HomeMy WebLinkAbout02034 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit P 2 0 3
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81801
I
Phone (303) 945 -8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Peter Christeleit 6
Bill Collins
Owner's Name olli 4954 214 Rd
P resent Address * New Castle Phone 984 -2265
System Location (Heather Lane) Christelsit Subdivision, Glenwood Springs
Legal Description of Assessor's Parcel No. 0 - (o, • • f - _ a <. C !!!
SYSTEM DESIGN 3 lief/ro ofy & z NOV 9 w X 41 1
MOO Septic Tank Capacity (gallon) he t Other
a Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3
Required Absorption Area - See Attached /1 19 /, i ,A l e Li an e/ /In e i e cl 72.10.- 4 v 4 LS }
Special Setback Requirements: 3 art( ( b e d t clone c 14r/ cd c1 rb ri / E r� 1 n r/P t-
Date Inspector - - ' - - - `.f �4
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before CC o . y
veriing Installation t
System Installer_ I3 C s " - 61--C
Septic Tank Capacity /J il a a
( \�
� I , ,.1 / �'
Septic Tank Manufacturer or Trade Name ACC/ 1 ? , , 11
Septic Tank Access within 8" of surface
P L.'
.2 Absorption Area —4-e / 3 7) '
Absorption Area Type and /or Manufacturer or Trade Name .2 / ear.......... nit""' ./ - 2 -
Adequate compliance with County and State regulations/requirements G-^
Other h,
p
Date /2-9 /. - Inspector �`e+1 °
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All installation matt comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
25, Article 10 C.R Revised 1984. a•.
2. This permit is valid Only for connection to structures which have fully complied with County zoning and building requirements. Con- ,1
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be aviolation 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 )ail or both).
Applicant: Green Copy Department: Pink Copy
� INDIVIDUAL SEIJA E DISPOSAL SYSTEM APPLICATION Application
Approval by
�� / /� County Official:
OWNER 1/LIS Ll vS oo
ADDRESS 4 19x`/ a 6w / � O f.�( PHONE 9yi -Z26,5 iD
CONTRACTOR NL>C - -- jA4
ADDRESS S,Am a PHONE
PERMIT REQUEST FOR: (X) 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 /4-2 1i6lcQ
Near what City of Town 6/4NWoofi s. Lot Size /Moo1 i7e
`]
Legal Description 312 C eet - C'42ISi 1 11 sq-6. _
WASTES TYPE: ( x ) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: si,ugto F.9m C.y
Number of bedrooms 3 / Number of persons
('o) Garbage grinder (,c) Automatic washer ( X) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (X ) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: A oN @
If supplied by community water, give name or supplier: --
GROUND CONDITIONS:
Depth to bedrock: cfO''
Depth to first Ground Water Table: ?OOP/
Percent ground slope: 4/2 ,4# dia7ms c?;em
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: NoN & •
Was an effort made to connect to community system? No N6 1i1 Mar
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
It ( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe: _
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF TIIE STATE? /✓0
,
Pane 2 7 ,-
ft
S01t PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.)
4 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 peri,ft.Is 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 niy 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 /O - l q- q2- Sign -d j am/ s/ � . f�
r ,illr •
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
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Page 3
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PLOT PLAN AND DESIGN FEATURES:
Include by measured distance location of wells, springs, potable water supply
lines, cisterns, buildings, property lines, subsoil drains, lake, water course,
stream, dry gulch and show location of proposed system by direction and distance
from dwelling or other fixed reference object, and additional submissions in
support of this application such as data, plans, specifications, statements and
coninitments.
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Page 4
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4 617 206 309 16 370 20 370 �2
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3 500 167 250 13 300 16 300 18
4 667 222 33:3 18 400 21 400 24
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:3 535 178 267 14 321 17 321 19
4 713 23B 356 19 428 23 42B 26
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:3 567 189 284 15 340 18 340 20
4. 75 252 378 20 454 2.1 454 27
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2 200 398 133 199 11 239 13 239 14
3 598 199 299 16 359 19 359 21
4 797 266 398 21 4713 26 4713 29
-'----]T----'---T- --- ------ 366 1. ,22 10 219 12 219 13
2 209 410 139 209 11 251 1 3 251 15
3 627 20 9 313 17 376 10 376 23
4 876 279 41E3 22 5()1 27 501 30
---- - 1 382 127 191 10 229 12 229 14
-� 2 219 436 145 21E3 12 262 14 259 15
=== '_---__-�� ��_
--�-- 39R 133 199 11 239 13 239 14
13 1
2 227 454 151 227 12 273 15 273 16
:5 6131 227 341 19 409 22 409 24
4 909 303 454 24 545 29 545 33
— '-------' 1 413 138 :206 11 248 13 2413 15
2 236 471 157 236 • 13 r83 15 283 17
707 236 354 19 4r4 27 424 25
4 913314 471 25 566 30 566 34
- 1 427 142 213 11 256 14 256 15
2 244 4813 163 244 13 293 16 293 113
3 732 244 366 20 439 23 439 26
4 976 3 48[} 26 586 31 5136 3
--- -------
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• 2 252 504 168 25:l! 13 302 16 302 18
3 756 252 378 20 454 24 454 27
4 100E1 336 504 27 605 32 605 36
'---- --- �-----'- - 455 22�' 12 273 15 273 16
2 259 520 173 260 14 312 17 :312 19
3 779 260 390 21 469 25 468 28
4 1V39 346 52(/ 28 623 33 623 37
- - - ------- 4�R 156 234 12 2B1 15 281 17
113 1 u o
:2 267 335 178 267 14 321 17 321 19
3 1302 267 401 21 481 26 491 29
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