HomeMy WebLinkAbout03221 vu
N S V'
' ' ,1 t
+4
� " GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N2 3 2 7 f ,
i
\ 109 8th Street Suite 303 A ssessor's Parcel No. , 1
l i k Glenwood Springs, Colorado 81801 t e
i Phone (303) 945 -8212
i i
f This does not constitute I
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. - '
F
PR � OPERTY ��������p - ( n/� /' 'I l / �2 t
f t . Owner Name_t.l0 YC� , O ��� Obf'f\ Present AddressQ(D9x C V 1 S &, �
SI I+ 1 ` n. Phone b (0 nat'r b
f j System Location nX fb G• V I C& ) Si f f I l C) , O I V 6'
1 !!
i i. Legal Description of,Assessor's Parcel No. • I Jt- OC l4 - C. C- ACft- p c'-o i15 t .
I S YSTEM DESIGN CrA - C'N4 6C0 11 4 1 Q ^ L/O cl It r'If r
$ r .i Tne Ala icJ 6 I tit = 3? .c../
t :,
( �
( j SOU Septic Tank Capacity (gallon) Other
+1 1
•
i i 1 i r P ercolation Rate (minutes /inch) Number of Bedxoonfs (or other) '
4 a
1 r Required Absorption Area - See Attached - - r
S pecial Setback Requirements: ` t
+ t .
Date " � - - n 9 — Inspector / 1 t-( c)
P ci
4 ) FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
,)
Call for Inspection (24 hours notice) Before Covering Installation
if
I
L 5 System Installer r / + S L /(C - -- t
ra l •Sd V — ______ 'f
. ti Septic Tank Capacity ,
E
Septic Tank Manufacturer or Trade Name J • ) r
Y.
) 1 Septic Tank Access within 8" of surface \/ C. S 1 } i t P 3
6 () 3 7 r1 ENC KC5.7 o F II- OA .'.� % , );'
) Absorption Area
t 1 I F iC - t tL A -r - o_Yl r5 r __ —_ \ .
Absorption Area Type and /or Manufacturer or Trade Name _ ` '
io Adequate compliance with County and State regulations/requirements
v
e
V '
Other
F a /� /1 • h
1r Dat 1 _ 1 LI — "/ 9 I ns pector A l ��- 4, • ,
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
• a CONDITIONS: '` °?
'i 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter }Q
25, Article 10 C.R.S. 1973, Revised 1984.
1 - 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- M ,
,
i 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
s"
requirement of the permit and cause for both legal action and revocation of the permit. k ,
,4
;; 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material ; i
variation from the terms or specif ications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 .•,
i; months in jail or both).
e ;
�' White - APPLICANT Yellow - DEPARTMENT
Aug -13 -99 03:21P P.02
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER h(In t gtkiir• LOC.
ADDRESS ObeeR iSln ,so4 -,CIS koS2. PHONE Q"70h ?74,
CONTRACTOR
ADDRESS PHONE
PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION (V) 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 %d-k Size of Lot 7. Lel at,
Legal Description or Address
WASTES TYI'E: ( DWELLING ( ) 1RA:NSIENT USE
( ) COMMERCIAL OR INDUSTRIV., ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:
Number of Bedrooms _5 Number of Persons el
(p Garbage Grinder (X) Automatic Washer ('C) Dishwasher
SOIYRCE AN1) TYPE OF WATER SUPPLY: (l() WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:____,
DISTANCE '"O NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System? '{ t.s>
A site plan is reauire4 to be submitted that indicates the_followint MINIMUM distances:
Leach Field ro Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field ro Irrigation Ditches, Stream or Water Course: 50 feet
Septic System to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAkSYSTEM PERMIT WILL NOT BE ISSUER WITHOUT
A SITE PLq�I
GROUND CI)NDITIO V
Depth to first Ground Water Table _
Percent Grou'td Slope__
2
Aug -18 -99 03:21P P.03
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;
( ) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIKATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?
–
PF.RCOI.ATg N TE$LBESULTS: (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 pe,r 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 end
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 at 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 1 Rtrther 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�WL -- — DateB(1g)99 - - ---
PLEASE DRJ,W AN ACCURATE MAP TO YOUR PROPERTY!!
3
Aug -18 -99 03:21P P.04
i \,:.... 1 i`i/ \I...A
r
a 0
v '-
A
in
pa tr
1 0
q 0
w
n n • N
7d 0 Z
n i r,
g . r g A'o \ I
. . O i
I .G
— g 1 6- (i , ,-- ----------
_- — -- ------ 7 ci
n
w - a; I \ —
n
a.
F S,
_ i
u
, d. %
I r: