HomeMy WebLinkAbout03831' -~ --... -·--
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945·8212
N" Permit -3831
Assessor's Parcel No.
i INDIVIDUAL SEWAGE DISPOSAL PERMIT
i PROPERTY ~ha\'\~ j Owner's Nam& QQ D\} F~ Present Address(}31j5 CR..:M Q
This does not constitute
a building or use permit.
) System Location 6i OOQ..~
f Legal Description of Assessor's Parcel No. _________ c;{_._/~R~/-~~do~~3~1 -_0_0 __ -_l_~ __ S. _______ _
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SYSTEM DESIGN
-----~Other _-7~~-() __ Septic Tank Capacity (gallon)
-~/~()~--Percolation Rate (minutes/inch) Number of Bedrooms (or other) __ / ___ _
Required Absorption Area -See Attached
Special Setback Requirements:
Date _____________ Inspector ___________________________ _
FINAL SYSTEM INSPECTION AND APPROVAL (as inst~lled)
Call for Inspection (24 hours notice) Before Covering lns,tallation
System Installer ·fl
Septic Tank Capacity jC})(.) t2/q >be.
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Septic Tank Manufacturer or Trade Name ~5,~A-fj-=7;-..~0~ce=t1~-------------------------
Septic Tank Access within 8" of surface -1'J-==-----------------------------
Absorption Area _f;,:....LJ'-""'~"'-'_,,d,=_· ----------------------------------
Absorption Area Type and/or Manufacturer or Trade Name _,,.,..;£.,_...l'.:~;6,_,.:--±:_,.......,4-....,=· ----------------u I
Adequate compliance with County and State regulations/requirements_µi+~"-------------------
Other--------------------~-~--~-,,._ _______________ _
Date lf)/o/() 5. Inspector~
RETAIN WITH RECEIPT~Cuel-ION 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 indtvldual se'Wage disposal system in a)'nannerwhich involves a knowing and material
variation from the terms or specifications contained In the application of permit cor;nmits a Class I, Petty Offense ($500.00 fine -6
months in jail Of both). ,/·
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INDMDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER FR.tD C..f.\EA~Y
ADDREss3l./S ~<.,.;i. ~~ '°PGAC.h VAllfy PHONE37f-/571 Kiiv1A1 FR£lfD1 GC
CONTRACTOR ?Ro ~4-rloN
ADDRESS ~() /!:,o)< ~3Cf S1L±, ( 0 $11..5l-PHONE11t.-S.15] Roe.
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PERMIT REQUEST FOR (,..-r'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:
NearwhatCityofTown N~ C..P.STL~ SizeofLot ? YO A<:.1~s t
Legal Description or Address 3 4 i; ...2 b.). Rd • P~AL h VA I h~. y / N.~ (~"'ST I E
WAS TES TYPE: ('}'!)WELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
()OTHER-DESCRIBE _______________ _
BUILDING OR SERVICE TYPE: __ lS_('i._..\ ________________ _
Number of Bedrooms _....oOo....-_________ Number of Persons_O ___ _
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( "11NELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:----'3"--"'...:....'•_,IE"""'S"--------
Was an effort made to connect to the Community System? ~N'-"--0 ____________ _
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 (septic tank & disposal field) 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 Slope __________________________ _
7.F INDIVIDUAL 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 ( ) EV APOTRANSPIRA TION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER-DESCRIBE T rJ (1 L ~Molls
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? NO ~---
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test)
Minutes ____ _,.er 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 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 and in legal a ·on for perjury as provided by law.
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Designate North Arrow
Your Neighbor's
Name & Address
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Your Plot -Shape to Fit
(No Scale)
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Locate well, all streams, irrigation ditchs, and any water cburses. 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.
County Road (Note the Road Number and Name)
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Your Neighbor's
Name & Address