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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 2 1 5 j
109 8th Street Suite 309 A is Parcel No. i
Glenwood Springs, Colorado 81801
Phone (309) 945 -8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name Brenda J. St. John Present Address 6029 -A CR 233, Silt CO Phone 876-2740
System Location 6023 CR 233, Silt
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN i f'
w, 4 0(' ('Septic Tank Capacity (gallon)Other
Percolation Rate (minutes /inch) Number of Bedrooms (or other)r r) i
9 (.- {l 1'1 Ai o c l F I_ r AC 1 - 15 c d.f-')( /... 4 r y .,
Required Absorption Area - See A1111Md t7 r 4 •7
Special Setback Requirements:
Y
Date D -• 4 ' - 9 2'Inspector i C \ ..;c4.. ^ /r-4,
FINAL SYSTEM INSPECTION AND APPROVAL (as Installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer 4,
Septic Tank Capacity I D '' y
i 1
Septic Tank Manufacturer or Trade Name .g ,/ rr.nt-Y/\
Septic Tank Access within 8" of surface
fi «1 7 --- .2 to 4 t i - s"Absorption Area _i
may^
Absorption Area Type and /or Manufacturer or Trade Name f 'i1 Jr i 2 t , ,4' 0 /1 I
Adequate compliance with County and State regulations/requirements F
Other
Date / r/ — 9 ip — 7 3 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.
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con
ltr,nectiontoorupewlth ny,dwellingoretructures ovsoby(heSuil IngrindZoningofficeshall automaticallybeaviola(Iott,prarequlrementofthe,permNlt and cauee for both. WSW „ t 1 i1 revocatloh of the Permit 11 1;
0 3 Anyperson oo V ( ) ,aiteh ,orinstall p tfi 0diaml) hliyeteminsmannerw tilch Involves a knowing and mat ielti fri, -I 'vdrlati ",1 l epeolf nt d1, r lcetionofpermitoommlts I1. u "
A,months in or h r,
Appllcent eisa r 'y , Department: Pink copy li t -iii uJ use -,i p,iu. Lar . _1---- &Jwa'v. - - - -- --: -,r I ii ,Y,,, +"W._. w
Application
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
County Official:
owAR re_ po iv mir 4.61221127n-
ADDRESS S d3 3 PHONE 00 --
CONTRACTOR_ in j. A
ADDRESS as, A i I PHONE 87A -d 7!`O
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. page 4.)
LOCATION OF PROPOSED FACILITY: County Gar-{f''c ld
Near what City of Town Sill-Lot Size
Legal Description cSfs )i JO.P .•.. i ii. e t . pt.! i pi
0411 t
WASTES TYPE:gDwelling Transient Use
Commercial or Institutional Non- domestic Wastes
Other - Describe
BUILDING OR SERVICE TYPE: Ya I J e Mt b "7
Number of bedrooms Number of persons
Garbage grinder I) Automatic washer Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: Y.1 well spring stream or creek
Give depth of all wells within 180 feet of system:44-14
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: y .n - yt;C
Was an effort made to connect to community system?74.0
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:
k) Absorption Trench, Bed or Pit Evapotranspiration
Underground Dispersal Sand Filter
Above Ground Dispersal Wastewater Pond
Other - Describe:
WILL EFFLUENT BE DISCIIARGED DIRECTLY INTO WATERS OF THE STATE?AM
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 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 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.
Ao
Date . Je fM4LA c 9 Signed e 4•1 fr
PLEASE DRAW / AND ACCURATE MAP TO YOUR PROPERTY
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