HomeMy WebLinkAboutApplication- PermitGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 Bth Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Permit:N°. 3 3 5 6
Assessor's Parcel No.
This does not constitute
a building or use permit.
EN/lay; Mit ill' a w( 6914 few f&c ie�iwS5 (A C k„
Owner's Name> f Present Address honei/li- - n/oG
c;f �1
44. System Location 04710HjgL (
all Oa. U P,/(WUDfi' p S coiv1/4,v(70/
t, �V./ j
19 Legal Description of Assessor's Parcel No.
r SYSTEM DESIGN
,
{.t
,4
•'1(
1 FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
1>l Call for Inspection (24 hours notice) Before Covering Installation
- ;
F; System Installer
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption AreaSee Attached
Special Setback Requirements:
Date Inspector K--IZr/4t^"`� -C...
t
•
kI
ik
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 inspector1
,4,I,, "" adint c • (a/ 13 /deo l ih - 1
O ,/ h/aoo
1. All Installation must comply with all requirements of the Colorado State Board of Health Individual Sewag 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 — 6
months In jall or both).
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
White -APPLICANT Yellow -DEPARTMENT
dt
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER (,v/J-L-//52M f. (5149n epx
ADDRESS 6 4147 6 Al CV 3 2 PHONE 941-,3 ' 6 )0 b
CONTRACTOR 351- p ctLarm < li SSG6 ,
ADDRESS MAid/A!a S/3 y 43140 /Pi C2 FAL PHONE 7*3 - 3 P LO
SAcsr
PERMIT REQUEST FOR ( ) NEW INSTALLATION 3X) 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 ,_5U, D F G t FN (A/6/op Size of Lot 3- aj01-ct-ee-B&
Legal Description or Address
WASTES TYPE: DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:
Number of Bedrooms 9 - /C /j tearrVTh Number of Persons
( ) Garbage Grinder ( ) AutomaticWasher ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: 74 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: 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 PERMIT WILL NOT BE ISSUED WITHOUT
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
FINAL DISPOSAL BY:
AERATION PLANT ( ) VAULT
COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
INCINERATION TOILET ( ) RECYCLING, OTHER USE
OTHER - DESCRIBE
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?
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 systemoreRrD nie Gainkcc
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 }i}.4).(4.71►.. I.
PLEASE DRAW AN ACCURATE MAP T
Date //( i 2 G-� 090
UR PROPERTY!!
3
JEROME GAMBA & ASSOCIATES, INC.
CONSULTING ENGINEERS & LAND SURVEYORS
113 9TH START, SUITE 214
P.O. BOX 1458
Gj_ENWOOD SPRINGS, COLORADO 81602-1458
P0NE: (970) 945-2550 FAX: (970) 945-1410
Mark Bean
Garfield County Building and Planning Dept.
109 8th Street
Glenwood Springs, CO 81601
Re: Slattery Residence I.S.D.S.
6476 State Highway 82
Glenwood Springs, CO 81602
Dear Mark:
`i RECEIVED JUN 1 4 2000
Tuesday, June 13, 2000
On May 17, 2000 Jerome Gamba & Associates, Inc performed a final inspection of the Slattery
Residence ISDS.
The system as observed by Jerome Gamba & Associates, Inc., was found to be in substantial
conformance to the plans and specifications signed and dated October 19, 1999, except for the
following field changers:
The grinder pump installed is a Zoeller, 820 Grinder Pump, for residential applications.
If you have any questions or comments, please call me.
Sincerely,
JEROME GAMBA & ASSOCIATES, INC.
Chris Strouse, Design Engineer
Cc: William Slattery
Page 1 of 1
G:\99839-SLATTERY\SLATTERY_FIN_LETTER.DOC