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Home My WebLink About03796GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945·9212 INDIVIDUAL SEWAGE DISPOSAL PERMIT Permit N~ 3796 Assessor's Parcel No. This does not constitute a building or use permit. Legal Description of Assessor's Parcel No.----------------------------------- SYSTEM DESIGN 1(200 Septic Tank Capacity (gallon) ______ ,Qther -~/~~~--Percolation Rate (minutes/inch) Required Absorption Area -See Attached Special Setback Requirements: Date $ '/ · 11 ~ Inspector -=~·,)jz;;,,;"1!!::.222~-L"ll/.lol!-.C~:...~"':;.,,,:;0 -~------------- FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer ________________________________________ _ Septic Tank Capacity_,~!14lt2, __________________________________ _ Septic Tank Manufacturer or Trade Name -'~=~,.,..,......_ _________________________ _ Septic Tank Access within 8" of surface -------------------------------- Absorption Area---------------------------------------- Absorption Area Type and/or Manufacturer or Trade Name -------------------------- Adequate compliance with County and State regulations/requirements _____________________ _ Other ___________________________________________ _ Date Jo-ZI ~O 3 Inspector ~·-'S}"-""'/J.~~"'-'-'/5~~&~'//~~,.=-· --------------- RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE •CONDITIONS: 1. All 1nstallat1on 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 . .. . ' • INDIVIDUAL SEWAGE DISP6SAL SYSTEM APPLICATION OWNER r-ow iJ Q\=-CAie...i?.c t>J~"\-Ui,..... ADDRESS 5'/f 'C.0Ul!IU{UP j,40. CA!,e...<o...illr/~ PHONE g(:,3 G,. / ss CONTRACTOR CA-t> "I' k-A s. So (.....•~c.-'> I ;..Jc..· ADDRESS Sl c... °'"" o o.J ....,-o.::.b i.....i • ~ o '-' o 4 '-c.. 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 FACil..ITY: Near what City of Town ~B ti ~~.o,.-1.J,;'._ Size of Lot 41 3 3 ~ U<...c.S Legal Description or Address / I CI c.,, ~ . ,e..o • I co WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES (X) OTIIER-DESCRIBE'---------------- BUil..DING OR SERVICE TYPE: ~:>TC)~C.E-I S Lg.Ji°'- Number of Bedrooms 0 Number of Persons _____ _ ( ) Garbage Grinder ( ) Automatic Washer SOURCE AND TYPE OF WATER SUPPLY: ~ WELL ( ) Dishwasher ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: _______________ _ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:__::l....:.'...:o'lc........:.frl,;;..;;..;..' _-t-______ _ Was an effort made to connect to the Community System? IV o rJ~ '\ ....,"' • .__.,, "''-~ A site plan is reauired to be submitted that indicates the foUowing MINIMUM distances: Leach Field to WeU: 100 feet Septic Tank to WeU: 50 feet Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet Septic System to Property Lines: 10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Gr01md Water Table ______________________ _ Percent Ground Slope __________________________ _ 2 ·' ' .I' • .. J '. TYPE OF INDIVIDUAL SEW AGE DISPOSAL SYSTEM PROPOSED: ~ r • ' '()(} SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PITPRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTilER USE ( ) CHEMICAL TOILET ( ) OTHER -DESCRIBE FINAL DISPOSAL BY: (xj ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTilER -DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF TilE STATE?_1'.J~O ____ _ 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 er inch in hole No. 2 Minutes _____ 1per inch in hole NO. 3 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 purposes of issuing the permit applied for herein. I further understand that any fitlsification 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 C---. ~ -C --..... -~~' t>t<N'f' Date \ '------------ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 ' . i .--------! 2---~--@,~---_ _:::: __ ?~- ----------2__..S~-----&.--LC:-----]?_Q __ --- -----------------1 __ J _______________ Cl __ is _____ -2s ____ _ ---------1--------------------------f~'l------- ·----------+ ----------------------------------------------- ~-------l-H.,,..__7_y_ -~--= -~~----------- . ! --- __ __ _ ___ J:..'efzt;fJ__!_~p<>'> J.X~_ _ ____ _ .. ---------------+-+----------3~!c.!L J_i__~ ~?. _!?_,(~----- - ------ • !l~~.Jt: .. f&#~~-:. ·~·"~"~·:""'.~·-~= GRAPHIC SCALE ;;;;:;;;~~======Fi ::::.::=·-·=-· ,::,';'~'£f~:;·~' ·· ... ·• •. . k,.,.-1 ~.:::: '~ 1 EXCAYAlE AROUND PERIUE1tR OF TANK 10 H BASE ~ .t.Wft---...._ INSTALL 4 CQtCRE1E aDC1C ANCHORS TO cotiFD&\1E "FQR' ~ IOUANCY. NSTALL 2 CABLE S1RAPS ACROSS D1Hlll DD OF Ti AND AnACH TO PRECAST m.oac RllCS. BACK Fl.L 'NI> caw. TO SUftll'ACE It 12" LFTS. ..... ' i 'i ~ ~ \ "-l I ~ . ' , ·~ _, PROPOSED LOW WLTAGE UQUIO Lr.a ALARM 10 IE INSTALLED H>OORS W/ \tSUAL AHO AUDIO ALARM. PLUG IN1'o 115V WAii. OU11.ET. USE CRENCO smtllS AllSEN1I SERIES ELEClRIAH 10 CO<RlllAlE W/ SCO. _.,,,, I itwUSED UNDERGRQUND DIRECT BURY ELEClRICAL CCN'lftCI. WR!S. PROWlE(2)140MJG£MBFOA......,.. ELEC1RIAN TO eooltl*A1E W/ SCO.· ~ALL A 24• OREHCO RISER, W/ SEALED ICl.T ~ TANK AOAPlER. ciW1t SEPTIC TANK PMilMY at.MeER ACCESS Of'D9IO. ~ \ \ l INSTAU. A ......... 24" l>AME11R ACCESS \ \ \ =-srt,,.,~~~~ .... lER, ACCESS OPENNQ TO ltSURE WA1ER11GH1NESS N«) FOR ACCESS TO YALLT M..NfM ASSIEla.V. RISlR TO HAW: INSULA'llD UD AT 1IE SURFACE. DEP1H TO TOP OF' TANK FR<* PROPOSED GRADE SS APPROXIMA.11..EY 24•, PWO/SEAL OU11.ET. STING PROPERTY LINE