The URL can be used to link to this page

Home My WebLink AboutSP-2610.41 . 4 1 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit Assessor's Parcel No. ./. 2610 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY This does riot constitute a building or use permit. Owner's Name Robert & Mary Procbbr Present Address 5033 Rd 335, Silt Phone 984-0548 OARm aN y+ 14-w System Location 6.3 11 County Road 331, Sierra Vista Ranch, Lot 14, Silt Legal Description of Assessor's Parcel Flo SYSTEM DESIGN ./S60 a6 Af/N Septic Tank Capacity (gallon) Other Percolation Rale (minutes/inch) Number of Bedrooms (or other) b -S- /.19/7 S /�/7 .0 deocX je..4c/9 BAP Com:: ,$' 8 13,0 4 Bets DQ 1969 413) a 1 -34f> -4,.s e,v s vi/ Inspector J �at+r 4.16.1y.r, Required Absorption Area - See Attached Special Setback Requirements: Date FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call fortInspection (24 hours notice) Before CoveringAnstallation System Installer ahVe, Septic Tank Capacity /•52 ‘44 - Septic . 4L /a 9a4.0 9a 9 Septic Tank Manufacturer or Trade Name Septic Tanifess within 8" of surface3r Absorption Area -Af_57/L /G = geo/vrrs fr746 Absorption Area Type and/or Manufacturer or,Trade Name S'0 ///".-fU-S-W< Adequate compliancenc/with County and State regulations/requirements Other GNC 7/0 Code( Date 4-43- 0 inspectorioef 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 10 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 whocor)etructs, 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). While - APPLICANT Yellow - DEPARTMENT r INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER A444- co CAG� ADDRESS 51:)3 335"l3 4 PHONE 119 if c S 1 CONTRACTOR ( UJ N ADDRESS PHONE PERMIT REQUEST FOR QC) 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• COUNTY Near what City or Town t'S i 14 Lot Legal Description WASTES TYPE: 4 Dwelling ( ) Commercial or Industrial () Other - Describe BUILDING OR SERVICE TYPE: \!`) O S C Number of bedrooms: Number of persons (9 Garbage Grinder V) Automatic Washer ) Dishwasher JRCE AND TYPE OF WATER SUPPLY: WELL O SPRING () STREAM OR CREEK Give depth of all wells within 180 feet of system: If supplied by communtiy water, give name of supplier: GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent Ground Slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: O 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: ¢v Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: ( ) Transient Use ( ) Non-domestic Wastes WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 1 PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer) 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 appliction 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 purposes of the evaluation of the application; and the issuance of the permit is subject to such terms and conditions as deemed necessary to inusre compliance with rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements make, 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 bre relied on by the local department of health in evluating the same fro 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 perjas provided by Signed 012 Date 3 9 ?T PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY lk 7-04 3 /M' 9 02g ' f3 95- 33 / 11 /Ad „7). /yl/qtr /5-C 'C-4-/ $a