HomeMy WebLinkAboutApplication- Permitcrri31-3D\
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
Permit
sessor'sParcel No. `-�
_AkLRO"ML'41
OP -103i
4 �. 9 9
t^� J
This does not constitute
a building or use permit.
PROPERTY
Owner's Name%; O - 1 Jj U`1 C&Oac -5 Present Address a(-0:: 1k SC) Phone y
J 0 (
System Location°i`D"VA-15r►ill Yv;F5CgikL, 1.04E [-1 x..11 ��e[����) �L
Legal Description of Assessor's Parcel No . \ I !a \LA` `"' LlLI l
SYSTEM DESIGN
/WO Septic Tank Capacity (gallon)
Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other) `--)
i/
Ism .- /
rl Ha/0641.(1) 11
Required Absorption Area - See Attached
Special Setback Requirements:
Date b'
Inspector
lit.,.. Q+-.0
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Instal_lattiionn,
System Installer f�"�"r�'"�'
Septic Tank Capacity V '
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area —4
cy
Absorption Area Type and/or Manufacturer or Trade Name
C ur," </ 3,/ y 4/3/,,T
Adequate compliance with County and State regulations/requirements
Other /vA
Date 7- /3-c)7
inspector 7i 7 lf�-�`l/
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 compiled 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 — 6
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
Hx Date/Time
FEU-U7-1U07(YIEll; U9:40
Feb 07 07 0852a Shawn Stewart
FORM rex
MVO
U1094
JJ3 7bf 9417
303-761-9427
WELL CONSTRUCTION AND TEST REPORT
STATE OF COLORADO. OFFICE OF THE STATE ENGINEER
WELL PERMIT NUMBER m N
ER NAME(S) GepP6E. ST-E.LAD�"
Mailing Address 3 5 0 L! Ak-D
city, st zip i.J U t_ 00 t to
Phone ( at.) _ _ •
I.U19
p.19
For Moe Use only
WELL LOCATION AS DRILLED: , r 1/4 h% 1/4. Sec. 0. / Twp. (Q s ,Range 93 to
ANCES FROM SEC. LINES: ' NE it 5 I~ it
ft. from Sec. line. and /[l it. from Sec. line. OR
nn a utnl L or
SUBDNISION: 9ss m e..r, yeAxi ',Lf LOT 8 BLOCK FfL1NG(UNR)
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION ‘15) ft. DRILLING METHOD A, 1pocptoay
DATE COMPLETED 4-0-99 TOTAL DEPTH Z ft. DEPTH COMPLE Fz
S. GEOLOGIC LOG:
Depth Description Matsdel (Type. Size, Calor. Meter Location)
1.-:- 7D/' ,` � ., o •+,4_ L4.1/504. -S.1 CIG."
l: JJ7 41 ale
law-- Zit, �' rdscro-^ ZIA".
?CLQ - Z..Fs- ale -ar7
5- 7_7U Se141-4"
B. HOLE DAM. (in.) From (ft)
�•Sr
To (ft)
X0
7. PLAIN CASING
00 (in) hand Wail Size From(ft) To(ft)
.244
PERF. CAS G_: Screen Slot Size: 1
(-f0
8. FILTER PACK 9. PACKER PLACEMENT:
Material ,5,1; mowe/ Type /
Size Y- r
Interval /40- 2.8C) Depth
REMARKS:
1.
DISINFECTION: Type
2
WELL TEST pATA: l
TESTING METHOD
Static Levet (f0.0
10. GROIIING RECORD:
7erial Amount Density Interval Pt
Z GIS )-7`f'' Amt. Used
Check1�if Test Data is submitted on Form No. GWS 39 Supplemental Well Test.
tiY�
ft. Datef ime treasured 4' 2 f 9 , Production Rate
Pumping level IL Date/rime measured Test length (hrs.) 3
Remarks
9Pnt
3. 1 have reed the statements made herein and know the contents thereof, and that they are true to my tolowledge. (Pursuant to Seaton 24.4104 (13)1
CRS.. the making of false 3850
atiVllarkLin the second degree and Is punishable as a class 1 misdemeanor.]
LINCOLN
CONTRACTOR uotnietv,s0Jerili Phone (3) f1 i?) -033b Lic. Noil2.6
Maibna Addre i;
Name/Title (Please type or print)
As _
bate