HomeMy WebLinkAboutSupplemental ApplicationGarfield County 11
Community Development Department
t/ 108 8th Street, Suite 401
-�' Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-countv.com
MAY 12 1014
RFlELD CQJ r .
•:•lA`rrr f TYPE OF•CONSTRUCTION
New Installation
WASTE TYPE
jsr Dwelling 0 Transient Use
0 Other Describe
INVOLVED PART
Property e y Owner: ll
p � � �,I'' 1 _ _ Phone: (�% } -
Mailing Address: a e 1!/c { .e,+9N4 Z
INDIVIDUAL SEWAGE
DISPOSAL SYSTEM
(ISDS)
PERMIT APPLICATION
0 Alteration
0 Comm/Industrial
0 Repair
❑ Non -Domestic
Contractor: o ,+` i .
Phone: (j 3 01
Mailing Address:
Engineer: Phone: (
Mailing Address:
PROJECT NAME AND LOCATION
Job Address: _ , _ .
Assessor's Parcel Numberal 94,3 1/1 OcV 7, Sub. e6dr 5 . iet t 1 Block
//oosc 11, a•
Building or Service Type: { 4oe 1605, di -M /4 edrooms:3 .42.,44tArGarbage Grinder s&
Distance to Nearest Community Sewer System: P,Ve 7,vr,/es
Was an effort made to connect to the Community Sewer System:
t4
Type of ISDS
❑ Septic Tank 0 Aeration Plant i 0 Vault T
0 Vault Privy
O Recycling, Potable Use 0 Recycling
O Chemical Toilet 0 Other
0 Composting Toilet
0 Pit Privy 0 Incineration Toilet
Ground Conditions Depth to i" Ground water table Percent Ground Slope
Final Disposal by
O Absorption trench, Bed or Pit 0 Underground Dispersal
❑ Above Ground Dispersal
O Evapotranspiration 0 Wastewater Pond 0 Sand Filter
p other
Water Source & Type 0 Well 0 Spring 0 Stream or Creek 0 Cistern
Effluent
O Community Water System Name
Will Effluent be discharged directly into waters of the State?
❑ Yes ❑ No
CERTIFICATION
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 upon said application and legal action for perjury
as provided by law.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provi the required information which is correct and accurate to the best of my knowledge.
'lf_,SL"7/f:
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Property -t rMnd Sign s
Date
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OFFICIAL USE ONLY
Special Conditions:
Permit Fee•
$- S 6°
P rk Fee: 0
len '�
Total Fees:
!9-3
Fees Paid:
4/.•'°'
Building Permit
Septic Permit:
Se_CrC= 3210
Issue Date:
Balance Dug
- CCJJ
BLDG DIV:
APPROVAL DATE
xL 5, L3•Iy o0
-410'78 J,-
Garfield County
Community Development Department
108 8`h Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.aarfield-countv.com
INDIVIDUAL SEWAGE
DISPOSAL SYSTEM
(ISDS)
APPLICATION CHECKLIST
SEWAGE DISPOSAL PERMIT CHECKLIST
Permit applications can be obtained and submitted to the Garfield County Community
Development Department at 108 8th Street, Suite 401, Glenwood Springs, Colorado. See
below for additional information. All applications are required to be submitted in person.
PERMIT APPLICATION & SUBMITTAL REQUIREMENTS:
• Complete application.
• 1 Copy of a Site Plan that includes 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 and design for our records prior to
final inspection.
FEES. FEES ARE NOT REFUNDABLE
Make Check payable to: "Garfield County Treasurer"
• Septic Permit for a New installation $73.00
• Septic Permit for alteration and/or repair $73.00
• Septic Perk test $100.00
ATTACHMENTS
• Percolation Test instructions
• Recommended minimum requirements for Individual Sewage Disposal System
(ISDS).
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.
(Applicant's Copy)