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Home My WebLink About03649. ' ' ' GARFIELD COUNTY BUll,.DING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springe, Colorado 81601 Phone (303) 845·8212 Permit N~ 36•' 1 1 1 AaaeHor'a Parcel No. ! 1 ~ i INhlVIDUAL SEW~QE DISPOSAL PERMIT f PROPERTY This does noi constitute a building or use permit. Phone !;.;.,~·owner's Namf..du,:,;J?\a."1N. ...,..eol\ffDPresent Address l4-~~8~'l. l System Location ()l/pt> C.ofi! ~;;..:i, (<,{le Q.O' 811.t. S:D t Legal Description of Assessor's Parcel No. __ L,,.,.c,_±1-· _ .... 4.J..J.1-./1--'-lq.!..!..(\_,_-\-_,....\.y=:::i_,S~_...lC:)r_,,'Llc_.£~.i.D.Lbd..JC~-j~_ ... ------- + t SYSTEM D;~6a Septic Tank Capacity (gallon) ______ .Other Number. ?f Bedrooms (or other) __ LJ __ _ ? ' ,,.., ' t _ ___,_2_..,__ __ Percolation Rate (minutes/inch) t' Required Absorption Area .. See Attached qoqcp ~tRJd </~ t/I:'/d ~ ;i, ~ (311.- S'IS t:i ,:...,._&.I i! ~ (1.,e") 'I ! ! Special Setback Requirements: Date Y-15 -01-Inspector---'~'-'"'='--"'. -"-':/....___,_J--'-'Jv=-::..::M!/=i..q _______ _ I l FINAL SYSTEM INSPECTION AND APPROVAL (es Installed) I Call for Inspection (24 hours notice) Before Covering Installation l • -~ I i ! ~ I i System Installer ___________________________________ _ Septic Tank Capaclty•_/'-"2'--'-S--=O'-------------------------------- Septic Tank Access within 8" of surface ---'+''""''-------------------------- Absorption Area _:--.Lle~·· ~"""c:z::_.__ _____________________________ _ Absorption Area Type and/or Manufacturer or Trade Name _;;-"-/""!c"'-;9-£&'". "-''-L;,"'-""'~"~"'-"'"'-a"'--------------- Adequate compliance with County and State regulationstrequlrements----'11&:."'-:1'.___ _______________ _ ~ Date ') -S--() z._ q(?/ (),___ RETAIN WITH RECEIPT RECORDS I\ l ' ~\ : f . ( • i' ' ; t ) I. ! ! " r I •CONDITIONS: 1. All Installation must comply with all requirements oft he Colorado State Board of Health Individual Sewage Disposal Systems Chapter .1!. 25, Article 10 C.R.$. 1973, Revised 1984. I, I I ' ' i ·~ f • 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 vlolatlon or a ' requirement of the permit and cause for both legal abtl 0n and revocation of the permit. , 3. Any person who constructs, alters, or Installs an lndlvldull sewage disposal system In a mannerwhlch Involves a knowing and material l 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 --.......... "--------------------~--~------------~-----------------------------~---~-- •• INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER '&LA£ E I ?eTU-~ ADDRESS \ y <eo G-<LAt--i~ A.v £ CONTRACTOR $ I LT CD . KI (, 52- ADDRESS 0,cJ t>JB-i--(?, u\ '-~ PHONE c.r;LL (pf 8' f<-flf / PERMIT REQUEST FOR OQ 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 PRQPOSED FACILITY: Near what City of Town flenJ.Jai-J f2-,.f u:;: .. ~ • l.--r Size of Lot 3-.1-Z ttc...:...e > Legal Description or Address Lcrr Y / AN 1'L!?iLS 01u ... t-W-D · ~ " IJ {).v • > • 0 .J WASTES TYPE: ~) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER-DESCRIBE. _______________ ~ BUILDING OR SERVICE TYPE:_e""e,___,'),,,,,I D:<..:~"'-!...::...:':...:':.:..."".:...:'--=----------------- Number of Bedrooms----'----------- ( ) Garbage Grinder ( ) Automatic Washer SOURCE AND TYPE OF WATER SUPPLY: {')() WELL Number of Persons----==~'----- ()() Dishwasher ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier:. _______________ _ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: \J6T 5'rf,f fl:'.()&\~~ ,.? l U Was an effort made to connect to the Community System? ______________ _ A site plan ls 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: (septic tank & leach field )10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GRQUND CONDITIONS: Depth to first Ground Water Table. ______________________ _ Percent Ground Slope MAY&f 1/z... -iv P~e<.&-"I 2 TYPE ~F INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: v (~ 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: ( ) ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER -DESCRIBE l N f IL /11.K\ll;)t-J 1"~ f>,.C~ ~'€.U) WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? NO PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes ____ __,..er inch in hole No. 1 Minutes _____ _,,er 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 fillsification 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. PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 Designate North Arrow t Your Neighbor's Name & Address vJ\L-'JO~ Your Plot -Shape to Fit (No Scale) (-¥:> \))~ \}~ ~ ~ \.\'' ~ ~S~~ \~O ;.,--7 ~\ !J/JLf,eJ> Locate well, all streams, irrigation ditchs, and any water courses. Draw in your house, septic tank & system, detached garages, and driveway. If a change oflocation is necessary, you must submit a corrected drawing, before a Certificate of Occupation will be issued. County Road (Note the Road Number and Name) me~ l3AJ ' · i._ Your Neighbor's Name & Address [.._p..N!;:.~~'€ \ ..