HomeMy WebLinkAbout03738,_ ----~-"=--.;;-·---~-c,q-~-~~-----t\.le~----·~o~·7"~0'1r ---"· . -·~""-... , '~\~ ' ~IVDf)-f-\5·'bld3,
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! ~ /).. ,, C> ~-?::;;> GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
W ?{ ' 'J Cf:,~ 109 8th Street Suite 303
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1 ,:-&--. ·. -.. Gle~wood Springs, Colorado 81801 V '\ / -'' / Z {:A,-/Jt:f/)i Phone (303) 945-8212
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J~ 1 '1_fi_DIVIDl,JAL SEWAGE DISPOSAL PERMIT
_ r .. pAoPERTY . _ .
f ~nel's Nam~~DO~ h,_)p i~ Present Ad~&701'£/Jc9. C1rkfo *'
t 8Y,!itm Location n ~; ,
Permit N: 3738
AsseHor's Parcel No.
This does not co11stltute
a building or use perm t.
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1 ~'~ . ~ i ~~_gal Description of Assessor's Parco! No. --------------------------------
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' SYSTEM DESIGN t ~ __ 'J_,_"~~D~-Septic Tank Capacity (gallon) ______ Other I
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_ _,./--'l"')'--Percolation Rate (minutes/inch) • Number of ,Bedroo6m~ (or other) r-:-I . ~_p;/ ....i ~ __ C/ 41 ~~ '1 w( /1--f t:rfA,.€--< I , ,~
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Date _ __,Clj._--J./_,8<--_:::0_"J.::::__ ___ Inspector ___ ___,,u~..-<-~12.-=t~f_._c_· .,,,£,_71-'-'7-'(-'-Jl'--'_'-"_,,c=-:. ,.d':'-. _···-------
Required ~bsorption Area • See Attached
Special Setback Requirements:
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FINAL SYSTEM INSPECTION AND APPROVAL (as Installed)
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Call for Inspection (24 hours notice) Before Covering Installation
System 1nstaller_--'C1_.."-~-"-==t---'fu""-''-',p'--·""J __ (l._.e=..·2u1<w-... ,:1=--"'""=h=-"·"'·",'-'J'--------------------
septic Tank Capacity I OD 0 ''!6.J:
Septic Tank Manufacturer or Trade Name _ _,_('-'lo'---r)i.J"""'""'-(i,_<>'=·-'d--"------------------------1
Septic Tank Access within ~" of supace _ _,,! -'l*"'Q/>-="""-.'----:_-::_-_------------------->-----
Absorption Area -bx. I/~, ft1 ~ ""' l~e.-,-.. c_f_ ,
· Absorption Area Type and/or Ma~ufacturer or Trade Name -~=·-7T==-=4=.;l,,==-·1.._ __ .;_!(.,_--'-(_,(~J'------l-----
Adequate compliance with County and State regulatlons/requlrements•-'f-t'F=--"'-----------------
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Date
Other ___ ,__-r·------------------------=-------------
/D/ -;;_{ Q.)-Inspector f)aa'r-rAAP--.c~-
/ ( RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
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•coND1fioNs: , l
1. All Installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter f-..
25, Article 10 C.R.S. 1973, Revised 1984. / ~
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2. This permit Is val Id only for connection to structures which have fully complied with County,tOnlng and building requirements. Con) ~
nectlon to or use with any d.welling or structures not approved by the Building and Zoning gfflce shall automatlcally be a violation 91'' 1
requirement of the permit and cause for both legal action and revocation of the per,rilt. .. ,r '
3. Any person who constructs, alters, or Installs an Individual sewage disposal system In a·~annerwhlch involves a knowing and m8terlal f ...
variation from the terms or specifications contained in the application of permit ~Its a Class I, Petty Offense ($500.00 fine - 6 J
months in jail or both). , . " , l
White· llPPLICAf\IT , Yellow -DEPARTMENT
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INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
PERMIT REQUEST FOR ( ..f"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 PROPOSED FACILITY:
Near what City of Town {..,.,. L o "'~ 1-(
WAS TES TYPE: ( ) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( 0NON-DOMESTJC WASTES
( ) OTHER -DESCRIBE __ .4~J+--'~k~•~,F-7¥f_<;..,_'f.~<? _f'~O\_,l-'i'""[,,_,t_.....,.,,,""'-'r 11'-'--
BUILDING OR SERVICE TYPE:_~g~""'~t"_V\'--11/~$11--'h=tJ_,.p'-+/~A+-=J1-------------
Number of Bedrooms Number of Persons 0 -----(4' Garbage Grinder ~~utomatic Washer (fDishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ~LL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_~/(/~()~/V~£~------
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 & disposal 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 ___ /V,_~()_/V_~£~-----------------
Percent Ground Slope ___ _L_-""'<--"-----------------------
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TYPE OF INDIVIDUAL SEW AGE DISPOSAL SYSTEM PROPOSED:
(~ SEPTICTANK ( ) 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 ( ) EV APOTRANSPIRA TION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER-DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? VO
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe Engineer does the
Percolation Test)
Minutes er inch in hole No. 1 -----r Minutes _____ per inch in hole No. 3
Minutes per inch in hole No. 2 Minutes per 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 1>urposes 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 ~l:......!...J"_.:: .. ~~"*------Date Se pt. 5 2 01'.;).-
PLEASE DRAW AN ACC TE MAP TO YOUR PROPERTY!! /
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FOUND RE73AR &-CAP Pls I J.J1 l
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THAT PROPERTY AS DESCRl8£0 IN BOOK 883, PA,
GARFIELD COUNTY, COLORADO
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SINGLE FAMILY RESIDENCE
WOOD FRAM[ CONSTRUcnoN
6 = 20'56'00"
R = !143.88'
/, = 125.43'
N 43'37'48" tr
124. 73'
"ir 'lo/J''' --,,___
S 88'58'16" l' I 73.73' . . /
-(Rieoii71zT · \\~'1"-'0/ 89'56 130" tr ,j/:J / 519.88' 9
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