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Home My WebLink About036931//O_ /0-CA) �V i l � �� V GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 Sth Street Suite 303 �.- Glenwood Springs, Colorado 811301 Phone (303) 945.8212 I INDIVIDUAL SEWAGE DISPOSAL PERMIT t PROPERTY Permit N2 3693 Assessor's Parcel No. i This does not constitute a building or use permit. IMf Owner's Name 9, I Ie U. L_fOWtll./4'%L'./JU7ep/re�s(ent Address 6a /Owi!) du Lie, GS F4hone d /V" &�7—d0 A System Location f w+� l Y� �Y"'1 SI Lt 6D Do/&5"_A_ Legal Description of Assessor's Parcel No. SYSTEM DESIGN Septic Tank Capacity (gallon) ` 0 Percolation Rate (minutes/inch) Required Absorption Area - See Attached Special Setback Requirements: Other Number of Bedrooms (or other)�^^•^�'( - &-15-tta 12osk -C...J F 3 1WPQ5 qo3- Cb 1,x ,,1 a ;tzPCS 3f L(USCSs a&4,..(.rn teeO 2SpeS 2X$ Date / /6 - e)7 Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation ( System Installer I `1G,,A) co Septic Tank Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface Absorption Area RETAIN WITH R€CEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: 1. All Installation must comply with all requf4Tents �.f� tColorado State Board of Health Individual Sewage Disposal Systems Chapter 25, Article 10 C.R.S. 1973, Revised 19 4.t t ? 2. This permit is valid only for connec lb � oair u IAB whlc��,'we fully complied with County zoning and building requirements. Con- nection tooruse with anyAwelling strutjqr nota&T ad by the Building and Zoning office shall automatically be a violation ora requirement of the permit and caul for b&h a &L action and revocation of the permit. 3. Any person whoconstructs, alters, or installs an in dual sewage disposal system in a mannerwhich inyoives a knowing and material variation from the terms or specifications contained in the application of permit commits a Class I, Potty Offense ($500.00 fine — 8 months in )all or both). 3 ''� WhifisjA14LICANT Yellow. DEPARTMENT a : INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER h 14 T*+- 4 Fr,ti.A- 12 i ADDRESS 6,L D Glirc-`ow7S�3a PHONE 2 I - 683-ogoo CONTRACTOR P r v t7 Eitvv Pi �jc c r o"Ta A c-ro ✓2 ADDRESS 11-31 Clid ki> 3_� $fLZ40 Jq/b Z PHONE 970-$7b-2`l6q 295'1 - PERMIT REQUEST FOR A/' 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 S) i ---r- Size of Lot / 2 O A c a t - c Legal Description or Address Sez_r 1 d-7 6F6FN Ig5EgYytnrr WASTES TYPE: IN DWELLING - - / ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: rfltr� r D c�—n Number of Bedrooms Number of Persons ? (x) Garbage Grinder (�Q Automatic Washer (N Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (X) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? N a A site Ulan is required to be submitted that indicates the following MINIMUM distances: 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: (septic tank &leach field)10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Percent Ground 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 F AL DISPOSAL BY: ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) ABOVE GROUND DISPERSAL ( ) SAND FILTER ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes__ per inch in hole No. I Minutes per inch in hole No. 2 Minutes per inch in hole NO. 3 Minutes ner inch in hole NO. Name, address and telephone of RPE who made soil absorption 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 � ' `' — 91/'t't' Date Y 1 0 L' PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 0 �la a� aVV��o''i�$nbzbbu 'a 'a Ua p b is Ov 0� b pp� ��Lab�abajbpa ii 0'Oa '+ai gyp, 7078_52' — — — — T / zz 'N Ovia w$b �• �o�y�O� O O nm aga n4N 14, i2 [er'�°�Sflaaamfcly Qr•„"cnSni:��nn5i ��K 0 pep.b i �la a� aVV��o''i�$nbzbbu 'a 'a Ua p b is Ov 0� b pp� ��Lab�abajbpa ii 0'Oa '+ai gyp, 7078_52' — — — — T / zz 'N Ovia w$b �• �o�y�O� O O nm aga n4N 14, i2 [er'�°�Sflaaamfcly Qr•„"cnSni:��nn5i ��K