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Home My WebLink About03716~ r ! I\. l I I ! ! I I I I I I I I I i ., GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945·8212 Permit N: 3716 Aaaeaaor'a Parcel No. i INDIVIDUAL SEWAGE DISPOSAL PERMIT ~ PROPERTY This does not constitute a building or use permit. ! owner's Na'm;\AA n::a~l-£1 .e I l System LocatioDL\t:)L\ (' Q · Present Address~ \Cj--\ C'~&\ 0 ' ·' • i Legal Description of Assessor's Parcel No.-------------------------------- : SYSTEM DESIGN ~ I l. ' I i I ,I l I 1 ' ! _,/i'-'l""')_,_Q'--"C!'---Septic Tank Capacity (gallon) ______ Other __ /~3~--Percolation Rate (mlnut9'!1lnch) Number of Bedrooms (or other) __ 3=--- (r-c,.'/ /!) /(l'.>Q(r l-e1>cJ1 rt<l-D . Required Absorption Area • See Attached Special Setback Requirements: Oate 9-L/-OZ. jt/ I .,::'J ( e~e h ('{'""st'"n:, / b' pcs 31~ lf 01 C!J t "' "" h M ,._,,.,3 ~,.. .s '2 'Z. I'<' s 3 I<'- 40"l .l!l l e-.,.cf, ~(,,.,..,'.$.,,.,,., JS pe'> 2Y¥ Inspector ~xi~ .. FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer·--------------'-------------------------- Septic Tank Capaclty~/,-','-'/_,.(-'-J,,_r-).:;..;">1· ·,_<>.c-ccf_'-----------------------------,:, /v 1/ Septic Tank Manufacturer or Trade Name(..• ..Qµ•"-''-~:&"'"=------------------------- Septic Tank Access within 8" of surface -.,l,.-f'".12."'~~.-:?"'---------------------------- ' , Absorption Area ~UL&:::------------------------------------ ' ') ( /) / '/;: ,,_;:"' .... Absorption Area Type and/or Manufacturer or Trade Name _,.,r_· G'-'2-"''-"_· __ ,_·..c-·',~dez.,<':io/=·-"/'"'.<"-"c":l-:.·:z,~~=----------- Adequate compliance with County and State regulatlons/requirements_-1·~4_. ________________ _ '/ -~'."'/~ -·/:?' . Oate Inspector --At-?tt-~A..L'.!7------------------ / (-&d-~o-r RETAIN w1TH RECEIPT REcoRos At oNSTRucT10N s1TE t' f I<) C'& c/ ,"r' ,.!if •CONDITIONS: ._, '/ s k'lfi-. 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. ' ! I ~ " ,. I ! • t I ! I I ' r • I i • ·~ • ( I 2. This permit Is valid only for connection to structures which have fully complied with County zoning and building requirements. Con-~ nectlon to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a ~ I ' I requirement of the permit and cause for both legal action and revocation of the permit. j 3. Any person who constructs, alters, or Installs an indivldual 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 flne-6 * months In jail or both). ' White -APPLICANT Yellow. DEPARTMENT i ' . INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER ~-t_),~~ ADDRESS~~ ~:;,{llZ,.~ ~3 PHONE,Z?'L"-,f?~ ~ · ££,s-3 CONTRACTOR ____________________________ _ PERMIT REQUEST FOR ( ) NEW INSTALLATION qs'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). Legal Description or Address C..:Z'L:'...if~Q.~~::...UO~---------------- WASTES TYPE: N DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER-DESCRIBE. _______________ _ BUILDING OR SERVICE TYPE: _______________________ _ Number of Persons --L----- ( ) Dishwasher Number of Bedrooms'-""--------------- ( ) Garbage Grinder ( ) Automatic Washer SOURCE AND TypE OF WATER SUPPLY: ( ) WELL qJ 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 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 to Property Lines: (septic tank &leach field)lO feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table,..~~~~-='-""'=-~t'.'.!>=--o='---------------- Percent Ground Slope~~ 2 --------------------------------------IF. ' TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 0 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: w 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?..,4~· ~""'------- PERCOLATION TEST RE$ULTS: (To be completed by Registered Professional Engineer, ifthe Engineer does the Percolation Test) Minutes. _____ per 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 pennit 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 pennit applied for herein. I further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any pennit granted based upon said application and in legal action for perjury as provided by law. Signed,~-~ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 "' Designate North Arrow ~A,,·,.._._,;,{ .. ;,,,r/;'..th. Your Neighbor's Name & Address \ ~ \ Your Plot -Shape to Fit (No Scale) ,f fl ~~o~~ ~~ ~ ;J I (---;--.__~ I I ---.... I~ A •• f,,u,~-- 7 I j !! .} 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. ·!.. Your Neighbor's Name & Address /jl~ ~ ,~v ~f' County Road (Note the Road Number andName)1 ~~ ;-,~&Go ,7 '/ ". ___ . i J lio~¥1µ =icc:\ic; lill61Ywipdooif' •Jpc t -----~- I ~A)