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Home My WebLink About03769.i .. I I I ~. ~ I· I I I • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N: 3 7 6 9 t' 109 8th Street Suite 303 A88eHor's Parcel No. ~ Glenwood Springs, Colorado 81601 , Phone. (303) 845·8212 ---------. ~ I This does not constitute t ·INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. f I ~ IAA~~ I ' Owner's ~ame\ C)tr e.s,l e~le ~ddress~...._.D_,_.,_,.5""'S_,_4--1----'-H_..,,,,,u'S_,_,__ PhonBlo"?2-c\)J~ B ' I 075'(,:, ('{\ '"\~ ~~ Q ~ ; ~ System Locatlon ___ "-----'----""-~,('.S..,_,,, ...... O!,...A~:;;;J___.--l__, ____ _,._-'-'-'--"-:r:..._ _________________ _ f Legal Description of Astessor 1~ ~#c;, No.-------------------------------- ' SYSTEM DESIGN _/i~~-O~(}~-Septic Tank Capacity (gallon) ______ .Other I \.· __ /~6 ___ Percolation Rate (minutes/inch) Number of Bedrooms (or other) _3=-'---- f I SIP/±> l<oafr ~ra,,-..-1. ht!l-o RequlredAbsorptlonArea-SeoAttachod .!37(f /:b le~~ 2.(.; f"'S T,r.t..,.~ .!x3 t t/5</CtJ l f'aA_,t. ('_;,~,,_/.)et( /X' "> 6.-iJ "J<ff I Special Setback Requirements: 'I :fl/ c:!i L. F°Ci.A',J~ c!lir~-U> z 7 (' C' <; I) "I) 2 )( r Dato /?-'!:r1 -0 Z lnspector-::z:;;_.-:;i.:..a"'· -=46==-"'~"--'/"""'_L'=--------------- 1 ~~~l~~rsl~:;:c~~:~~E:~~Nn:::t::i:~v~~v~:~n~:~:;:~!tion ~ I •· l l I I I I J t • I I I r ' " ~ t * • Septic Tank Access within 8" 9' surface -'"""'""'..;....-------------------------- Absorption Area // 4, r;:;.,·£ / . " I ,. .// ,(L, tL. Absorption Area Type and/or Ma~ufacturer or Trade Name ,.'-.,"''"'';,'2</b."-';f.k-"'~1..""3/;,:..a.··~~-h=~:z.··~_,"'-,'-____________ _,__ / -,,,.. :::j.,6-·-:;_.~j"--,..,-=-~-"'· ""'S'-' ./_;' ___ Inspector 5$),6-A? R!=Jh-IN WITH RECEIPT RECORDS :ZrRLJcTION 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. i ! ' • ' • t I ! t ! ! \ I I , ! , .. ~ 2. This permit Is valid only for connection to structures which have fully complied with County zoning and building requirements. Con· noctlon to or use with any dwelllng 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 attlon and revocation of the permit. 3. Any person who constructs, alters, or Installs an lndlvldual 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 ]all or both). I ' I :~''·' .~ :·· ' I Whtte. APPLICANT Yellow. DEPARTMENT ., t i , , INDIVIDUAL SEW AGE DISPOSAL SYSTEM APPLICATION PERMIT REQUEST FOR (...-YNEW INSTALLATION Kft'(J PHONE C(f1' S"7/t>- 37tf ySI 3. ( )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 ofTown, ____ ..::~:;,,,LJ/l'-----------Size of Lot Legal Description or Address, ___ ~C-=.:.R.l.......!&""2....'5""_,:_qL__-1.5_J.J..1'-lQ!...~!!'..._ _________ _ WASTES TYPE: (t.-{DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WAS TES BUILDING OR SERVICE TYPE: Sr+? Lf ~/4 Number of Bedrooms ---=.]'--_________ Number of Persons_¥ ____ _ ( ) Garbage Grinder ~utomatic Washer ('-:}'Dishwasher SOURCE AND TYPE OF WATER SUPPLY: MWELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:. __ __,_7-=Pt.='/'-"~"'------- Was an effort made to connect to the Community System? ___ ___,,?1,=--.;V:::__ ________ _ A site plan is required to be submitted that indicates the followinit MINIMUM distances: Leach Field to Well: C (x)', 100 feet Septic Tank to Well: S~P 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 Percent Ground Slope __ ....:->:....__r _______________________ _ 2 , • TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( ) SEPTIC TANK ( ) ABRA TION 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? ___ _ PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe Engineer does the Percolation Test) Minutes ____ .per inch in hole No. 1 Minutes ______ 1per inch in hole No. 3 Minutes er 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 . d L litG Date /iYkf(~ PLEASE D~CCURATE MAP TO YOUR PROPERTY._!_! --'---_,_.--"-,r->"----- 3 ' \ ' Designate North Arrow .,,,..,,._,Y/, ~ '-'/ rr-.. Your Plot -Shape to Fit (No Scale) 1 Lffe~e. ~ L7 ---.__ Your Neighbor's ~ ~'9~ Name & Address Your Neighbor's I Name & Address ~ f;0;e \ 1/ Locate well, all streams, irrigation ditchs, and any water courses. Draw in your house, septic tank & system, detached garages, and driveway. If a change of location is necessary, you must submit a corrected drawing, before a fl M/I Certificate of Occupation will be issued. County Road (Note the Road Number and Name) eric c:\wpwin60\wpdocs\plot.loe I ~ll)