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Home My WebLink About4085.pdf?.V /Q. C) . 5 O O GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY '6PQSSD., fit` 1-{osf Permit Assessor's Parcel No. This does not constitute a building or use permit. Owner's Name Cv �("� Present Address 44- Ari Phone CR a y/ i.1 ew Cas -f/ -e ki,v7 Cpx cam rep Legal Description of Assessor's Parcel No. U` 0441-66 System Location SYSTEM DESIGN Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached• _1 ISS r., „��; _'r: Special Setback Requirements: 2447# 1, %1c — /02- c.i„ , 7 /)7,r., fiO / Date Inspector 2c/ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Septic Tank Capacity Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface Absorption Area Absorption Area Type and/or Manufacturer or Trade Name L J. Adequate compliance with County and State regulations/requirements Ii Other Date 5"--M- 0 Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE 714--e-ctek *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 — 6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT 07/28/2005 15:25 9706258608 STERLING CONST MGMT PAGE 02 Garfield County - [SIS Application Page 3 of 15 5Tre,e4-42 .l#.9si.•iy fwev"0 aICry INDIVIDUAL SEWAGE DISPOSAL. SYSTEM APPLICATION OWNER ADDRESS /#S2/ ` X 2y/ ,Vew&s,z Ce' 8/gt'7 PHONE 5'7037/5" 'n / CONTRACTOR ADDRESS 0 CO I' 1 ` /� PHONE 97* .S9c 5299 PERMIT REQUEST FOR: %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;CI/1' Near what City or Town L/ �� &) ('JJ/F ( Size of Lot .//0 At ets -y i, ' Legal Description or Address 3 `I v WASTES TYPE: Dwelling () Non -Domestic Wastes () Transient Use () Commercial Or Industrial () Other: Describe: BUILDING OR SERVICE TYPE: Number of Bedrooms Number of Persons z http://www.garfield-county.cornihome/index.asp?page=689 7/28/2005 07/2B/2005 15:25 9706259606 STERLING CONST MGMT PAGE 03 Garfield County - ISDS Application Page 4 of 15 ,(Garbage Grinder Set.utomatic Washer dishwasher SOURCE AND .TYPE OF WATERSUPPLY: WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: d6 Awes - was an effort made to connect to the Community System? () Yes p(No http://www.garfield-county.corniltome/index.asp?page=689 7/28/2005 07/28/2005 15:25 9706258608 STERLING CONST MGMT PAGE 04 Garfield'Counly - ISDS Application Page 5 of 15 A site plan is required_to be submitted thatindicatesthe following MINIMUM distances: Leach Field to Well: Septic Tank to Well: 100 feet S0 feet Leach Field to Irrigation Ditches, Stream or Water Course 50 feet Septic System to Property Lines: feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS; Depth lo first Ground Water: 3.8' Table Percent Ground Slope: TYPE OF.INDIVIDU.AL EWA_GE Elisep$ALS.YSTEM PROPOSED:: R Septic Tank O Vault Privy () Pit Privy () Aeration Plant () Composting Toilet () Incineration Toilet () Vault ( )Recycling/ Potable Use () Recycling/Other Use 10 http://www.gatfield-county.corn/home/index.asp?page=689 7/28/2005 07/28/2005 15:25 97062513606 GarfieldCounty - 1.SDS Application () Chemical Toilet STERLING CONST MGMT PAGE 05 () Other — Describe: FINAL DISPOSAL BY: Absorption Trench, Bed Or Pit () Evapotranspiration (} Underground Dispersal () Sand Filter () Above Ground Dispersal () Wastewater Pond () Other — Describe: WILL EFFLUENT RE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? lie, Page 6 of 15 PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) 7:5z Minutes /7 per inch In hole No. 1 Minutes g Minutes 40 per inch in hole No. 2 Minutes (711 per inch in hole No. 3 h.ttp://www.gaifield-county.com/home/index.asp?page=689 7/28/2005 O7/28/2B05 15:25 9766258606 STERLING CONST MGMT PAGE 66 Garfield CCounty - ISDS Application Page 7 of 1.5 RPE WHO MADE SOIL ABSORPTION TESTS: Name: Address: Telephone: RPE RESPONSIBLE FOR DESIGN OF THE SYSTEM: Name: //chi &,,ivn y ertig•Wier e✓/7/4 Address: /iSS7 A829.ileo 400 •P 'e aeroDCACM#zs Telephone: 970 94(%f(, 74. 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. Date: alar http://www.garfield-county.com/home/index.asp?page=689 7/28/2005 07/28/2005 15:25 9706258608 STERLING CONST MGMT PAGE 07 Garfield County - 1SDS Application Page 8 of 15 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 4' `F http://www.garfield-county.com/home/index.asp7page-489 7/28/2005