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Home My WebLink About03737GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit NS 3737 109 Sth Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 01601 Phone (303) 945.6212 r This does not constitute 1 INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. @ PROPERTY Owner's Name1'O:SQ A t�S 4#OA fy Present Address(3Q53 N. 1M\*M((o W Vre 1,04y S Phone 9 r i 1 r7 / y System Location act / 5 OQ (`I� C Re $s+ t' of Yl -e- `t)f- a TR>irO �i X395-aaa— a-�o�o4K��roWs3 Legal Description of Assessor's Parcel No. — -- SYSTEM DESIGN � r/! pL ,11G) ;'46 nL (i- 14;2n 1 14;2n Septic Tank Capacity (gallon) of Percolation Rate (minutes/inch) Number of B drogms (or oth4�0,c 1 /� 60 760>cK Pec Required Absorption Area -See Attached0 / fir^ 5 Special Setback Requirements: DateU % U Z.-- Inspector i FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) Cell for Inspection (24 hours notice) Before Covering Installation System Installer c�T a Septic Tank Capacity // 0nn GG ��1 M !^1 /p Septic Tank Manufacturer or Trade Name /o 2 L S i Septic Tank Access within 8" of surface t- 4 Absorption Area _l Q4,4 ('`�� 1 I Ove[- I Absorption Area Type and/or Manufacturer or Trade Name /_u -a t 1 Adequate compliance with County and State regulations/requirements f Other Date 11— V `� Cl Inspector 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 compiled 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, orinstallsan individual sewage disposal system in a mannerwhlch 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 — e months In jail or both). White - APPLICANT Yellow- DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION' OWNER— rl►'1dP�/5 # N-t� k9 4-vsa ADDRESS CONTRACTOR PHONEo2c�' %91 ADDRESS f• o . $off N01 CS • S 106 0b PHONE 0 (o l 8 - 0 618 PERMIT REQUEST FOR 14 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). • 14 L. 14• • �II•��lf'itl Near what City of Legal Description WASTES TYPE: BUILDING OR SERVICE Number of Bedrooms (X Criarlia/g7e GrindA '64 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER - (Xl Automatic Washer Number of Persons A) Dishwasher SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: GQ K P &Ao W S UaA f"' DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? A site elan 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 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (}Q 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: (x ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) 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. I Minutes per inch in hole NO. 3 Minutes„ner inch in hole No. 2 -Minutes per inch in hole NO. Name, address and telephone of RPE who made soil absorption tests: Name, address and telephone of RPE 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 JDate 0— PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTYI I Z014 "�2 7.20 acres/ E OSTINGGRADE PROPOSED LOURS FINISHEDGRADE GRADE CONTOUR " ONSTRUCT SWALE TO ---- --------- ---- `-, DIRECT DRAINAGE AWAY 30 001 A01 -f LE TO AWAY Tw. Benchmark �- - Elev. 1001.00 1000 _ - - - - -1010 t0A1 --- - - r i --- - 3. r - 24 l t�`ic Xonsrmer ` E'l€ctric Meter- -- J�%moi Water. Shutoff _ Y Telephone Riser - II Fire Hydron t 45.00 'L,� 10 .r j f Proposed 2 Story Wood Frame House DRAINAGE �° "' 1 °O�,�O4 Dl YlN./182032 SCHEJZr & : tV 4s -sae s• OAr r GENERAL NOTES � I