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Home My WebLink About03529' I I I· I I' I '· I.! 1: ,. ~ '1 i' 1 • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT I .. 109 8th Street Suite 303 ' I Glenwood Sprlngs,Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PRbPERTY -..,..--.,.,..-. ...,-, Permit N: / 3529 Assessor's Parcel No. This does not constitute a building or use permit. • I f .. ~ '. ·<>r,er's Namefu ! I 0 ~OH-\... ) Present Address }b Tux I '.2::? Phone 'f>7 {p ,() '1 ¥3 ' \ Syiiem Location d] 7 s &!"( .·· 30 (,(.... ~ 7_1 L{ <.-14 ,.,..-~ 1 LI f ll r Legi~I Description of Assessor's ~8r9el No.-------------------------------- ' SYSTEM DE~IGN ; ... ______ ,Other Se~tic Tank Capacity (gallon) ''--11DI (2775 · S'Jl>l/1J.J to ,) <102. /:'{+Percolation Rate (minutes/inch) Number of Bedrooms (or other) , <:_ l-f ~-:dC r{'-j) g.2501 ··-2775 c~...,iu. 14 {rl•JoJ//)JCH ~ Jpl .'n F7 ])!5;>c~54\ i'l~r./\. .. Required Absorption Area -See Attached l~ ~\ ·-~ /l\ /lf-7 ~/1f:J~ {~C-<•-l'b~ /....2)-•• v· Special Setback Requirements: F<>e 277.f (..; .211 ~ . ·'<' / ''twH.1... e. '-" Date ____________ Inspector l. 'J ' W fl ... FINAL SYSTEM INSPECTION AND APPROVAL (as installed) 'Call for Inspection (24 hours notice) Before Covering Installation • · r·i System lnstaller·~·~_:C::::-:....!!:'.IU~,,,.,~UAJ~~~---'j'-,..,..-_:_;· '!,k,f~q.{.~'t;J.'!_ ___________ _ .. ,,\ !!... " ' ... I Septic Tank Manufacturer or Trade ame ~ 1 ( Septic Tank Access within 8" of surface -'-~-'-i-".J----------h"'7+--'-'-.L<.L.!:r..r:-"0'------------• '11 J I + J;I Absorpti_on Area .. «, ,~ ~ '].. J ~sorption Area Type and/or Mah1ac!urer or Trade ~.~ ,C · Adequate compliance with Countyrnd State regulationff.'~irements+ __ __...,_,"'-''-------------- Other ~~~~~~~-cT~~~~-t-.--l-flt't----l~~~~?../.f!t'=+t¥Jc~'=J...~~~_.lL~&':>::!~~~~j I " •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 ·' - - - - - - - ---------------I . ~,<l--fefM~ARFIELDCOUNTY ~ #o-l?,vo )~~ 51,~ P/Gnt'-~t~10NDEPARTMENT 109 8th Street, Suite 303 . Glenwood Springs, CO 81601 K~oUA I /.AP~Jrf'f!~5-:f;121<9!Jk~ s 12 e 1f t> '1h4. PROCEDURE REQUIRED FOR ~~LIANCE WITH THE GARFIELD COUNTY SEWAGE DISPOSAL REGULATIONS. ~: Ste,p II: A. B. c. D. A B. C. Application Obtain a standard "Individual Sewage Disposal System" application from the Building and Planning Department, 109 8th Street, Suite 303, Glenwood Springs, Colorado 81601, 970-945-8212 or 285- 7972. Return completed application, map to property, site plan and diagram of site to the Building and Planning Department (Pages 2 and 3) and building plans. INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMITS WILL NOT BE ISSUED WITHOUT AN APPROVED BUILDING PERMIT. Make check or money order payable to "Garfield County Treasurer" (The cost for the permit fee and percolation test is $150.00 or if a Registered Professional Engineer does the percolation test, the cost is $50.00 permit fee). FEES ARE NOT REFUNDABLE. Your Individual Sewage Disposal Permit will be issued along with your building permit provided no prohibitive problems are encountered. Percolation Tests -SEE DETAILED INSTRUCTIONS ON PAGE 6 Prepare three (3) percolation holes 4 feet deep, 8 to 12 inches in diameter, and 20 feet apart in the area of the proposed leach field area (Instructions for post hole or back hoe holes are on page 4). Fill percolation holes with water llllll for the required eight (8) hour soaking period. Request percolation test by Sanitarian. (To avoid construction delay, we suggest arrangements for percolation test be made at least 24 hours prior to the end of the soaking period). Please have at least five (5) gallons of water for each hole available at the site for the percolation test. lllllMPORTANTI!!! Please be advised that ifthe Sanitarian's initial field visit to your property reveals any unusual difficulties such as high water table, excessive percolation rates, bedrock, etc., the services of a Colorado Registered Professional Engineer and/or Board of Health approval will be required. Ste,p III: A. B. C. D. Final InS!>ection When all components are in place, connected and ready to cover, request a final inspection by the Sanitarian. DO NOT backfill any part of the system prior to the inspection. The initial fee covers the percolation test and one inspection before cover up. Any additional percolation tests will be charged at $100.00 each and additional inspections will be charged at $42.00 each. Upon final approval, carefully cover the entire system. <. . INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION 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 , ')I 'j f Size of Lot t./[)~ Legal Description or Address 2.:1 )5 CJ( L. I L/ J S / L / WASTES TYPE: ( v(i)WELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER-DESCRIBE. _______________ _ BUILDING OR SERVICE TYPE: _______________________ _ Number of Bedrooms __ __,,...,._ _________ _ Number of Persons__,__,__ ___ _ ( ) Garbage Grinder ( H-"7tutomatic Washer SQURCE AND TYPE OF WATER SUPPLY: (~LL ( '"11}ishwasher ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: _______________ _ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: ___________ _ Was an effort made to connect to the Community System? ___ -+/{_,__,~'--'N'-'--'f= .... -_______ _ A site plan is required to be submitted that Indicates the following MINIMUM distances: Leach Field to Well: 100 feet Sepdc Tank to Well: 50 feet Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet Sepdc System 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. __________________________ _ 2 -------------- . . TYPE OF INDIVIDUt,\L SEWAGE DISPOSAL SYSTEM PROPOSED: (~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 ( ) EV APOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER -DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?_~6f'-"'·~(}~-- PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe Engineer does the Percolation Test) Minutes. ____ _,,er inch in hole No. I Minutes ______ per inch in hole NO. 3 Minutes er inch in hole No. 2 Minutes er 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 pennit 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. 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