HomeMy WebLinkAbout04625GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 401 4625
Glenwood Springs, Colorado 81601 Permit
Phone (970) 945-8212 Assessor's Parcel No.
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Name' ...OVATTIe; -\LI- : Present Address i jE
System Location - d
This does not constitute
a building or use permit.
N Phone Le l D ,9
Legal Description of Assessor's Parcel No. /)---12/7 • -7..
•
SYSTEM DESIGN
Septic Tank Capacity (gallon) 12.4 - Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 /n - r a
Required Absorption Area - See Attached %% g•
�� 3y
Special Setback Requirements: J 7� y �5, 4,01 . ` ! J 73 /1 6,
Date ,{'_ ( Inspector •
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer `<-)—>+ ; f"
Septic Tank Capacity
C.
Septic Tank Manufacturer or Trade Name /94dZ. c.G•':5/-C-d—
Septic Tank Access within 8" of surface
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name lit / —h / 0 61 `i - z
Adequate compliance with County and State regulations/requirements
Other �.GZ-a-+1
Date s./4/ -C: 7
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. Connection 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 1, Petty Offense ($500.00 fine - 6 months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
GARFIELD COUNTY SEPTIC PERMIT APPLICATION
108 8rh Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003
www.gar£eld-county.com
1
Parcel No; this information is available al the assessors office 970-945-9134)
I.9 .36 304 ( 5 6
2
Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description
-r 0.3) c R ((5 C1-1-.1.) C.) Ooh SPElr iotas )1,6,0(
3
L8l Size: e ry7- X �j
No:
) Block No: Subd.l Exemption:
I
1Ly
(<11-t1--01./P11-1-
,c1./P11-i5
�tk^ti j f
Mailing
fSP�CC
SI 612
\
PSD 61 o 905 r\
61--0 61goIg14
AIt Ph:
5
Contractor:
iv 5 cor,i`�-0KTWA) I It1C ,
Mailing Address
413- c211.5,G- ►wcn�sr l sfooc
Ph;,Alt
1 •(.9 3S`+22. -ado
Ph;
�7.ek 15 50
6
Engineer:
Mailing Address
Ph:
Alt Ph:
7
PERMIT REQUEST FOR: (f) New Installation ( } Alteration ( ) Repair
t;
WASTE TYPE: (s )Dwelling ( }Transient Use ( )Commercial or industrial ( )Non- Domestic wastes
( )Other - Describe
9
'
BUILDING OR SERVICE TYPE: .C1 !J6 Le Ftt`tl L '7>t")a 1—t- IN (-
Number of bedrooms .. 5 Garbage Grinder ( )Yes (viNo
SOURCE & TYPE OF WATER SUPPLY: (/)WELL ( )SPRING ( }STREAM OR CREEK ( )CISTERN
It supplied by COMMUNITY WATER, give name of supplier:
I U
I I
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: r+'2fZCi • 5 rt 1 L --E-5
Was an effort made to connect to the Community System? N D
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
12
GROUND CONDITIONS:
Depth to 15' Ground Water Table Percent Ground Slope 254?
13
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:
(,/(Septic Tank ( )Aeration Plant ( )Vault ( )Vault Privy ( }Composting Toilet
( )Recycling, Potable Use ( }Recycling, other use ( )Pit Privy ( )incineration Toilet ( )Chemical Toilet
( )Other- Describe
14
FINAL DISPOSAL BY:
(,r )Absorption trench, Bed or Pit ( }Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter
( }Wastewater pond ( }Other- Describe
15
Will effluent be discharged directly into waters of the state? ( )YES (ANO
1G
PERCOLATION TEST RESULT: (b be completed by Registered Professional Engineer, if the Engineer does the Percolation Testi
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 & telephone of RPE who made soil absorption test:
Name, address & telephone of RPE responsible for design of the system:
17
Applicant acknowledges that the completeness of the
the local health department to be made and furnished
issuance of the permit is subject to such terms and
reports submitted herewith and required to be submitted
and are designed to be e)ied on by the local de
understand t .. any f . sulcation or misrepres to
application is
by the applicant
conditions as deemed
by the applicant
rtment of health in
may result "
conditional upon such further mandatory and additional test and reports as may be required by
or by the local health department for purposed of the evaluation of the application; and the
necessary to insure compliance with rules and regulations made, information and
are or will be represented to be true and correct to the best of my knowledge and belief
evaluating the same for purposes of issuing the permit applied for herein. I further
' denial of the application or revocation of any permit granted based upon said application
and leg ' for
I'
.:rju ,as provided by la
U
OW GN:' rEL. DATE
Permit Fee:
(73.
Perk Fee:
STAFF USE ONLY
Total h3.5b
Septic Permit #:
B i Plan Ing Dept: v
\JA% 5/g/01
APPROVAL
mg
Issue Date:
Building Permit #:
12.4
DATE