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Home My WebLink About04472GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Owner's Name �,( J ' System Location \vsn Present Address 1SC C lv5 `bWL r f Assessor's Parcel No. This does not constitute a building or use permit. 4L- Phone (c)�C.^.; 31'1 Legal Description of Assessor's Parcel No j,i SYSTEM DESIGN A90J Septic Tank Capacity (gallon) Other > 'Lr 7 Percolation Rate (minutes/inch) Number of Bedrooms (or other) z s , fl ,kccK 4-9 / S Q, ! T ./// 7 o ic,V -± .S79 seQ . F77 /Air S 17 74— r Required Absorption Area - See Attached Special Setback Requirements: d s Date C� a�%-' r'1 Inspector r - FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Septic Tank Capacity Septic Tank Manufacturer or Trade Name t- tie- `^""'d L/1;) -" 0411:2 J_ Y'_S Septic Tank Access within 8" of surface 244 . 9' ?, t( r� / ,4 Absorption Area 4 1"- Absorption Area Type and/or Manufacturer or Trade Name P/ P Adequate compliance with County and State regulations/requirements Other t c, Date , de,„:) Cfr *CONDITIONS: Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE 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 ($500.00 fine -6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT GARFIELD COUNTY SEPTIC PERMIT APPLICATION 108 8th Street, Suite 401, Glenwood Springs, Co 81601 Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003 www.garfield-county.com FF USE ONLY Permit Fee: Pe)Ni„, mforrSor' ilable ihhee aassesso ;g70-9459134) 2 Job Address: (if an address hasasnot been (�assigned, L O I pplelase 1ovide Cr,,HH�wx or Street Name 115 t 1eIWOOd ]& City) or and legal description vCpl'4.w s Co 3 Lot )Size:. j Lot No: Block No: Subd./ Exemption: ICI 4 `STAjii Owner: (property owner) r /hQt'e Mailing Address «0 13ox //Yf carl»ndJe-- Ph: 638 '7Ylc2 Alt Ph: 5 Conlrac (/S f , /11 7 /moo Mailing Address Ph: Alt Ph: 6 Engineer: Mailing Address Ph: Alt Ph: 7 PERMIT REQUEST FOR: t$ New Installation ( ) Alteration ( ) Repair 8 WASTE TYPE: (YrOwelling ( )Transient Use ( )Commercial or industrial )Non- Domestic wastes ( )Other - Describe 9 BUILDING OR SERVICE TYPE: 3 Number of bedrooms Garbage Grinder ( )Yes ( )No 10 SOURCE & TYPE OF WATER SUPPLY: 0(j -WELL ( )SPRING ( )STREAM OR CREEK ( )CISTERN If supplied by COMMUNITY WATER, give name of supplier: 11 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN 12 GROUND CONDITIONS: Depth to 1s) Ground Water Table Percent Ground Slope 13 TyffE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED: )Septic Tank ( )Aeration Plant ( )Vault ( )Vault Privy ( )Composting Toilet ( )Recycling, Potable Use ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet ( )Other- Describe 14 FINAL DISPOSAL BY: (Absorption trench, Bed or Pit ( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter ( )Wastewater ( )Other- Describe pond 15 Will effluent be discharged directly into waters of the state? ( )YES (1VW0 16 PERCOLATION TEST RESULT: (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 per inch in hole No._ Name, address & telephone of RPE who made soil absorption test: Name, address & telephone of RPE responsible for design of the system: 17 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 by the local department of health in evaluating the same for purposes of issuing the permit applied for herein. 1 further understand that any falsification or misrepresentation may result in the denial of the application or revocation of an permit granted based upon said application aQd legal < '•• a • -rjury r id bylaw. -IC -0 7 /DATE QQQ OWNERS SIG ATURE FF USE ONLY Permit Fee: Perk Fee: Total fees: Building Permit #: Septic Permit #: Issue Date: Building & Planning Dept: APPROVAL DATE Garfield County Building & Planning Department ALL APPLICATIONS ARE REQUIRED TO BE SUMBMITTED IN PERSON PROCEDURE REQUIRED FOR COMPLIANCE WITH THE GARFIELD COUNTY SEWAGE DISPOSAL REGULATIONS. Permit applications can be obtained and submitted to the Garfield County Building and Planning Department at 108 80 St, Suite 401, Glenwood Springs, Colorado. See below for additional information. I PERMIT APPLICATION & SUBMITTAL REQUIREMENTS: • Complete application. • Site plan (1 copy) to include well, all streams, irrigation ditches, and any water courses. Draw in your house, septic tank & system, detached garages, and driveway. If a change of location is necessary, you must submit a corrected drawing.) • Engineered System will need copy of perk rate & design for our records prior to final inspection. FEES: Make Check payable to: Garfield County Treasurer • Septic Permit for a New installation $73.00 • Septic Permit for alteration and/or repair $50.00 • Septic Perk test $100.00 FEES ARE NOT REFUNDABLE. II ATTACHMENTS: • Percolation Test Instructions • Recommended minimum requirements for Individual Sewage Disposal System (ISDS). III FINAL INSPECTION: • When all components are in place, connected and ready to cover, request a final inspection by the County Inspector. • DO NOT backfill any part of the system prior to the inspection. • The initial fee covers the percolation test and one (1) inspection before cover up. Any additional percolation test will be charged at $100.00 each and additional inspections will be charged at $50.00 each. • Upon final approval, carefully cover the entire system. • Engineered Systems are inspected by the Engineer prior to backfill. A final sealed letter by the Engineer is required to be submitted to Garfield County.