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Home My WebLink About03983?' I`I I oq 0. 15.(31) 6-0L4( Ir 1 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit ' g 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 ) (/D l ' L . uu -L)vTU Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT This does not constitute a building or use permit. PROPERTY T)y j ! 1 Owner's Name P1-11.55; 6 f I �Pr9sent Address / 5 ` C�3 (4 i (t 1- cRiG5" phone 96 3 i 6-76D System Location I�3) `�`-~ 3 s l I F ag/ — i Ulm Id) c»%/" a602 -00-0YV Legal Description of Assessor's Parcel No SYSTEM DESIGN Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) i. Required Absorption Area - See Attached ) Special Setback Requirements: L 7 - Date Inspector Cts' 1, cxl.ik FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Septic Tank Capacity Septic Tank Manufacturer or Trade Name 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 OWNER INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION fcc ADDRESS /C.? I tR, = 3 L(2__ S i LT PHONE L K r Z i r s� CONTRACTOR ADDRESS PHONE 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 s L� Legal Description or Address WASTES TYPE: ' 3 C - Size of LotSL S It ( DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER—DESCRIBE BUILDING OR SERVICE TYPE: Lis + €—Qacttfiv Number of Bedrooms "z--- (TO t z4) Number of Persons Z_. ( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher 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: f 2- / r L(T 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: 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 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (() SEPTIC TANK ( ) ( ) VAULT PRIVY ( ) ( ) PIT PRIVY ( ) ( ) CHEMICAL TOILET( ) FINAL DISPOSAL BY: AERATION PLANT COMPOSTING TOILET INCINERATION TOILET OTHER -DESCRIBE ABSORPTION TRENCH, BED OR PIT UNDERGROUND DISPERSAL ABOVE GROUND DISPERSAL OTHER -DESCRIBE VAULT RECYCLING, POTABLE USE RECYCLING, OTHER USE ( ) EVAPOTRANSPIRATION ( ) SAND FILTER ( ) WASTEWATER POND WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? X11 O 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 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: 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 pe.tiuit 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 applic tion and in legal action for perjury as provided by law. Signed PLEAS D Date r . AN ACCURATE MAP TO YOUR PROPERTY!! 3 This does not constitute a building or use permit. GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH 2014,Biake Avenue Glenwood Springs, Colorado 81601 •j: INDIVIDUAL SEWAGE DISPOSAL PERMIT - . Donn F111** •ystem Location Nil. 41.8. Licensed Contractor °1m*: * Conditional Construction approval ishereby granted for 8 /O gallon Septic Tank or Aerated treatment unit. Absorption area for diapersaf area) computed as follows: . Pere rete of one inch in e76 minutes requires a minimum of 42'•"7.3 Esq ft of absorption area per.bedroom. Therefore the no. cg. bedrooms x 9Z3C1 sq #t.` minimum requirement a total of 67 q ft of absorption area. May we suggest „: "•-•1r`-1,2Pre--- d /� '.� .5:8` �X. ,3 r ✓ " Date C 7 7 inspector INAL APPROVAL O;f~ YSTEM: No systemshall 'be'tfined to be in compliance with the Sewage Disposa[Laws until the assembled system is approved prior to cover ?yr Ing any part. " Septic Tank cleanout to within 12" of final grade or aerated access ports above grade. Proper materials and assembly. .w rade name cif ,tspr aerated treatment unit, -1' Adequate absorption for dispersal) area, Adequate compliance with permit requirements. Adequate complianceLvvith County end State regulations/requirements. Other Date 4P.- r7 Inspector RETAIN WITH RECEIPT RECORDS AT C INSTRUCTION SITE ``CONDITIONS: 1. All installation must comply with all requirements of t1e County Individual Sewage Disposal Regulations, adopted pursuant to au.`. thority granted in 66-44.4, CRS 1963, amended 66.3.14, CRS 1963. 2. This permit is valid only for connection to structures Which have fully complied with County Zoning and building requirem ntsi Connection to or use with any dwelling or structures not approved by the building and Zoning office shall automatically be a ivipW:. tion of a requirement of the permit and cause for both legal action and revocation of the permit. Section III, 3.24 requires any person who constructs, alters, or Installs en individual sewage disposal system in a manner which In;:.. volves a knowing and material variation from the terms or specifications contained in the application of permit commits a Class,l,r,. Petty Offense ($500.00 fine — 6 months in jail or both. Building Official — Permit White Copy Applicant — Green Copy Dept, — Pink Copy 3. lam laauara a aa-lsrfl aMAalasaaaaaaaSaaaaaaaa�a�aaaaaaaaaaaa.ra_� aa' e'_