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Home My WebLink About04262GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Owner's Name Permit Assessor's P 3 4262 a3. ti C R( (TO C `ria l� Present Address System Location �.3 1 C (CD C (ct u tC 3 Legal Description of Assessor's Parcel No }' Coffman Rc N exeivocs rcel No. 6 -da-a This does not constitute a building or use permit. phone30 g— 86 c SYSTEM DESIGN Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date /21-€100-4 0eZ-1 5=41-017 �i� Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Septic Tank Capacity �i — '--1 Septic Tank Manufacturer or Trade Name G� J '� /61 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 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 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 r ->d tt5b— C y rl� 7 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Owner's Name i✓I°uell System Location Legal Description of Assessor's SYSTEM DESIGN BFH Permit 4 2 i? 2 Assessor's Parcel No. I This does not constitute a building or use permit. (t Je /f a 33 C '6,14 ,- Present Address Phone ()3 I r (~o Cdl a k_1 (0)3 Parcel No o ')— C of fimct R 0,0 otc, C)coikAe-k Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) 07 C Required Absorption Area - See Attached 1�' e , , 4� y �v r � y Yr Special Setback Requirements: Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer C� 2 !it IVI G Septic Tank Capacity, Cy /S/ (90 9 Septic Tank Manufacturer or Trade Name 0 +.�Q zi �.� �� azetie.../e" 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 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 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 aknowing 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). While - APPLICANT Yellow - DEPARTMENT OWNER ADDRESS .2pv, INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION' 2i -57)( C/43 CONTRACTOR , ADDRESS �jj Zi � (1 '1 ' [ U) —610/11_ PHONE (iba({) LoD PHONE 306j' W'�r�lG�O 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 (I1J11d(Q._ Size of Lot Legal Description or Address 5S1 Co WASTES TYPE: 0 IOD 61 Itc. GELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER —DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms �L ( ) Garbage Grinder ( )Automatic Washer Pic -2(31:64:4 Number of Persons ishwasher SOURCE AND TYPE OF WATER SUPPLY: ( WELL ( ) 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? A site plan is required to be submitted that indicates the following MINIMUM distances: Leach Field to Well: Septic Tank to Well: Leach Field to Irrigation Ditches, Stream or Water Course: Septic System (septic tank & disposal field) to Property Lines: 100 feet 50 feet 50 feet 10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. 10 of /rte C; v1 i GROUND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 TYPE PINDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( 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 ( ) OTHER -DESCRIBE ( ) EVAPOTRANSPIRATION ( ) SAND FILTER ( ) WASTEWATER POND WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ‘ko 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 per 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: l(Wibefi- 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 mis resentation may result in the denial of the application or revocation of any permit granted based upon said application end in legal action for perjury as provided by law. Signed �CJl,U Date Z 1 q 0 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 Designate North Arrow Your Neighbor's Name & Address Your Plot - Shape to Fit (No Scale) Locate well, all streams, irrigation ditchs, and any water courses. Draw in your house, septic tank & system, detached garages, and driveway. If a change of location is necessary, you must submit a corrected drawing, before a Certificate of Occupation will be issued Your Neighbor's Name & Address County Road (Note the Road Number and Name) enc c:Vwpwin601wpdocs1plot.loc (3 FD TJMBERLINE ENGINEERING CIVIL / STRUCTURAL / CERTIFIED ENERGY DESIGN PROFESSIONALS May 18. 2009 Garfield County Building Department 108 8th St. #401 Glenwood Springs, CO 81601 Re: Is -1,S Installation Lloyd Residence 2331 County Road 100 Carbondale, CO 81623 Dear Building Official: The installation of the ISDS system for the above project has been completed and has been installed in accordance with applicable county specifications. If you have any questions, please call me at 963-9869. Sincerely, TIMBERLINE ENGINEERING David AIS gWell,_. PF ;, Reg. No. 28 • i P.O. BOX 631 CARBONDALE, CO. 81623 P. 970 963 9869 F. 970 963 9003 timberline@sopris.net