HomeMy WebLinkAbout02745 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Pdrmit .• I it U
/ 109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
'° does not constitute"' .-.s4-•
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name Robert & Tomi Higgins Present Address 32954 River Frontage, Silt Phone 876 - 2901
System Location 31 6 3 Highway 6 & 24, Silt
Legal Description of Assessor's Parcel No
ii. Roe L.C-AcFt t cc C., g.. ,`Zy $ Q Fr• 27
SYSTE D #SIG I 1 r f LT ti /A..: oti • On " .r' L a f Q K9 C( r' / p / Cc
0 0.0 �3 I y> D�FTus t t cof 1 )
y(2^
Se Tank Capac (gallon) Other _....)
Ir y
- 13 F'` f 'Pk,colation Rate (minutes /inch) Number of Bedrooms (or other) 3 •
, 1
Required AbsorptioniArea - See Attached .�
Special Setba9K Requirements:
� /� p /I 1 ,
" Dete I - ' 6 t � Inspector /^-t "�"`"' ,
FINAL SYSTEM � I {{ N ' $PECT49N AND APPROVAL (as installed)
Call for inspeptfoh (24 notice) Before Covering Installation
System Installer 1 / 4 A-. 0 ( r 0.._ '
F4 - _
" � I J � ,.
Septic Tank Capacity / f r
Septic Tank Manufact or T r ade - N am e / ' i ( r -' 7
11 C9 di ( -,vcp ' r
, Septic Tank Access wlthlr,8 ot,surface "
(til C J '- L7 4 qt
f „
Absorption Area - -
7 Absorp Area Type and /or Manut tGr6r br T Qe e a7 Pi c C L
Adequate compliance with Codnte nd State regulations /requirement `
Other "`"'_.
Date , ! 1-1 n pe _
r . RETAIN WITH RECEIPT REC AT CONSTRUCTION SITE
•CONDITI5PIS I 4
1. All installatlo must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
'*/ f5. Aycle10 C)R.S. 1973, Revised 1984. ....
-2. this parmitis vJ!}}dd only for connection to structures which have fully complied with Qounty zoning and building requirements. Con -
nectiontoor g office shall automatically be a violation or a
rpquireent of the permit and cause for both legal action and revocation of the pe It.
3. AAny4 n who constructs, alters, or installs an individual sewage disposal system in manner which involves a knowing and material
variktio}ryrfrom the terms or specifications contained in the application of perm' mmits a Class I, Petty Offense ($500.00 fine — 8
months In jail or both).
0 7-: White APPLICANT Yellow- DEPARTMENT
INDIVIDl1AL SEWAGE DISPOSAI. SYSTEM APPLICATION
OWNER geD Am s _ M /Ct S c
ADDRESS I , L U c S c 14._ 00 & - q „ S Z PHONE ?3(..- ZS O (
CONTRACTOR Y4t -t #- @e7 4
ADDRESS `7F [Le (,DO; I I CC PHONE 77t%O Z--, 7
�6r «r--
PERMIT REQUEST FOR (4 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:
Near what City of Town C1 f ( / Oki . f Size of' Lot Z 'J,12 , 4Ac'tfj
Legal Description or Address L0 f�tV4C)1l f _l. L 'e-f5 (Olct to 41
WASTES TYPE: ( DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON- DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: 1 1 - 4 - 1,4 - 144 t ( y9 letetz4Th ! i0e.a
Number of Bedrooms "3 Number of Persons L i
(>4 Garbage Grinder (VQ Automatic Washer Dishwasher
SO! JRCE AND TYPE OF WATER SUPPLY: WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: kV A-
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 2' •141 t
Was an effort made to connect to the Community System? k) C)
• i • tlin i r• •uir•d s • ,mitt. • tha in'i ate h• fill, in• MINIM ?M di tance •
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.
GROI JND CONDITIONS:
Depth to first Ground Water Table •I1` (ph F i r
O
Percent Ground Slope
... , •: .
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
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE E0i tl 1 4nn..r1 --toz
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? N 0 1
pF.RCOLATION TEST R T (To be completed by Registered Professional Engineer, if the Engineer does
the Percolation Test)
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 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.
Signed / ! Date I" if
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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