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Home My WebLink About4216T I :rib I .f)()- R ;;1,-s c :La GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Aljl'f_l' Permit • • \' Assessor 's Parcel No. This does not constitute a building o r use permit. Owner's Name t:' 111 t ( ' n( 'If' I Prese nt Address I )L /r )l / C t/ I 0 l/ (' 1JI7) L Phone r f ( fJ3-.~/ fi 53 System Location () \}-o ( Q 'r ln\P -=-") ?) r r ::2 -'.c=1 ::2.., • t, "' -! , "' Leg~ Description of A ss e ssor ~ Pare~ No .~~~~~~~~-~~~~-~--~~,~~~~~~~~~ lL~J ~~~-~~l~ )~~~~~~ SYSTEM DESIGN ~7.L....,-->""r-'O""---Se pti c Tank Capacity (gall o n) ----';t/-'--:...!./,4-'-_0ther ~---'-/-'~=---Percolation Rat e (minut es/i nch) Number o f Bedrooms (or other) ___,!~=-__::_~~:£_F~ <.. a~~ ( 'I 3t.~ .t)r~~ u,? r Required Absorption Area -See Attached 7 , . -.1-~ J 5" ~.,_e, /~ ~ .71t».._J. ;. ~;). ~0~ Special Setback Requirements : '). f ::l. 1 , '' ~.;., _A.t:.rl .:-~ <] ""-"-"•~ Date tJ-1)-C/6 Inspector -~~tf~~- FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Cover ing Installation System Installer /7. t_bl/./,'r.?-1/-"h Jq /( II 'I II Septic Tank CapacitY~--=1,(;~/h-'----'0=--~------------------------------~ Septic Tank Manufacturer or Trade N ame .,.--.!...~~~=~=~~~~~~~~~~~~~~~~~~~~~~~~~~- Septi c Tank A cces s within 8" of surface _7./P..F-:....:"'--~~~~~~~~~~~~~~~~~~~~~~~~_::__~~ (/ Absorption Area ~-;.-z.:::~=.::c..::'.,-,:;'""~"---'-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~- Absorption Area Type and/or Manufacturer or Trade Name ~-'-(.""~=:.;~:::.·....4=~9"---'=3~¢~~' ~----::-~~~~~~~~~~~~- ;)_. --:2. .&-h.v&L Adequate c o mpliance w i th County and State regulations/requi rements·~-:';;'-/...:::~:::....!::::::..._~~~~~~~~~~~~~~~~- Other / v h Date __ .A_,;_jl-=-/---'-{_c/. ____ Inspector -~-~-~--~-U-~_~_/.._"U._~-~------------- RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION S ITE •CONDITIONS : 1. All installat ion 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 i s valid only for connection to structures whi ch have fully complied w ith County zoning and building require ments. Con- nection to or use with any dwelling or structures not approved by the Building and Zoni ng office shall automatically be a violation or a re q uirement 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 i n jail or both). White -APPLICANT Yellow -DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Lkl~ ~:::ss cW ~c;;z!U?;c&&PHON~~P;~ ,;2~s-3 CONTRACTOR ~ f[--/t1t4/h__ 0(,1AJ;~e~ c:;'7ir?1J c?tt/1/kvr 1/krtl?tJ //IJC~ ADDRESS f;'c:J, -Jl"x It{?/( "F)A:>A't::(' C'.cYb~ PHONE CJb. < ~ 'J,.);i_ 'z Jtvflf'Jrttt I'"'-· :tt.· I '(;o3o'~l e;L(' 'B' <5£ -c>( PERMITREQUESTFOR 0{NEWINSTALLATION ( )ALTERATION ( )REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location ofpotablewater wells, soil percolation test holes, soil profiles in test holes (See page 4). Near what City of Town Size of Lot-="""'-'~,....,"" Legal Description or Address.La-"'t:P,· "'---"""'e""""'"-,--'-...2~~""-"'-""-'""'-""--""-"'SIL-"--'-"--7~"'-T,P-<+-~"'-'=<=<o/f.~~""" WASTES TYPE: (~ DWELLING ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( )OTHER-DESC~BE ________________________________ _ BUILDING OR SERVICE TYPE: __ _J_c_::__::.:___ ___________________ _ Number of Bedrooms Number of Persons ./-- ( ) Garbage Grinder ( ) Automatic Washer Wbishwasher SOURCE AND TYPE OF WATER SUPPLY: (_)()WELL ( ) SPRING ( ) STREAM OR CREEK 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?---------------- 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: D h fi G d W T bl 11"7{.) Pr: ept to rrst roun ater a er--::-.,---_l_ _ ____/__--"'----------------------- PercentGroundSlope ___ ~~~~~~~------------------------ 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: J><1 SEPTIC TANK ( ) VAULTPRIVY ( ) PIT PRIVY ( ) AERATIONPLANT ( ) VAULT ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET( ) OTHER-DESCRIBE·-~-~--~--~--~--~ FINAL DISPOSAL BY: (}')-ABSORPTION TRENCH, BED OR PIT ( ) UNDERGROUND DISPERSAL ( ) ABOVE GROUND DISPERSAL ( ) EVAPOTRANSPIRATION ( ) SAND FILTER ( ) WASTEWATERPOND ( ) OTHER-DESCRIBE------------------------~ WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? !/){J • 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. ______ -t'er inch in hole No. Name, address and telephone ofRPE who made soil absorption tests:-------------~ 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 perjury as provided by law. Signed £ ~£~ Date ~· PLEASE DRAWAN ACCURATE MAP TO YOUR PROPERTY!! 3 0'15' nee of ence d •ption land 1ption tand ditch '"to I I I I I I Tract3, Jean and Dee Blue Amended Subdivision Site Plan Section 25..c Townshi~ 7 South, Range 88 West, 6th P.M., \.ounty of Garfield, State of Colorado County Road 104 z Wooden Deer Subdivision Reception # 441908 30' County R S89"22'02"E 485 65 Easement. 15' -....._ 0 · SideofCente ine '-_ ----_ ...... C_2-N67•4 f21-E -N87 "~1'21"E _ ---=-=--- 221 .61 ' -~~ --· L -....... -....... -....... 0 30' Easement -..... ... -.... ~ .......... --8 376' Centerline /-.......?;} ~~ L ~ Access Road, -....... -....... -89•7:--....7 tJ 30' Easement. ~ ~......... "' 1s· Each Side Gate -® w ......... n1 of Centerine " ~ 30' y-......... ......... /Jt5'&M Single-Family Rc!Sidence Easement Harris 8380 P393 S89"22'02"E 169.30 -saa"3Zo4-e- -~ 169.22' -S00"11'09"E 72.95' Provt011:lat / N89"48'.0 Une Adlusted --./' 91 .6T byThlsP\at Amended Tract 1 ......... 2 .30 acres --......... 9. ......... ......... ~-::-... ......... ......... ~69·17:s.,-....... --.......3.1? ... ~ '1-v .................. 0 -....; . ..,,. ......... ......... _ .......................... N88"48'36"E 159.88 Centerline ot 20' Watec Lila Easement,10' Each Side of Centerline ......... ......... - \ ~ \ ~ \ 0 ~ ,.,.,------