HomeMy WebLinkAbout03763'
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GARFIELD COUNTY BUILDl.NG AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springe, Colorado 81601
Phone (303) 945·8212
Permit N~ 3763
ABBeBBor's Parcel No.
This does not constitute
a building or use permit.
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., INDIVIDUAL SEWAO. E DIS. POSAL PERMIT
PROPERTY
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-:;$ ' e.J2...i33/ Phone <?J (a -'g 77tfE
I System Location llt>{p~-~ ~
\ Legal Description of Assessor's Parcel No.--------------------------------
' SYSTEM DESIGN
~ ~/~ct:"'"':W""---Septic Tank .capacity (gallon) ------'Other
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? -----Percolation Rate (minutes/Inch)
Required 'Absorption· Acea • See Attached
Special, Setbac,k Requirements: . ·<' (·:;
Date / 2 2 S-O<t. l!l1' ,
FINAL SYSTEM INSPECTION AND APPROVAL (as Installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer /Je,1/111 15 /J!?ou.Jn
I </;->rs.
17/)e.:;
(•j ;'JC'$
Septic Tank Capaclty~~='cJ,-'Q~----------------------------"'--
vi,.,u!l....._
Septic Tank Manufacturer or Trad~ ~~mJ -'~"'-.,.,.""-'""-="""------------------------
S.ptlc Tank l\CCOSS'dlf~ln 8;; of surface _c~[::::;L~··;:O:'::_; ----------------------_.,,.:__ y\ -
Absorption Area .=-i::.~~!u~~-----------..,.---,---.,..-----------------
f ~h-.£, ~ ~ ') v Absorption Area Type and/or Manufacturer or Trade Name'l'/7""7J...<;l>a.JL.:-'-"'=~~~::__..a.~o....1/~L-----------
Adequate compliance with County and State regulatlons/requlrements--'C~-'f.· """'------------------<>
Other ___________________ ~-~,__ __ ~_.,,r _______________ _
Date~/_·_· _c,._-_O_$ ______ lnspector -k·i11~
( -~ .-03 RETAIN WITH RECEIPT RECOR~~?s;RUCTION SITE,~
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•CONDITIONS:
1. All installatlon 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 ls valid only for connection to structures Which have fully complied with County zoning and building requirement&. 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
requirement Of the permit and cause for both legal action and revocation of the permit.
3. Any person who conetructs, 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 flne-6
months In jail or both).
Yellow· DEPARTMENT
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INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
PHONE 'g7{p-87]<{
PHONE le ::2..6" p;;,i 3 o-fi:-
37Cf-~01~ De+->t->:1 Gel),_
PERMIT REQUEST FOR ([/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. _ __,~=""........._/_,_r __________ Size of Lot S-. ~-A. SS
Legal Description or Address ,;li 7 %L 7 l(ac> y7,5-'fO '<( CCR..3 "3 l $1' ( .f..
WASTES TYPE: rf:/ DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTICWASTES
BUILDING OR SERVICE TYPE:,$": ;_,'iLF. G:i-e4;i ~;,A,_<'
Number of Bedrooms ______ .=-<., _____ Number of Persons-"?.,,__ __ _
( ) Garbage Grinder M Automatic Washer (fq Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ff) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:__.~r=-''---------
Was an effort made to connect to the Community System? --~~---~"~-141~'~·--------
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 __ uµ,_K:..M __ ""-'""-'-'..J~----------------
Percent Ground Slope ~fu., ,{{vp---,7 -¥' %
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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:
f > ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRA TION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER-DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? lf'l?
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe Engineer does the
Percolation Test)
Minutes ____ _,,er inch in hole No. 1 Minutes _____ per 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: ·J;J,·_µµi< S~t.J
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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.
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