl a building or use per 0 I~ >t/JZtz- l~DIVIDUAL SEWAGE DISPOSA~ PERMIT PROPERTY 0.wner's Nam'""''-'---'--'-=---=c:;.~-1--'--=-f--PresentAddress Lo If 5'kr f1t ?~ 1~ Phone ft.$_\~¢,!:ffe System Location __ L_J_-"'---"'-----'-""-'-"'"-____:J:_:/'--=.3:__ ____________________ _ Legal Description of Assessor's Parcel No.-----------------------'-------~------ SYSTEM DESIGN !- ______ Septic Tank Capacity (gallon) ______ ,Qttier ' ------Percolation Rate (minutes/inch) Number of Bedrooms (or other) ____ _ Required Absorption Area -See Attached Special Setback Requirements: FINAL SYSTEM INSPECTION AND APPROVAL (as ins Call for Inspection (24 hours notice) Before Covering I stallation Septic Tank CapacltY--------------------------------------- Septic Tank Manufacturer or Trade Name -------------------------------- Septic Tank Access within 8" of surface -------------------------------- l' Absorption Area---------------------------------------- Absorption Area Type and/or Manufacturer, or Trade Name -------------------------- Adequate compliance with County and State regulations/requirements __________________ ~--- Other ___________________________________________ _ Date _____________ Inspector ___________________________ _ /'IETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE •CONDITIONS: 1. All lnstallatlOn must comply with all requirements of the Colorado State Board of Health Individual Sewgge Disposal Systems Chapter 25, Artlc"8 .10 C.R.S. 1973, Revised 1984. • ...,, ' 2. This pefnt1t Is valid only for connection to •tructures which have fully complied w County zoning aod building requirements. Con· nection to or use with any dwelling or structures not approved by the Building and nlng office shafi automatically be a violation or a requirement of the permit and cause for both legal action and revocation of the ~It. 3. Any person who constructs, alters, or installs an Individual sewage disposal system in manner which Involves a knowing and material variation from the terms or specifications contained In the application of permit co Its a Otass I. Petty Offense ($500.00 fine -6 months in jail or both). WMe -APPLICANT Yellow -DEPARTMENT .. _ .. OWNER ..... ADDRESS INDIVIDUAL SEWAGE DISPOSAL ftYSTEM APPLICATION .• ' CONTRACTOR ___ , _________________________ _ ADDRESS ________________ _ PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION <.><i:REP AIR 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). F,Ki'-Tl,,,j(;, LOCATION OF PROPOSf P FACILITY· Near what CityofTown (·a rboN.£a \ e, SjzeofLot /)'/lei?+ .__ Legal Description or Address _it ........ ~ ... &z'-'(,""-' _ _,_I _,.L3...___..._f?_=J....__,C ..... u .... = v._· .... lx .... >""-M....._6 ..... a .... L .... ' e...,.,____,_(_,,'c""")_,_/_._o..__8"'-"-! .... 6"-'2=· ... s.._ WAS TES TYPE: _{)r•DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER -DESCRIBE DO rur:--BU IL r I vv 19 :V--{"· ·r-2. BUILDING OR SERVICE TYPE:_'Ra'-"""'"'-~<4-/..,1/....,~""MJ./..._~ =ef::i.._· -------------- Number of Persons ------ ( ) Dishwasher Number of Bedrooms --t,---------------- ( ) Garbage Grinder ( ) Automatic Washer SQURCE AND TypE OF WATER SUPPLY: ( )/J WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: ________________ _ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_..:..!t/a,,....,_.__t-'....::~..=.=if"-'~~"""'-'===---- Was an effort made to connect to the Community System?-'-';J_.o'"-__.n .... c""20,_.__,,1_·::c ...... 1..,d' ... · _ _,_8.......,l_..1,.,_f:l-tr--- 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: SO feet Septic System to Property Lines: 10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WIWOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table.__;;chr'--<-1._./wi,~..,.~ ... · -"-""------------------ Percent Ground Slope ___________________________ _ 2 · __ _. •·· · · --r-_ • .v ro 6..e-• c-x1s·11NG--t/'1#/ of TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED. A12j1/~ ('f) SEPTICTANK ( ) AERATIONPLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POT ABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER -DESCRIBE FINAL DISPOSAL BY: ( "() ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER -DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ____ _ PERCOLATION TEST REStn:rS· (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes. _____ 1 per inch in hole No. 1 Minutes ______ p 1 er inch in hole NO. 3 Minutes per inch in hole No. 2 Minutes per inch in hole NO. _ Name, address and telephone ofRPE who made soil absorption tests: ______________ _ Name, address and telephone ofRPE 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 _______________ _ Date. ____________ _ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3