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Home My WebLink About02012 , :+4i"7rrAr 1699' i,'.;. p' .° s..-WISCaer"RW.pq:Mir.Sr77np7PrilirragiFitigrxn c:Y firx^'r' c � c GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 2 0 1 a 109 8th Streator Sulte 303 Assessor's Parcel No. i Glenwood Springs, Colorado 81801 " Phone (303) 945-8212 [[ This does not constitute ? INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY 3000 E. Ceder Ave. 12 1 Owner's Name Frederick C . Fisher Present Address Denver CO Phone 777 -1408 1 ! System Location 1/9.4/.9 County Road 243, Dawson Sub., New Castle d Legal Description of Assessor's Parcel No. k. SYSTEM DESIGN 1 060 Septic Tank Capacity (gallon) Other f / -,I:A, a., ^ -E got/6 46,1,- ,, A4 n :, t e » +'+ _ ' ; . Percolation Rate (mTnutes//inch) Number of Bedrooms (or other) / , fo f~IA . 1. v Acf+ e co -. /FF X;' ? 4 r¢) Required Absorption Area - SeeJWteehed 4 A31 _T..7,...9, 7 t 6 , A T or 0r 3 ± / r , ; 4 , 2..7 Q C o G/ t A c 't o v try 37- r- /' ' c , -c 5 1 Special Setback Requirements: ( i • C7 _ 1 Date 1-7- / -1 Inspector CM & FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer `-+mom • t TM/Kr $ .'1 Septic Tank Capacity 4 6 O " -�C' ^�'''`�Q]�' } Septic Tank Manufacturer or Trade Name 1 "1. 1, Septic Tank Access within 8" of surface La- y �r 1 Absorption Area Absorption Area Type and /or Manufacturer or Trade Name . " If I Adequate compliance with County and State regulations/requirements L � — • Other 7 p jam.... /,,�( /� ,.,�� R, Date / � /(/' - / 7+ Inspector a J I . ( ?` -4-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. ( p 3. Any person who constructs, alters, or installs an individual sewage disposal system In a manner which Involves a knowing and material i variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 1 Ins — 8; months in jail or both). it d Applicant: Green Copy Department: Pink Copy • " ( 5 r GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT PROCEDURE REQUIRED FOR COMPLIANCE WITII TIIE GARFIELD COUNTY SEWAGE DISPOSAL REGULATIONS: Step I: Application A. Obtain a standard "Individual Sewage Disposal System application" from the Building and Sanitation Department, 109 8th Street, Suite 303 Glenwood Springs, Colorado 81601, 303- 945 -8212 or 625 -5571. B. Return completed application, map to property, and diagram of site to the Building and Sanitation Department (Pages 2, 3, &4). • C. Obtain a receipt for the applicable fee. Make check or Money Order payable to "Garfield County Treasurer ". FEES ARE NOT REFUNDABLE. Step II:. Percolation Tests SEE DETAILED INSTRUCTIONS ON PAGE 6. *A. Prepare three percolation holes 4 feet deep, 8 to 12 inches in diameter, and 20 feet apart in the area of the proposed leach field. B. Fill percolation holes with water once for the required 8 hour soaking period. C. Request percolation test by Sanitarian. (To avoid construction delay, we suggest arrangements for percolation test be made at least 24 hours prior to the end of the soaking period.) Please have at least 10 gallons of water available at the site for the percolation test. D. Upon completion, you Individual Sewage Disposal Permit will be issued provided no prohibitive problems are encountered. *If a drywell (seepage pit) is proposed, consult with the Environmental Health Department for percolation test procedures. IIIMPORTAHTII Please be advised that if the Sanitar.iari's initial field visit to your property reveals any unusual difficulties such as high water table, excessive percolation rates, bedrock, etc., the services of a Colorado Registered Professional Engineer and /or Board of Health • approval will be required prior to the issuance of your Individual Sewage Disposal System permit. Step III: Final Inspection A. When all components are in place, connected and ready to cover, request final inspection by the Sanitarian. B. DO NOT backfill any part of the system prior to inspection. C. Upon final approval, carefully cover entire system. Please feel free to contact the Building and Sanitation Department if questions regarding your shwage'treatment system arise. (FOR APPLICANTS INFORMATION) Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: OWNER '(" (Z EDER.I CIC C . FISHER.. ADDRESS 3Crne E .• Cedar Age.. #b' 2_ PHONE '111— 14 'o$ CONTRACTOR ADDRESS _ PHONE PERMIT REQUEST FOR: ( ✓) 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: County Gar f ie (pc, Near what City of Town i4QW CAS'+€ Lot Size Zo £CreS Legal Description � L.o - 1" 3 ,, bnw&ov-. &4 aXtioNlo 'I /J % o. Z WASTES TYPE: ( ✓) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms 3 Number of persons 2 - . (✓f Garbage grinder ( ✓) Automatic washer (I Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: — Depth to first Ground Water Table: Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to connnunity system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (✓f 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 TIIE STATE? o _, . 1 • SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) 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 purposes of the evaluation of the application; and the issuance of the pe rmft.i3 subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements 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 under- stand 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 per- jury as provided by law. Date G/2-0 9Z Signed PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY • • n P i ri r 1