HomeMy WebLinkAbout04497GARFIELD COUNTY SEPTIC PERMIT APPLICATION
108 8f° Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003
1
arcel No: (this into anon is available at the assessors office 970-945-9134)
Awn A- t4� �7PWOL, - s" au3 zzr23� 64 237 -TanivutM '2,50v-04t2>i r'' 4 tot -` .
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61
Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & Cil),) or and legal description ' 6 Ado — E41e/' a, C' ,
'7013 C12.Il r1 ��Nato) r -i en
3Lot
Size: Lot No: Blo No: Subd./ Exemption:
Z13 Arcs 4--
4
Owner: (properly owner)
AMY v -,A Lvi wilt i h'
Mailing Address ////� /�
7$ Ce. 1) 7 (�lclliagp+v'vv
Ph: �j G
s /ZD'%D
Alt Ph:
O &D7,�(`--.
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Contractor:
amen^ -
Mailing Address
4o r
YYhh
Alt Ph:
6
En ineer:
&it 0190*
Mailing Address
Ph:
Alt Ph:
7
PERMIT R UEST OR: .' New Installation ( ) Alteration ( ) Repair
8
WASTE TYPE: ()Dwelling ( )Transients A )Commercial or industrial )Non- Domestic wastes
Other — Describe JaA'YNfAO1r r Tri
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BUILDING OR SERVICE TYPE:
.FARQ
Number of bedrooms 0 Garbage Grinder ( )Yes Wo
10
SOURCE & TYPE OF WATER SUPPLY: ( )WELL ( )SPRING ( )STREAM OR CREEK ,(CISTERN
If by COMMUNITY WATER, name of supplier:
supplied give
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DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: ?
!I»�/Le"�
Was to connectto the Community System? Cs
an effort made !"
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
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GROUND CONDITIONS:
Depth to 1s' Ground Water Table Percent Ground Slope
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TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:
eptic Tank ( )Aeration Plant ( )Vault ( )Vault Privy ( )Composting Toilet
( )Recycling, Potable Use ( )Recycling, other use ( )Pft Privy ( )Incineration Toilet ( )Chemical Toilet
( )Other- Describe
FINAL DISPOSAL BY:
sorption trench, Bed or Pit ( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter
( )Other- Describe
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( )Wastewater pond
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Will effluent be discharged directly into waters of the state? ( )YES WO
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PERCOLATION TEST RESULT: (to be completed by Registered Pmfessionai Engineer, if the Engineer does the Percolation Test)
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, & telephone of RPE who made soil absorption test:
address
Name, & telephone of RPE responsible for design of the system:
address
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Applicant acknowledges that the completeness of the application is conditional upon such further mandatory and additional test 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 y the local department of health in evaluating the same for purposes of issuing the permit applied for herein. I further
under. and tha f-ny falsification misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application
4o for ded bylaw.
-/zwos
O> - :IE DATE
STAFF USE ONLY
Permit Fee:
73
Perk Fee:
t co
Total fees:
173
Building Permit #:
/0 727
Septic
Permit #:
Issue Date:
T
ildingfan•
1 t:
P•
0 AL \ DATE
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
Permit ..9/
Assessor's Parcel No.,
This does not constitute
a building or use permit.
PROPERTY r
Owner's Name \ \mv fl (. \) i t 1 `1 te"�Present Address V -i 0 ,c -i Phone ""_ ��(-�"
Ute') C �� �S V� J �
C:1 Na4,1_ CS)cc;
System Location
Legal Description of Assessor's Parcel No
SYSTEM DESIGNI
cJ 41967 Septic Tank Capacity (gallon) Other
//!..2 L� Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date
Inspector
s'y2,
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity
;. �:�.JJ`✓� : `i (7 4- %t.../ -`
_fav
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area titc - e, /�
Absorption Area Type and/or Manufacturer or Trade Name
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Adequate compliance with County and State regulations/requirements
Other
� i
Date ff "f��'�e^rS. Inspector , 016;-/ 4//t-„ C
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 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
William J. Young
3960 South Pinehurst Circle
Denver, Colorado 80235
October 11, 2008
Larry Thrun
7843 CR 117
Glenwood Springs, Co 81601
RE: ISDS Permit — Completed Installation — Final Approval Letter
Dear Mr. Thrun,
I have completed the final inspection of the above referenced project for the tank,
distribution box, and infiltrators for the ISDS installation. All work has been
completed to within the specifications as per the drawing stamped and dated
October 6, 2008.
If you hav- , estions or comments, please call me at 303-881-6631.
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