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Home My WebLink About03854• • i ~ . ' ' ' • ' • • ' ' ! ~ ' I ' 1 • ' ' i' ~ t'· ' .. ' ' rl' i " I l ! ' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81801 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT SYSTEM DESIGN _,_/~D-D~O-Septic Tank Capacity (gallon) r --J ______ Percolation Rate (minutes/inch) ______ Other Number of Bedrooms {or other) __ .::.;~'/.~-__ _ Permit N'.: 385A Assessor's Parcel No. This does not constitute a building or use permit. Required Absorption Area -See Attached A) ~~.11 ~~ -13~ .n l ~_.... ¢ k /µ/ -/{p ~ (j,Y~ Special Setback Requirements: /f':J / -vv .L i::; X' C:--Date_~/~O~-/~-~O~J~ ____ Inspector ___,_M~~~~·--~----'--''-U'---/-1_~ ____ rciL-__ 0 ___ _ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before CoV.ring Installation / ' System lnstaller-"'~·~l;-_. _)·_L~'-L/L-'='---------------------------------- Septic Tank Capacity-'i--'-''---'l.L----------------------------------- Septic Tank Manufacturer or Trade Name _{.;.:o:S"--..1_,____JB'-"f&='.I'."="------------------------- / Septic Tank Access within 8" o! surface __.l.!4{--'Q"VV-'-'---·---~.-----t---~----------------- • \ '• 1 ~ wiWt ~ tf.a,.,~ ,! 11 {p ) • Absorption Area --'.~::.J""-----=--------------'·------L.-------------~-- Absorption Area Type and/or Manufacturer or Trade Name -~=-'-''¥'A"'ll"-"'----'-';j"--'c;,""------'-J/_,__----'/-0 __________ _ Adequate compliance with County and State regulations/requirements__..,~..,..(!,y=------------------- ] Other----------------~--~----~------~-~---------- Date_"-'/ (_.\_--=cd_1_,__/--'0"'---"")<---__ rnspector _,_t)""'--"it'-"J""'lz'-'"-. (!"'"-'--(_/-'---','--/ L=-.f'--,.-{.'-,__J__· ________ _ RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE •CONDITIONS: --. 1. All installation must comply with all requirements of the Colorado State Board of Health -lndbt'idual Sewage Disposal Systems Chapter 25, Article 10 C.R.S. 1973, Revised 1984 . 2. This permit is valid only for connec:tion to structures which have fully complied with County zoning and building require~nta.-Con- nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatic~lly ~ ll',Vi~lon or a requirement of the permit and cause for both legal action and revocation df the permit. ·~ , :~~~~ . ': f (Ji, 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which in~~owlng and material variation from the terms or specifications contained in the application of permit comT!tSrf Class I, Pi ~88 i$50<).00 fine - 6 monthsinjailorboth}. ' ... ~;~\.,.1 1.· 11 t~" .. -'M-1}'1 i ) ' t-\i/f.\ ...... , .. : f'Ui1 ';, ' 1'._A, ' .,. White-APPLICANT Yellow-DEPARTMENT , ' '.;,', f'. ~ I r t INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER ~A£' 1 L 4-I AMN 1E Lee C /~sse-J ADDRESS Jb5 lplf C&nfi1 2{) 2Dtf PHONE 9Jo .-285-SO{f;q CONTRACTOR r PHONE ____ _ PERMIT REQUEST FOR M 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: I Near what City ofTown'----t--i_...._.· ""0_..fbi ......... ?J+>t-U~---------'Size of Lot~ Legal Description or Address C,R.. d. 0 4 '1°\.~ Lte Cc . WASTES TYPE: C0 DWELLING ( ) TRANSIENTUSE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ()OTHER-DESCRIBE _______________ ~ BUILDING OR SERVICE TYPE: HtJ~Jl,f coc•TIJR£0 bloME Number of Bedrooms --=..E~ __________ Number of Persons_'/.....__ __ _ ( ) Garbage Grinder (I) Automatic Washer SOURCE AND TYPE OF WATER SUPPLY: (\/)WELL If supplied by Community Water, give name of supplier: M Dishwasher ( ) SPRING ( ) STREAM OR CREEK 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 followine 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: ('fj 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 ( ) EV APOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER-DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?_._;/_c~ PERCOLA TION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe Engineer does the Percolation Test) Minutes, ____ --.1per inch in hole No. 1 Minutes _____ _,.er 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:---------- 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 perj provided by law. Sig!M:4..;;~~!'.2Z'/J/....LL~ PLEASE ORA WAN ACC 3 ) Designate North Arrow Your Neighbor's Name & Address Your Plot -Shape~ ~·-.,-; <N~&;atie""·--. i -)>: ~ \ '< .' ~:. : '. '') ) ~-r,,:-r:· .. : /!: '. j. : : ,, / . ,-! . . \ )~ 1· c. ::,, .. osDTITT)o '. ~--·_._: ~,~ -~~-~~: -:.;.;,:.::., j sLliJ). t ~o'AN U(.€8/G ; ~ ·. ,' .' "' " ·u' .·.:\-. ~......,..! =-:.-:_~ Ifa c. _, ,...;;:;~:::::--' / / / ! • AVV D<!-1;;' o'~ &-'' .! ,, .• ~" . '·' .. · i) -. ""-_)"' //"J" 3 ! D 5e)ic:. -TUN\<. o>(.t\Y o! p. "l.;<2 1-.J€ ~J>lt ·_::.,·'" 1--'°"" I ~::--~~~~- ---~--=--. ·- 12' 'P 1!a'T" C11't:.U .), ----= ~ 7""--~<::~' 11 s~tion ditchs, and any water courses. raw in your house, septic tank & system, detached garages, and drivew e of location is necessary, you must submit a corrected drawing, •n nr Certificate of Occupation will be issued. • County Road (Note the Road Number and Name) {I rua+u t.D M I ~ C'\wpwin60\wpdoes\p1ot.loc . -...... ·\. Your Neighbor's Name & Address