HomeMy WebLinkAbout03782. '
GARFl~LD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N~ 3782
109 8th Street Suite 303 Assessor's Parcel No.
1/ Sc. ID
_"'"'-\.AL.,...._G..,le .nwood Springs, Colorado 81601
one (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
This does not constitute
a building or use permit.
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SYSTEM DESIGN
______ Percolation Rate (minutes/inch)
Required Absorption Area -See Attached
Special Setback ReQ
FINAL SYSTEM INSPECT!
Call for Inspection (24 hour
System Installer __ +----\-------+---------------------------
Septic Tank CapacitY-+------'>-------1----------------------------
Septic Tank Manufactu er or Trade Nam
Absorptio Area----+-------------------------------------
or Manufacturer or Trade Name--------------------------
Other ______ __,'<-\------------------------------------
Date _____________ 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 1s 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).
'tihi1e -APPLICANT Yellow -DEPARTMENT
4243 Coumy Road 214
Silt, CO 81652
RE: Permit#3782
Gartield County Building and Planning
108 8th Slreet, #201
QJenwood Springs, CO 81601
Dear Garfield County Building and Planning-
RECEIVED
i ) {.' 7fl03
G.«l'lr.::~u COUNTY
:Ji,i;i.GiNG & PLANNING
I got a permit to replace the distribution lines in my leach field. Scott Moyer of Down
Valley Septic told me1hat my existing lines had collapsed Upon further inspection, by
digging up the lines, I found that the existing ones were still intact and in good shape. I
c-aJ1ed your office and relayed this new information and was told that it was all right to
OOYertbe lines beck up and send this letter1D infmm you 1hat I won't need the pennit or
the foJJow-up inspection. I d!ank you for aH your help in !his matter.
RespectfuJJy,
Doljrgtas Oliver
UJU4U~lL--
Gfi•vfM:{ti 6Jiiiiji I
Regular Voucher
Vend'l{ ~a!"e ])~~ Vendor Nwnber Special lnstmctiono Foe Wanant
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Invoice Vendor Invoice.
Date Number Fund Dept Item p, . -.
• 3/11/~ ~~~1<\"t oO( "* :-=sri 3tl50 03lf .:;' ODDD
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DepartmentHcadApproval: DATE:
Financial Management Guide Limits; DATE·
(Needl tD be lipelf "1 Co..•ty ..W..Paitbir If a-$10.000)
PoskdBy;
~~~~~~~~~~~~
Date Stamp:
(Acc.auntingU11e °'11)').
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Brief Description .. " . ~-ll-~
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1-TI• ... ,u ... n~"
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Invoice Dollar
Amount ($0.00)
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Total $ . $0. 01)
Invoice Accuracy Verified By: Cf s@<t/03
•
INDIVIDUAL SEW AGE DISPOSAL SYSTEM APP
OWNERc__,Jd:!~~-1..LLJ~~==---------'---~\.-\.--
ADDRESS,__:s~..L~~.i.i.:~~~-=-::..:u-1----
CONTRACTOR'--..!:'5~L'=-.!....r ______ --l-1----~-"'....-~~~~~~i
ADDRESS·-----------~+----
PERMIT REQUEST FOR ( ) NEW INST.AI/ ATIO ( )
Attach separate sheets or report showing entire arf with res ect to surro ding eas, topography of area, habitable
building, location of potable water wells, soil Pef ation test oles, soil p files in test holes (See page 4).
I
LOCATION OF PROPOSED FACILITY: 1
Near w t City ofTown,_S---'-1 L=-1_,_ ___ -+---1-------+---Size of Lot q, 7 Mee
Legal De l" C 0
<'/J DWELLTI-iG
( ) COMME~CIAL OR
B~ORS
NumberofBedroom."'-_.,,L,__ ____ _,_ ____ _
( ) Garbage Grinder
SOURCE AND TYPE
( ) Automatic Washer
WATER SUPPL : (I() WELL
e of supplier:
( ) TRANSIENT USE
( ) NON-DOMESTIC WASTES
b of Persons 3. ·-~----
()() Dishwasher
( ) SPRING ( ) STREAM OR CREEK
NlNlUl~ TY SEWER SYSTEM:.__,,,J'--'· .,_/ "'-'----------
Was an effort made to co unity System? --'-",d_,_/,~4: __________ _
at indicates the followin MINIMUM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, trea or Water Course: 50 feet
Septic System (septic tank & dispo I fi Id) to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DIS AL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
Depth to first Ground Water Table _______________________ _
Percent Ground Slope ___________________________ _
. . . .
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( ) SEPTIC TANK
( ) VAULTPRIVY
( ) PITPRIVY
( ) AERATIONPLANT ( ) VAULT
( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) 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
( ) 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 _____ _,,er 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 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.
1J 1
Date of If (o_:;
AN ACCURATE MAP TO YOUR PROPERTY!!
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Your Ne\ghbor's
Name & Address
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Locate well, all streams, irrigation ditchs, and ~ ~er courses. Draw in your house,
septic tank & system, detached ara es, and driveway.
If a change of location is necessary, you must ub · t a corrected drawing, before a
Certificate of Occupation will e issued.
County Road (Note the Road Number and Name)
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Your Neighbor's
Name & Address
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