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Home My WebLink About03919GARRELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 .~ INDIVIDUAL SEWAGE DISPOSAL PERMIT ' Permit N~ 3919 Assessor's Parcel No. This does not constitute a building or use permit. • i -1'.!IOPERTY ' . i .J-L-1-!-"~"""-'-t-~~N ~~g~ess ~ C r<..'d \Di w\) 1>honloci'd-~~ cR~ro . I System Location 1 Legal Description of AS8essor's Parcel No. ------~J~_/_')~v'J--_~~~O___,C{_-_O_o_~_OO __ lf _________ _ j , SYSTEM DESIGN ' _/_2_-~S_O __ Septic Tank Capacity (gallon) ______ Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) _4_,__ ___ _ Required Absorption Area -See Attached I 11z.. ;.i:J Special Setback Requirements: ~f /.j::lj J 4 z /{'J 709-!!; a.:f J f /k' 5 1 ot ru c..-'f" 'f z.. fas Date .c/ ...!(! ?2$/ Inspector _=:;.=~t;.__~'ll<;zl.J'"'°(~etz~~~E..or...¢.~'----------- FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ~ " ' Call for Inspection (24 hours notice) Before poyering Installation \'J c r. L,J ~~ •. System Installer_~·~'-"-~"'-·-~------------------------------------,.,,. Septic Tank Capacity·----=u~·"'u""'c...i.""'~'------------------------------ Septic Tank Manufacturer or Trade Name ------------------------------- Septic Tank Access within 8" of surface -------------------------------- Absorption Area 4o I A.~k 0 l.A-" bR _ ( '~ X 'D) Absorption Area Type and/or Manufacturer or Trade ~~e -1~;;;<.-'<l.'-'~6"·,,~.Att,,·_, ._L-'(,..L~="=·--/.'-'-/_--'-/_D::;::_ _________ _ Adequate compliance with County and State regulatioMstr.quirements-lµ::.<:t::_ _________________ _ I Other-------------------~~----------~------------Date_/1-·~J_C._·_O_t /~ __ Inspector _ _/{,M~a14,("""k4?.a../_' ]1'---'Le=2'.a"-'L.d_-==-=-______ _ ! 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.RS. 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 ora 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 ($500.00 fine - 6 months in jail or both) . White -APPLICANT Yellow -DEPARTMENT l I I ' ; I l 1 • ' I ' l r I \ ., ' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER ,frrky 1-t1/uid1.1 ThcJMpSoC) ADDREss Joo Cte .;>.JC; frftj(e1 cc <tlGSO PHONE ??o-t;ZS--?ozo CONTRACTOR 8/ // W \.\.t le ADDRESS PHONE ----- PERMIT REQUEST FOR ( ) NEW INST ALLA TI ON ( ) ALTERATION {X)REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PROPOSED FACILITY: NearwhatCityofTown_~fJ~"-f .... f ...... e~---------'SizeofLot S.8tp acre ~ 3''"'' r '" ' co Legal Description or Address ______ ~_.,_u::.....::. u_'-Y'-___ t?-____________ _ WASTES TYPE: W DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL . ( ) NON-DOMESTIC WASTES ()OTHER-DESCRIBE _______________ _ BUILDINGORSERVICETYPE:____,~-''--=$_.~-d~f-(-('"------'~'-=-'---'-<-'-l~+--'-IJ=-u.>e..-={'-'-'/1_~~r1-------- Nurnber of Bedrooms __ _..t,.__L-+\ _______ Nurnber of Persons _ _,~----- ( ) Garbage Grinder ( ) Automatic Washer SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL If supplied by Community Water, give name of supplier: J){Dishwasher ~ SPRING ( ) STREAM OR CREEK DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: i ,, .... , /c:-L1f) /"II I 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 A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table ______________________ _ Percent Ground Slope __________________________ _ 7 . '\ TYPE OF INDIVIDUAL SEW AGE DISPOSAL SYSTEM PROPOSED: 9<> SEPTICTANK.-e~isH"'J ( ) AERATIONPLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PITPRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET( ) OTHER-DESCRIBE Lecc_b f:-1ef cJ ' FINAL DISPOSAL BY: ( ) ABSORPTION TRENCH, BED OR PIT ( ) UNDERGROUND DISPERSAL ( ) ABOVE GROUND DISPERSAL ( ) EVAPOTRANSPIRATION ( ) SAND FILTER ( ) WASTEWATERPOND ( ) OTHER-DESCRIBE _______________________ ~ WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? t/O PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe 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 application and in legal action for perjury as provided by law. Signed };:'/) '-llJ~ --Date 1-/;tM PLEASE DRA2WQN~ MAP TO YOUR PROPERTY._!!L-1-="--'------- ti' " ' i. Designate North Arrow Your Neighbor's Name & Address ::p-;~ D Your Plot -Shape to Fit (No Scale) '.;-{W ; ~~f_,.,-,·ke.. ~ ptcipoM. l~~eld " ~-e,ld wo.-f-ur 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. County Road (Note the Road Number and Name) tnc e \wpwmCSO\wpdocs\plot.loc l3A) ' . l. Your Neighbor's Name & Address Co~d T IV..•. I.er pill.YI<_ ~ l.t -f 21.( ~IA-f I ( ()