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HomeMy WebLinkAbout03098 'T«c5nm•�.ylw +`.e ..:.; ...�.. ;.�. _... : ,...o-. -m... n,- -. _ ... ...- _... -. ..T. .-.., ._ �_ - -- err; • $ r 1 1 8 '' a r GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N2 3 0 9 8 ' 1 ° . 109 8th Street Suite 303 Assessor's Parcel No. . ' Glenwood Springs, Colorado 81601 c 1 Phone (303) 945 -8212 t g $ k .. This does not constitute C r 1 q INDIVIDUAL SEWAGE DISPOSAL P ERMIT a building or use permit. 14 PROPERTY r ��-� ^� Q •\ Phon )5 O S8 t + (' Owner's Name '- R n r Ck S Present Address a5 C " a3� ""' f Q 4cQ • �3 K' -F (e co 816 s a , ■ System Location /� ( lJ(+6/t�� • a M c / . Legal Description of Assessor's Parcel No. 1.-0± I 61 00 i , ( ( t C A i 9 p Or'-( W t c L. Q 1 Nr t Al 5 EOyv 3� ( t r;, I tg K) 4, I C' 4 ' . SYSTEM DESIGN o /L 1 3 K ( 3 yC I t . 5j' i t l 1 i 1 S ep ti c Tank Capacity (gallon) Other t i y p. f • S / a Percolation Rate (minutes Number of Bedrooms (or other) . t > fib • Required Absorption Area - See Attached( . t q f Special Setback Requirements: d ` 1 Date O - 9 Inspector i 4 K ; } . FINAL SYSTEM INSPECTION AND APPRO (as I nstalled) ; a Call for Inspection (24 hours notice) Before Covering Installation, • 6 F 1/1 { 1 ° System Installer 6 I A / 1` ! ` ' ` YY Septic Tank Capacity ( 0 0 () k , C 0 P A t4D (I Septic Tank Manufacturer or Trade Name r ) °) Y ES a t t Q Septic Tank Access within r of surface 1 1—i )( ( (4 x 1 0 p n e << t • ; Absorption Area ?, Absorption Area Type and/or Manufacturer or n 4, 6 Trade Name ;. ) ' S, Adequate compliance with County and State regulations /requirements. . r ir k Other ^ q r ' N Date J `'' f. � `' f I nspector / A � f 1' ' i 1 RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE > " • 1 1 .i •CONDITIONS: $ 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter 6 25, Article 10 C.R.S. 1973, Revised 1984. I ' 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- ' w ' nection to or use with any dwelli r structures not approved by the Building and Zoning office shall automatically be a violation or a requirement of the permit an for both legal action and revocation of the permit. Y 3. Any person who construct Is an individual sewage disposal system in a manner w involves a knowing and material variation from the term ntained in the application of permit commits a Class I, Petty Offense ($500.00 fine —8 1 1 i " months in jail or bott ANT Yellow - DEPARTMENT • - INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER eit1Q1V1'an. /7 K (( 77 0� ADDRESS ` 3c2S Po gc(• a3 PFIONE65,2 - ��2` 05 CONTRACTOR 1011.1l7lhJ ADDRESS 3'2 5 Co • 93.R 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). J,OCATION OF PROPOSED FACII .TY; Near what City of Town i e Size of Lot q Aakeei Legal Description or Address 3 q '? S (.n I k o/ 3 3 WASTES TYPE: (>4 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: vq 4 k 52 Od tri-zite- Number of Bedrooms 3 Number of Persons ( ) Garbage Grinder (X) Automatic Washer V) Dishwasher 50I MGR AND TYPE OF WATER SIMPLY: ( ) WELL n1 SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of' supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: i1`zIylcel.o 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: to oco -Ph. 50 feet Leach Field to Irrigation Ditches, Stream or Water Course:.20t450 feet Septic System to Property Lines: 10 feet,%-fl; -aeimat YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GRO! IND CONDITIONS: Depth to first Ground Water Table /.iir, Percent Ground Ground Slope 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (4-r 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: ( ) 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? - 71-e pERCOI.ATION TEST REST JI,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. Signed .�.. %. / rain' Date /0 ), 6 ^9g PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 e. .6 • !' {. 0 k c5 �/ # I ±t z I \ ,� / 7 [ ( \ pa r pus :I; i % f § z 'a; .14.-.3..e > � / X / • /P.. $. O � K■ 1 ;¢ ƒ z k § « � ( §� § n \ f— 2 \ k� »f / to _ ^ � , b / 2 �) / c / *�$Q ' ƒ w ma ] 2A% 6 » � ~ , 0. ...»� /k� [It 5 ƒ 777 \ { , « � / _ 8 0 ct ~ 7 . t_ Z / & R < § t Wi a. 0 ." w © . ' \ �/ 2 \i §�§ Po . , . — \ ƒ . ■ r , .< 3 { , .. \ \ \. .. ... . . .. . (_ . _ i n) B k » f n n 3.7 �%flrr ® ' F! ® # > a \ : \ .rE� �( { - &% "s $II 7 § { ( ) // �( i " 0.1 `D •