HomeMy WebLinkAbout02789 t GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2789
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 Camp Christian Present Address 2915 County Road 241 phone 9 84 -2211
System Location 2915 County Road 241, New Castle
Legal Description of Assessor's Parcel No.
Tying into an existing Septic Line & Sewage System. We will. be using
SYSTEM DESIGN the same volume of water.
Septic Tank Capacity (gallon) - Other
, • Percolation Rate (minutes/inch) Number of Bedrooms (or other)
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 1
Sy�(em Installer_ A CC U n /4 T C- ( ` p SA -
Septic Tank Capacity 1 b Q 0 !
Septic Tank Manufacturer or Trade Name N 0 n- EA-- 7' c s r
.00
Septic Tank Access within r of surface
Absorption Area G X f T i At G
Absorption Area Type and /or Manufacturer or Trade Name n C IC ' c �A C. - -6 �y
Adequate compliance with County and State regulations /requirements
Other
Date _ - 97 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 Sy ems 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 off ice 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 Jail or both).
White - APPLICANT Yellow - DEPARTMENT
'.Al . SEWAGE DISPOSAL SYS'I EM AI'PI I('Al ION A-2611,4(/
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ADDRESS - -- — 07 <f / 0- _ PHONE _ --
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l'ONTRAC'I'OR RAND � .. J�!�f/"• C��! - - --
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ADDRESS — � rs'
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I'NRMIT REQUEST FOR ( ) NEW INSTALLA ) REPAIR
Attach separate sheets or report showing entire area w -11 - if area.
C -425 —
habitable building, location of potable water wells, soil 7� s (See pa ge 4 )
IAICAIION OF PROPOSED FACILITY. / 2 9& °Z
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Near what City of Town /v/ Lc/ (4 3 7 it °.0
Legal Description or Address / f C�
WASTES TYPE ( ) DWELLING 97°— ��
( ) COMMERCIAL OR I - vv ASTES
( B OTHER - DESCRIBE , _ ..1 to —
BUILDING OR SERVICE TYPE. <. ".- '��/t f�_t - - -_—
Number of Bedrooms — — _ - - - -- Number of Persons
( ) Garbage Grinder ( ) Automatic AV' er ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY__( WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Neater, give name of supplier: —
DISI ANC'', TO NEAREST COMMUNITY SEWER SYSTEM: —
\V'as an effort made to connect to the Community System? /
A site plan is required to_ be submitted that indicates flowing, llowing-MINIMU]\1 distances;
Leach Field to Well: 100 feet
Septic 'hank 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
W'I'1'1IOUT A SI'Z'E PLAN. (,t//' tier '.q(/et G .i. / (1 f . , ' 6
GROUND CONDITIONS:
Depth to first Ground Water Table F 4 ttr :./a! i - -i — > — —
(/tYtct,.t. P ( EP, t-
Percent Ground Slope— _ -- -- —
2
INDIVIDI TAI. SEWAGE DISPOSAL SYSTEM APPLICATION Id
OWNER 64t hp /'{i/S ?mod
ADDItESS _ �i 11 2 ' // ton n I HONr? e 'P /
CONTRACTOR SiNO VAN CtleV . e/ - — — --
ADDRESS - PHONE 1J,m >_•l <c797
PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topoeraphy of area,
habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4)
LOCATION QF PROPOSED FACILITY:
Near what City of Town /✓/ S 7 ` Size of Lot
Legal Description or Address
WASTES TYPE. ( ) DWELLING ( ) TRANSIENT IJSE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
(✓ OTHER - DESCRIBE (2/1
BUILDING OR SERVICE TYPE: .5.90 ' itt [R Cietti ? S'
Number of Bedrooms Number of Persons
( ) Garbage Grinder ( ) Automatic W er ( ) Dishwasher
SQURCE AND TYPE OF WATER SUPPLY: ( WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: ,,
DISTANCE 7'O NEAREST COMMUNITY SEWER SYSTEM: S 1
\Vas an effort made to connect to the Community System? /11)
Amite plan is re_quiretliOte submitted that indicates the following MINIMUM distance
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. U / , crier jtv /A. G %d 7 (0 4 /
QROIJND CONDITIONS: ` S 4 / � ` z e e " A t e' ::.,' !t:vx�C / 7''"'
✓ 1
Depth to first Ground Water Table v Lf�lt � 't 1 i c �- —
Percent Ground Slope____
2
Par! SO. 0:g � /--7319
F INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
1 p�f SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE
FINA ISPOSAL 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 ? /j/)
PERCOLATION TEST RESI JI -TS: (To be completed by Registered Professional Engineer, if the Engineer does
the Percolation Test)
Minutes per inch in hole No. I 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 grant d based upon said application and in legal action for perjury as
PLEASE by law.
Sign - --'_"` .._._� Date ./
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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