HomeMy WebLinkAbout4272GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 427 2
108 Eighth Street, Su ite 201
Glenwood Springs, Coloradof 81601
Phone (9 70) 945-8212
INDIVI DUAL SEWA GE DISPOSAL PERMIT
Assessor's Parcel No.
This does n ot constitute
a building or use permit.
PROPERTY ~( ~ ;;;2_~-/3Cl3
Owner's Name~\~ T. ~~ ~ Present Address \9 D S j h..J€.tY+Or"\ G. OA Phone --;;t/ ~-5 L/(JCf-
:S Oq( rJ'L?JC15 ]?~~ ~C?S-CffD9~ System Location
~g~~Kri~ionof~uwr~~~INo . ____ ~~-~~~D=~q~--~@~4-·~a~~O=D~--~l~~~~~~----------
SYSTEM DE SIGN
_____ Septic Tank Capacity (gallon) ______ Other
_____ Percolation Rate (minutes/inch)
Required Absorption Area-See Attached
Speci al Setback Requirements:
Date _____________ Inspect or ---------------------------
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
Sy stem In staller _______________________________________ _
Septic Tank Capacity _____________________________________ _
Septic Tank Manufacturer or Trade Name---------------------------~---
Septic Tank Access within 8" of surface -------------------------------
Absorpti on Area ________ ___: ______________________________ _
Absorption Area Type and/or Manufacturer or Trade Name -------------------------
Adequate compliance with County and State regulations/requirements. ____________________ _
Other __________________________________________ _
Date ------I.L-\J"---"-D::::........:~'---c:R--=---...c.... ___ lnspector lh~\.c · \l.)~ (CblOlQd() ~c:£cSS\OV\C1L fVlCO)
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. Al l installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
25, Articl e 10 C.R.S. 1973, Revised 1984.
2. This permit is va l id only for connection to structures which have fully complied with County zon ing and building requirements. Con-
nection to or use with any dwelli ng or stru ctures not approved by the Building and Zoning office shall automatically be a violation o r a
requirement of the permit and cause for both l egal 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 C lass I, Petty Offense ($500.00 fine-6
months in jai l or both).
White-APPLICANT Yellow-DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
PHONE Z I 6 -5-'-IOl/.
CONTRACTOR V¥1-e....f'.cl't, Lf' 'F)L CA u,._~(lv> ·
ADDRESS {q() <;;\.J-e.zftn C~ · PHONE 2.1 ~->'to</
PERMIT REQUEST FOR C>4 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:
Near what City ofTown, __ ~ftL.!.lA1t"h!l4C"'··"'-A."".t"-k-'---'-· ________ Size of Lot ,3 )~ r90!!t"J
LegalDescriptionorAddress Le-i-2 Qy\..~ ?-J 3DD berzbG-11%
WASTES TYPE: ( (iJ DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER-DESCRIBE _______________________ _
BUILDING OR SERVICE TYPE: __ 'R...:.l...:.e.:::c~o:..J-=-&.::cc"'-'(_='--f/-h'-"~='--"-'-. ---------------
Number of Bedrooms ----<..L-. __________ Number ofPersons_5=-----
( )lj) Garbage Grinder ( 0) Automatic Washer
SOURCE AND TYPE OF WATER SUPPLY: (»WELL
If supplied by Community Water, give name of supplier:
( ~ Dishwasher
( ) SPRING ( ) STREAM OR CREEK
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: __ f~m'-'-.'/"'__,..l::.c··--------
Was an effort made to connect to the Community System?--+' -".e.,_· ____________ _
A site plan is required to be submitted that indicates the following MINIMUM distances:
Leach Field to Well:
Septic Tank to Well:
100 feet
50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System (septic tank & disposal field) to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
Depth to first Ground Water Table: _ ____,l.:l_L~:r.._, __________________ _
Percent Ground Slope __ _.Z=.LJ"""'-·-------------------------
2
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(~ SEPTICTANK ( ) AERATIONPLANT ( ) VAULT
( ) VAULTPRIVY ( ) COMPOSTINGTOILET ( ) RECYCLING,POTABLEUSE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET( ) OTHER-DESCRIBE (-c ~ F ce I j .:v/g ;?:y~ r:,_,. { r-"7., $J/)cQ,
FINAL DISPOSAL BY:
( ) ABSORPTION TRENCH, BED OR PIT
(Xi ) UNDERGROUND DISPERSAL
( ) ABOVE GROUND DISPERSAL
( ) EVAPOTRANSPIRATION
( ) SAND FILTER
( ) WASTEWATERPOND
( ) OTHER-DESCRIBE _______ ~~----~~~~~---~---
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? No·
PERCOLATION TEST RESULTS: (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 ofRPE who made soil absorption tests:--:-:;-----------~
L-e,> Wo 0 c'-2 ry . l-<Sb ?.
Name, address and telephone ofRPE 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 peljury as provided by law.
3
Designate North Arrow --------0 I e;t~ puc./\. . ---.......______
' ur Plot -Shape to Yf
(No Scale)
Your Neighbor's
N arne & Address
1 I
'o/50
~ l /..,v ,,-~~ 'Ql tz,Lf'.
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Locate well, all streams, irrigation ditchs, 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, before a
Certificate of Occupation will be issued.
County Road (Note the Road Number and Name) 0~-
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Your Neighbor's
Name & Address
JoA£-·
/ rz:;tL·
I 1\A' i-e-
Nov 07 07 01:57p Lori and Jason Metcalf
Mr. David Mead
Garfield County Inspector
Dear Mr. Mead,
November 7, 2007
970-285-9698
Lesl ic G. Wood
23 Holly Way
Parachute, CO S 1635
p.2
This is to verify that I designed and inspected the septic system at 5091 County Road 3()0
in Parachute, Colorado. The system is for Jason and Lori Metcalf for their new home.
The septic system that was constructed is in substantial conformance to the design and is
acceptable.
(\~ftdd;;t~ i?&si);: G. \V'(;~d I
Colorado Professional Engineer #5175
cc: Jason Metcalf
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