HomeMy WebLinkAboutApplication- Permitf
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Name •e
System Location
Legal Descrlptio •f Ass Dr's Parcel No Pc1 a sit_ r r-'tI L-1 l.�Y✓.
SYSTEM DESIGN
Idalig dft/Present Addres
Permit N2 3772
Assessor's Parcel No.
This does not constitute
a building or use permit.
Phone (45_. rF t
Septic Ttf k Capacity (gallon)
?Urn -ora-oo-�5s
Other
1 i ,�0 moi , / /V II/Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback qeents:
Date � 3`
Inspector
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
Adequate compliance with County and State regulations/requirements
Other ��
Date 1/— //f -03 Inspector illi tett in) LHt/.
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
•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 aviolation 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 ($500.00 fine —6
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
GARFIELD COUNTY
9703843470
01/07/03 09:37am P. 002
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER BATH4R + Lt1PRbGL. /Well lb
ADDRESS O47$ cos,ELA. RD. 6t..60' °° 3Al2I46s PHONE 99s—Os 87
CONTRACTOR WI?r i}omeIS
ADDRESS 73-3 F,PPREt-t.6 DR. BAtfi&met n►Gsn PHONE Rt5-'?534
PERMIT REQUEST FOR (X) 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 of Town Stet Size of Lot a 9.19 o AeRES
Legal Description or Address 3757 cower& Ro. al
WASTES TYPE: (4 DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER -DESCRIBE
BUILDING OR SERVICE TYPE: gees 'DEArnAL
Number of Bedrooms 3
DwcLc.I nib
Number of Persons a
(s) Garbage Grinder pQ Automatic Washer
SOURCE AND TYPE OF WATER SUPPLY: (X) WELL
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER
00 Dishwasher
( ) SPRING
SYSTEM: ?
( ) STREAM OR CREEK
Was an effort made to connect to the Community System? No
A site plan is rewired to be submitted that indicates the following MINIMUM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 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 SE33TAGE DISSOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
&,SITE PLAN.
GROUND CONDITIONS:
Depth to first Ground Water Table n%eR,'c -RHtn+ 5
Percent Ground Slope "" 5 7a
2
■
5P I EL 13 COUNTY
V
9703843470 01/07/03 09137am P. 002
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(X) 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:
(K) 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? NO
PERCOLATION TgST RESULTS_ (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test)
Minutes Der inch in hole No. 1 Minutes per inch in hole No. 3
Minutes par inch in hole No. 2 Minutes per inch in hole No.
Name, address and telephone of RPE who made soil absorption tests:
Name, address and telephone of RPE responsible for design of the system: 44NC04.N—ogvoitt
19'!? #a -TOR ST. GAJtnD Ic-t• 815D5 aye— We? 1r
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 • 04 n for perjury as provided by law.
.j f Date t -7—o3
PLEASE DRAB AN ACCURATE MAP TO YOUR PROPERTY!!
3
ti
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Detail
roposed Two Story
od Frame Residence
(Nat to Scale)
Rebar and Cap
LS No. 16842
Approximate
Location of
Leach Field
SITE PLAN
Parcel 2 Sonnier Exemption Map
S 89°45'39" E 957.28'
25.8 -
65.9'
t\
275.1'
--j
See Detail
10.0' -]
Rebar and Cap
LS No. 16842
Parcel 2
29.190± Acres
I• Existing wee
}�—Exsiting Dirt Drive
S 89°50'02" W
a12'
10' Utility Easement
S 89°59'30" W 869.84'
County Road No. 214
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970 963 9003 p.1
'TIMBERLINE ENGINEF.,RING
STRUCTURAL/MEL ENGINEERING CONTRACTING *CERTIFIED ENERGY DESIGN PROFESSIONAL
November 19, 2003
Garfield County Building Department
109 8th Street, Suite 303
Glenwood Springs, CO 81601
Via Facsimile 384 3470
Re: ISDS Installation
Armijo ISDS
3699 CR114
Garfield County, CO
Dear Building Official:
The installation of the ISDS system for the above project has been completed and has been
installed in accordance with applicable county specifications.
An as -built drawing %r the system will be forwarded to you as soon as possible
If you have any questions, please call meat 963-9869.
Sincerely,
TINIBERL11 EN) INEERING.:.:.
ir/
David A. Powell, PE -- f
Reg. No. 25851 n(1
P.O.130X 631 CAR]BONDIt .E, CO. 81623 PHONE 970 963 9869 / FAX 970963 9003