HomeMy WebLinkAbout04111tb leo
q-a3�a5
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY ^ �1n'
Owner's Name C' IL_
System Location
n4 Call Ck_
Present Address5r1
I L\.�
Permit 4 . 6 1
A is Parcel No.
resit C Cyt[
(93°7 o3D_.- Q5
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
Septic Tank Capacity (gallon)
Other
J` Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date I" - (1 Inspector
/--j1'
Ll9f
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) BeforelCovering Installation
J
System Installer c !ill- 7 PNS
Septic Tank Capacity / ()co
This does not constitute
a building or use permit.
Phonegq�—� 3,0
(/av\lbotr(e&)
a --
p}'
Septic Tank Manufacturer or Trade Name Kr/WO h
Septic Tank Access within 8" of surface l/1-5
Absorption Area
(.211
Absorption Area Type and/or Manufacturer or Trade Name n + I fl
Adequate compliance with County and State regulations/requirements
Other
Date /r— (7 _r'
,� 7,7
Inspector 1 %�/'
RECEIPT RECORDS ATC NSTR
RETAIN WITHUCTION 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 materiel
variation from the terms or specifications contained in the application of permit commits a Class 1, Petty Offense ($500.00 fine —13
months in jail or both).
Whits- APPI WANT VdN,., ncoe orlcrrt
a INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER t C oral COM
ADDRESS 0-88� Counity�ci 1494 G,WS PHONE Sys -73/8'
CONTRACTOR WaXXetr5 l ,orn r.ny Tete..
ADDRESS
PHONE 946-2451
PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION (PAIR
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 GW5 Size of Lot r f"QCerg
Legal Description or Address O n gt Cok,,,1/21'd 149 A GW 5
WASTES TYPE:
(4''DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER—DESCRIBE
BUILDING OR SERVICE TYPE: g in+ ctitnay, r-esi,aerct.
Number of Bedrooms 3 Number of Persons
( ) Garbage Grinder ( rrAutomatic Washer (,4'bishwasher
SOURCE AND TYPE OF WATER SUPPLY: (y)"(JELL ( ) 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?
A site plan is required to be submitted that indicates the following 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
AP
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(vi SEPTIC TANK ( ) AERATION PLANT ( )
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( )
( ) PIT PRIVY ( ) INCINERATION TOILET ( )
( ) CHEMICAL TOILET( ) OTHER -DESCRIBE
VAULT
RECYCLING, POTABLE USE
RECYCLING, OTHER USE
FINAL DISPOSAL BY:
(V( ABSORPTION TRENCH, BED OR PIT co feria&.
( ) UNDERGROUND DISPERSAL d iOiri buati o n
( ) ABOVE GROUND DISPERSAL
( ) OTHER -DESCRIBE
EVAPOTRANSPIRATION
SAND FILTER
WASTEWATER POND
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? NJO
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test)
Minutes
Minutes
per inch in hole No. 1 Minutes per inch in hole No. 3
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 appli tion and in legal actifor perjury as provided by law.
Date 7- 23 • 's
R.A(- A,N RA6TT: ' TO YOUR PROPERTY!!
3
P•
N itrCO 9kr..-- .vie., 0
/Pre*. bciAct
oa
4=+tISTfi / , ersb �acc crz
o.
z:
^4 r 11
6,ktcrittiwee
L
7Z
0
13
70
r.
is
PAC II() 11
A 20 ACRES
0
Jr
c.\SOLAR
COLLECTOR
TTT
Et h.Lp.h 11
1
f
0
0
a1
W
•
•
- POIN I OF BL ldldtd...
L3
WEST 520.62'
LEGAL DESCRIPTION
A trod Ol land designated as ' .tet low fid 001A /YID "• ,teJ e. 1110 a E/4 yy
4. SW 1/4 SW 1/4 of Se_I x asap. • SOS. slur y, 6i R+nE d Mm IMM"
rnncipal Meridian, also being s I__:m s /ills 3 aid w S SKS= 1 S -..SIE.- SrR
Range 89 West of lne 6th Pr. co y,wylr Vag -E101•11 d — sa.uilsj - S+
.ay Ione of a road as constr,.ctea ata lR Vie 11180 SOO"d ILm 02100/T tC,
Tract No 12 of said Chelyn Aues .a4 UNA 0Ikd St1111y •010fC441
ticyinniny 01 Inc soulh.esi .., c :e INNS SIRS a ' .S arae q
',gat of .ay .me of said rooa.ir rppbl Se11100111.11114 anew d inti
rt en n% t3_ . 1 JAR0"1 i f....