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Home My WebLink About03664.,_ •• , r . "' , ' ' I ~ ... I \ ,.. - GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 : INDIVIDUAL SEWAGE DISPOSAL PERMIT ' Permit N: 3664 ASBessor'a Parcel No. This does not constitute a building or use permit. · ~ PROPERTY ' : Owner's Nameb~~(_c_e-+:~tg~.,;_t._-t_K_Wf--+-Present Address of (,,o c. iLlho G J (-1) '{/ bO ( ~ System Location_~(lf~c.f~r./_?>~f a_c_K_]e~a~l~~J~.-----'G=-·=-5----'· ~'-'-/(p""-'o'-'-/ ____ _ J Legal Description of Assessor's Parcel No. -------.. d~-~(~1~5~_~_3 __ D~J,~--~O~O~-~/,b~C,~----------- • " ; SYSTEM DESIGN .7)0 Septic Tank Capacity (gallon) -----~Other _ _,/~/9~--Percolation Rate (minutes/inch) Required Absorption Area -See Attached Special Setback Requirements: Date <£-f -Ol/ Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System lnstallerUt.-A'@?!" Septic Tank Capacity·-"'"'-"'-'-""-''------------------------------------- Septic Tank Manufacturer or Trade Name ~~'""'°""""'~~=--------------------------- Septic Tank Access within 8" of surface ~'f"'"'----------------------------- Absorption Area foe) /a214'i fflc .,a 30 Ix 30 I Absorption Area Type and/or Manufacturer or Trade Name-------------------------- Adequate compliance with County and State regulations/requirements,__,ift,,,_ __________________ _ Other 'l sfem Date 'i·/ 7-0'( 512,-0 jC,R 5 f3eo fonm ~ Inspector '~4v7~;£ RETAIN WITH RECEIPT RECORDS AT CONS UCTION SITE •CONDITIONS: 1. All installation must comply with all requirements ofthe"'ColoradoStateBoard of Health Individual Sewage Disposal Systems Chapter 25, Article 10 C.R.$. 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 ~~~::sfUo/t ~~fr:~ CONTRACTOR. _ _u':M.J~~"'-------------------------- ADDRESS ________________ _,_P~H"""'-N~E~------------ PERMIT REQUEST FOR (~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 pro es in test h es (See page 4). LOCATION OF PROPOSED FACILITY: COUNTY_,;,e::_~~.tflJIU!e'..__._ ___ _ NearwhatCityorTown ):{,~ SizeofLot ,J6 ~ Legal Description or Address J)iL/~ &,,..___, GJoa.<J. {3Al\A:Q~ fGt)..' ~ WASTES TYPE: (t::Yi5WELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER-DESCRIBE ________________ _ BUILDING OR SERVICE TYPE: ______________________ _ Number of Bedrooms _ _,,._ _______________ Number of Persons__..._~--- ( ) Garbage G1inder ( ~utomatic Washer (~hwasher SOURCE AND TYPE OF WATER SUPPLY: <)4 WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system:_~~~~~~~-------------- lf supplied by Community Water, give name of supplier __________________ _ GROUND CONDITIONS: Depth to bedrock: ______________________________ _ Depth to first Ground Water Table. _________________________ _ Percent Ground Slope _____________________________ _ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: ______________ _ Was an effort made to connect to community system? ( ) YES ( ) NO TYPE OF INDIVIDUAL SEW AGE DISPOSAL SYSTEM PROPOSED: <X1 SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER-DESCRIBE _____________ _ FINAL DISPOSAL BY: ~ ABSORPTION TRENCH, BED OR PIT ( ) UNDERGROUND DISPERSAL ( ) ABOVE GROUND DISPERSAL ( ) . EVAPOTRANSPIRATION ( ) SAND FILTER ( ) WASTEWATERPOND ( ) OTHER-DESCRIBE ________________________ _ WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ______ _ 2 ·PERCOLATION T.!iiST RtSULTS: (To be completed by Registered Professional Engineer) . ' Minutes • per inch in hole No. 1 Minutes per inch in hole No. 3 MintJtes _____ per inch in hole No. 2 Minutes _______ per inch in hole No. __ _ Name, address and telephone ofRPE who made soil absoqition 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 repo1ts as may be required by the local health department to be made and furnished by the applicant or by the local health depa1tment for purposes of the evaluation of the application; and the issuance of the pennit is subject to such tenns and conditions as deemed necessary to insure compliance with mies and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The w1dersigned hereby certifies that all statements made, infonnation and rep01ts submitted herewith and required to be submitted by the applicant are or will be represented to be trne and correct to the best of my knowledge and belief and are designed to be relied on by the local depa1tment of health in evaluating the same for puqioses 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 pe1mit granted based upon said application and in legal action for perjury as provided by law. Date ~P~ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 .;: Designate North Arrow Your Neighbor's Name&Addr1 ~ C",) • ~ ~ ".) ~ ~~./ 1 oo~· ~v \ Your Neighbor's Name & Address ff \ / ' I ' ' \t jl/ Locate well, all streams, irrigation ditchs, and any water courses. Draw ~~u ~se, septic tank & system, detached garages, and driveway. ~ If a change of location is necessary, you must submit a corrected drawigg; fore a Certificate of Occupation will be issued. _, / County Road (Note the Road Number and Name) 07 JI&/ {jfl.lvlL ,{,./' ,~ ~ ~ N ,<. l.~ ...... , .... _°flo<Joc -11. S'I • 7 ~~ ~'°"" .... ~~ . ooi.ti "1,~£>,....J...J ~,a.ro ., •'