HomeMy WebLinkAbout03580•
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945·8212
Permit N'.:. 3680 t
Assessor's Parcel No. , ~ ,
This does not constitute i •;t i
~ INDIVIDUAL SEWAGE DISPOSAL PERMIT
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a building or use permit. J, .
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t owner's NameJock 1' f.WD. &>w~ent Addres;i ~I C¥!? a I g1 (lo J PhonefiJ/v;-'· i System location 0°11 q CR Q/g s·, H-l Co ?'J~5d--
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t· Legal Description of Assessor's Parcel No.--------------------------------
;! SYSTEM DESIGN
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1000 Septic Tank Capacity (gallon)
___ fl~--Percolation Rate (minutes/Inch)
Required Absorption Area • See Attached
Special Setback Requirements:
Date_-<.?_-..:.J_'J.._. (J'--2..---~---lnspector
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F.INAL SYSTEM INSPECTION AND APPROVAL (as Installed)
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Call for Inspection (24 hours notice) Before Covering Installation
System Installer Ounl.£.1.,,_
Septic Tank Capaclty_L/L...:S::::;°b:..=:._ ______________________________ _
Septic Tank Manufacturer or Trade Name _,do="'-lpd:'-'-'-'"-·-6"-:o·_,__ ... d-_________________ ~---
Septic Tank Access within 8" of .surface, -"'4,.._"""'::_-.---=---,-------------~-------
Absorption Area J tj ~ 1.-r-~~__,.~II\.(? Yb (2 {Aa:.,~.,_. r/) 7
Absorption Area Type and/or Manufacturer or Trade Name-~~~-!\-~· ~·~-/-·'-/"-'~"---"'---'-/_,_(_-.;./~O"--------'-lr-r A~oquate compliance with 'o~Jd State regulations/requirements
Other .
Dato _ _,_,3,_-__,_@_,_,_o=.p):_·· _· __ Inspector ----'-'/J""'~ c=.Cu!"l-=-><-~d-'-"' }lU!'-'-"=-'-'11,_· -"J_---, ... ~?""''"-. .1 """.J_' --.. -..... ·""'/: •• ,_
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE ./ff.'':' ...-
OCONDITIONS: ~-./
1. All lnstallatlon must comply with all requirements of the Colorado State Board of Health lndlvldu~ Sewage Disposal Systems dliapter
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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 ~onlng and building requirements') Con· '
nection to or use with any dwelllng or structures not approved by the Building and Zoning offlce'iha .. ll automatlcally be a vlolatlo~ or a )
requirement of the permit and cause for both legal action and revocation of the permit. , f
3. Any person who constructs, alters, or Installs an lndlvld1.1al sewage disposal system In a mannerWhtch 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). · ' I ., Whtte. APPLICANT Yellow. DEPARTMENT
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INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER Jack & Ava Bowles
ADDRESS921 County Road 218, Box 77, Silt, co PHONE (970) 876-5610
CONTRACTOR owner-built
ADDRESS PHONE ________ _
PERMIT REQUEST FOR "N) 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 PRQPOSED FACILITY:
Near what City of Town. __ S_i_l_t ______________ ""'S""'ize"'-"'of~Lo..,..t_3"""._0_6_a_c_r_e_s __ _
LegalDescriptionorAddress Lot 1, Heavenly View Subdivision O'ffqc_~ JI'?
WASTES TvPE: ~) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER-DESCRIBE.~--------------
BUILDING OR SERVICE TYPE:__.p-=r-=i.;.;;m.:;;ar"-y'--r-'e-=s-=i-=d-=e.:..:n_ce-'------------------
Number ofBedrooms __ 3 ___________ ~-Number of Persons ___ 2 ___ _
( ) Garbage Grinder ~) Aut~atic Washer
SQURCE AND TYPE OF WATER SUPPLY: _0\) WELL
( ) Dishwasher
( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: ________________ _
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_1_/_4_m_i_l_e _______ _
WasaneffortmadetoconnecttotheCommunitySystem? no, we're outside the city limits
A site plan ls regulred to be submitted that Indicates the following MINIMUM distances;
Leach Field to Well: 100 feet
Sepdc Tank to Well: SO feet
Leach Field to Irrigation Ditches, Stream or Water Course: SO feet
Sepdc System to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SIIEPLAN.
GRQUND CONDITIONS:
Depth to first Ground Water Table_u_n_k_n_o_w_n ___________________ _
Percent Ground Slope_v-=a-=r-=i..:.o-=u-=s------------------------
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TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
-~) SE;PTICTANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POT ABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTIIBR USE
( ) CHEMICAL TOILET ( ) OTIIBR ·DESCRIBE
FINAL DISPOSAL BY: ~) ABSORPTIONTRENCH,BEDORPIT infiltrator
( ) UNDERGROUND DISPERSAL
units( ) EV APOTRANSPIRATION
SAND FILTER ( )
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATERPOND
( ) OTIIBR-DESCRIBE._~~~~~~~~~~~~~~~~~---
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? __ n"""'"o ___ _
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test)
Minutes. ____ _,,er inch in hole No. I Minutes --~--_,..e.r inch in hole NO. 3
Minutes per inch in hole No. 2 Minutes er inch in hole NO.
Name, address and telephone ofRPE who made soil absorption tests: ______________ _
Name, address and telephone ofRPE 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 LA!{ ..?f~ Date %-Z-( -O (
PLEA~ AN ACCURATE MAP TO YOUR PROPERTY!!
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Designate North Arrow Mesa View Subdivision easement to the North
Your Neighbor's
Name & Address
Stella May Olseb
Trust
505 Williams St
Glenwood Spgs.,to
to the West
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Your Plot -Shape to Fit
(No Scale)
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Lot } -3. 6/; Ac..'f'e_s
Locate well, all streams, irrigation ditchs, and any water courses. Draw in your house,
septic tank&. system, detached garages. and driveway.
If a change of location is necessary, you must submit a corrected drawing, before a
Certificate of Occupation will be issued.
County Road (Note the Road Number and Name) county Road 218
• lllil« ; . IF $' Pa' .....
Jack & Ava Bowles, 921 County Road 218 to the South
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Your Neighbor's
Name & Address
Michelle Soet
923 C.R. 218
Silt, CO to
the East
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