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Home My WebLink About03604I~ ' I' ,, { ,1 l i I. I i ;' i l I I ,. I l I • . ' • • · 150. (})): : . ' • /O(C)'f/of GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT i PRPPERTY Permit N: 360A A89e89or's Parcel No. This does not constitute a building or use permit. • • O"(~er's Name {!,/~rK\I~ L. Present Address 00717 f-ft>.r"'•°ffef\ !)f. G. s. Cfh!!."° 1 C/'<fS~ ;?1..51, System Location _____ .L-?+1~3~o~C~~~~.....,l~lf,___S~i' f~'+~G>'-'---.::.1(':....::( b-=.S:=~--------- Legal Description of Assessor's Parcel No.~~--------------------------------- SYSTEM DESIGN QSJ Hf l(i Septic Tank Capacity (gallon) ______ ,Other __ q~Q~--Percolation Rate (minutes/inch) Number of Bedrooms (or other) ~W~ (JJIU. C-lw.X Special Setback Requirements: · (A\ Required Absorption Area -See Attached 4 i3.i?. G G,_, 1-1(11 1[°>-t~1N I-# · Date _/'-'Q'-· _,,jc=O_· ,,Q_,,f ______ Inspector l~ ·~ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Cqvering Installation System 1ns1~iier,,, . ...,.,_--------------------------------------- Septic Tank Capacity• __ ·,"' . ._,.----------------------------------- Septic Tank Manufacturer or Trade NB.me _._ .. _· ------------------------------ Septic Tank Access wlthin 8" of surface ---------~---------------------- Absorption Area-----------------------------------~---- Absorption Area Type and/or Manufacturer or Trade Name -------------------------- Adequate compliance with County and State regulations/requirements _____________________ _ Other ___________________________________________ _ Date _____________ Inspector Jb C, 14 C,ut?+'t'l.f ~1u«fi.1<A( f ~2-0/ 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 - -----------------~----··----------~------------------~ " I 1. ' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION =•~zi~~;., CONTRACTOR_....:::>6!2!Z2...COC:::::.._ _____________________ _ ADDRESS ________________ _ PERMIT REQUEST FOR (..-('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~.-,5.., • ....,'t"'z=.c..__~..1..<?_....a2.....· _________ _,;iSize~.i.t.OfuLo!.<!o/.l.t _ __,.;i'2!....:!::.........4£..~ ... v::..i"'!L.4L" _ Legal Description or Address .37.:"fa ~e--i}-K,../ .+ 1 ¥ WASTES TYPE: ( -1'DWELLING ( ( ) COMMERCIAL OR INDUSTRIAL ( s; ,/,~/ cc . ~~ (-' ) TRANSIENT USE ) NON-DOMESTIC WASTES ( )OTHER-DESCRIBE _______________ _ BUILDING OR SERVICE TYPE:~ .. .;:s;'.1.t.#ll!jruk~--:/;a::d;a' .... <Uf~-A&rL.s:.cL.' ol.eL~d<'-"'':...0"'~------ Number of Bedrooms-~'-------------Number of Persons--",.;?--=----- ( f) Garbage Grinder ( /) Automatic Washer ( 1) Dishwasher SQURCEANPTYPEOFWATERSUPPLY: (ef'°WELL ( ) SPRING ( ) STREAMORCREEK 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 JJiIDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( .,..y SEP'fiC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POT ABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER -DESCRIBE FINAL DISPOSAL BY: ( ) ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER -DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? A/a PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe Engineer does the Percolation Test) Minutes ____ _,..er inch in hole No. 1 Minutes ______ p,er inch in hole NO. 3 Minutes er 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_ to ";:t ~, /... Date'--'/'-'''""2'------'-'{_-0-=t'-------- PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 PEACH VALLEY ROAD • • (/) CD 00 0 (>J ·-- .-60' +/-~ ----J . (>,I -~ -rn (J.I -·-··-··--~-· (>.I (JJ (JJ ~ (X) OJ . . • (>J tN I\) 01 - 199. 34• = . " April 22, 2001 Garfield County Building & Planning I 09 Eighth Street, Third Floor Glenwood Springs, CO 81601 Re: Clark ISDS-HCE No.2011108.59 3730 County Road 216 To Whom It May Concern: ' !RECEIVED JUN O 3 2002 On April 2, 2002, High Country Engineering (HCE) personnel inspected the construction of the ISDS located at 3730 CR 216 in Garfield County, Colorado. HCE's design calls for a trench system with l' gravel, 4" perforated pipe, filter fabric over the pipe and 1' of topsoil for cover. There are a total of7 trenches. (I) 1250 Gal. Septic tank is installed and all piping from the house to the tank and from the tank to the trench is insulated with blue board. At the time of inspection, the contractor had constructed the trench system and installed a 1250-gallon concrete septic tank and the required chamber units. No backfilling had taken place. Field personnel observed that the depth of the trenches with gravel did not necessitate ventilation and advised the contractor to install standard inspection wells. Otherwise, the installation of the system was in conformance with the intent of the design. If you have any questions, or need additional information, please contact us. Roger D. Neal Project Engineer RDN/cmt Cc: Troy Clark 923 Cooper Avenue, Glenwood Sprin&'. CO 81601 Telephone (970) 945-8676 -Fax (970) 945-2555 14 Inverness Drive East Suite B-144 Englewood, CO 80112 Telephone (303) 925-0544 -Fax (303) 925-0547