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Home My WebLink About02831f . • q GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2831 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY 4Se Is TMra/ry i &a) Owner's Name Vivian Stark Present Address 3811 CR 331, Silt Phone -2968 System Location 3811 County Road 331, Silt Legal Description of Assessor's Parcel No. Ptcccs floe - K- ce4C -4 OE 64 SYSTEM DESIGN a 11 Cft - MOE«. DEO G y2 eV u rncnc rt --A A, 11 fret-) t t 0 O 0 Septic Tank Capacity (gallon)Other I rtttr-31n - Percolation Rate (minutes /inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: PO1DateI —1 b Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Gut+ ,e Septic Tank Capacity l >O Septic Tank Manufacturer or Trade Name r o c .c MtZ Septic Tank Access within 8" of surface YCs Absorption Area 6 N Absorption Area Type and /or Manufacturer or Trade Name J lc , < < L i PATOP • (ftrAr,0 Flf UN ITS 7 Adequate compliance with County and State regulations /requirements Y L` S Other c L a r r -t a c Date /r2 - ? 9 7 Inspector lLir< o•/s • 0 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 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 materialvariationfromthetermsorspecificationscontainedintheapplicationofpermitcommitsaClassI, Petty Offense ($500.00 fine — 6 months in )ail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEW ' E DISPOSAL SYSTEM APPLICATION 4'tei OWNER e_ alit ra y ADDRES SagI !t"g_PHONE F 6 -9/O rr CONTRACTOR i / M/d ADDRESS 1 X11 i.PHONE C( V a (9(f, rC PERMIT REQUEST FOR 4 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 (See page 4). LOCATION OF PROPOSED FACILITY: Near what City of Town I i iz . 9 S A Legal Description or Address SSW-n WASTES TYPE:DWELLING TRANSIENT USE COMMERCIAL OR INDUSTRIAL NON - DOMESTIC WASTE OTHER _ - DESCRIBE P f F t f BUILDING OR SERVICE TYPE: V I2 d2t/ I, ea f" lefrIfNumberofBedrooms37Number of Persons 41 Garbage Grinder Automatic Washer 5C) Dishwasher SOIJRCE AND TYPE OF WATER STJPPLY: WELL SPRING STREAM OR CREEK If supplied by Community Water, give name of supplier:J(. DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM :a1ii1" -P4 Was an effort made to connect to the Community System?Lilt) 1 r'1 11• 1 1i\ 1 h• 1 4.'11 ill_N u u 1• t1 Leach Field to Well:100 feet Septic Tank to Well:50 feet Leach Field to Irrigation Ditches, Stream or Water Course:50 feet Septic System to Property Lines:10 feet YOIUR INDIVIDUAL, SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. CrROIIND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: yg 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: D A ABSORPTION TRENCH, BED OR PIT L -o p n d EVAPOTRANSPIRATION UNDERGROUND DISPERSAL SAND FILTER ABOVE GROUND DISPERSAL WASTEWATER POND OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 1/4- O PF.RCOI,ATION TEST RF,SIII.TS (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) 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. _ 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 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 in legal action for perjury as provided by law. Signed Shit t Date g 9 7 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 L mo 2Ficr V.:7 z .<o w p wN d O ff4 A C P.° z N n n 0... n-t O C y -,sC N v 0 E O c z w w o R Q 14 co a 0 c tic z o w L etc1 1S 11 N N N tet t n 5 rD s, c a OE 6 -e t 0 N T. r A 1+w Fp Q° 1 f 0 mO c< n. n 8 - e eve y w Trnya O:rct.T3 6 y C y IMMIMIMMIN 2 y r o sV , k. i, 521 0 -t m O ti w r ' ' CL C P N C. V C . n N 1 s S To cr c a c X IClioIgV CIS I J E A o, Fo -t a- N N r N y 1 • n N. Cr W I