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Home My WebLink About02522 Rl/WSIfl •p :•`-'0-4•150•41-2••••W F 1 F 1'7 ,v.rvr - "In , - 411 111 • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 25"i2 • 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY J` Owner's Name Sharron Johanson Present Address PO Box 267 Carbondale Phone A6-0934 System Location 17117 Flying Fish RD. • • Legal Description of Assessor's Parcel No. 4 SYSTEM DESIGN — QeN2 A?% i /f _Se / 47ie et/we w /SI/plin 1 /✓ew 7 , 4AM( O4 /min! tt4N/K ,t.-ii e Septic Tank Capacity (gallon) Other Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached Special Setback Requirements: Date: Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer elbadaP se/n 4.7 txrr7unr //44 Septic Tank Capacity /COO a/ - . Septic Tank Manufacturer or Trade Name GO "ean ^x7 eoi°< /?ere Septic Tank Access within of of surface ) /c5 Absorption Area _- / ne eO f' "T se,O Absorption Area Type and /or Manufacturer or Trade Name 1/./4 Adequate compliance with County and State regulations/requirements yes Other t"< TO Car-1 Date /1' Zp' Inspector 1/4321 Ace 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 G.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 - " nectionio or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a require(nent 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 Item the terms or specifications contained In the application of permit commits a Class I, Petty Offense (5500.00 fine — months in )alyor both). White - APPLICANT Yelkhv - DEPARTMENT r /9 62portr il f to GARFIELD COUNTY S Ifsem P BUILDING AND SANITATION DEPARTMENT PROCEDURE REQUIRED FOR COMPLIANCE WITH THE GARFIELD COUNTY SEWAGE DISPOSAL REGULATIONS: Step 1• 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, 970 - 945 -8212 or 625 - 557I. 13. Return completed application, map to property, and diagram of site to the Building and Sanitation Department (Pages 2and 3) and building plans. INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMITS WILL NOT BE ISSUED WITHOUT A BUILDING PERMIT. C. Obtain a receipt for the applicable fee. Make check or money order payable to "Garfield County Treasurer ". FEES ARE NOT REFUNDABLE. D. Your Individual Sewage Disposal Permit will be issued provided no prohibitive problems are encountered. Step 11 Percolation Tests - SEE DETAILED INSTRUCTIONS ON PAGE 6 *A. Prepare three (3) percolation holes 4 feet deep, 8 to 12 inches in diameter, and 20 feet apart in the area of the proposed leach field area (Instructions for post hole or back hoe holes are on page 4). B. Fill percolation holes with water once for the required eight (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 five (5) gallons of water for each hole available at the site for the percolation test. *If a dry well (seepage pit) is proposed. consult with the Environmental Health Department for percolation test procedures. !!!IMPORTANT!!! Please be advised that if the Sanitarian'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 111. Final Inspection A. When all components are in place, connected and ready to cover, request a final inspection by the Sanitarian. B. BO NOT backill any part of the system prior to the inspection. C. The initial fee covers the perc test and one inspection before cover up. Any additional percolation tests will be charged at $100.00 each and additional inspections will be charged at $30.00 each. D. Upon final approval, carefully cover the entire system. Please feel free to contact the Building and Sanitation Department if questions regarding your sewage treatment system arise. (FOR APPLICANT'S INFORMATION) 1 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION c 4 ' �,.�, ADDRESS ��//// PHONE 9 .R$ — cps) CONTRACTOR PA .4 Fi(C4.41 Atli j r , - .., ADDRES /yt4 Pi ifd. WED+ ' PHONE 9 ^ 333 PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION 7) 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 Near what City or Town Size of Lot Legal Description or Address WASTES TYPE: (>0' DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTIIER - DESCRIBE BUILDING OR SERVICE TYPE: Smote F+.r..y Ostalbedc. Number of Bedrooms 3 Number of Persons 3 ( ) Garbage Grinder (x) 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: /1/ 4 - 441/At n aria If supplied by Community Water, give name of supplier GROUND CONDITIONS: Depth to bedrock: n/ Re,on..e 70 BR es nnrc- s.wes Depth to first Ground Water Table /z7A Percent Ground Slope /r/At DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: AMC . -, Was an effort made to connect to community system? ( ) YES ( ) NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ((4 SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) MT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAL DISPOSAL BY: EX /3770vG ( ) ABSORPTION TRENCH, BED OR PIT (/ EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER- DESCRIBE WILL EFFLUENT BE DISCI IARGED DIRECTLY INTO WATERS OF THE STATE? No 2 • P *i,RCOI_ATION TEST RESULTS' (To be completed by Registered Professional Engineer) NA 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: //41' Name, address and telephone of RPE responsible for design of the system: /y/A 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 fimrished by the applicant or by the local health department for proposes ofthe evaluation ofthe application; and the issuance ofthe permit 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 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 tine permit applied for herein. I further understand that any falsification or misrepresentation may result in the denial ofthe application or revocation of any permit granted based upon said application and in legal action for perjury as provided by law. Signed ;�v /ran Date / / //J /.5' PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! n yin Fis R4 3