HomeMy WebLinkAboutApplication- PermitGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY l()
Owner's Name / 1 C c% /t/
�)?H` Present Address
Permit
4013
Assessor's Parcel No.
This does not constitute
a building or use permit.
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System Location -)(P 79 ` RD /17 RC „aJ
Legal Description of Assessor's Parcel No
SYSTEM DESIGN
S0#
?395-0D2- Jc-o/
Septic Tank Capacity (gallon) Other
• 7
v Percolation Rate (minutes/inch) Number of Bedrooms (or other)
85-0 ht6 y6 as
Required Absorption Area - See Attached
i9 ' (,s/hrs
Special Setback Requirements:
Date /O n UU
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer L
Septic Tank Capacity 11 0
Septic Tank Manufacturer or Trade Name 0' --
Septic Tank Access within 8" of surface `yam
Absorption Area i )t 11.2
Absorption Area
Adequate compliance with County and State regulations/requirements tkila
Other
2
Date / 6
Inspector
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 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
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
c
OWNER Kevin & Kathy Kneipper
ADDRESS 827 Pitkin Ave Glenwood Springs, CO 81601 PHONE 970-384-2044
CON] RAC'I'OR Kevin & Kathy Kneipper
ADDRESS827 Pitkin Avenue Glenwood Springs, CO 81601 PHONE 970-384-2044
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 Glenwood Springs Size of Lot
Legal Description or AddressTBD County Road 117
SE(.T,T WN,RNG:ST-f9 SUB:CBELYN ACRES WTO DESC: TR 22 B@0440 PG:0051 BK:44ST PG:0052 BK:0931 PG:07% PARCEL: 2391032-00-H9
WASTES TYPE: (a) DWELLING ( ) TRANSEg4TUE.
+- cres
( ) COMMERCIAL OR INDUSTRIAL ( ) NON -DOMES'T'IC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:
Number of Bedrooms Five (5) Number of PersonsFive (5)
( ) Garbage Grinder (X) Automatic Washer (X) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (X) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 2 1/2 Miles (Glenwood Springs)
Was an effort made to connect to the Community System? NO
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 (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 tirst Ground Water Table REFER TO SUPPLIED SOILS REPORT
Percent Ground Slope REFER TO SUPPLIED SOILS REPORT
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
2
(X); S);RTIC 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
UNDERGROUND DISPERSAL
ABOVE GROUND DISPERSAL
OTHER -DESCRIBE
( ) EVAPOTRANSPIRATION
( ) SAND FILTER
( ) WASTEWATER POND
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE
STATE? NO PERCOLATION TEST RESULTS: (To be completed by
Registered Professional Engineer, if the Engineer does the Percolation Test)
Minutes 19 per inch in hole No. 1 Minutes 23 per inch in hole NO. 3
Minutes 24 per inch in hole No. 2 Minutes per inch in hole NO.
Name, address and telephone of RPE who made soil absorption tests: James D. Kellogg, P.E.
CTL Thompson, Inc. 234 Center Drive Glenwood Springs, Colorado 81601 970-945-2809
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 fumished 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. 1 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 09-26-2004
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
Turn right onto county road 117, continue on county road 117 for 2.2 miles, turn right onto
Driveway located next to power pole 3677, lot is located to the left of the driveway.
3