HomeMy WebLinkAbout1.17 Existing Septic PermitI '
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GARFIELD coufJTY~u1Lo1NG AND SANITATION DEPARTMENT11~1$
I . f t, -& ~tJ:L ' 109 8th Street Suite· 303
Glenwood Springs, Colorado 81801
Phone (3113) 945·8212
permit N: 35qo
Assessor's Parcel No. ' I -------1
J. INDIVIDUAL SEWAOE DISPOSAL PERMIT
Thls does not constitute
a building or use permit. l
tfPROPERTY : (\
r Owner's NameLB ~ ·KPOU.... Present AddresolDcrl Wes!tn "~.pd . Phone'OR4 -Olio'\
I System Location N\o ; "k n M>nC • Bl d(3 ~ RD"i\o -B~ nch
L~igal Description of Assessor's Parcel No. b G:J 'S
1 SYSTEM DESIGN . . ('
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1,_,,S"---0 __ Septic Tank Capacity (gallon) Other ~a,A ~ I
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6> Percolation Rate (minutes/Inch) Number of Bedrooms (or other) fJ0.13-n1rt',~ @ IS:, , <
2.o~ x 1s1J = ~oo 9 0J I ~. •
Required Absorption Area. See Attached ~-·"' t:I lst>OJ A'.l MG-. -'-I so ad ~ ,,; 8 ,_ it"!lbt.) •~u ~ I -rrt% /IO.S"i ~
Special Setback Requirements: A ':: -;r-.,/"h :: {)-;).I If.I / 131.(p. l'fl(X.
fur rf Iv« .L ( Oate_~8~-~1\.~--""-'1-_______ Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
Septic Tank Capaclty_-1..1.LJ.4.L---------------------------------
Septic Tank Manufact\:l.cer"Of'.Trade Name ~f2,~~~1.e~g=· 4==~ ..... L~·~· ~-------------------"--
Septic Tank Access wlthi.n .8" of surface ~
AbsorptionArea ~~ (3 l;,q,XL~)(/-u,Ji)
Absorption Area Type and/or Manufacturer or Trade Name _,.J__,"'''"'lt"'""""':tlJ""''-"ti'-'1;._ .. ""f:J"'. ----'J-/--'-_-_f_O ________ _
Adequate compliance with County and State regulatlons/requfrements _ _,,~~~"'"'------------------
Othe•-------------------:::,--------.-----.--------------
Date_q~-~5~~ ·~D~J..--~ ____ lnspector _ _,LJ...._,,..'a"'-<l""b-1.. _,J,,.,~_' ,,_/N,_,..._..l,(l'-4.l~---------
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
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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~ i ,
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a .. :.,.:ilf~~ ·:
requirement of the permit and cause for both legal action and revocation of the permit. £.~,JWf~'
3. Any person who constructs, alters, or Installs an Individual sewage disposal system in a manner which Involves a knowing and material '·~:) .. 1 ','+.
variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense ($500.00 fine-6 ··r'•~-:?i.
months In Jell or both). · <'.
iWhite· APPLICANT Yellow. DEPARTMENT
vJC-S./IS,A-N1L--i2 € -~VldJ~._ . . .
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION ..
OWNER L-. fS · ease_ (2~,.Jc H L-LL
ADDRESS l{)()7 tNG'SJ]~zA,Jt: IZJ-fu,:I; f5/{,8f PHONE °?fSl-( -01<.:9
coNTRAcToR Go,.w CoiJ5t?:..1Kh cX0 r o
ADDRESS fu r--.e~ l~f) Gv-!'.::> g/r,,o-L-PHONE C)lK,' 7zPi I
PERMIT REQUEST FOR ( ) NEW INSTALLATION _9Q 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 ofTown__.D.<JJ.4tr-n..=l ...... rJ"'".z:""_'--~t""i'--'6'"""r,"-"ei"'-~""'"'""""""J_5flzt=-;'-'-'-'--<l"ff-'1i,,,ize""-"o"'-f""Lo,,.,t~.._~ .... · ""'--'-r__,Acf?-'--"'""-'~s.
Legal Description or Address ~/~0~0~7~~1N~C-_<:>~q/~ff+~~-(...-~(2_Jl_~· _fu~t..J)~--~<-<~')"--_,~._/'"'"~"-"-(J-'--l __
WASTES TYPE: ~ DWELLING ( ) TRANSIENT USE
COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
OTHER -DESCRIBE f/11,A? rJ ktJ ?1..Jc l.-PJ/l J"'-<rJ7 -
BUILDING OR SERVICE TYPE: VIJA11J f..edAJc f~ f3i2/ ... .A1,-i') {J) f2~t ;_ e~.,J,..
Number of Bedrooms .1)._ Number of Persons /D-ZO
Garbage Grinder ( ) Automatic Washer
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL
Dishwasher
SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: lli>7J'"e>fy0 t--WA:'f"Cd.--
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_lf--1 ~M~'~i--=£..~--------
Was an effort made to connect to the Community System? _ __,_--=D'-------------
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 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. __________________________ _
2
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ______ _
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe Engineer does the
Percolation Test)
Minutes er inch in hole No. I -----r Minutes ______ per 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 telephone ofRPE 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 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 .
fi!L/ L /L Dote & c3,1-tJZ---
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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