HomeMy WebLinkAbout02848GARFIELD COUNTY BUILDIN~ AND SANITATION DEPARTMENT
109 8th Sfreet Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Name J •• Dale I.aper Present Address 0275 Killer Lane 1 Rifle
Permit 2848
Assessor's Parcel No.
This does not constitute
a building or use permit.
Phone 625-4468
System Location __ 0_2_7_5_M_i_l_l_e_r_La_n_e~•-R_i_f_l_e ___________________________ _
Legal Des~ription of Assessor's Parcel No.----------------------.--------~-=----
· I""::-. fl. -L -0 t:O t0 "3 S f. E:/
SYSTEMDESIGN \JJLI Lf-A<:"i Cll/,-,M(':>(1<. QCO r::J /0 I '\..'1.'7 ; S 0 '8 -lf f't) ' 11 "f"llfif'l"C~lj
·-~~---Septlb Tank Capacity (gallon) ______ Other
" . SJ, ,.,. (fl(
f -0 Percolation Rate (minutes/inch) Number of Bedrooms (or other) __ 2 __ _
Required AbsorptiQI)_ Area • See Attached
Special Setback Requirements:
Date er -g -CJ J lnspector ____ .J.->.~{\.'--~""-'~0-=----------'>.-----------
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
E { 1 ~ -r 1'1 -t t\ K Septic Tank CapacitY-l'----'-~"'-='--:__--J---...l...-"'--'--'--'----'--'2...--'--':UC:'-LI -'-'"--,f------------
Septlc Tank Manufacturer'br--El&-l'la111li ___ A_C'~C..=0~11...=0~1~-,....r~_(, __ 't~O~ __ O_<v~/'<~C~""---· ~~~--------
" c Septic Tank Access within 8" of surface ------+-~~----------------------
Absorption Area _____ ?._.)_I __ "Q __ __,( __ ?... ___ l_A_E_N_(_._H~€._S __ G~--~-· ~"~..,)~--
Absorption Area Type and/or Manufacturer or Trade Name --~~f-..._l~F_·_l_L_~r~f~'\~/.--\~1_o~v_\~$ _________ _
Adequate compliance with County and State regulations/requirements _____________________ _
Other--------------------------------------------
Date __ q_,__<)~--q~l----lnspector ----,irti--t-· -~--------------------
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 I, Petty Offense ($500.00 fine - 6
months in jail or both).
White -APPLICANT Yellow -DEPARTMENT
SEP 03 '97 09•03AM CQG GLENWOOD SPGS CO
•
INDIVIDUAL SEWAGE DISPOSAL SYSJ'EM APPLICATION
OWNER l. 't¥Jir~ofJef2_
ADDRESS oa&/1iJJn. /_if,L , ~E. (o
coNTRAcToR ttlaL1:1A/:> Co·
ADDRESS _________________ _ PHONE _________ .,...._
PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION C'j) 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 tes1 holes, soil profiles in test holes (See page 4).
l.OCAJ"ION OF PRQPOSBp FACil,ITY
Near what City ofTown __________________ -ilS~iie~o!l.f.i.I.<ilot~--------
Legal De&cription or Address ____________________________ _
WASTES TYPE: ()('> DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUS'l1UAI. ( ) NON-DOMESTIC WASTES
( )OTHER-DESCRIBE._~~---~--------~-
BUILDINO OR SERVICE TYPE: QltJO.\~ ~1\,, e;Q1;1 d;;;c..e__ 'ti I
Number of Bedrooms -...Oil&--------------Number of Persons __,.-:2i;zi ____ _
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher '·
SOIJRCE AND TYPE OF WATER SllPPLY <X> WELL :I ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: '{f • .0 ~
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:.~=3..;=<.!..!I -1-::--........ ....-....--------
Was an effort made to connect to the Community System? J\S1[Va ,jdl'.){~ * A site plan Is reqglred to be sybmlttgd that Indicates the followtnir MJNIMJTM distances:
Leach Field to Well: 100 feet
Septic: Tank to Well: SO feet
Leach Field to ITrliratlon Ditches, Stream or Water Course: SO feet
Septic System to Property Lines: 10 feet .
( YOUR INDIYJDllAI. SEWAGE DISPOSAL SYSTEM PERMIT WILL NQT DE JSSJIBP)
WITffOJJT A SITE PLAN.
GROIJNp CONDtTIONS;
Depth to first Ground Water Table·--------------------------
Pcrcent Oround Slope•-----------------------------~
2
OQ/03/97 09:12 TX/RX N0.1835 P.003 •
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Designate North Arrow @73 ~ Rd.--N7 g
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Your Neighbor's I I i:i ~ Name & AddreM. Your Neighbor's § Name & Address \1 ~ 0
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.... and any water counes. Draw in your house, 00 w ~and driveway. (JI
If a clwige of location is must submit a comrted drawing, before a c . . will be issued.
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--SEP 03 '97 09•04AM CQG GLENWOOD SPGS co P.4/10
'TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( ) SEPTIC TANK ( ) ARRA TION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POT ABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTIIER USE
( ) CHEMICAL TOILET ( ) OTHER -DESCRIBE
FINAL DISPOSAL BY:
( ) ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND Fll.,TER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER -DESCRIBE
WlLL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF Tim STATE? -J
PERCOLATION lJ!.ST RESIJI TS· (To be completed by Registered Professional Engineer. if the Engineer does
the Percolation Test)
Minutes~-----« inch in hole No. I Minutes-----~-¥·« inch in hole NO. 3
Minutes per inch in hole No. 2 Minutes. ______ _,.er inch in hole NO. _
Name, address and telephone ofRPE who made soil absorption tests: ________________ _
Name, address and telophone ofRPE responsible for design of the system: _____________ ..,,.._
Applicant acknowledges that the completeness of the application is conditional upon such further mandatory and
additional tests a.nd reports as may be required by the local health department to be made and fiunlehed 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 regulation•
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
loeal department of health in evaluating the same for purposes of issi.iing the permlt 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 and in legal action for perjury as provided by law.
Signed----------------Date·--------------
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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09/03/97 09:12 TX/RX N0.1835 P.004 • ·-