HomeMy WebLinkAboutApplicationGARFIELD COLINTY SEPTIC PERMIT APPLICATION
108 8th Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 I Fax:970-384-3470 / Inspection Line: 970-384-5003
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OWNERS SIGNATURE T
(this information is available at the assessors office 970-945-91 34)
Job Address (if an has not
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( )Commercialor
Cr, Hwy or Street Name &or and legal
New lnstallation
( )Transient Use
assigned, please
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REQUEST FOR:( ) Alteration ( ) Repair
Domestic wastesWASTE TYPE:tng( )Other - Describe
BUILDING OR SERVICE TYPE:
Number of bedrooms Garbage Grinder ( )Yes
SOURCE & TYPE OF WATER SUPPLY:( )sPRrNG (
lf supplied by COMMUNITY WATER, give name of
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM
Was an effort made to connect to the Community System?
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
GROUND GONDITIONS:
Depth to 1't Ground Water Table_ Percent Ground
TYBE OF TNDIV|DUAL SEWAGE DTSPOSAL SYSTEM (|SDS) PROPOSED:
ffieptic Tant< ( )Aeration Plant i )Vautt ( )Vault Privy ( )Composting Toilet( )Recycling, Potable Use ( )Recycling, olher use ( )Pit Privy ( )lncineration Toilet ( )Chemical Toilet
BY:
f(Absorption trench, Bed or Pit
{ )rfiastewater pond
( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter( )Other- Describe
Will effluent be discharged directly into uaters of the state? ( )YES
Professional Engineer, if the Engineer does the
per inch in hole No.1 Min inch in hole No,3
per inch in M tn
Name, address & telephone of RPE who made soil absorption é
Name, address & 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 test and reports as may be required by
the local health department to be made and furnished by the applicani or by the local health department for purposed of the evalualion 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
reporls submitted herewith and required to be submitted by the applicant are or will be represented to be true and correcl 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 action for perjury as by law
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DATE
(to be completed by RegisteredMinutes '1n
Minrtes---------16-
Test)
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I Perk Fee:
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Permit Fee:Total fees:üIì3.-"
Septic Permit #:
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Building Permit #:
Issue Date:
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DATE
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GartieW County
Building & Planning Department
ALL APPLICATIONS ARE REQUIRED TO BE SUMBMITTED ¡N PERSON
PROCEDURE REQUIRED FOR COMPLIANCE WITH THE GARFIELD COUNTY SEWAGE
DISPOSAL REGULATIONS.
Permit applications can be obtained and submitted to the Garfield County Building and Planning Department
at 108 8th St, Suite 401, Glenwood Springs, Colorado. See below for additional information.
I PERMIT APPLICATION & SUBMITTAL REQUIREMENTS:
. Completeapplication,o Site plan (1 copy) to include well, all streams, irrigation ditches, and any water courses. Draw in
your house, septic tank & system, detached garages, and driveway. lf a change of location is
necessary, you must submit a corrected drawing.). Engineered System will need copy of perk rate & design fôr our records prior to final inspection.
FEES:
Make Check payable to: Garfield County Treasurer. Septic Permit for a New installation. Septic Permit for alteration and/or repair .... Septic Perk test
FEES ARE NOT REFUNDABLE.
..,,,..,$73.00
........$50.00
,,....$100.00
II ATTACHMENTS:
. Percolation Test lnstructionso Recommended minimum requirements for lndividual Sewage Disposal System (ISDS)
III FINAL INSPECTION:
o When all components are in place, connected and ready to cover, request a final inspection by the
County lnspector.o D0 NOT backflll any part of the system prior to the inspection.¡ The initial fee covers the percolation test and one (1) inspection before cover up. Any additional
percolation test will be charged at $100.00 each and additional inspections will be charged at
$50.00 each.. Upon final approval, carefully cover the entire system.r Engineered Systems are inspected by the Engineer prior to backfill. A final sealed letter by the
Engineer is required to be submitted to Garfield County.