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HomeMy WebLinkAboutSP-2794i•• GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit Assessor's Parcel No. 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY This does not constitute a building or use permit. Bill. Collin 45755 Hwy 6 & 24, Glenwood. 945-4079 Owner's Name ��rr Present Address hone_ 0040 Huiiibinger Drive, Westbank Mesa, Lot 61, Glenwood Springs System Location Legal Description of Assessor's Parcel No. SYSTEM DESIGN Septic Tank Capacity (gallon) Other 3 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 System Installer kit.-L/I45 Septic Tank Capacity ate* ''''./4-64f) Septic Tank Manufacturer or Trade Name C'pPV-H- Septic Tank Access within 8" of surface W Jll1/U Absorption Area to L% g IA, Absorption Area Type and/or Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements Other 0 L L 8 Date 6 - 4b`" ay- 1)01, Ts- t/67,e4 i� ES Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: 1. All Installation must comply with all requirements of the Colorado Stale 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 end 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 41, INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER ` ` COW ih6 JOSHUA (7006,5E LI, ADDRESS '51 5 rj O w Y h t aLf G(tromo k EfCi 4 S1(A (0 PHONE '1 - 110 7 CONTRACTOR CSO K i tt5 l 6 ec74st GOh5&0 � n © U' ADDRESS 610 3. Sdu4L y Oukolect S ftd 5 (uO PHONE R 1-{o79 PERMIT REQUEST FOR (}P 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: Q L} Near what City of Town C lete Lkia p d �c(0 b 5 Size of Lot L.€ D` 116 Legal Description or Address 00 t b .vta\�tr 14 k- k t"(14‘S 4 WC5#to1in (� WASTES TYPE: PQl DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: 4P-Qcx dr; Number of Bedrooms Number of Persons ( ) Garbage Grinder O'< Automatic Washer (x Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (tel WELL ( ) SPRING ( ) STREAM OR CREEK t If supplied by Community Water, give name of supplier: ` i` DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? A site plan is required to be submitted that indicates the following MINIMUM distances: Leach Field to Weil: 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 DISPQSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. AROUND CONDITIONS: {{ Depth to first Ground Water Tab1e(.pfn4l4L- (-115k y Cf Et‘61ateef i n r .Ly. h � Percent Ground Slope 19c- g6 7 (� TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ,1 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: (ecz) 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? N PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes per inch in hole N. 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: CIL- 11 air, o n Name, address and telephone of RPE respon}sible for design of the system: _ 0 'ton 5 j Co n Bfbot 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 u+on said application and in legal action for perjury as provided by law. SigneDate PLE SE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3