Loading...
HomeMy WebLinkAbout03129 -W -777--- .1/ 1 \ ! R 1 7. ti 1 ' � �, r '% GARFIELD CO TY BUILDING AND SANITATION DEPARTMENT Permit us 3 1 2 9 � m Y6 Y - 108 8th Street Suite 303 Assessor's Parcel No (: 9 < GlenGrood Springs, Colorado 81601 k `' Phdne (303) 945-8212 .( h This does not constitute " + , 1 k INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY ��hh II,, v I, Owner's Name f . ! a • � Present Address 05 C � honeq 1 - _ ( A' Qo - 4 C - ).V\fA , 0 t C . , ed , r. ` i System Location r q k y q 1 Legal Description of Assessor's Parcel No. Sr : A % SYSTEM DESIGN \ ' C r. ') Septic Tank Capacity (gallon) Other 3 i ) } Percolation Rate (minutes/inch) Number of Bedrooms (or other) h y, tr A k Required Absorption Area -See Attached r r !' a S t Special Setback Requirements: ' d I r r -mate - Inspector t, 8 °, n FINAL SYSTEM INSPECTION AND APPROVAL (as installed) r t t Call for Inspection (24 hours notice) Before Covering Installation r System Installer WWWEI4 SX CA Y I i �( i Septic Tank Capacity /O© D &AI r F" 4; n .S0F Septic Tank Manufacturer or Trade Name 0 0 i a '„' i'. , 1711 Septic Tank Access within r of surface Or /�. , - , u R Absorption Area q Q 0 NI d F 4 (Los." S «- VA (SCO , F k C! A,(?sorption Area Type and /or Manufacturer or Trade Name 3 I 0- Q ( ( r 0 S e x c f Adequate compliance with County and State regulations /requirements ` i � t Pt: c 2 . C S 4 N ( T -Tc£ 0, $ CI Other / /� /' �/) //� �'^ /1 . 1 Date / �// 9 Inspector C J1i ' tC LC4 I / , � �/ i {' ' i RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE h t i i *CONDITIONS: F•! 1. All Installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter M 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- lit nection to or use with any dwelling or structures note approved the Building and Zoning office shall automatically be a violation or Y g PP by 9 9 Y $' 7 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 — 8 ( months In jail or both). e 7 ■ - - - - - White - APPLICANT Yellow- DEPARTMENT r • Chic-- INDIVIDUAL SEWA GEDISPOSAL SYSTEM APPLICATION OWNER /kit is C I4/ U t rOtt 4 loot e ADDRESS gO ee STCJOJ Pe 6w.S eJ !S((6o I PHONE f`(J ffI3 (o CONTRACTOR £e J t t W tiAJ ;?..- ADDRESS 4C 4-sit. CANLit,.3 (2 . S'/&3O PHONE l3- SI 2 - I PERMIT REQUEST FOR (4 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 7 1L & S —t Size of Lot /, J 4 t Legal Description or Address tor / � et h,4 S , 64/26 fc i) et , C' v WASTES TYPE: (4 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE cc i BUILDING OR SERVICE TYPE: c.5' Ai nt Number of Bedrooms 4 Number of Persons Z— OO Garbage Grinder ( Automatic Washer (4 Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: /Via) (" A s rG ti DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: • Was an effort made to connect to the Community System? NO 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 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 3 / AJ /CO A' r Ccil( sf t ' C- 2 f TYPE 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: (✓4 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? V 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: aJwd 2 We ti 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 a( 1 r'C 4. - Date (Pt If PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: 9WNER Carl Maulbetsch and Victoria Palmer, D.V.M. .:JDRESS 805 Crestwood Drive, Glenwood Springs, CO PHONE 945 -8136 CONTRACTOR Owner is general contractor. )DRESS PHONE PERMIT REQUEST FOR: (XX) New Installation ( ) Alteration ( ) Repair ":tach separate sheets or report showing entire area with respect to surrounding areas, ipography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes. (See page 4.) )CATION OF PROPOSED FACILITY: County Garfield near what City of Town New Castle Lot Size 1.559 Acres 1- ?ga1 Description Lot 1, Cedars Subdivision WASTES TYPE: (XX ) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe JILDING OR SERVICE TYPE: Private Residence Number of bedrooms 3 Number of persons 2 XX) Garbage grinder (XX) Automatic washer (XX) Dishwasher .,OURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek rive depth of all wells within 180 feet of system: None f supplied by community water, give name or supplier: Town of New Castle GROUND CONDITIONS: epth to bedrock: 8 to 9 feet in area of leach field Depth to first Ground Water Table:none encountered in a secondary, 12 -foot deep exploration ercent ground slope: variable, 6.25% to 18.75% in area of leach field hole. DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:2,000 feet plus as an effort made to connect to community system ?no, subdivision was permited for ISDS TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (XX) 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: (XX) Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( .) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: "ILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? No • SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) Minutes 89 per inch in hole No. 1 Minutes 68 per inch in hole No. 3 Minutes 62 per inch in hole No. 2 Minutes per inch in hole No. Mime, address and telephone of RPE who made soil absorption tests: Robert W. Pennington, P.E. c/o Jerome Gamba & Associates, Inc. 113 9th Street, Glenwood Springs, CO 81601 945 -2550 Name, address and telephone of RPE responsible for design of the system: Same as above ')plicant acknowledges that the completeness of the application is conditional upon such irther 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 Purposes of the evaluation of the application; and the issuance of the permit is subject to ich terms and conditions as deemed necessary to insure compliance with rules and regulations ...iopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements made, information and reports submitted herewith and required to be Jbmitted by the applicant are or will be represented to be true and correct to the best f niy 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 under - rtand that any falsification or misrepresentation may result in the denial of the application r revocation of any permit granted based upon said application and in legal action for per - jury as provided by law. � // ate June 21, 1999 Signed d1 Ce LEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY Please see attached plans and details from Jerome Gamba & Associates, Inc. dated June 21, 1999 PLOT PLAN AND DESIGN FEATURES: Include by measured distance location of wells, sprin s lines, cisterns, buildings, property lines r potable water supply stream, dry gulch and show location of subsoil erains, le water distance course, front dwelling or other fixed reference object, and system additiona1 submissions in support of this application such as data, plans, specifications, statements and comni tmen ts. Please see attached plans and details from Jerome Gamba & Associates, Inc., • dated June 21, 1999 Page 4