HomeMy WebLinkAboutApplication- PermitGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 9th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
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PROPERTY
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Owner's Name) I Wil IYfY1 IIfli U Present Address
System Location
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Permit N— 3050
Assessor's Parcel No.
This does not constitute
a building or use permit.
Phone
37c/z775
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Legal Description of Assessor's Parcel No.
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Septic Tank Capacity (gallon) Other
SYSTEM DESIGN
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Percolation Rate (minutes/inch)
Required Absorption Area - See Attached
Number of Bedrooms (or other)
Special Setback Requirements: 11 1 f (.)
Date 1 0 -10(- q Q P Inspector (4 /41
F(N L SYSTEM INSPECTION AND APPROVAL (as installed)
Call for4nspection (24 hours notice) Before Covering Installation
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Septic Tank Capacity
Septic Tank Manufacturer or Trade Name C. ( e ` 4. r(0
Septic Tank Access within 8" of surface
Absorption Area
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Absorption Area Type and/or Manufacturer or Trade Name 1 ti 1 F l 1- T n- Q
Adequate compliance with County and State regulations/requirements
Other h
Date 1 a -'"LG` 13 Inspector A` `'" j
RETAIN WITH RECEIPT RECORDS AT -CONSTRUCTION SITE
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*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 a violation 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 — 8
months In jail or both).
White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
ADDRESS 2-50 ( GP } 1J :o PHONE 'sOc) - 2 2-3 37- 2 -
PERMIT REQUEST FOR ((W 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 FACILI
Near what City of Town S 1 Cr- Size of Lot ? M (P14�f
Legal Description or Address
WASTES TYPE: (✓DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: ! r Lo a 1 A (-194-- (M11 -DCCT 1-4,06
Number of Bedrooms
( ) Garbage Grinder
( .Automatic Washer
Number of Persons
( Dishwasher
SOURCIAND TYPE OF WATER SUPPLY: (WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 'W III it
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: 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 DISPOSAL SYSTEM PE1 MIT WILL NOT DE ISSUED
WITIWIIT A SITE PLAN.
GROUND CONDITIONS:
Depth to first Ground Water Table
Percent Ground Slope
2
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
SEPTIC TANK
VAULT PRIVY
PIT PRIVY
) CHEMICAL TOILET
AERATION PLANT
COMPOSTING TOILET (
INCINERATION TOILET (
OTHER - DESCRIBE
VAULT
RECYCLING, POTABLE USE
RECYCLING, OTHER USE
FINAL DISPOSAL BY:
( ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATERPOND
( ) OTHER - DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? d
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. 2
Minutes per inch in hole NO. 3
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:
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
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Date 5° 7 (f2-
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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-90 10:52 AM OAKWOODHOMES. L0T234
OAKWOOD
MOBILE
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2508 HIGHWAY 6 6 50 • GRAND JUNCTION. CO 81505
AUGUST 3, 1998
OAKWOOD HOMES INC.
2508 HWY 6 & 50
GRAND JUNCTION, CO 81505 -
REFERENCE: ARMANDO BENCOMO
SERIAL NUMBER: H00015F02260
702420447
P.01
+ 970.242-2924 • FAX 970-242-0447
THIS HOME ABOVE HAS A 401b LIVE SNOW LOAD AND IS BUILT TO
THERMAL ZONE III REQUIORMENTS. IF YOU HAVE ANY QUESTIONS
PLEASE FEEL FREE TO CALL ME AT 1-800-273-3721.
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THESE PLANS MUST BE KEPT AT
BUILDING SITE OR INSPECTION DE-
LAYS MAY OCCUR. CONSTRUCTION
SHALL CONFORM TO THESE PLANS.
ALL CHANGES SHALL BE APPROVED
BY THE BUILDING OFFICIAL
THANK SOU-_, //
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" DAVE PRINCE
GENERAL MANAGER
APPROVEL
SUBJZCT'110 NOM)
VCF PTIONS & 1NSPSCT)O E
i;/FIELD COUNTY
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EL COPY
NO INSPECTION W1YHONN
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AUG -25-98 04:06 PM OAKWOODHOMES.LU72E4 702420447 P.01
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