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Home My WebLink AboutApplication- Permitit# •' r 1 INDIVIDUAL SEWAGE DISPOSAL PERMIT (44 PROPERTY it l l� ,t {C • r GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 4. t • Permit N2 3077 Assessor's Parcel No. This does not constitute a building or use permit. Owner's Name i 11! u` r S4"' ` ►'resent Address ' ^ `'`�✓Phone� 5T�`►' E � Gam1� 7 System Location , !( i-kivy 82_ j fit(Si CJ Legal Description of Assessor's Parcel No. SYSTEM DESIGN 11,1 65- Cleptic Tank Capacity (gallon) Other / `f 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 installed) CaII 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'surf4oe Absorption Area C) e 4 I'.. Absorption Area Type and/or Manufacturer oY Trade Name 4 i ,v 1 Adequate compliance with County and State regulations/requirements�r� t 4*3 f *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). Other Date — — 1 Inspector /� ^ r RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE .4 White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISI'?SAL SYSTEM APPLICATION OWNER /.1,,t,24(c '`' `" ` ti ADDRESS 3 1l PHONE %2 S7' CONTRACTOR vs r 6 ADDRESS PHONE 9 s 5� 9- PERMIT REQUEST FOR(\):W INSTALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or repong 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), Near what City of Town Legal Description or Address Y� f - /Z Size of Lot WASTES TYPE: t(WELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms ' 7 Number of Persons (- Garbage Grinder ( iutomatic Washer ( ) Dishwasher SQURCE AND TYPE OF WATER SUPPLY: (ELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: ,, /,� DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 1 �aa�' `� 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: (3 U t `^ 100 feet Septic Tank to Well: /c)-v� 50 feet Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet Septic System 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 T1 PE*OF 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: { fr ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) 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 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 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. Signe Date PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 a i oa i4o � ftl. o a 1,25 l E g 0 s €� 81.8 8. ti a 0 F 1 8 1 1 20 r 8 s cI0 :l 7o 1/ 30 2 dr 11,3 2ti 4 1( g 2 PfA-C "rt ODr-M, 111,)2x _�� r� 3 f a e GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY r 17. j r(# iVi jr 1 G4trt r " u► Prbsent Address System Location Owner's Name Permit N i U 7 7 -► Assessor's Parcel No. Legal Description of Assessor's Parcel No. SYSTEM DESIGN c eptic Tank Capacity (gallon) Other 1 "/20 This does not constitute a building or use permit. PhoneCt4 J56) Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date Inspector (- v 2 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call,for Inspection (24 hours notice) Before Covering Installation System Installer r Septic Tank Capacity Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface f ( Absorption Area (.` ' ( 4 fF r . Absorption Area Type and/or Manufacturer or Trade Name 14- C (;) C l f �. Adequate compliance with County and State regulations/requirements Other Date Inspector rte` 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 compiled 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 e 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 1, Petty Offense ($500.00 fine — 8 months In jail or both).