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Home My WebLink About03656~·· rS-~.~ '// 17 /o;;r-- -,.,.,--.----.-... ---~- I i GARFIELD COUNTY BUILDING AND SANITATION.DEPARTMENT . \ 109 8th Street Suite 3~ .. . . Permit N: 3656 A88e88or'a Parcel No. Gl6nwood Springs, Colorado ~&,~ _./ Phone (303) 945·8212 · · -----------'· l ' INDIVIDUAL SEWAQE,Dl.POSAL PERMIT ! PROPERTY f ,. ; owner's Name\\0£{U;1G5 l:hrold Present Ad~ress0~0. ~jiS~. Siti ~ System location Y?JXO c:~ a~\ 5, ~.,,.../. ·. ' ' '' ' This doeS not constitute a building or use permit. Phono~-5DEh'C ~ Legal Description of Assessor's Parcel No.----------~----------------------"- ! 1 SYSTEM DESIGN • I 1 • ~ ; ' 1)50 Septic Tank Capacity (gallon) Other d q Percolation Rate (minutes/i.nch) Number of Bedrooms (orj\her) L/ . . f1'S7 IJJ (};,,_,_;,ye;~ .. Required Absorption Area· See Attached .· /.;l:> 1 "/ ¢ / AJ2..~ ,J -::? ft:, u 1,,,,_h //A I'-/ i/J & cf-, '¢3 CA~ f:,/ (..) ~,,. ' . I o<-:T/ v-~ (it~) Date~5'"'-·_,'.1"-·~0~d--~-----Inspector /{)ft.,, r ti /JU /1. ;_t Special Setback Requirements: .\ " • ' • •• I • • • l f ' I FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) ~ Call for Inspection (24 hours notlcet Before Covering Installation System Installer cJz»tt/1e /*'"" £ I '-" /1<!. J, Fun .. .., i 6-f"·CIZ,.. T1/-j ' ~ • , ' • l ' '· Septic Tank Capaclty_,_/,..'$4....,~a..__ _ _,(.._..¢,.,,~12"'/tHtJ<-L-'u.<.------------------------ 1 Saptic Tank Manufacturer or Trade Name _..,C_.a ... .,1.,4~0_,,h</""'~------------------------ Septic Tank Access within B" of surface _."""----------------------------- Absorption Area-""-------------------------------------~ Absorption Area Type and/or Manufacturer or Trade Name ~/,wl1uc.E-LLILll,__2'f/,_ . .,_.f("'-•SL----------------- Adequate compliance with County and State regulatlons/requirements~"'-'"'"-.'/------------------ (,; •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 permlyis valid only for connection to structures which have fully complied with County zoning and building requirements. Con~ nectlon to(or use with any dwelling or structures not approved by the Building and Zo~!ng 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 lnstall\an Individual sewage disposal system In a manner which Involves a knowing and material variation from the terms or specifications ct>ntalned 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 f ~ J ,. ' I I • • I ' i ' I ' • . INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER Ha.co 1d e f/,ffn,,.,., 1 'st<-,... ADDREss ~ .<-1 aPo e · /?, 3 ~ J PHONE ~8L-!?'--"'/.'--_,,_5'.../Ld_..~~11;l....- coNTRAcToR _!_c;::~""<-""'-lf--'l!/'c;__. ---,,..--------------- ADDRESS CD 3 ~ e R 3 db PHONE __,_S'--'oc=)t)~t""' ___ _ 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 'fi /Lr Size of Lot I 6 -I- Legal Description or Ad·d-r-es_..s :·::,L/:=.""'"3-8:::o=~=c::a:u:n::::J.,:y=:12~"""J-_-"'"'-3~3::,:::::~:::~~~~~~= WASTES TYPE: O('.) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER-DESCRIBE.-+------------------ BUILDING OR SERVICE TYPE:--.. /Vf O! fl 11.fac.fM ~ !f dfl1e Number of Bedrooms __ ;/""---'------------Number of Persons __,_4L.,_._____..~ooe---- ~ ~ Automatic Washer ()</Dishwasher SOURCE AND TypE OF WAIER SUPPLY: fXI WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: JI I A--~.,,_,_..._ ___________ _ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:._,_!JJ"--R/1-=---------- Was an effort made to connect to the Community System? _ ___,rl""IJc..,,ILf=r+------------ A site plan ls reaulred 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: (septic tank &leach field)10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GRQUND CONDITIONS: Depth to first Ground Water Table. ______________________ _ Percent Ground Slope. __________________________ _ 2 'TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: <A{ SEPTIC TANK ( ) AERATION PLANT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) CHEMICAL TOILET ( ) OTHER -DESCRIBE FINAL DISPOSAL BY: ( ) ABSORPTION TRENCH, BED OR PIT ~ UNDERGROUND DISPERSAL ( ) ABOVE GROUND DISPERSAL ( ) VAULT ( ) RECYCLING, POTABLE USE ( ) RECYCLING, OTHER USE ( ) EVAPOTRANSPIRATION ( ) SANDFILTER ( ) WASTEWATERPOND ( ) OTHER-DESCRIBE.~----------~----~---+-- WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?_-+-&.X..,~b')'---- PER.COLATION TEST RESULIS: (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 er inch in hole No. 2 Minutes per 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 pennit 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 pennit applied for herein. I further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any pennit granted based upon said application and in legal action for perjury as provided by law. Signed _______________ _ Date ____________ _ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 4C:' Designate North Arrow Your Neighbor's Name & Addr.>fS 1?'1.~fte., ,Y, Ue , e. 87~-J:>ID LfJgD t~?* I Your Plot -Shape to Fit (No Scale) 2./-3'1:o rJ£ ?; 3 / 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) 3~ ericc:\~ 13~} ' . '- Your Neighbor's Name & Address v fte,-;.., o7 (t-f /e-r<.. 1 ot' ~i..r-tM4· l.{40 i (/ t R :;31 •