HomeMy WebLinkAbout040320- rI:c z ;
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
yr
Permit dr ` 3
Assessor's Parcel No.
PROPERTY
Owner's Named
J%vly2!\
' Present Address .c,c-( kL.\j/ D51_4-
030
,_4-03bC 2- aL t
System Location
Legal Description of Assessor's Parcel No
02131-3coy—oo-0411
This does not constitute
a building or use permit.
Phonon
- 3 I -7
SYSTEM DESIGN
la 5r) Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other) V4' """
Required Absorption Area - See Attached
Special Setback Requirements:
-I-1-oma,
Date
//pSGI 14.J'ji
72'
919 t-,, Le -S9
Inspector f! JLIai-r /V ?L1. a a A-
.6( -1A \At ' Q Q
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity 12.5t) /� ,(
Septic Tank Manufacturer or Trade Name (.i c I p� - a- A
Septic Tank Access within 8" of surface
Absorption Area 55 ('-L
Absorption Area Type and/or Manufacturer or Trade Name - '- �' .tJ !. !. r r
Adequate compliance with County and State regulations/requirements /.2i
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 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 specifications contained in the application of permit commits a Class 1, Petty Offense ($500.00 fine — 8
months in jail or both).
White - APPLICANT Yelksw - DEPARTMFNT
p {
GARFIELD COLRJTV
9703943470 01/14/05 10:47rn P. 019
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER ,lend4j
ADDRESS T&9 GrnfP ,bong-- c26/24. PHONE 97f).0?
CONTRACTOR �jQ 47 !7lJIftr, kr S
ADDRESS 3Q, 7 /guy 6 $;/r do. PHONE RtU -S 20c7
PERMIT REQUEST FOR 04 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 boles (Sec page 4).
LOCATION OF PROPOSED FACILITY:
Near what City of Town 3 / 7r Size of Lot
Legal Description or Address 1, ]r cQ &fel StfAr1 i v.S/mto -Jr%;o,
WASTES TYPE: 04 DWELLING ( ) TRANSIENT USE CE t 4 /
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:
Numbcr of Bedrooms 1 Number of Persons OZ
QQ Garbage Grinder ()Q Automatic Washer (Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (4 WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /1////
Was an effort made to connect to the Community System? ////4
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 fust Ground Water Table
Percent Ground Slope
2
GARFIELD COUNTY
9703849470 01/14/06 10:47am P. 020
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
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
UNDERGROUND DISPERSAL
ABOVE GROUND DISPERSAL
OTHER -DESCRIBE
( ) EVAPOTRANSPIRATION
( ) SAND FILTER
( ) WASTEWATER POND
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE
PERCOLATION TEST RESULTS: (To he completed by Registered Professional Engineer, if
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 finished 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 riles and regulations made,
information and reports submitted herewith and required to be submitted by the applicant arc 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. 1 further understand that any
falsification or misrepresentation may result in the denial of the application or revocation of any pemrit granted based
upon said application and in legal action for perjury as provided by law.
PLEA � DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
Date 2 (0:5
3