HomeMy WebLinkAbout03691I
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GARFIELD CO,UNTY BUILDING AND SANITATION DEPARTMENT
;109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945·8212
Permit N~ 3691
AsseBBor's Parcel No.
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t INDIVIDUAL SEWAOE DISPOSAL PERMIT a building or use permit. }
I PROPERTY '
I ' Owner's Name L 'B Rose BCiOCb Present Address \001 \to.le ~t;n J;;'.'..Q;i Phono38Lj -Ol<o9 ,· f'
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System Locatlon\DC'1 \t,jesM;n "'.Klli Bec;:J.roorn~8 c~ ;
J ~~ '.'?:nt' ~/'._\_J"A~ .• ~ ,j ". f Legal Description ot Assessor's Parcel No. ~ ~--V---ll::S'.:Cd~l:!..2! -~ 1:
1· SYSTEM DESIGN
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Septic Tank Capacity (gallon) ______ ,Other
Percolation Rate (minutes/inch)
• • Required Absorption Area • See Attached
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Special Setback Requirements:
Date _~/'-"o+/-'. 2=/+)c.J..<l.o:Z...:=------Inspector
FINAL SYSTEM INSPECTIQN AND APPROVAL (as Installed)
Call for Inspection (24 hours notice) Before Covering lnstallat11n
System lnstaller _ _,[..Lil..L_e,_:::::_ ______________________________ _
Septic Tank Capaclty•_,/,..(P_~~""-'t)"------.,,.,-.,,---,..-----,-------------------?flE~,/ ~
Septic Tank Manufactur•r or Trade Name -1Uf2="'~""'-""'=~J-. -'~""'"""-<.'--------------------
Septic Tank Access~ 8" of su'ce
Absorption Area ~-·
Absorption Area Ty==turer or Trade Namec;:ei~~-~""-'~"""""':!l!..:il!!!::. ______________ _
Adequate compliance with County and State regulatlons/requlrements---,fJ?/.;F'-'------------------
Other--------------~------,~----,...-r-----------------
lnspector .,;,.t;;V,.··="'-":ib4!"9""'"""=l~------------------Date //-;,-··o Z-
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
•CONDITIONS: I
. r . '· , , 1. All Installation must co~Jywlth a11.~,q1J!ret"e. nts of the OQlor•do State ~oar~ of Health Individual Sewage Disposal Systems Chapter
25, Article 10 C.R.S.19 .'.Revised 1984.'.J··.1 ,· ' ·'°
2. This permit Is valid only 1 ( conriect(qn to structures which have fully complied with County zoning and building requirements.· Co.n-
nection to or use with any dY1elilng or structures not 9pprovedbyjpe Building and Zoning office shall automatlcally be a violation or a
requirement of. the .permit and cause for both legal l\btlon and revocation of the permit.
3. Any person whC>conS~ructs, a1,ers. or Installs an lnd1v1dUa1 sewage.disposal eystem In a manner which Involves a knowing and material
variation from the tetms or epljclflcations contained In the application of permit commits a Class I, Petty Offense ($500.00 fine -e
months In jail or both). ·
White· APPLICANT Yellow· DEPARTMENT
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~~rtz-cor>"I ~ z_ . '
INli>IVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER L' ,8_ ?c?S.C::-4'/1/Cd .( / c
ADDRESS /c>rY7 t1le~g:: .RL (!Ns { 6i;:, PHONE C?7o :!.SY·-{)/09
""' CONTRACTOR t4cvJ ~ . .-JST/lv'cf/d,,.__j -?;v'-
PHONE 9-0 ~<-729/
PERMIT REQUEST FOR ~ NEW INSTALLATION ( ) ALTERATION ( )REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable
building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY:
Near what City of Town t'&r?ccfr c>~ bcE,J,_>c.of {ffe,,.? S. Size of Lot ~ -r A,.€£ <:., -
Legal Description or Address &sc /2.A-rJ'c_.,_1 4-o,./ Co./~.S c -
WASTES TYPE ( ) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
9<) OTHER-DESCRIBE Te:sz-go:¥'"1 s o ,.0 £.a,/ {",,.1,-z ~$'-
BUILDING OR SERVICE TYPE: 11~"i:il-iZc>c)e>'Z c).A.i 6ac F Co.J/1..s e.-
Number of Bedrooms --1f---Number of Persons ~v;,.,.'z
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK
;T";2;2-/C7,,:'>·]IJ;J --/lh,v -p,, 7 A/?.< E-~
If supplied by Community Water, give name of supplier: ________________ _
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: __ /_----';Y1,'----',1.-~_c _______ _
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: 1 O 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. ___________________________ _
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- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -. ' ' ' TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
()() 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, POT ABLE USE
( ) RECYCLING, OTHER USE
( ) EV APOTRANSPIRATION
( ) SAND FILTER
( ) WASTEWATERPOND
( ) OTHER-DESCRIBE. ___________________ ~--
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?_~M---"(;2'-----
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe 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 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 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 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. S_ jj:L,i-p(/_ Dm CJ e-2/ -{) 2-
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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