HomeMy WebLinkAbout02616 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 616
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name Dave Bartlett Present Address 2555 49th Street Denver Phone 447 -3730
System Location 0476 Panoramic Drive, Silt
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
/17.44
/WO Septic Tank Capacity (gallon) ,/4 _kat44t 6
/ Percolation Rate (minutes /inch) Number of Bedrooms (or "ot�her) 3
/N // ini i 4;7 P.0 t r-rs9cN 8eD
Required Absorption Area - See Attached
at 0 //sbc C?-raki Ott 5,0 Q/WO-gees -, 3)3
Special Setback Requirements:
Date r' -03 1 Inspector v e-
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
sn
System Installer v v" '1 5-0 L yr1,
Septic Tank Capacity /a G p' Z- �J /
Septic Tank Manufacturer or Trade Name d0 p A 4t1
i
i
Septic Tank Access within 8" of surface yG,
Absorption Area .0 .X /✓ (IL T H / oR 5
Absorption Area Type and /or Manufacturer or Trade Name
Adequate compliance with County and State regulations /requirements
Other
Date 7 - 5 q ( Inspector
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 — 8
months in )ail or both).
White - APPLICANT Yellow - DEPARTMENT
i
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER 1 ' _1t• 'A
ADDRESS .._te _ y '�•") bMg - i/ 7 -3'
CONTRACTOR 0 , ' eles _ 0)
C ,�( 945-0715/
ADDRESS JL�)_' .. / 'nIt al ,.I Ma PHONE
PERMIT REQUEST FOR O 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 profile in tt%st holes (See page 4).
LOCATION OF PROPOSED FACILITY COUNTY Eith e,t ,
Near what City or Town_4/ 1_ Size of Lot
Legal scription�i _ Address N f/_ 6 44 �" I :; 1 ' . 11 / /L h 1I
D4 l) 76 14Nomn i c & t4t , ,S 1
WASTES TYPE: (X) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
) OTI IER - DESCRIBE
HIDING OR SER E T E: Sir
Number of Bedrooms i Number of Persons
( ) Garbage Grinder (t/) Automatic Washer (14 Dishwasher
.Ol1RCE AND TYPE O ' ATER SUPPLY: (WELL ( ) SPRING ( ) STREAM OR CREEK
Giv- • li of . ae Is within 180 feet of system:
If supplied by Community Water, give name of 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 community system? ( ) YES (✓�NO
TYPE OF IND VIDUAL SEWAGE DISPOSAI. SYSTEM PROPOSED:
( WSEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE
FINAI. DISP SAI, 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 THE STATE? /
2
TERCOCA_1 ION 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 bole No.
Name, address and telephone of RPE who made soil absorption tests:
Nance, address and telephone of RPE responsible for design of the system:
Applicant acknowledges that the completeness of the application is conditional upon such thither 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
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 sane for purposes of issuing the permit applied for herein. I fiuther
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 DR AN ACCURATE MAP TO YOUR PROPERTY!!
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