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Garfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.Rarfield-countv.com
TYPE OF CONSTRUCTION
0 New Installation
WASTE TYPE
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
0 Alteration
Of Repair
13' Dwelling 0 Transient Use
0 Comm./Industrial i 0 Non -Domestic
0 Other Describe
INVOLVED PARTIES
Property Owner: '` 1-.1 cri : � Phone: (3i L , }.1 t; - I 6 q
Mailing Address: I (a 1 0 \t` pr-- c .,, ¥ S o.p ion
Contractor: ___L_isSzc gaQ LLC_ Phone: 01 ) O1 -i
Mailing Address: P C '1
Engineer: --
Phone: (
Mailing Address:
PROJECT NAME AND LOCATION
Job Address: 41r41 C ci c,11 Q -c Spc`\ a, LC I
Lot ;. ' Blacks'/
Assessor's Parcel Number: 33q•Sub. 114
Building or Service Type: Ref,„ k l � 6 c4 #Bedrooms: Ca Garbage Grinde K ,c
Distance to Nearest Community Sewer System: 1Vcc CKLc�, w4 12
Was an effort made to connect to the Community Sewer System:
Type of OWTS
Septic Tank 0 Aeration Plant 0 Vault 0 Vault Privy 0 Composting Toilet
O Recycling, Potable Use 0 Recycling 0 Pit Privy 0 tndneration Toilet
O Chemical Toilet 0 Other
Ground Conditions Depth to e Ground water table Percent Ground Slope
Final Disposal by
Water Source & Type
Effluent
O Absorption trench, Bed or Pit
4 Underground Dispersal 0 Above Ground Dispersal
O Evapotranspiration 0 Wastewater Pond 0 Sand Filter
O Other
11 Well 0 Spring 0 Stream or Creek
0 Cistern
O Community Water System Name
Will Effluent be discharged directly into waters of the State? 0 Yes J No
CERTIFICATION
Applicant acknowledges that the completeness of the application is conditional upon such further
mandatory and additional test 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 legal action for perjury
as provided by law.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided the required information i is c ect, nd accurate to the b t of my knowledge.
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Property Owner Print and Sign
OFFICIAL USE ONLY (
Special Conditions:
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,—
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Permit Fee:
Petit Fee: j
total Fees:
Fees Paid:
Building Permit
Septic Permit: i
Issue
te: 1
Balance Due: l�(
BLDG DIV:
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APP 'OVAL DATE
c)
Er'
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81801
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT i• ° 1939
Owner Art Angelo
System Location
0477 C.R. 167 Glenwood Sprints
This does not constitute
a building or use permit.
Licensed Installer
Leo Jammaron Construction
Conditional Construction approval is hereby granted for a .f C' rn ') gallon
F Septic Tank or — "----- Aerated treatment unit.
Absorption area for dispersal area) computed as follows:
Perc rate of one inch in / r minutes requires a minimum of sq ft of absorption area per bedroom.
Therefore the no. of bedrooms 3 x - sq ft minimum requirement = a total ofsq ft of absorption area.
May we suggest: K� J!::, r �.. �.�<',-1.(,-,2'' /r'` '` , r
!�/7 ,.`,.t c r r
Date r Inspector < f f -°=7-t1 (""',.,„2,/,.., i' ,k,
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.
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.
Adequate absorption for dispersal) area.
Adequate compliance with permit requirements.
Adequate compliance with County and State regulations/requirements.
Other
r
Date / Inspector _44_
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All installation must comply with all requi rements 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. Connection to or use with any dwelling or structures not approved by the Building and Zoning office shall
automatically be a violation of 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 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 — 6 months in jail or both.).
Applicant: Green Copy Department: Pink Copy
Ott uaw .l4`ff CS" 1 lel a*4
.GARFIELD COUNTY BUILDING AND S N ATION DEPAR
- , :109 •
;:8th '
Glenwood Springs .Colorado 81601 -'
(303) 9454212
INDIVIDUAL SEWAGE DISPOSALPERMIT
.Nr
Owner
Art Aruej o
This does not constitute
a building or use permit
System Location
0427 C.R. 167 Glenwood Spring
Licensed Installer
Leo Jammaron Construction
* Conditional Construction approval is hereby granted fora 1) d 0 0 gallon
)/"Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in / 5 minutes requires a minimum of """" sq ft of absorption area per bedroom.
Therefore the no. of bedrooms x sq ft minimum requirement = a total of sq. ft. of absorption area.
kiX' X 3' 8.erciq !- e o c h t3 e d oma q 3-.."0.%, £ t � ,
err- # 3
May we suggest: ,TM/t.f�te,. A AIp.ce.c�e4
Date /0 —1°' 9/
Inspector
FINAL APPROVAL OF SYSTEM:" J Yom_
f.
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.
60 0 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.
2y r)' i- X ? i Adequate absorption (or dispersal) area.
�r Adequate compliance with permit requirements.
1�.. Adequate compliance with County and State regulations/requirements.
Other
Date // `7/ Inspector
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. e •
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 pr structures not approved by the Building and Zoning office shall
automatically be a violation of a requirement of the WO 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 — 6 months In Jail or both.).
Applicant: Groin Copy D.partm.nt: Pink Copy
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER .#1;r- -! 1 e) D
ANUS'S 00:7 Go pa /47 PHONE '9'5--o 7r
CONTRACTOR -roil owl ll�a-IL / /-d.o SA -M keAdeN) 9i45--5ib
ADDRESS gip -it
PHONE 87646 67
PERMIT REQUEST FOR: (14 New Installation ( ) Alteration (
Attach separate sheets or report showing entire area with respect
topography of area, habitable building, location of potable water
test holes, soil profiles in test holes. (See page 4.)
LOCATION OF PROPOSED FACILITY: County i Acr ici
Near what City of Town q7674, wow c( 5),G/d1Gj Lot Size % 7 ,4ctd.5.
Legal Description
Application
Approval by
County Official:
feeo''�
fe rL
) Repair
to surrounding areas,
wells, soil percolation
WASTES TYPE: ( V) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non-domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE:
Number of bedrooms — (S'zeI A,e. 3 EL4Oree4umber of persons
{ ✓)Garbage grinder (✓) Automatic washer ( L Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: u N k u o - u
If supplied by community water, give name or supplier:
GROUND CONDITIONS: /
Depth to bedrock: --
Depth to first Ground Water Table: UO iCuoav r)
Percent ground slope: 0— /
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: £ /w/
Was an effort made to connect to community system?
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( '1 -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
( ) Underground Dispersal
( ) Above Ground Dispersal
( ) Other - Describe:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?
( ) Evapotranspiration
( ) Sand Filter
( ) Wastewater Pond
PLOT PLAN AND DESIGN FEATURES:
Include by measured distance location of wells, springs, potable water supply
lines, cisterns, buildings, property lines, subsoil drains, lake, water course,
stream, dry gulch and show location of proposed system by direction and distance
from dwelling or other fixed reference object, and additional submissions in
support of this application such as data, plans, specifications, statements and
commitments.
Page 4
SOIL 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 Mo.
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
purposes of the evaluation of the application; and the issuance of the pernui'tis'subject to
such terms and conditions as deemed necessary to insure compliance with rules and regulations
adopted 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
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. 1 further under-
stand 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 per-
jury as provided by law.
Date
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
(
Signed
L°MC 1—lirid 6L/