HomeMy WebLinkAbout03982GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 81h Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
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Permit N— 3982
Assessor's Parcel No.
(93ct l-0/-063
This does not constitute
a building or use permit.
PROPERTY//� blab/4°14414)/C°
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Owner's Name "`^ 11 n 47 b tam0 t 414) ° %sent Address 19a9G5h'��f l;) kel . ` SQIT Phone
System Location 0-71-a-- !_ uck Pok+ "' • C (cQ •""' c gi«° a3
Legal Description of Assessor's Parcel No. c b STCO0` 53/ /On Orcx rv.ct Rarci1e.
?391 - /1 I-0/- oc,3
SYSTEM DESIGN
ga 7- 0553
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�fJ/�(O/ 05 Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SIT - Q () f / L .
*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 specif ications 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
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OWNER Tc.0 Rw•isN m Paat.o S
ADDRESS 2 %--11,1k R O PHONE 1:1? -7 • aSS 3
CONTRACTOR L4 4. R-1-AiI-4- Col Xj .&c -Z +oma
ADDRESS 534- biAv-a4.45. R RR+x-N Rb
PHONE 618 - 41 2 !
PERMIT REQUEST FOR (X 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 C- t•QoN t *s
Legal Description or Address 1-6w•z51's rt
WASTES TYPE:
Size of Lot -1 • 5-2-
-
2
- INE `Rv . C Poi arc QD
01 DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER -DESCRIBE
BUILDING OR SERVICE TYPE: 'P25
Number of Bedrooms Number of Persons 4
00 Garbage Grinder (1O Automatic Washer (X) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (1 ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:-Qis•1?+iv1/4"44 t e D eo4lN1-41
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
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:
(1) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER -DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? pc.
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 ma result in the denial of the application or revocation of any permit granted based
upon said applicati in gal actr n for perjury as provided by law.
Signed
Date yV ANA, 3 — o f
PLEASE DRAW AN ACC 7 TE MAP TO YOUR PROPERTY!!
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County Road (Note the Road Number and Name)
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nar3EIREINE ENGINEERENG
STRUCTURAL/CIVIL ]ENGINEERING • CONII'RAC FD G *CERTIFIED ENERGY DESIGN PROFFESSIIONAL
May 26, 2005
Garfield County Building Department (via Facsimile to 384 3470)
109 8th Street, Suite 303
Glenwood Springs, CO 81601
Re: ISDS Installation
Diamondopolis ISDS
Homestead 53A, Buckpoint Road
Carbondale, CO
Dear Building Official:
The installation of the ISDS system for the above project has been completed and has been installed in
accordance with applicable county specifications.
If you have any questions, please call me at 963-9869.
Sincerely,
T
ENG
David A. Power, PE
Reg. No. 25851
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]P.O. BOX 631 CARBONDAILE, CO. 81623 ]PHONE 970 963 9869 / FAX 970 963 9003