HomeMy WebLinkAboutApplication- Permita
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit I�: 233 d H
109 Bth Street Suite 303 Assessor's Parcel No. f "•
Glenwood Springs, Colorado 81801
Phone (303) 945-8212
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INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
This does not constitute
a building or use permit.
Owner's Name Gary & Sherri Thuratin Present Address P.O. Box 76, New Cantle, COhone_ 984-2474
System Location County Road 250, Lantpiris Exemption, Silt
Legal Description of Assessor's Parcel No
SYSTEM DESIGN
DO 6 Septic Tank Capacity (gallon) Other qq
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>� C t I () Percolation Rate (minutes/inch) Number of Bed .00ms(or other)
Required Absorption Area - See Attacked
Special Setback Requirements:
Date tie .' F"
t` I -r
I
Inspector
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FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
CaII for Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity /UC3a
Septic Tank Manufacturer or Trade Name tie t e
Septic Tank Access within 8" of surface
Absorption Area s o7 4
Absorption Area Type and/or Manufacturer or Trade Name I8
Adequate compliance with County and State regulations/requirements
Other
Date
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inspector
RECEIPT RECORDS AT CONS UCTION
SITE
WITH
*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 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 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).
Applicant: Green Copy Department: Pink Copy
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OWNER (13-00-1.- {) Lr -1 4
ADDRESS PO. ?Y `7 Lo, PHON
-:ONTRACTOR -CL ,Lc3
ADDRESS X3.` 7. � � � CO PHONE -
'ERMIT REQUEST FOR: New Installation () Alteration ( ) Repair
'Mach separate sheets or report showing entire area with respect to surrounding areas, topography of area,
labitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes
;See page 4).
: County C c?d
Lot Size 10
Application
Approval By
County Official
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Legal Description - c_ P -.<12%f.
[near what City or own
WASTES TYPE : �(,') Dwelling O Transient Use
( ) Commercial or Institutional ( ) Non-domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: Pi m t
Number of bedrooms 5 Number of persons
( ) Garbage grinder `(4,4 Automatic Washer AS./) Dishwasher
SQURCE AND TYPE OF WATER SUPPLY; (V) well () spring () stream or creek
Give depth of all wells within 180 feet of system: h �A
If supplied by community water, give name of supplier: n i ok
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? r0
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
Septic Tank ( )
Vault Privy ( )
Pit Privy ( )
Chemical Toilet ( )
Aeration Plant ( ) Vault
Composting Toilet ( ) Recycling, potable use
Incineration Toilet ( ) Recycling, other use
Other - Describe:
FINAL DISPOSAL BY:
( ) Absorption Trench, Bed or Pit
'N Underground Dispersal
( ) Above Ground Dispersal
( ) Other - Describe:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? tQ
()
()
()
Evapotranspiration
Sand Filter
Wastewater Pond
EXHIBIT A
A TRACT OF LAND SITUATE IN LOT 4, SECTION 30, TOWNSHIP 5
SOUTH, RANGE 91 WEST OF THE 6TH PRINCIPAL MERIDIAN BEING
PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT A POINT WHENCE THE WEST 1/4 CORNER OF SAID
SECTION 30 BEARS N 00 DEGREES 22'26" W 1893.96 FEET; THENCE N
90 DEGREES 00'00" E 746.77 FEET; THENCE S 04 DEGREES 47'43" E
719.78 FEET; THENCE N 89 DEGREES 59'12" W 452.26 FEET;
THENCE N 00 DEGREES 22'26" W 373.38 FEET; THENCE N 89 DEGREES
59'12 W 350.00 FEET; THENCE N 00 DEGREES 22.26" W 343.71 FEET
ALONG THE WEST LINE OF SAID SECTION 30 TO THE POINT OF
BEGINNING.
COUNTY OF GARFIELD
STATE OF COLORADO
ALSO KNOWN AS
LOT 3
LAMPIRIS EXEMPTION
ACCORDING TO THE PLAT THEREOF RECORDED JUNE 21, 1994 AS
RECEPTION NO. 464833. ___
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on
)iL 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. _
ame, address and telephone of RPE who made soil absorption tests:
ame, 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 permit is 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 understand that any falsification or misrepresentation may result in
the denial of the application or revocation of any pe a ed. ed upon said application and in legal
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action for perjury as provided by law.
Date
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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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