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HomeMy WebLinkAbout03549• •· ·' " • .. GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945·8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Owner's Name I 1oTIB 1 tao I Uf\!»D Present Address )10 Tl-)LlOOCR, U;1UG°' Permit N: 3549 Assessor's Parcel No. This does not constitute a building or use permit. Phone c) l/ 5 l/2 75 System Location ____ __.C._..R+-JILL2_c_,l~,r--'-G-'-'-L""E."'uy""""""'"CQ""' ""'-'-LJ"--"~~Y.LLIR"-'-'1 A,.,,.)6"':"'_-'S,_,_1 _,C""._,.Q"'---------- ' • ' '· ., 3..., v1-111S 64 '.3 ~ LeQ_al Description of Assessor's Parcel No. --..., .... ~~~~--'°--l~I -·-.)~/~A---------------------. 'fLf") ~-(.'lo -9<\l. SYSTEM DESIGN L-<\... /l...C.14 C H A µ1 0 € 4,, (!;,[; 0 .. Number of Bedrooms (or other) ____ _ ::>I v t'1'){) 0 Ll i I;) ' I 3 -:---.... ·. 'c ,, ..,,,. "t /\. c:: ,..., c ff c > ' I 17 ~V Septic Tank Capacity (gallon) I '( Pe~colation Rate (minutes/inch) ______ Other Required Absorption Area· See Attached > I '· Special Setback Requirements: Date I (_ 1-( Inspector --'-A..\.--~-"------------------------ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call !or Inspection (24 hours notice~re Covering Installation . , / System lnstaller _ __,Q~~...._:r+--'----------------------------------- ,1,. l '• "' I Septic Tank Capacity __ _,/r.'2"-'sQ""'-=--~-----------------------------c~ ,q-ea Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface -------------------------------- Absorption Area----------------------------------------- Absorption Area Type end/or Manufacturer or Trade Name JNf1( ~) Adequate compliance with County and State regulations/requirements ~ :SJ ::::r __ 1_1_-_,_s~,0 __ , _''_t 1 ___ lnspector iS 3=©1 RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE •CONDITIONS: 1. All installation must comply with ell requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter 25, Article 10 C.RS. 1973, Revised 1984. 2. This permit'ls valid only for connection to structures which have fully complied with County zoning end 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 ; ., .., INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER hil-'=> ' t./A!l.ll'> f ~11\fVA tt l,ortA ADDRESS lLO 1 ~µ~&r.,f!::c Di2-t\JG PHONE C'J ":}(/ , "'J '( ~ -l(;). ~ CONTRACTOR C-Aiz.,.iel gfYPI"t\ eP> {ptA.1>!· { .vc,. ADDRESS If/I ~. p,µi::; ~,.. ~11-&-.vb~<-e, Co I PHONE &'if'b -q (,, J ,-q JC/ ~ 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), LOCATION OF PROPOSED FACILITY: Near what CityofTown Gl&"-'wO<""> ~i'JZ:1v<Y> Size of Lot C/,) A-cl?e 5' Legal Description or Address _,/.e!""'-!__-3..__-__,IA/=..,,C:,,,,1"=v~~•i=:z..::___,,t:;,S.=-"\.,,~,..,1>LL.!..>1 v"''""s"""'-J __________ _ WASTES TYPE: ()Q DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER-DESCRIBE. ________________ _ BUILDING OR SERVICE TYPE:_~f2.._,e-~s_1=f:>~e~tv_T~' "'~'----------------­ Number ofBedrooms __ 4~------------ <oQ Garbage Grinder (x:)_ Automatic Washer SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL Number of Persons __.t~---­ ()() Dishwasher ( ) 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?_-"-'"-"o'--------------- A site plan is required to be submitted that indicates the following MINIMUM distances: Leach Field to Well: 100 feet Septic Tank to Well: SO 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 WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table _______________________ _ Percent Ground Slope ___________________________ _ 2 v -' .• TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED ,<'f.J 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 <'fj UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER-DESCRIBE.~~~~~~~~~-~~~~-~~--~-- WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?---"J.}"-o ____ _ PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe Engineer does the Percolation Test) Minutes. _____ per inch in hole No. I Minutes ______ per 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. Date _ __.,,51+t-'-1 'f-y/t_o_,_1 _____ _ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3