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Home My WebLink About04321l , on:) 6/7a7 RFP 112 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY /n� /j /� r / �� /y C G c( -5 -- Owner's ` r/ Owner's Nam�Q m N�� X16'1 (�( Y )AQ lr(-�p CI I ,/3 f P'V v� C --CP phone l 75 � J .resent Address 6 _ System Location 0 d 9 C( As en �c L " "S t 6 O Ci) 8. / / .:Ce Legal Description of Assessor's Parcel No /9Q Q K �acovs So a a not % ;�r� Assessor's Parcel No. This does not constitute a building or use permit. SYSTEM DESIGN Id 7.9 Septic Tank Capacity (gallon) 7!� Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date (-0 I 9 ',x-iti 3 Zr 712,0 fru) gi4,Y-j pector '2iL.)IrL) FINAL SYSTEM INSPECTION AND'AP*ROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Instauerj-- r ( ✓ -*' trh-7 1c? a Septic Tank Capacity J CC) ) 75-2d4,44 1:1-4G I a-cr-2 Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface.' 112'2 - Absorption Area t, 4 %"`'C` Absorption Area Type and/or Manufacturer or Trade Name 62-€,(1--'%' Adequate compliance with County and State regulations/requirements' ��"'t ./=' d , �'%✓ Other Date /4 i 7 >-a7 Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION 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. 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- nection 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 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 - DEPARTMENT vrifrov snesyo W • 10 d d — C a • 0 o 0 0 0 0 i 0 N 0) N »' o o 0 U d Q N a G,42 -a0 N .s t0 0 > l4 N E E 0. M 'p O Y In d c co N M C6 a) r .0 — la N c E O E - t U O o U-...........__N. a c L i 0) ✓ 0 O p O • U N O 13 d i a5 f., 42 E m .00 y .c a1 ▪ .0 a) y as o -t c N .0 • C y O 0 0 ✓ d a) O R 0 0 >- .0 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER aeidec`J at/44A~ eet ADDRESS 0075"( 4A w ' 7A 6W SPHONE %7o 7S6CS 4.1` CONTRACTOR ADDRESS PHONE 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: Q Near what City of Town 6/ \ W N 00 Sp r ! Ai s Size of Lot 3 if Legal Description or Address 0 d-- L( Q6" ` WASTES TYPE: DWELLING ( ) TRANSIENT USE COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES OTHER — DESCRIBE BUILDING OR SERVICE TYPE: 31/Voir %ia/ grn Number of Bedrooms 'i Number of Persons 17 ( ) Garbage Grinder (X) Automatic Washer (k) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (k) WELL (0) 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 (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 Percent Ground Slope 2 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: ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION UNDERGROUND DISPERSAL ( ) SAND FILTER ABOVE GROUND DISPERSAL ( ) WASTEWATER POND OTHER -DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? YQ. PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes per inch in hole No. 1 Minutes per inch in hole No. 3 Minutes per inch in hole No. 2 Minutes per inch in hole No. _ Name, address and telephone of RPE who made soil absorption tests: Name, address and telephone of RPE 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 maybe required by the local health depai fluent 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 peiniit 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 Date Of Lod 7 PLEASEi(RAW AN ACCU ,TE MAP TO YOUR PROPERTY!! 3 o Designate North Arrow V O U cct crs Julie or Kathy This permit is ready to final, but he paid for second perc test that was never performed. I requested he send a letter requesting a refund. I had spoken with Andy prior and he said that would not be a problem. If you need more info or have questions let me or Andy know. Thanks Matt Invoice Dollar Amount 0P t 0 Brief Description (64 Characters or Less) r 1 1 e o 1 Line Item (64 Characters or Less) c v ti R U U 4w' ro Account Sub Dept ^0 C ` 2. 8 Prepared By: C Vendor Invoice Number y 0 CI u Invoice Date r" "t(( =J c'a 0 e Accuracy Verified By: Julie or Kathy This permit is ready to final, but he paid for second perc test: that was never performed. I requested he send a letter requesting a refund. I had spoken with Andy prior and he said that would not be a problem. If you need more info or have questions let me or Andy know. Thanks Matt GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Permit 4 a 2 Assessor's Parcel No. 1 This does not constitute a building or use permit. c,. Owner's Nangra h'i ♦Q 6 I1(. i a /'P�.eessent Address (,-;d,_.1114 + Phone 7y �r System Location UO� y .71-. %en (JJct.[ ( . S... 76 v/ ci1/.1''7 <4 Legal Description of Assessor's Parcel No. / SYSTEM DESIGN - 1) SL) Septic Tank Capacity (gallon) y/ Otiier r' LG'S Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached 191 t ( ✓ j r ( Special Setback Requirements: Date =(-/-'`b- D 7:RU Pk Ni'ieK'j (fp?ector' FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer (;4'64:,4 ( cr ! Septic Tank Capacity La CO Septic Tank Manufacturer or Trade Name __E._C`�.7-a+��°f� Septic Tank Access within 8" of surface' Absorption Area /// 5 4y'"e -e4d v Absorption Area Type and/or Manufacturer or Trade Name 6a/4.4iG`( Adequate compliance with County and State regulations/requirements' -Zk'•u / Other Date ' 5'07 Inspector /4;rr "iYy RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION 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.P.S. 1973, Revised 1984. • 2. This permit is valid only for connection to structures which have Cully complied with County zoning and building requirements. Con- nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or 8 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 specif icationscontained in the application of permit commits a Class I, Petty Offense ($500.00 fine —6 months in jail or both).