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Home My WebLink About03675i 'i rt!X -fu-;; &, z~ htRJ/<() /Lc.>ec_5 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Owner's Name R,y d r"self • ; System Location 'J::>r'ck PresentAddress'f..3<{8C~llt;" GS ~ff.,o/ 43 'fK el?. lls G;. s. <!.n ff <..o 1 ---::: Permit N~ 3 6 7 5 Asse,aor's Parcel No. This does not constitute a building or use permit. CoOf' • .WC/-1i1 .;J.c; PhoneGi't4( HJ ·r~s .· 6J~~,;3v7 Legal Description of Assessor's Parcel No. ----"~'--'/~g~_1_-~~-'8:..._;)..~_-__ 00 __ -_0-''~'3 ... 7~------------- SYSTEM DESIGN • ~/_t0_<9_0~-Septic Tank Capacity (gallon) 3o ______ Other Number of Bedrooms (or other) I 3 -----Percolation Rate (minutes/inch) /Z'-f-z. d:> ~~ f:".....d./ Required Absorption Area-See Attached t; i;;:: ~ ~,._J,~ 3'/ f>C:> Special Setback Requirements: .5& '"41'-',12'1 "'4 I·~· 1 /,o t:i:J L e.......t.. (JJ :::::~ I~ '-/ 0 f'Q.<:: ;>~ ,'.4: ' ( f'"'•p I /!\ti(% ?fh I ~ / ~ ~ ./ -~ "'<Cl-0 4_,ff'l/r.tt ex. 8 Date -f -f 0-0 Z Inspector __ .-1.l.L."""::.z,..,!::l:!:...,,.1164D~::r:....i"y-~~-------------- FINAL SYSTEM INSPECTION AND APPROVAL (as installed) can for Inspection (24 hours notice) Before Covering Installation System Installer f ,Sc__ Ce-rrtf\J,P- Septic Tank Capaclty--<./:=.5"8-=:...::0:__ _____________________________ _ Septic Tank Manufacturer or Trade Name .... 12 .. ~,.,...="'==~-------------------~--'-- Septic Tank Access within 8" of surface ------------------------------ Absorption Area ~ 4 Z.,oe!-5 I //~ / Absorption Area Type and/or Manufacturer or Trade Name-'-#"""'""""~"'-'~<><.!"""="-"'~=--------------- Adequate compliance with County and State regulations/requirements_,,,~"------------------- Other_-::--·------------;::::::::;:'7)-r---;'7,l~-;;;;>;:f'--------------- Date __ 9~---~---CJ_2.. ____ 1nspector _,tj.~~~f:!::.~~Z.-------------- RETAIN WITH RECEIPT RECORDS AT CON TRUCTION 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. Cona ~ct ion to or use with any dwelling or structures not approved by the Building and Zani ng office shall automatically be a violation or a r'equlrement 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 ina 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 •• 4 l. i. ' '· ! ~ ' i . s ~ r'· ' " ,,_;, -·· ' •I" GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glen-od Springs, Colorado 81801 Phone (303) 945-8212 ' ' INDIVIDUAL SEWAGE DISPOSAL PERMIT I PROPERTY .... ~ . ., ~ Permit N~ '". 367.5 Aaaeasor's Parcel No. This does not const.i'tute a building or use ~rmlt. • t • ! Owner's Na;,../{-!J,'J:(~ Dick Present Address 'f 3'{8 C 'I-II<;" G' .S ~ 11.o I &:ii?-JP<1-f1..>.s Phon•GiQH;f lfo;itt>s: , 6;;.S-J;)17 ~ System Location ' 43 c{K C-1?.. {IS ~-S. e, ff <.o t Legal Description of Assessor's Parcel No.----------------------------------- 3 SYSTEM DESIGN y/1 !l /.f l"'o it'o Septic Tank Capacity (gallon) -----~Other ______ Percolation Rate {minutes/inch) ~ ! Required Absorption Area· See Attached ' 'i FINAL SYSTEM INSPECTION At;D,APPROVAL (as installed) ; Call for lnspectior (24 hours notilie) Before Covering Installation • System lnstaller _______ ~_~.;..·_1;-'"'----------------------------- Septic Tank CapacitY--------------------------------------- Se . ' ptic Tank Manufacturer or Trade Name---'~-~"'------------__,_ _____________ _ Septic Tank Access within 8" of surface -------------------------------- Absorption Area ____________ __,_ ___________________________ _ Absorption Area Type and/or Manufacturer or Trade Name----'---~,_,__... ________________ _ Adequate compliance with County and State regulations/requirements _____________________ _ ,__... Other ___________________________________________ _ •CONDITIONS: / 1. All installation must comply with al•Nqujrements 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 11ot approved by the Building and Zoning office shall automatically be a violation or a 11equirement of the permit anQ cause for both regal 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 ($500.00 fine - 6 months in j~" or both). ' Whtte -APPLICANT Yellow -DEPARTMENT .. . l ·, I \ • ' INDIVIDUAL SEW AGE DISPOSAL SYSTEM APPLICATION OWNER Qzk AwJ;>J/ ADDRESS I 217 tk lls1al L,, C,,.,_lc'4< , L..J; -993 CONTRACTOR 6tqa/ /j,-:45 ::4v:._ • ADDRESS /t.(~/ <Jirpar± R,./ /?rP~ (,, <7/?(Cl PHONE 42 S' -.><.5 't? PERMIT REQUEST FOR (')(} NEW INSTALLATION ( }ALTERATION ( )REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PROPOSED FACILITY: Near what City of Town G felAvJlfb ~ £~11 l'-~5 Size of Lot 2121'?? .2 { ~(J Legal Description or Address / j · l::r..J _'-/...:...:;.3_,'l_.¥<.........:CG=.::u;;:.;.._'-'t-....,7'--'-/(-'-"',,/::....:......,__.t'"'/_,_S-_______ _ WASTES TYPE: (}4 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER-DESCRIBE. ______________ ~ BUILDING OR SERVICE TYPE: S;it' ~t~/<-/;.-1{,. ep.!',.,,<.,j.,...( -crcldr--t-J-~ •~ Number of Bedrooms Number of Persons _ _..___ ___ _ <i<$ Garbage Grinder ~ Automatic Washer SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL <)<! Dishwasher ~ SPRING ( ) STREAM OR CREEK 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?__,_iu.-------------- A site plan is required to be submitted that indicates the foDmyinr MINIMUM distances: Leach Field to Well: 100 feet Septic Tank to Well: 50 feet Leach Field to Irrigation Ditches, Stream or Water Coone: 50 feet Septic System to Property Lines: (septic tank &leach field)lO 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 I . ~ TIP,E.OF ~IVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: • jPJ SEPTIC TANK ( ) AERATION PLANT ( ) VAULT • ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PITPRIVY ( ) 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? ______ _ PERCOLATION TEST RESULTS: (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 per 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, infurmation and reports submitted herewith and required to be submitted by the applicant are or will be represented to be true and comet 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 fillsification or misrepresentation may resuh 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/,L & / Date, _ __,')4'--'~'-:i-J/t.c;:~;_'.:)...'----------1 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3