HomeMy WebLinkAbout04335- (0538.'
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 4 3 3 5
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 9458212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
Assessor's Parcel No.
This does not constitute
a building or use permit.
PROPERTY
Owner's Name SPC4,1 f C'` YS TC Present Address LIA t CA 1)0M -A r] ICU
t Phone CIt4 r ��
System Location 006g F+s 1.in us),1 ! +CiWS
Legal Description of Assessor's Parcel No A -3`(S"'22,2 -62-o 0-9- / OG - v`ie WS p\q't)- (0-1-
SYSTEM DESIGN
/lee, Septic Tank Capacity (gallon)" ,75/'6a9##*t /04/11k
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date
Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity
7z--- pens/n/6- 7-31-4/ J/(
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area // 5, s -q, A/
4/ 03 f -.5/rsAA[P
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
Other
Date 3- Inspector //i`H Cela/ y /!�0�/,v//
7?//AL–.
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
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER J ►1,'S l,J '4&i
ADDRESS •=g;y ?�" PHONE'%Q -64 930
CONTRACTOR 0 tA)N ^' L`,5'VCe'
ADDRESS 4) l t -t I - 4)u O $r L &)
PERMIT REQUEST FOR NEW INSTALLATION
PHONE
( ) 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 City of Town e71 -101)03A0 AI S Size of Lot g .ao /Acu5
Legal Description or Address LT 7 OW, t 031,i3 PL ,1JOO S
WASTES TYPE: ki DWELLING ( ) TRANSIENT USE V" 1
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER ---DESCRIBE
BUILDING OR SERVICE TYPE: `' IO U P! .fu (N 4 t(
Number of Bedrooms 4 Number of Persons
(X) Garbage Grinder (x) Automatic Washer (Y) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: or) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: OAK t'"t iiA i)owgw4 i J As-s1�
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 distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System (septic tank & disposaI field) 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
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(c) 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
( ) UNDERGROUND DISPERSAL
( ) ABOVE GROUND DISPERSAL
( ) EVAPOTRANSPIRATION
( ) SAND FILTER
( ) WASTEWATER POND
( ) OTHER -DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 1Q
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 per inch in hole No.
Name, address and telephone of RPE who made soil absorption tests:
Name, address and telephone of RPE 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.
Signed
PLEASE D
AN ACCUR
Date {P/ (67
MAP TO YOUR PROPERTY!!
3
CIVIL ENGINEERING
October 13, 2008
Andy Schaller
Garfield County Environmental Health
108 8th Street, Suite 201
Glenwood Springs, CO 81601
Re: Jay Spry ISDS
Dear Andy:
NES
An Employee -0%k lied Company
LAND SURVEYING
The following letter is to confirm the engineer's acceptance of the designed septic system of the
Spry Residence located up 4 -mile in Oak Meadows. The design included a 1,000 gallon septic
tank minimum, a fluid dynamics dosing tank and a sand filter bed. All of the inspection wells,
tanks crossings and cleanousts were inspected and were installed satisfactory. The addition of the
siphon dosing tank was changed to eliminate the mechanical maintenance, and is shown per the
attached as -built drawing.
With the above -noted changes, the system has been completed with the intent of the original
design.
If you have any questions, or need additional information, please contact us.
Sincerely,
HIGH COUNTRY ENGINEERING, INC. ��ve��4
O
\'J ROsC/CFrf,'8
,L_ (f)
Roger : 1 eal
Seni. 'roject Manager
RDN/blf
Enclosure
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1517 BLAKE AVENUE, SUITE 101
GLENWOOD SPRINGS, CO 8 1 601
970.945.8676 • PHONE
970.945-2555 • FAX
WWW.HCENG.COM
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