HomeMy WebLinkAbout03453--. "'"'
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springe, Colorado 81801
Phone (303) 945-8212
INDMDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
PermH N~ :S4 5 3
A1H1eor'1 Percel No.
Thia -not conatltute
a building or uoe permit.
0..-'1,._JllE FLIGHT Df£L PresentAddress35JC.R35'2.,~~. ~l~~ho"" lQ25-l/533 ,
~ l.ocetlon 35] CR MZ.' JS ltlF c.o
lAgal Deocriptlon of Assessor's Parcel No.--------------------------------
SYSTEM DESIGN
-----Septic Tank Capacity (gallon)
------Percolation Rate (minutea/inch)
Requll'9CI Ablorptlon Area -See Attached
Spacial Setback Requirements:
FINAL SYSTEM INSPECTION A
Septic Tank Manufacturer
Septic Tank Access within 8" of surface ---.\-----------------------------
AblorptlonArea _______________________________________ _
Ab10rptlon Area Type and/or Manufacturer or Trade Name--------------------------
Adequate compliance with County and State regulations/requirements, _____________________ _
Othe•--------------------------------------------
Date _____________ Inspector ___________________________ _
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 fulty 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 permlt and cause for both legal action and revocation of the permit.
3. Any person who constructs, altars, 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
P.01
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
-OWNER. -fhe-yl1qV\± J2e,,p -
AI>I>Uss 357 Cn'b1"/ &nJ 3-'~.&i.Uw, PHONE cr10-43,,--qv-.,
CONTllACTOR~--U~P~r~~~--~~-J.Ctr)~~~~~~~~~-
ADo.RBss /_-s:.,-1 ,J:"~"t Joe< PHONE q 1tJ o! '13 -t/~I.?-.
PERMIT REQUEST FOR ( ) NEW INSTALLATION PQ ALTERATION ( ) llEPAJR.
Aa.Kh separate sheets or report &bowing entinl area with re&pect to sul'l'Olmditlg areu, topography of aree, habitable
buildU!& location of potable water wells, soil perwlaUon test holes, soil profiles in test holes (See page 4).
LQCATION OF PROPQSJ:jfj:! ~CillTY:
Near wbm: City of Town ]{;}ti; Size ofLot .SP.e..-J)b, ""\
LcplDesaiplionorAddrea 3.=f7 {h.,,.JJ &:aJ ~-).. &:IJ,,ry ..1® '
WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
~ OTHER. -DESCRIBE H() /J, ~ ±4 n K
BUllDING OR SERVICE TYPE: Ai f'.C,,t&& t Ha t"j' t'A ;1
Number of Bedrooms 0 Number of Penone ------
( ) GarbageGnncter ( ) Automatic Wuber ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) WElJ.. { ) SPRING { ) STREAM OR CREEK
If supplied by Community Water, aive name of supplier:__.A-'-'-: \...:...£1,/c_ • ._ ________ _
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_~AJ.......,..l ..... A _______ _
~~ Was an effort made to connect to the COllllllUllity System? ___ -+f-:--~....;;'<..J~--------
A site Pl!• ii reaaiml to be su!tJpkted •bet lncflgtes tllit ftllpf• MINIMUM dlm!!fpj
Leada Field to Well: IOI feet
Sepde Tank to Well: . 50 feet
Ladt Field to lrripdon Ditdles, Stram or W•ter Coune: 58 feet
Sepdc System to Property Linet: 10 feet
YOUR INDMJ>UAL SJ:WAG£ DIVo§M SYSTEM PERMIT WH.L NOT Blj ISS111i'.n WQ'HOUT
A SITE PLAN·
GROYND CONDITIQNS:
Depth to first OroW1CI Wara-Table. __ ~Lf"U...----------------
Pc11:ent Grouad Sl~-------..~~'-------------~~--~
2
Nov-27-00 02:51P TPI Indus'~r a z,.., NtJ..!•c1-~ 'QIC • ..x;;.r rr1.u1·~""" .__...._..,.,.....,_. _,,...,.......,..... ,
. r ~ -.
TYPE Of tNDIVII>UAL SEWAGE DISPOSAL SYSTEM PROPOSED:
• ( ) SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULTPRIVY ( ) COMPOSTINGTOIIEf ( ) RECYCLJNG,POTABLEUSE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLINO, OTHEll USE
( ) CHE.MICAL TOILET ~ <YrnEa-DESCRIBE tb Id. I Nf ·pa,, K f"hx /)at 1r-. s
PINAL DISPOSAL BY:
( ) ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FD.TER
( ) ABOVEGROVNDDISPERSAL ( ) WASTeWATERPOND
c > otHER -DESCRIBE ,50 )-if Ol@o 7 & lo A 1Jk1-
WILL EFFLUENT BE DISCHARGED D.l.RECTLY INTO WATERS OF THE STATE?-.t.dJ"'~;...:;....---
mm .A.DON mJ Jffl$QLTS: (To be completed by Registered Ptoftsaional 13nginea-, if the Engineer does the
Percolation Test)
Minu1es Al} >1 Pet inch in hole No. 1 Mirartea ____ __..per inch in hole NO. 3
MlnlllCS per inds in hole No. 2 MilllJtQ""----.---"• inch in hok NO. _
N-• .....,._ aact tei.phoae af llPE who made soil absorption tests:_ .... d/~1,_..kf<-4-________ _
Name. addreU and telep.bolle otll.Pe responsible ft>r design of the S)'S*ll: ___ A.J ...... .,_7,_j! _______ _
'
Applic.tnt acknowledges that the complet-of the application i& eonditional upon IUdl further mudatory and
additional teas and RPOrts u may be niquired by 1he klCl1 hellltb depertm.enl to be made and furniahed by the appliclllt
or by the local health department for purposed of die evaluation of the applicalion; and the itsuUICe of the pennit is
... iii-io llUCh i.rms lllld conditions u deemed necessary to insure comoliaDce with rules and reaulations madl.
illbmlbon end reports submitted herewith and required to be submitted by the applicut are or will be represeated to
be true IDd comet 10 die best ot my knowledge Utd belief ud ari: dctignnl to bi: relied on by the local deputmcnt of
health in evlluatiDS the same for purposes of isluing the permit applied fbr herein. I fUnlter understallcl that my
&!sffiralion or mi8"(XCAt1dation may r..wt io die denial of the application or revocation of any permit granted baled
upon elli<l ..,pication and in lepl action fiw pcjury u provided by law .
._Qba '211(~ .-11-;.1-oa
PLEASE DRAW AN ACCUJlATE MAP TO YOUR PROPERTY!!
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