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HomeMy WebLinkAbout03942bP-OL GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N° 3 9 4 2 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Owner's Name Assessor's Parcel No. raThis does not constitute building or use permit. ` ' , Present Address° \� 1 )(1;bel ►� C Phone C/kz_tikC� 4 System Location Legal Description of Assessor's Parcel No SYSTEM DESIGN l eft:r 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 r U " Inspector � /6114-"(2 at ` v L E l RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SI *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 I, Petty Offense ($500.00 fine —6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT r1c;•r--1-2a"a 06:45 (.r1 . TES 9706258315 p.02 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION ADDRESS tSs�� _fi�1_�.? PHONE �.., CONTRACTOR r �r....d., �.�. �....�..�.,.�..,�,�. M ADDRESS PHONE PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION (REPAIR Attach separate sheets or report showing entire area w;th 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 PRQPOSEDCILITY Near what City of Town �� Size of :trot Legal Description or Address ‘J \ ViAtt IttiaiSa WASTES TYPE: ( DW]ELLINQQ ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DONIF.STIC WAS'T'ES ( ) OTHER -• DESCRIBE I i../,I I.I'.,)f'd''!G OR SERVICE E TY I:.: it\ Number of Bedrooms Number of Persons QQ, Garbage Grinder 00 Automatic Washer vti.DishwashOT SOURCE AND TYPE OF SUPPLY: (0 WELL ( ) SPRING ( ) STRE.AM CO2.. CREEK If supplied by Community Water, give name of supplier: -s DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 2., fi ± 5 Was an effort made to connect to the Cornniunity System'? 100 A site plan is requirellkke submitted that indicates the folloiviagaiiNDEMAiiilitligtvi Leach Field to Well: 100 feet Septic Tank to Welt: 50 feet Leach Field to Irrigation nitches, Stream or Water Course: 50 feet Septic System (septic tank & disposal field) to Property Lines: 10 feet Y ., :R INDIVIDUAL SEW , f"E DISPOSAL SYSTEM PEFaittyriLLNDT BE I aggj .L9 C2 GROUND CONDITION' Sb Depth to first Ground Water T7b1e Percent Ground Slope _ MAY -15-2€ 4 es:45 AM TES TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 706258315 F'..I3 SEPTIC TANK ( ) AERATION PLANT ( ) VAULT VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE CHEMICAL TOILET( ) OTHER-DF.SCRiAE�_ FiNAL DISPOSAL BY: O ABSORPTION TRENCH, BED OR PIT ( ) UNDERGROUND DISPERSAL ( ) ABOVE GROUND DISPERSAL ( ) OTHER -DESCRIBE ( ) EVAPOTRANSPIRATION ( ) SAND FILTER ( ) WASTEWATER POND WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WA -1 ERS OF THE STATE? k 0 PERCOLATIQNjj J RhSULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes Minutes_ _per inch in hole No. 1 per inch in hole No. 2 Minutes es Name, address and telephone of RPE who made soil absorption tests: _per inch in hole No, 3 _per inch in hole No, 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 famished by the applicant or by the local health department for purposed of the evaluation of the application; and the issuance of the permit i3 subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations made, infonnation 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 perrnit applied for herein, I farther 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 fcr perjury as provided by law. � Signed rr�'. ) In°(1 V Date s PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTYI! Grj._ Y MAY -LS 2 '004 08 46 ititi TES 97062581T L5P.04 re" 29) BOUNDARIES UNLIMITED INC. Civil & Consulting Engineers June 21, 2006 Garfield County Building & Planning 108 8th Street, Ste. 201 Glenwood Springs, CO 81601 Re: !SDS for 161 Vando 'oa_, arfield County, Colorado BUI Project: 2005-k DS -Ward To Whom It May Concern: Earlier this Spring, Boundaries Unlimited Inc. personnel observed the construction of the ISDS for 161 Vandorn Road in Garfield County, Colorado. A new 1000 -gallon septic tank was installed in series with the existing 1250 -gallon septic tank and a 13' deep, 15'- 3"+ diameter drywell system with had been installed. No backfilling had taken place. The contractor was advised to install the filter fabric over the gravels before covering with topsoil. Other than that, the system was installed in conformance with the intent of the design. If you have any questions, or need additional information, please feel free to contact me at 945-5252. Sincerely, BOUNDARIES UNLIMITED INC. ruce D. Lewis, P.E. Project Manager Cc: Bob Ward 823 Blake Avenue Suite 102 I Glenwood Springs Colorado 81601 Ph: 970.945.5252 I Fax: 970.384.2833 ;: / \© / &\ (, q \§ // �») /V<Z& §;\\ \, \/ in [.z : (` \ ` iln ° . r \.�\~� 1 \Z2 Prf !N 41,7 ` 9- / 2 ci ;\n TYPICAL EXTERIOR FOOTING a§