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Home My WebLink About03746i ...... ----r ~l~~ti~C> _,,if~~~ qi~ . I~}" 1D GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945·8212 Permit N~ 3746 A88e88or'a Parcel No. This does not constitute a building or use permtt. I . I I I I I ' I I. ! INblVIDUJ~~ SEWAGE DISPO AL PERMIT · PROPERT. I ., .... r·· ~ ,).~gal Description of Assessor's Parcel ' I '·SYSTEM DESIGN , i •· /,DOD Septic Tank Cap~lty (gallon) ______ ·Other I ~ , , , Percolation Rate (~utes/inch) I Required Absorption Area • See Attac~d Number of Bedrooms (or other) I Special Setbackf?fments: . \ l • Date ___________ _ spector _________________________ _ t FINAL SYSTEM INSPECTION AND APPROVAL s Installed) ,. ~ ! t ! ' I • ' I ,, I ,, \ i ~ ; , I \ I I ' , ' I I I i Call for Inspection (24 hours notice) efore Cove 'ng Installation ~ · 1 J. ·f -t--I System Installer /"k/:;J · .· " 7\ /A2._,L/l-£.vt;. I I fl I> Septic Tank Capacity ;,; . (f,(' ·~ Septic Tank Manufacturer or Trade Name . ( //J.-,,, I Septic Tank Access within 8" of surface~(_,. /_(~ .. ~_··J-~ _ _,, _____ ~------------------ C . k} \ / I Absorption Area C-,(AJI . .-1·-lf Xl--C · 1'-f/,,c.,[' . .00 / .. , T \ ?CJ.:: Absorption Area Type and/or Manufacturer or Trade Name-~"---------------------- \ Adequatp compliance with County and State regulatlons/requir~ments~// __ " _________________ _ Date Inspector -"'-'~+<.4.W~'-~L-1"--''-'--"-"'-':...:>-----'-------/tJ. ·~ct/ 0" RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE •CONDITIONS: J f 1. All Installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Dlsposal 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 usa 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 -DEPARTJ'NT ------------------------r---, INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION (.)<) REP AIR 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 ~ k.vwaap 5~:..v'J s Size of Lot. ___ _ Legal Description or Address /'it> $. ,PAK. WA '-I WASTES TYPE: (X) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ()OTHER-DESCRIBE ________________ _ BUILDING OR SERVICE TYPE: _______________________ _ Number of Bedrooms ___ 3~ ________ N.umber of Persons ____ _ {X) Garbage Grinder (le.) Automatic Washer SOURCE AND TYPE OF WATER SUPPLY: ~)WELL If supplied by Community Water, give name of supplier: ~)Dishwasher ( ) SPRING ( ) STREAM OR CREEK DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: __ c./~~hl~;~_e_s _____ _ Was an effort made to connect to the Community System? --------------- A site plan is required to be submitted that indicates the followin2 MINIMUM distances: Leach Field to Well: e.>ve,e_ 100 feet Septic Tank to Well: P.,~,e_ 50 feet Leach Field to Irrigation Ditches, Stream or Water Course: p.,<lt.. 50 feet Septic System (septic tank & disposal field) to Property Lines: .t.V""lO 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 r --------- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - ------ - - - ----------------- • TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: <)() 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: (X) 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? A./O PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes er inch in hole No. 1 -----r 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 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 ~ ~ ~IJ' ~e /tfJ-8--D Z..-- PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 r" ,)(· ,,., Designate North Arrow Your Neighbor's Name & Address M""" ,e;e'-4> ~ ~ Your Plot -'shape to Fit (No Scale) ~,_;, -,Jft. vi/' ' :s~ i' l\j t.>et.C.. 0 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) ericc:\wpwin60\~ / ':ln) ·\. Your Neighbor's Name & Address ~ '