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Home My WebLink About03952GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY � Owner's Name '3(1.t 1 J\f\ System Location • Legal Description of Assessor's Parcel No. l o 10-3/ Present` .dress Cn /�& SYSTEM DESIGN ?CV ] V min Septic Tank Capacity (gallon) /) Percolation Rate (minutes/inch) Required Absorption Area - See Attached Special Setback Requirements: 6-16 - °tl1 Date Inspector Permit N_ 3 9 5 Assessor's Parcel No. This does not constitute a building or use permit. V"0 ✓�' Phonecro3 -3373 2737/3 — -10-33y Other Number of Bedrooms (or other) rC�q ,r 1;, [•7fkt !cc. P FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Septic Tank Capacity /L'L70C 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 Dale 7 ` ca( Inspector RETAIN WITH RECEIPT RECORDS AT CO RUCTION 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 off ice 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 ($500.00 fine — 6 months in jail or both). White -APPLICANT Yellow -DEPARTMENT OWNER tie Cowart Kosoc.> te+3 ADDRESS G4RitoDALE Cz CONTRACTOR PI FCO — DIAA-KIE Pi S'ER tan. adletg DR, ADDRESS ad.:1sr1)nMP/ CA Ir.2�i GARFIELD COUNTY 9703843470 06/26/04 03i23pm P. 002 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Jaru< 4 GLYP.DA GAusr4ELL PHONE 970 963 573'1 PHONE 9?0 16$ 817G PERMIT REQUEST FOR 9Q NEW INSTALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of arca, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (Sec page 4). LOCATION OF PROPOSED FACILITY: Near what City of TownaD M..€ CA Size of Lot '+5 ACIEES I 7o e-0 Win/ Rom, 10 3 Legal Description or Address CAt&osl oA,t,E7` Co 8 tt.Z3 WASTES TYPE: (>9 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER—DESCRIBE BUILDING OR SERVICE TYPE: Awes Sony p wsa.I..am unI I r Number of Bedrooms 5n0IO A•Pol-0.1-495t9Number of Persons 2. (X) Garbage Grinder ( ) Automatic Washer tic (29 Dishwasher SOURCE AND TYPE OF WAT R SUPPLY• (Jy WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER. SYSTEM: t*Wt EWA It Was an effort made to connect to the Community System? f)UNE MAIL A&E. A site plan is required to be submitted that if icates the foliowing MINIMUM distances: Leach Field to Well: 100 feet Sepdc 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 y_OUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUNDCONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 GARFIELD COUNTY 9703849470 05/26/04 03: 29pm P. 003 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (x) 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 ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER -DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes per inch in hole No. 1Minutes per inch in hole No. 3 Minutes per inch in hole No. 2Minutes 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 bc made and furnished by the applicant or by the Iocal 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 bc represented to be true and correct to the best of my knowledge and belief and are designed to be relied on by the Iocal 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 nd i ' legal action for perjury as provided by law. Signed -i u Date .5/3 Vo PLEASE DW A ACCURATE MAP TO YOUR PROPERTY!! 3 4 County Road (Note the Road Number and Name) c° ap^ O R., ''! O' kI ei a M D W g H W $..o 4--N7n m (r y O ' v, 7 CI e C L ti ci t 6i T T PA W L.p n E Z o w orsN � ' n (3 9 n 3. y — re a z;n �oo� X n n u w i Oo to N Ph N �� Cr0 �o 1i a ei- raja CD Ti a" co ter, � i o pn�r t rre 4 G,n 0.G n r ro \ gen g'E a f r %1 e°(' x 4 n r ar ^n31 '.e q / r C 6 1 � r C ,--Q' 0 lP n O J Cs to WI l tv iv r t' 41 at - 01a tA 1 fr) L or 0 W Moil WuoN ateuBisaQ