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Home My WebLink About03852t ' • • • I ~ . ' . ' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945·8212 ' <!;. I ;•~ ...... " ' • • Permit N'.: 3 8 5 2 ., Asaesaor's Parcel No. J ~ 17q.cJ n 60 r,,g L '' INDIVIDUAL SEWAGE DISPOSAL PERMIT This does not constitute a building or use permit. t • ~ ' ' ' PROPERTY f'/l ;c:J.,i.ef-+~~AJ.i., 1 ' 1).. A · St ~:-fr ... G.&ll m nuc_ "\r..J:.t 5 Present Address fJI-'O ..J CG.<.• C... '· · Phone "1 -,~ O''-',j le:> ·---~--~ Owner's Name System Location __ ~--'-"'-___.,,'""'h:....:.:C<:..:.:i_:_r_____.,fu~r __ f..=--J_. __:Si:_:_1L/+~Cc~8'..:.:l~:....::S~-- Lega1 Description of Assessor's Parcel No. ______ l~o~-f~3~ __ $=-V"t----1i'-'--'--/ _1 6_w _ __,C_'sfr..=.:_fes_;:::;_ ____ _ ) SYSTEM DESIGN • ' < j i • I l \ .. ; ' /{)(20 Septic Tank Capacity (gallon) ______ Other i t -~/_t/ ___ Percolation Rate (minutes/inch) 3 Number of Bedrooms (or other) -~--- 3 5' 'I f/; ~ ~w-" cfl.. vr L/ ;u./ ;j ~ j,,,_c( ~ /</ U7<·.~ ; :;:i J ,,...,,~ f3o/ t,) . ,.., 7 /.L~~ ~ vg)· _,... I Required Absorption Area -See Attached Special Setback Requirements: Date_~/~/ ·_._3~/~(_.-'.•'?_· ___ Inspector __ .£..AJ-"""'itt:"'ttk~-·~r/_1 _,.c./_./LJ2. __ ..£_~_· _________ _ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation /'1. System lnstaller_..t""' ~....o.tV.=...=""",,__---------------------------------- Septic Tank Manufacturer or Trade Name-------------------------------- Septic Tank Access within 8" of surface _._{P<"'------------------------------ Absorption Area -'+""""-"""-':L-----------------cc----------------- Absorption Area Type and/or Manufacturer or Trade Name ~ c4 //~ Adequate compliance with County and State regulations/requirements'~+-"==------------------- Other-----------------------~~.,....-~~--------------- Date / 2 -2. 0 ·3 Inspector --z;--~/~? ~~~-~---R-E-1:-Al_N_W_ITH RECEIPT RECO~T~UCTIONefe •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 1~. 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 se•age disposal system in a manner which involves a knowing and material variation from the terms or specifications contained in the a~plication of permit commits a Class I, Petty Offense ($500.00 fine - 6 months in jail or both). White -APPLICANT Yellow -DEPARTMENT • ' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER ~rlluf/u111n A:&~ ADDRESS C!har /3-,,-2:xif kf -ill.3 PHONE ~~ 8'ij.sfs' CONTRACTOR'---------------~~~~~~~~~ ADDREssg7;3 ffea.,q vf: :?fl<:C2 Sl0s-o PERMIT REQUEST FOR cvrfu:w 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 _ ___,,~=-:• /_../: ___________ Size of Lot 35' c;c.rc.".:> Legal Description or Address ~/ ..... &r R=.ef 4t :ii:. :3 rocz, llaf/o<...:> ~::>i'1bJ WASTES TYPE: ( ..,y'DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ()OTHER-DESCRIBE _______________ _ BUILDING OR SERVICE TYPE: _ _,/%'"-,a.LJ ... ~,,{'-=L.c~~c=.'--""'""-------------- Number of Bedrooms -~~~---------Number of Persons_=~-=------ ( ) Garbage Grinder vfAutomatic Washer ( '1'f>ishwasher SOURCEANDTYPEOFWATERSUPPLY: ( )WELL ( )SP~ ( )STREAMORCREEK (~ C10.f.e.r-Y? 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 followin& 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-INDMDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table ______________________ _ Percent Ground Slope __________________________ _ \ TYP~F INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (v'( SEPTIC TANK ( ) AERATION PLANT ( ) ( ) VAULTPRIVY ( ) COMPOSTINGTOILET ( ) ( ) PITPRIVY ( ) INCINERATION TOILET ( ) VAULT RECYCLING, POTABLE USE RECYCLING, OTHER USE ( ) CHEMICAL TOILET( ) OTHER-DESCRIBE _______________ _ F~ISPOSAL BY: ( ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRA TION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER-DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? t1u PERCOLATION TEST RES UL TS: (To be completed by Registered Professional Engineer, ifthe Engineer does the Percolation Test) Minutes. ____ _,,er inch in hole No. 1 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 application and in legal action for perjury as provided by law. Signed~~ Date_-=&"_;;2:;_--~------ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! • .~ Designate North Arrow Your Neighbor's Name & Address Your Plot -Shape to Fit (No Scale) ~ ac.r=-:s Ll'i>Jc:..<.)"<:'.) c::1 Cl C:1 == ;'• I '-....._ 1-1.-~ .--..A-. 1..~n F,·~lel flo~Vl 11"- Locate well, all streams, irrigation ditchs, and any water courses. Draw in your house, septic tank & system, detached garages, and driveway. If a change oflocation is necessary, you must submit a corrected drawing, before a Certificate of Occupation will be issued. County Road (Note the Road Number and Name) ene o:\wp9i1J1.60\wpdoca'1'lot.loc l3A) l. Your Neighbor's Name & Address <..~~~' .. ., . ' .,. ... . , . ···-:':t~ ·~;L~---• _...._~ , 'lfARFIELD Vt Cl CORRECTED PLAT 4SIS OF' BEARING • -. w4.1'62• £ 11177. 111· ll:rrr. f'«OIW</ N lltr44'411" £ 2642.0IJ' J C() ~ TRACT 2 ~ .-.' T~~.S,\ =-3 'UN£ TRACT 5 .J7 . .J9 ACRES -tlJrNUSt I/NE •='TT .,..,.,,,,. .. ..... .JS. T 0 ACRES I~ . ~Et=14 - l'IE !e'Tj ~ ~ ......... .,_ ,,,./'- ~~~If-, __ . ---==> zJ;//:.'" -r. c;' Ml II. """"' - ~- TRACT 35.03 ACRES