HomeMy WebLinkAbout02984 .1 M GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2984
' 109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
/
Phone (303) 945 -8212 :
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name krj Y'(StIVY C- PresentAddr (l' UX V ( • • Phone 1 tP L 1 3 o
System Location 1 J t Ue L4� // • , 5 7' l6 ,
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
Septic Tank Capacity (gallon) Other
4 Percolation'Rate (minutes/inch) Number of Bedrooms (or other) d�
Required Absorption Area - See Attached ./ , "\
Special Setback Requirements: —
Date Inspector 1 8 a ft. ` '� 6 —
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) '
Call for Inspection (24 hours notice) Before Covering Install
{ -
System Installer `lam. -P" t.4/'7 l ri ./9'1�+.f�"r /'"✓ ,
Septic Tank Capacity / 5 0 , / t' v
Septic Tank Manufacturer or Trade Name . `? ,` S -r /
Septic Tank Access within 8" off surface
Absorption Area / 4 n .2 t 1
Absorption Area Type and /or Manufacturer or Trade Nan — / faertn 0 S
" Adequate compliance with County and State regulations/requirements v
Other
Date/l. / Q ' / ^ Y W ',w„ pector `E J el'1 OQA `.
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 disposafsystem 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
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER • •••• - e 5,i/c,:.) S e n
ADDRESS A /lox /173 R---S' 0 0 PHONE 995 -&
CONTRACTOR 7k?S . �ar Frf 2e •
�y ADDRESS $x A (zs- • S . On /6c 2— PHONE 763 .
PERMIT REQUEST FOR (k) 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 PROPOSFD FACA JTY:
Near what City of Town ( 6ivwod cV Kl'AnvSs Size of Lot 3S — iQC"
Legal Description or Address S t Ye! o - M e ,oCYy (IC See 7 1 74°. Ss. t. RS to • /c fo #
WASTES TYPE: DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE � "�
BUILDING OR SERVICE TYPE: /te'a-�2' -/ l�4 ;N
Number of Bedrooms o — t'ec600 Number of Persons 7
( ) Garbage Grinder (x) Automatic Washer (y) Dishwasher
SOI1RCE AND TYPE OF WATER SI TPPI .Y: ( ) WELL ((X) SPRING ( }aREAM OR CREEK
If supplied by Community Water, give name of supplier: /�.4
DISTANCE TO NEAREST COMMUNITY SEWER SYSTE /& /i, 45
Was an effort made to connect to the Community System? .moo
1 ! ' .1 • 1 1 111 1. 1 1 X11 1 i i'. i' u \ u u l• ,1 • •
Leach Field to-Welk-Sp/ Ooeh hi , _
Septic Tank toWell:att%7 Cues 50 feet)
Leach Field to Irrigation Di c es, S Course twee-50 fee
Septic System to Property Lines doe-10 feet
s :♦ 1 4 1 a a. : 1 TX.: u' to • \1 : 1
WITHOUT A SITE PLAN.
GROI IND CONDITIONS:
Depth to first Ground Water Table St nee r
Percent Ground Slope a °o"e#- 02a '
2
•
.TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(g3 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:
(X) 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? .fl0
pRRCOL.ATION TEST RRSI II,TS: (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.
.0 Signed r • ! / Date �� 217
PLEASE DRAW AN ACCURA • ' TO YOUR PROPERTY!!
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, P.O. Box 1908 /`1<\ (970) 945 -5700
1005 Cooper Ave. (970) 945 -1253 Fax
Glenwood Springs,
CO 81602 ZANCANELLA ANO ASSOCIATES, INC.
ENGINEERING CONSULTANTS
October 15, 1998
Mr. Don Owens
Garfield County Building Department
109 Eighth Street, Suite 300
Glenwood Springs, CO 81601
RE: Chaney /Keyser Creek Cabin
Dear Don:
At your request, attached is the Septic System Design for Chaney /Keyser Creek Cabin.
If you have any questions, please call our office at (970) 945 -5700.
Very truly yours,
Zancanella & Associates, Inc.
�T C A,ti,.cc, e titic c < u
Thomas A. Zancanella, P.E.
Attachment
cc: Fred Chaney
r �
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