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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit tri: 21 0 4 i(
109 8th' Street Suite 303
Glenwood Springs, Colorado 81601
Phon0303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY -
Assessor's Parcel No.
This does not constitute
a building or use permit.
Cat hetrt" Via! 0366 Cattle Creek DA, CtdAle
Owner's Name Present Address one
System Location 0366 Cattle Creek Road (County Road 113), Carbondale
Legal Description of Assessor's Parcel No
SYSTEM DESIGN
Septic Tank Capacity (gallon)Other
943-3292
2
Pescc�ation Rate (minutes/Inch) Number of Bedrooms (or other)
4/,9Roc 14 4- / e. c ti e d --- �' .2 `X 3Z, 1)(3 ' r
Required Absorption Area - Ssealifielied cry.- rt.2 ! A TO
.2 7j1 Co-) t A c -tor q.✓ I ,; f'
Special Setback Requirements:
Date Cr
Inspector •
FINAL SYSTEM INSPECTION AND APPROVAL (as Installed)
Cali for Inspection (24 hours notice) Before Covering installation
System Installer c
1,2
Septic Tank Capacity 4r6,gyp,,, �,,,
Septic Tank Manufacturer or Trade Name � v r�'✓�
Septic Tank Access within 8" of surface v
Absorption Area / 2/ h I/6'1 f?
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
Other
Date -- — speotor'Uf
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 to 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 offioe shall automatically be a violation or a
requirement of the permit and cause for both legal 10tion and revocation of the permit.
3. Any person who oonstructs, 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).
Applicant: Green Copy Department: Pink Copy
•
OWNER
ADDRESS OS(P‘, e-PertL".61WACZOPtO PHONE 4)1-Sa.9—
,
CONTRACTOR .5A M
ADDRESS PHONE
floTrowurt
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
CivrotKIA6 VD,II)JC/
Application
Approval by
County Official:
PERMIT REQUEST FOR: ( ) New Installation ( ) Alteration ) Repair
Attach separate sheets or report showing entire area with respect t 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 c12,4 -
Near
what City of Town 1341,014A, 04(00(1411/41k " ttC1101)D Lot Size ,..9 C1j
Legal Description X44 1L 1Lc C(( M. R& ( C -ii& .113 C'iol %li . 00
WASTES TYPE: (V) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non-domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: 'SfV,IL (kMtJ Pott.
Number of bedrooms Number of persons �.
( ) Garbage grinder utomatic w9 her ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (✓ ) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: NOf 01411,'r. ISN faA'
If supplied by community water, give name or supplier:
GROUND CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table:
Percent ground slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: AIR.
Was an effort made to connect to community system? g/
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
Optic 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:
(I—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? 72r�-
Nino 7
4J
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.
Nance, 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 permft1s 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. I 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
11 iu jV Signed dr\
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
Cv (A/
Cf� Rd. 113
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Page 3
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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.
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