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Home My WebLink AboutApplication-Permit.pdfGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Phone (970) 945·8212 Permit Assessor's Parcel No. This does not constitute a building or use permit. Owner's Name \-\ \)(l ~,l..\J \JI \ll ( fr\\\\_"( ~y-C\,resent Address ~'Pwi~o<~. ~L~\ \:_'£~·:_!-]~-"\;'.~. \'-'t._\_~""---Phone, ______ _ System Location L10(~ q c [ -")()\:,\ .. ¥. \ ~· \ e Legal Description of Assessor's Parcel No. ~d~\ ~' r~~~J~_:,_,_~--~L~\~-_.,C,,>~C)..,._-_C~l~i~C\~·~------------------ SYSTEM DESIGN '7 5b ------Septic Tank Capacity (gallon) IS ------Percolation Rate (minutes/inch) Special Setback Requirements: ______ .Other Number of Bedrooms (or 9the~ :) J G If~ · /th~J . 1/7 1 j., !(' I;, /'1 . Ii d( f /··· .µ,ol-£..,~-1 _j 7:'. .J I 1/ d:J .,,,,.._ C1P11c.-c \ Z Z. t/ ··~'.;:8 ~ ,-I, · ~ ' 1/ ,2 z; VYl-'-"A 0 ! 5 £. lil "1 ' ;.:y? .. ;;;- Required Absorption Area ~ See Attached Date_~.:_-~)_· __ /_. ~(~)~D~ ____ Inspector _M~-~· ~Cl.~.A_.1 -t_. ~/~P+i_J_·]V~-~;c~' ._.£~-----------------; FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation fl ~DOI System Installer 1.lU'. C. '\)A Ov\Jl · Septic Tank CapaciW---+-'''-'("-:>~0---------------------------------- Septic Tank Manufacturer or Trade Name -'~-"O'-'i,._,):;u'-""'-"-Ll..---------------------~--- Septic Tank Access within 8" of surface _\+'i .J~/t-------------~---------------- u' ,, ·,, 1 , r /b v~ \:'\,' ~ \,J,/lJ T(;>D ' Absorption Area __,,,...,,,,~~'"-'-'\i'""'-~v~"'=~"=---='~l~'\--c~--~-------~----.,--------~· /\ J (i)c . + I I Absorption Area Type and/or fylanufacturer or Trade Name _'_...V~l_,"'@~~·~~(),JVYL~~---~~==~~--l~~\~·--0------ \ b Adequate compliance with Coui\ty and State regulations/requirements•J'--\1.,..o'-"'-------------------- \ Other ___________________________________________ _ ( . . \\ ~ Date __ ~\•~? --~~~'~\)~_-_C~Ji~C~) __ Inspector _),__·,~'~~1 (w~·~l~G~~~f\~~~Q~fA-il,_,~~--------------- RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE •CONDITIONS: 1. All installation must comply with all requirements of the Colorado State Board of H9alth Individual Sewage Disposal Systems Chapter 25, Article 1Cl 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 l.n jail or both). White-APPLICANT Yellow-DEPARTMENT \i . ' ::\ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 GARFIELD COUNTY SEPTIC PERMIT APPLICATION 108 8'h Street, Suite 401, Glenwood Springs, Co 81601 Phone: 970-945-8212 /Fax: 970-384-3470 I Inspection Line: 970-384-5003 www. l?arficld-countv .coin Parcel No: ~s information i~ilable at the assessors~ \e-{45"9134) \'i-'":>.,-;sl...\-{')CJ-Bu ,./t4',"· -P.a-,, rn , +-::#-I n ,, u S- Job AddresrJi(\~qs rs;t b~ Ane.d, ~c;;o~~u~ Street Name & City) or and-t'egal description Lot Size: Lot No: Block No: Subd./ Exemption: Owner: (property owner) Mailing Address pa.-t<-I·~ Alt Ph: E:d j-/-.,;u, I u-,,vl tf f:7 &>'1 /1~«-n fv /{/ 'J t'J C)' .rfJ5-;2~{,> Contractor: fJ/tO (J",'/df,,_,,_, -Mail~ Address f.VP' ''1"11: Alt Ph: & 'f?l-c. ..... ./., 12 ./.. 'J?J l 1 I t'P ·615 5 J. _ Engineer: Mailing Address Ph: Alt Ph: PERMIT REQUEST FOR: 'Kl New Installation ( ) Alteration ( ) Repair WASTE TYPE: 9'l!JWelling ( )Transientuse ( )Commercial or industrial ( )Non-Domestic wastes ( )Other -Describe BUILOING OR SERVICE TYPE: Number of bedrooms ;;;_ Garbage Grinder 0d'f es ( )No SOURCE & TYPE OF WATER SUPPLY: ( )WELL t¥'PRING ( )STREAM OR CREEK ( )CISTERN 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? YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN GROUND CONDITIONS: Depth to 1" Ground Water Table Percent Ground Slope TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED: ~epticTank ( )Aeration Plant ( )Vault ( )Vault Privy ( )Composting Toil et ( ) ecycling, Potable Use ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet ( )Other-Describe FINAL DISPOSAL BY: ( )Absorption trench, Bed or Pit ffcnderground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter ( ) Wastewater pond Other-Describe Will effluent be discharged directly into waters of the state? ( )YES iXJNO PERCOLATION TEST RESULT: (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 & telephone of RPE who made soil absorption test: Name, address & 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 test 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 upcn said application and legal action fo~~rJ ry ;:;rd~ Y-~()-03° OWNERS SIGNAT RE , DATE STAFF USE ONLY , Permit Fee: Perk Fee: Total fees: Building Permit#: 1-~ \\)\:) \t~--'C)E)4 '::> Septic Permit #: Issue Date: LJ L.\L.\ \ L\-~0-() 'i) Building & Planning Dept: C\-7JO-t!) l'.> ) ' \}\ ·-APPRU &.1 ~ l v DATE \., '\./ Garfield County Building & Planning Department ALL APPLICATIONS ARE REQUIRED TO BE SUMBMITTED IN PERSON PROCEDURE REQUIRED FOR COMPLIANCE WITH THE GARFIELD COUNTY SEWAGE DISPOSAL REGULATIONS. Permit applications can be obtained and submitted to the Garfield County Building and Planning Department at 108 81h St, Suite 401, Glenwood Springs, Colorado. See below for additional information. PERMIT APPLICATION & SUBMITTAL REQUIREMENTS: • Complete application. • Site plan (1 copy) to include well, all streams, irrigation ditches, and any water courses. Draw in your house, septic tank & system, detached garages, and driveway. If a change of location is necessary, you must submit a corrected drawing.) • Engineered System will need copy of perk rate & design for our records prior to final inspection. FEES: Make Check payable to: Garfield County Treasurer • Septic Permit for a New installation ...................................................... $73.00 • Septic Permit for alteration and/or repair ............................................... $50.00 • Septic Perk test .............................................................................. $100.00 FEES ARE NOT REFUNDABLE. II ATTACHMENTS: • Percolation Test Instructions • Recommended minimum requirements for Individual Sewage Disposal System (ISDS). Ill FINAL INSPECTION: • When all components are in place, connected and ready to cover, request a final inspection by the County Inspector. • DO NOT backfill any part of the system prior to the inspection. • The initial fee covers the percolation test and one (1) inspection before cover up. Any additional percolation test will be charged at $100.00 each and additional inspections will be charged at $50.00 each. • Upon final approval, carefully cover the entire system. • Engineered Systems are inspected by the Engineer prior to backfill. A final sealed letter by the Engineer is required to be submitted to Garfield County.