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Home My WebLink About03837, j ''f?/jt)ri3' J';.:: .'· ..• • • GARFIEL~UNTY 'eulLDl~G AND SANITA~ION DEPARTMENT 109 8th Street SuHe 303 Glenwood Springs, Colorado 81801 Phone (303) 945·8212 ; INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Permit N~ 383'7 Assesaor's Parcel No. This does not constitute a building or use permit • '! •· I ' t i Owner's Name GJ11 Co ( Oic~ \ Sfel't .. ~t Address /YI 5' r-lwr f,). C:Ja~hone tb ,) s-:-0 IQ)) 1 System Location _____ _;;6Qaf,!~o::_ _ _c()~c?-g.~~K;:__Aao~"'->'2f{'fl~/r_;_;~l".f.f__j~&.lft~·~~--------- ,. Legal Description of Assessor's Parcel No.----------------------------------- ~ .i SYSTEM DESIGN ' " ~, ""' ! 'r -{./ ______ Septic :rank CapacifyJgallon) ______ .Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) ____ _ Required Absorption Area -See Attached Special Setback Requirements: Oate ____________ ~lnspector ___________________________ ~ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ! Call for Inspection (24 hours notice) Before Covering Installation . ' ) F I System lnstaller--',r_. ""'U..,W""'-L---------------------------------- j I ! l I i ' ' 1. I i ' • ' , • Septic Tank Capacity_,~"-"-<---------------------------------- . Septic Tank Manufacturer or Trade Name _C:.....1.:o4p,...~<.v,..· ~ .. 0«<1'-=. "A-"------------------------- Septic Tank Access within 8" of surface .J....µ.~,_ __________ _:::.,,.._:_~--------------.. " Absorption Area : i "PA !.&--V, Q,." if-{ (2 -fo-f ) fl ( U . ...J-t;_' /\ -1 I Absorption Area Type and/or Manufacturer or Trade Name ~Yz~tl.o-L 1 <t' , t.? Adequate compliance with County and State regulationslrequirements_J;if'""-'------------------- Other--------------------~--~--~-~--~------------ Date _____ ~ ______ lnspector -----;;::., /,~~ RETAIN WITH RECEIPT ~ECOROS AT Co;;tR(?c'TION 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 specification• 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 I ' ' i ' \ I ' ! ; I j t '· • l i ' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION PERMIT REQUEST FOR ( 0 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~!CILITY: Near what City ofTown, _ __!...~ ..... ~"'--4+-'l""e.~---------S,ize of Lot )) 4c. vL ".::. t 05" O£ f~5 Legal Description or Address tJ z 2 ~ p,, w er / ,· .,, R..J WASTES TYPE: ( ) DWELLING ( '"f-) TRANSIENT USE<, 94. COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER-DESCRIBE aJ-yr.:. /sh" p BUILDINGORSERVICETYPE:. ________ ~~--------------- NumberofBedrooms "'j... Number of Persons_..,.~,__ __ _ ( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher SOURCEANDTYPEOFWATERSUPPLY: (~LL ( )SPRING ( )STREAMORCREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:.--1-1 ~_.,__,i'l'l._,_,_,_,.'/~(------ Was an effort made to connect to the Community System? --------------- A site plan is required to be submitted that indicates the followin& 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 ASITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table__.2=-0 ____________________ _ Percent Ground Slope __ -f~lld..JL--_____________________ _ ., • TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: t-f,.) SEPTIC TANK ( ) VAULTPRIVY ( ) PITPRIVY ( ) AERATIONPLANT ( ) VAULT ( ) COMPOSTING TOILET ( ) RECYCLING, POT ABLE USE ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET( ) OTHER-DESCRIBE. ______________ _ FINAL DISPOSAL BY: ( ><J ABSORPTION TRENCH, BED OR PIT ( ) UNDERGROUND DISPERSAL ( ) ABOVE GROUND DISPERSAL ( ) EV APOTRANSPIRATION ( ) SANDFILTER ( ) WASTEWATERPOND ( ) OTHER-DESCRIBE·---~~~~----------------- WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 4/0 PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes ____ _,.er inch in hole No. 1 Minutes _____ .... er 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 [~catio and in legal action for perjury as provided by law. Signed / . Date ~ PLEASE DRAW AN ACCURAT TO YOUR PROPERTY!! • .. I " \.. Designate North Arrow Your Neighbor's Name & Address [c..S r i"o.!. ~~e.5"-lski ~ 1' ~ f.. "1. .,.ol ... d· ; .. 1 ~c-,1'"'\'- R~fl t., C 0 ~(b)O No~t~tw~~ f- l> c.,. "'"l Li S i " !:,._I.. I '1-z. t7 { '1''1 p.,,~ fl, I!," ;..,1-l, Lo g-(6"2-\ f +W N -~' : ~-1..r_ ~ i \; I\ t. ---..... [] 0 1' f ~ v ·' ~ " • 'J°"'o~ Your Plot -Shape to Fit (No Scale) '-..... .._ ....... -<;~\\.fl-~,_ v O vi.I\ .__,__....." 1 "' Q.. --------, .. Ct Locate well, all streams, irrigation ditchs, and any water courses. Draw in your house, septic tank & system, detached garages, and driveway. If a change oflocation is necessary, you must submit a corrected drawing, before a Certificate of Occupation will be issued. 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