The URL can be used to link to this page

Home My WebLink About04165\ft1115-C;(' Li.- to -oma GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 5454212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Owner's Namei r) �cL4 ess Permit 4 16 5 Assessor's Parcel No. This does not constitute a building or use permit. 1 RcI "1 Phone t.J� ! System LocationlJ�b-•1� �� -�--' Legal Description of Assessor's Parcel No C SYSTEM DESIGN Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for inspection (24 hours notice) Before Covering Installation System Installer Septic Tank Capacity 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 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 Budding 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 aknowing 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 DISPOSAL SYSTEM APPLICATION OWNER J eon k I t c F-v\.(‘y ADDRESS ?0, i cn& i (14i S l e i t, socx) S Pc mss c °PHONE 9:0 "- _ . . _ fps'® CONTRACTOR Sea.vN ADDRESS SPHONE Std j PERMIT REQUEST FOR (N 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 of Town t 'kr‘ t.jooc.) t vk@j5 Legal Description or Address o S"7 coS ['�c` 1� artic iti 6 ( -7 (.,,\)R S`'CtAle < WASTES TYPE: (k) DWELLING ( ) TRANSIENT USE tu' ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) „OTHER —DESCRIBE Size of Lot 2-i' i Ptcces BUILDING OR SERVICE TYPE: St, A8t e: tN,Ho r Number of Bedrooms Number of Persons ` .. (14 Garbage Grinder ( ) Automatic Washer (X) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (Y) WELL ( ) 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? ye S" A site plan is required to be submitted that indicates the following MINIMUM distances: Leach Field to Well: Septic Tank to Well: Leach Field to Irrigation Ditches, Stream or Water Course: Septic System (septic tank &• disposal field) to Property Lines: 100 feet 50 feet 50 feet 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 PRIVY ( ) COMPOSTING TOILET ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) CHEMICAL TOILET( ) OTHER -DESCRIBE FINAL DISPOSAL BY: (() ABSORPTION TRENCH, BED OR PIT ( ) UNDERGROUND DISPERSAL ( ) ABOVE GROUND DISPERSAL ( ) OTHER -DESCRIBE VAULT RECYCLING, POTABLE USE RECYCLING, OTHER USE ( ) EVAPOTRANSPIRATION ( ) SAND FILTER ( ) WASTEWATER POND WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? re 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 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 perjury as provided by law. Signed C0_,tTN_ Date 9 2a -q Sr - PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 October 22, 2007 Nathan Bacon Owner, lot 57 Westbank Ranch Filing 4 Re: ISDS Engineers Approval Letter Dear Nathan, RI -113 MOUNTAIN CIVIL, INC. Please accept this letter as Red Mountain. Civil, Inc.'s approval of your now constructed septic system. As requested, I came to the site on October 19h, 2007 and documented the layout and installation of the septic system. Noted changes from the plan are as follows: -The tank was placed farther from the house as designed The trenches were located along the south side of the house instead of the west comer of the property. -You chose to utilize the minimum 4 trenches None of these changes alter the function or the design of the system and are acceptable to RMC. Your tank had the appropriate tees and the Biotube filter on the discharge. As you finish your lot, keep in mind maintenance access for the tank and the field for septic pumping or the observation ports for the trenches. RMC_approves_oLtheinstalla.Ci~o ._citb1s system as in general compliance with the intended design. Rick L. Barth, P.E. Red Mountain Civil, In Silt, CO 81652 ....,;7...R...,ENG,..77,.. 3♦ :V-rs". — i ; 36749 r s a , t-0• =4... •0e•eo••e``�1 ON•Ai.c- .� � 10- 'k -+w ryrr/cvwe ri m. velY•:rl:•014 ��a •aul'pr) teaenoW Paa NVTd SUSI X sasimcs.1.of.sasfnoare OD 'AJ) alUIRW:) SCIS[ a 11:1 'LS 101 f i Lv- lg x a4, a.c 4 , MO a IiivsHgg �X s 5 6001E00'd O # 9e:tt 600g/Lg15Q :tUOJA