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Home My WebLink About03024 • 3aay 1, GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit NC All "M 4 F f , 109 8th Street Suite 303 Assessor's Parcel No. I ^s 1 Glenwood Springs, Colorado 81801 ! f Phone (303) 945-8212 t 6 e This does not constitute ' t i it INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. i k Y PROPE . ,; ' f ;• t . Owner's Name_ Is fl9 Ytan � ti-V f di $r \ e s se ent Add ress 0 9R C G f 1 c r"'f S M . � `(Qo�y e 62 4163 "'sr t 0214 p� System Location S / n W .L f � I . � "� M �" `' ^ 6 / (D t Legal Description of Assessor's Parc No. IA e ` A 1 , 1e Cat K4x"' • • LeO+ 1 L 1 5 T SYSTEM DESIGN * Ye Ake D ' Adel c 3D 44,5re ea.9 ' ' ' 0P 3' X 70 Fee# of Reck f/taci -. ! ) Septic Tank Capacity (gallon) Other 1 t bed. 04 Ito pieces ofcat/T?'`gr r r Percolation Rate (minutes /inch) Number of Bedrooms (or other) I ,1+! f { Alto& t 4 4 r, b f _ Required Absorption Area - See Attached 'a , 40 ■ f Special Setback Requirements: . , i , i' I Date Inspector i I FINAL SYSTEM INSPECTION AND APPROVAL (as installed) C ), * r . Call for Inspection (24 hours notice) Before Covering Installation ➢ 1 t i :, System Installe flat 4442.-- 1 ■ r y Septic Tank Capacity 't ■ L�1 NCB Septic Tank Manufacturer or Trade Name R' y l , i.i S eptic Tank Access within 8" of surface tT 4^.4c. ,t / j ' r 1 Absorption Area 4 n 0 A Dn RS kJ i` A bsorption Area Type and /or Manufacturer or Trade Name � 3r X A`ip-[. -rF4 YOB /L pe-S. i } Adequate compliance with County and State regulations/requirements Y Cg t t 4 , t f Other > bi Date //- ii.- 9/ cgs-- Inspector yc-C/ ; fii RETAIN WITH RECEIPT RECORDS AT NSTRUCTION SITE S ' `. *CONDITIONS: 1 1. All Installation must comply with all requirements of the Colorado State Board of Health Individual Sewage bisposal 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 uirements. Con- r f 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. t 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a k nowing and material " , variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 t. F 1 months in )ail or both). e 9 •' White - APPLICANT VNlow - DEPARTMENT `/ w INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER // • /f, etieb ADDRESS 036A 8 Q 0 PHONE 7t`.> 'e l r CONTRACTOR Q./MA/WI- 6cO/C- 5 Sit u• - , - 14 &.c- l'c4 -x ADDRESS .c.Z-1c/ C/1`sZCc- " PHONE PERMIT REQUEST FOR ( ) NEW INSTALLATION (v)4TERATION ( ) 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 Size of Lot Legal Description or Address WASTES TYPE: ( .WELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: /ti c4.0- Number of Bedrooms c-2 Number of Persons 2 ( /Garbage Grinder (c3"Automatic Washer (4" Dishwasher SOURCE AND TYPE. OF WATER SIJPPLY: (WWELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? A site plan is required to be snhmittedshot intlicntes the following MINIMUM distances: 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,. ('TROT JND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 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: (4 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? pERCOI.ATION TEST REST I1.TS: (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 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 F: 4111'" ° , , ' r y .. it �/ 7 v ,"-f' ' t , • c ' A ' ' 4- ftA " ' i t 4 ta'i r,4t- .ot'FA t1n y p::: i n " f t . t l ;f iiSw r� - t ti , i . ; ;;,S1 ';.' ... ''' 1 I ci b e "i �,. + ;1.'1' + 0 t" i , iP i -a c l u� e Syw Is i ., 4' tt n �Mtd� VY � 'i n' w„ :¢ ' , e M 11Y i t14 '" : klT� t �^�' Cu l r , Y ' Ii' N x 5 s a g 4 � ,5 , tir . f,, '', , } }}})) ,yttw� 1arl` • - ' S' ,' ° ' k 1 ��4', r, •s r 4)`4 1 1 d ! '4t' lk {X ' ✓ te•.l4: /r':;,`, Theedoesnotc onsfitute t J f li 8 ps• �'• ` o' {,+, the''+. 