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HomeMy WebLinkAboutApplication- Permit43Ito los p&. 150 ut GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL. PERMIT PROPERTY Permit A is Parcel No. 01393 -,$y -(Da -tor 4068 This does not constitute a building or use permit. Owner's Name I I C tSl, S0.UC Present Address 100 G441010°0/ " "'? . ` ("' k Phone ` �3- C a S System Location cc Glenwood AiR_ Cartoondaall _e_,v&v�-}8 11°43 Legal Description of Assessor's Parcel No. Let �o '1 CC " H— GriCif } 1"1` Wlf iS; SYSTEM DESIGN Septic Tank Capacity (gallon) Other Percolation Rale (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements' Date 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 /�C Date 7 / o`n/)� 6L Inspector 111 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 a violation or e 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 ($500.001 ine —6 months in jail or both). wire kDDt IPA .m v u nen • MP. .e... INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER JceGl lam,//e7 ADDRESS /00 /e—r Ig --e CONTRACTOR f�- PHONE 910 r -o9 -r ADDRESS PHONE PERMIT REQUEST FOR Q$ NEW INSTALLATION l04) 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 Ccer-4.-r04,_ Legal Description or Address /QC 674,76 -oec .,Q DWELLING ( ) COMMERCIAL OR INDUSTRIAL ( ) OTHER -DESCRIBE WASTES TYPE: Size of Lot 73 sepia ( ) TRANSIENT USE C1 .tick .— ( ) NON-DOMESTIC WASTESws;Lt r BUILDING OR SERVICE TYPE: Number of Bedrooms 2 ( ) Garbage Grinder rb(f Au omdic Washer Lo+ zAr Number of Persons ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: (s, c er 7 tI&z'er DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? A site ' Ian is re ' uired to be submitted that indicates the followin 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 SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 043- 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: _ 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? nG 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 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 Date �� PL DRAW AN : - URATE MAP TO YOUR PROPERTY!! Cse Septic Tank Replacement and Leach Field Pipes Repair/Replacement The purpose of this application is to replace an existing septic tank with a new 1000 gallon concrete tank. Also, to replace leach field pipes as required. A Garfield County building permit has already been issued for the site construction. # 9502 to Jack Wilfley, 100 Glenwood Ave, Carbondale. JACK WILFLEY PO BOX 2330 DENVER, CO 80201 Date 582 23-7001/3020 Pay to the /M9 // (, 6/ y— Orderof n cc,.� 7. — 1 $ O� t /�d�.e /6rs uy Main OI140• 303310.2300 14306 Ent Alameda 1400347-5323 Aare. 0030012-2500 lww.RaurnycU.mp For 1:3020700L31: 52L2962-'8» 0582 en Dollars e sr re M GUARDIAN* SAFETY OWE WD0L NOTES RECEIPT DATE RECEIVEDFROM wrl¢I/. ADDRESS P -o . W k 216220 46) G' /0 d NO. 5334 • (o 8O20! FOR S ACCOUNT HOW PAID AMT. OF ACCOUNT CASH AML PAID CHECK / sr) 08 BALANCE DUE MONEY ORDER BY ©2001 REDIFORMs 8L806 ERLDE ENGMTERRING STRUJCFURAII JCIIV . ENGINEERING* CON'FRACTTI G *CERTIFIED IED (ENERGY DESIGN PROFESSIONAL July 28, 2006 Garfield County Building Department 108 8th St. #201 Glenwood Springs, CO 81601 Re: ISDS Installation Wilfley Residence Satanic Township Carbondale, CO Dear Building Official: The installation of the (SDS system for the above project has been completed and has been installed in accordance with applicable county specifications. Enclosed is a drawing of the final location of the system. If you have any questions, please call me at 963-9869. Sincerely, �h� TIMBERLINE' ar •f"'+5C''� ti }�c? \0 a P0it 4l5�i David A. Po • e i� P 1 Reg. No. 25851. ,•s i �s'^ t , Y REC, I_. 1 h_, In 2 8 LUL GAr _ Y BUILD',N3 'rLF,^:rr!NG P.O. 130X 631 CA RJ3ONDAILIE, CO. 81623 PHONE 970 963 9869 / FAX 970 963 9003