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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 845·6212
'1., f :1'NDIVIDUAL SEWAGE DISPOS~~ PERMIT
Permit N~ 3635
Asseasor's Parcel No.
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1 This does not constitute
a building or use permit.
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'i PROPERTY
f, o';ner'sName{f)c.:C:,,-/t?shi /<.a.~ PresentAddress~·'" LU' • A-Vf. /(;fie ~"~ne 6;.5-o~'>'l ;
J"sy-tem Location' zc:Mg QR C:Z.fo A..1.f(-e, Co. rf &5"<:> ;
! Legal Description of Assessor's Parcel No. l of= '3 c. rdi lJ,) 6v. bJ' t
1 SYSTEM DESIGN P.en...c.. Aid:£ -too s:~ -~,1!4-it
! ~ ~~J.ht.Rtl 'I-Septic Tank Capacity (gallon) Other 0
l ?~~ d ~ ;; !:/ Percolation Rate (mlnutes/incqi,:S ~umt ~r'lt~so(J other) • 2 ; "'"'~'~·••·-'"-"~ ~~~* -,-B?::r~ g~~
:·; · , .... l. ., Date Inspector _ _,N_,,,,_~t1A""'"J..t""''"'--'fl'-'-1.£tl=-=;;:;g_""-', "'------------
·w· ~ I FINAL SYSTEM IN .( l ··Call for lnspectlo (24 hours notice) Before Covering 19stallation
,i\ ~ System ;nstaller K (.. ko7~hl\ ---
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11, I\ g pt1c .an apac ty_._-=-~'-"---------------------------------':. \ c~/~··
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Septic Tank Manufacturer or Trade Name~-._.,_,,,.,_=~-~-~~~---------------------
/ l Septic Tank Access within 8" of surface --''1.q.;f._:,,V=-------. -----
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1 Absorption Area ~ ~'Mk "" I) \?iq '3 ~ Qft..(V\,
j Absorption Area Type and/or Manufacturer or Trade Name ~J.'°""~''l' J,r'"'~ltid~·~==Af"l,_,,._·_,·•~l"'-----------.,,C..A_,,,, __ ,, .7~
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Date _ __,'/_·,_/ r~-~P,__:v-____ Inspector _ _,_£) .... ~ti.~<t..,.J~·""!--,....-7_~~~~i_·==----------
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
•CONDITIONS:
1. All lnstallatlon must comply with all requirements of the Colorado Slate Board of Health Individual Sewage Disposal Systems Chapter
25, Art1e1e·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 w1th any dwell Ing or structures not approved by the Bull ding and Zoning office shaJ.I 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 )all or both).
White. APPLICANT Yellow. DEPARTMENT
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• INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION •
:W:ss ~f4t1:~~to~11c1=i2
CONTRACTOR /2UJVlg fi...-~ PHONE fd?S-()3?£1
ADDRESS _______________ ~
PERMIT REQUEST FOR <_X 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).
LOCAIION OF PRQPOSED.~UftlfY:
Near what City of Town ~ Sjze ofLot /0 c'.lc.xe__..
Legal Description or Address L,.bt .3 &w fuNi 111;.10Tu
WASTES TYPE: Cf.) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( )OTHER-DESCRIBE:-·----,,...---------'-----
BUILDING OR SERVICE TYPE: S(f ~
Number of Bedrooms Number of Persons --'S-=------
( ) Garbage Grinder QO Automatic Washer ( )9 Dishwasher
SOURCE AND T)'PE OF WATER SUPPLY: ()() WELL ( ) 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? ______________ _
A site plan Is required to be submitted that indicates the following MINIMUM dlstancg;
Leach Field to Well; 100 feet
Sepdc Tank to Well; 50 feet
Leach Field to Irrlgadon Ditches, Stream or Water Course; 50 feet
Sepdc System to Property Lines; (septic tank &leach field)lO feet
YQUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN•
GRQUND CONDITIONS:
Depth to first Ground Water Table ______________________ _
P~tGround Slope·---------------------------
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TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
· ( 'J(' .. SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POT ABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET ( ) OTHER· DESCRIBE
FINAL DISPOSAL BY:
c>ef' 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 RESULTS: (To be completed by Registered Professional 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 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 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.
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PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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SITE PLAN Randy & Marcia Mcintosh, Owners
-Craw Subdivision Exemption Lot 3
According To Plat Recorded June 3, 1997 as reception number 509030
E9 192 ft
Existing Well
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~ 253 ft
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Septic Tank • --z____
I Leech Field I
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Grand River Ditch
Lot 3
435,600 SqFt
10.00Acres
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