'I„ i+ tr i, ky p iiti - r ;, f "f a building or Use perAlrt 4 +,,' GARFIELD COUNTY DEPARTM ,FNT OF ENVIRONMENTAL HEALTH 1P +t ..;,,,,k.,!, a ,:; i T�e � {f : ` 2914 Slake Avenue • . - , `' J •' a ' r + q0 ,Se kfi� 1 {{ p fl r Glenwood Springs, Colorado 81601 , - m , ,, •a Glenwood � �� , , nao c, � ♦��J w ¢'*4v ny� INDIVIDU A SPOSALPERMIT; NL ' >29� , , . ,; J' f.. 4 Y 'i ^1 f'CG, 1r o 7 e e r- it rr tklfnalr K1 ng tt# Cede 4' . Own System Location Lot'' 7, Up Cattle `Creeki Subdivision '- Carbondale 4. `.0 . ,Y.,. David J. Hu hes• ; ; , Licensed Contractor _ g t Construction approval is hereby granted f o r e - 7 , gall ` ,. , ^t' ` _ Septic Tank or Aerated,treatment, unit ti Ab rption area (or diapersal area) computed as follows: Pere rate of one inch in minutes requires a minimum of a sq. ft. of absorption area per bedroom Therefore the no. of bedrooms _gas__ x •3°sq ft. minimum requirement = a total of _ glit:Pq, ft. of absorption area. ` May we suggest Al / r 3 X ti%, IvC�' t o Date__ - rte ! mg-' Inspector . ,, • ',. 4 f FINAL APPROVAL OF SYSTEM: I ' No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to cover: ing any part. Septic Tank cleanout to within 12" of final grade or aerated access ports above grade. 0....a 7;'-••• 7ro,, '47:,: 7 �Pr oper materials and as sembly''l'+ .,4 Ac!,, . • - •' • . .. S7> /A'6 T ar ,5�.�lWerrfade name of se tank or aerated treatltlent unit. 6: --.0-9--744 /.a .,. , .- t 'l-- A dequate absorption (or dispersal) area. / Ck_3 SiX - S C L � � CI r 1 ' Adeqate cpmpliat ce with permit requirgrnq ,.. - ' .., t ti, X ---.• _. Ade uat om liance with County and. State regulations /requirements. / Other kk'•i•K, • # l L` ii1 ' Or; i , i i {, t Date__ —/7 ! { ' • RETAIN WI RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: f 1. All installation must comply with all requirements of the County Individual, Sewage Disposal Regulations, adopted,pursuatft_r .4,. thority granted in 66 -44 -4, CRS 1963, amended 66-3-14, CRS 1963. r v *, f � 2. This permit is valid only for connection . to structures which have fully complied with County Zoning and buildingrequi(amerts Connection to or use with any dwelling or structures net approved by the building and Zoning office shall automatically beta u o tion of a requirement of the permit and c ause for both legal action and revocation of the permit.';, „• , f ''�r l 3. Section III, 3.24 requires any person who constructs,' alters, or installs an individual sewage disposal system in a manner, w (L`i'I N k ,, volves a knowing and material variation,from the terms or specifications, contained in the appl ication of permit commits i ' .i' Petty Offense ($500 00 fi 6 months in aile r both ua'`) , `-' •g I '• , r / �, ', S +) 1' 4ta a { r ,„t *c� ∎, a r ,If .r ` .r �4 , ��t ^��ik�inh qfi <i � ) , 1 b.{,' Building Official - ,Permit White Copy \: ,.rt Applicant — Green Copy Dept -- Pink Copy , / i t ' i n�4(.,. - ......`%.,.r;___tt.. tkrzr;:n - ,.n. v... ,:..,,,I,- -.J:v.n,.r...,.. — ... ..r.,-..,:,- .•. ....M. -..r.. -.fin.. ,L.'.. (TO BE RETURNED TO HEALTH DEPT.)