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Home My WebLink About03814" ... , .... ,,,.' ' " ,. ,, ' ~ ' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 9th Street Sutte 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT Permit N: 3814 Assessor's Parcel No. This does not constitute a building or use permit. ! Owner's NalRe'-Jl'-<l:;;).l....1..1:....,f-l.L~""=:S,J+-J.1-(!~ _.,.__,, Systemlocation_~~,.,b.~"----l-'....__.L-.1,.....r."'"-;-"'-"''-''-'-'....!.-_J_~./,,,-f..~..W~l__ _________________ _ SYSTEM DESIGN ffet?t::?f~eptic Tank Capacity (gallon) Other ,/J#' Percolation Rate (minutes/inch) I Num~r' Bedrooms (or other) • Required Absorption Area -See Attached V ~ / ~()0 JJ. 7 ~ Special Setback ) FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ., Call for::lnspection (24 hours notice) Before Covering Installation System lnstaller ____ _,./)t(~MDtL/1-~~~----------------------------- • .. ' Septic Tank Capacity ___ _,,/l,_,,,O."'D."'~"'"4..,,.4.....,_,f"-"--------------------------.:,;.,J".i",: I ·l .. J11 Septic Tank Manufacturer or Trade Name-------------------------------'- Septic Tank Access within 8" of surface -------------------------------- Absorption Area Type and/or Manufacturer or Trade Name-------------------------- Adequate compliance with County and State regulations/requirements~--------------------- Other ~ ~ tt)~ w-L ;:;ti I ;·~ -J;/A;· /1 Date_cb~-~o~-~tJ~3~ ____ Inspector • I H~~~ RETAIN WITH RECEIPT RECORDS AT C{)NSTRt;C'liON 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). While -APPLICANT Yellow -DEPARTMENT :·~ :'•1'- I i INDMDUAL SEWAGE DISPOSAL SYSTEM APPLICATION JQQPP?S £ £ ?~OR. _ _....Q~O.:.--'~u~~'-------~~~~~~~~~~~ 1 · rss __ __,,_S ..... 0-.=-o...r!V'e_ ___ cx._s _ _.CL=b"""o ... ,,-=L=---PHONE ____ _ PERMIT REQUEST FOR ( v("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 ofTown._~'P_1,_,_f<.f=r--__________ stllill-ot fJ '1. 3> ~ Legal Description or Address 3o95 C. R rMQ 34<€ 1 J{ r R-L ({0 _ WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER-DESCRIBE 0EF1c..r /Sc 41 r.. tLsr $ArHROP7'1 I BUILDING OR SER VICE TYPE:_J'ii[lu<.1.~'\1.11H-£S.!t:£l>..'l\~-=._J)_~J<!2)!SB1t.tif-~o'*1~L_JM~uk!!!:JIAA~"U_iju...~~t.nfi~~-- Number of Bedrooms --~kl-',~A,__ _______ Number of Persons. ____ _ ( ) Dishwasher ~ ~ -~ ( ) SPRING ( ) STREAM OR CREEK ( ) Garbage Grinder ( ) Automatic Washer 7 ~ Tdl!IMI• I ii Si!Pk' g. ( )WELL If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:___,5.LL!M.""--'-l _______ _ Was an effort made to connect to the Community System? --------------- A site plan is required to be submitted that indicates the followini: 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 __________________________ _ • TYPE OF INDIVIDUAL SEW AGE DISPOSAL SYSTEM PROPOSED: ( ) SEPTIC TANK ( ) AERATION PLANT (v( VAULT ( ) VAULTPRIVY ( ) COMPOSTINGTOILET ( ) RECYCLING,POTABLEUSE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET( ) OTHER-DESCRIBE _______________ _ FINAL DISPOSAL BY: ( ) ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND (...,.Y OTHER-DESCRIBE ]:4....,2 q ~L WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?-';./,_,.o=-- PERCOLA TION TEST RES UL TS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) f4 /4J. 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: ~Af="'-"-/l.,,. ______ _ 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 regnlations 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. ~ :f. !Vli I ho f V't'l lf!fJ , <(C'.>( 03 PLEASE DRAW AN ACCURATE MAP TO YOUR PRO RTY!!