The URL can be used to link to this page

Home My WebLink About03169 " C 6Y2 (mot' —'2 ti y 3'C�r'''' • •, -ir T i GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N2 3 1 6 9 1 109 8th Street Suite 303 A ssessor's Parcel No.a L. x a Glenwood Springs, Colorado 81601 E Phone (303) 945 -8212 { r 3 This does not constitute + i i t INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. { '; R j;, a.. r 4, PROPERTY S r ! 1 n(� 1 �(� n 1 1 � Q u r,1 /_2 0, IO ': f ±; Owner's Name � t) ` - 1 „`R r , !a n P / Adddress &DC CR �O I ( `Q C \ hoon ( e '' t R •-" . � �1r O • i'' i 3 System Location V d(j C'` 3b\ 1 '^Roc u e ` m " 14, 3 1i 1. ; Legal Description of Assessor's Parcel No. ' ) 1 1 S SYSTEM DESIGN S '. iA I ( Septic Tank C apacity (gallon) Other ` ' i ; • r Percolation Rate (minutes /inch) Number of Bedrooms (or other) 1 i , LLL Require l Absorption Area - See Attached L i Y i!! a r Special Setback Requirements: i4 1 i Date Inspector ' (1 y i _ i, V 1 0 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ,, r A( q ; Call for Inspection (24 hours notice) Before Covering Installation \, ` . $ ,r 1 i 4 System Installer fL.., Al Q" K C ' .. ii ») Septic Tank Capacity /n4j0 - I '' ' 5 ': Septic T ank Manufacturer or Trade Name e p 1` r i i i Septic Tank Access within 8" of surface 4 )F C i; i4 i i Absorption Area .' Absorption Area Type and /or Manufacturer or Trade Name Z En 7 . tr,ATnpr 7/7A L9D i nt , r i c. Adequate compliance with County and State regulations/requirements YK i to Other . i Date 7- 1 7 • if Inspector /4 • ' - :r RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE ' A, a ( •CONDITIONS: 1 " 1. All installation must comply with all requirements of the C olorado State Board of Health Individual Sewage Disposal Systems Chapter . r ,, 25, Article 10 C.R.S. 1973, Revised 1984. t( 2. This permit Is valid only for connection to structures which have fully complied with County zoning and building requirements. Con - 4. nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a i i r'I 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 materiel .' L E f variation from the terms or specifications contained in the application of permit commits a Class 1, Petty Offense ($500.00 fine — 6 i t ;' ( months In )ail or both). r " i3O " White - APPLICANT Yellow - DEPARTMENT e. INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION • OWNER DA-Ki UL) 1.C, 6 USA ADDRESS Apt, RZ. fp A D t 4 2 AMA &(-4A 1'S t CO PHONE 285 R4 t t8 CONTRACTOR ADDRESS 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). LOCATION OF PROPOSED FACILITY: Near what City of Town Size of Lot Legal Description or Address WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: /. / t -L• / , _+tats i Number of Bedrooms r F _ ._ A L� Number of Persons ( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Conununity Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 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: 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 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: ( ) 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. Signed lAti1/4,9-794M Date i9 f Z qg PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 • This does not constitute a building or use permit. r y - GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH 2014 Blake Avenue Glenwood Springs, Colorado 81601 nut one (303) 945 -7255 ,24107 -6 /-e 3 -00/ INDIVIDUAL SEWAGE DISPOSAL PERMITr 635 Owner Robert J. & Nary Jane Rowlands, Jr. System Location Grand Valley - Sec. 7, Blk. 1, Lot 1, Green subdivision - 0:212 Rd. 301 Licensed Contractor Conditional Construction approval is hereby granted for a 7.± 7 7 gallon -'� Septic Tank or Aerated treatment unit. Absorption area (or dispersal area) computed as follows: Perc rate of one inch in =a {-) minutes requires a minimum of •-2 0 sq. ft. of absorption area per bedroom. Therefore the no. of bedrooms =� x ' 2/49 sq. ft. minimum requirement = a total of sq. ft. of absorption area. • May we suggest /0•• /X .> '`�' �k • Date // - ? /- 7.- Inspector FINAL APPROVAL OF SYSTEM: No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to cover- ing any part. , ''w Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. -- Proper materials and assembly. "' Trade name of septic tank or aerated treatment unit. ,/c OC r fi ^ • " - Adequate absorption (or dispersal) area. Adequate compliance with permit requirements. Adequate compliance with County and State regulations /requirements. Other Date ?,o * l "_ Inspector i' :Z.c- c.. /.,.•C: _ - RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: 1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations, adopted pursuant to au- thority granted in 66 -44 -4, CRS 1963, amended 66 -3 -14, CRS 1963. 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Connection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a viola- tion of a requirement of the permit and cause for both legal action and revocation of the permit. * 3. Section III, 3.24 requires any person who constructs, alters, or installs an individual sewage disposal system in a manner which in volves 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). Building Official - Permit White Copy Applicant - Green Copy Dept. - Pink Copy (TO BE RETURNED TO HEALTH DEPT.)