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Home My WebLink About03774r· ·r .... ~.~~~ !·~~a~ '· ; ".' '"lJ I I • ' . '(?} GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N'.: 3774 t -« 109 8th Street Suite 303 ~ A88e88or's Parcel No. . ~· Glenwood Springs, Colorado 81601 Phone (303) 945·8212 ,. --------' ~I I INDIVIDUAL SEWAOE DISPOSAL PERMIT J PROPERTY This does not constitute a building or use permit. ~ ·,. t • i ) u i Owner's Name8to • ~--::bhQ Present Addre:.:Po ,L\ 75 5 Q J-.= 1 System Location C-if:... C}/c{tJ Z? >fZj SL.LJ..: 0 ( ~O Phone(e>dcQ'-~\ I.~} I Dov.i-r~(R., ~ ! : Legal Description of Assessor's Parcel No.-------------------------------- • ~ SYSTEM DESIGN I· " ~ I ·I . f ;i ' I i l ' • l I f j ! ! i • ~ >, \ ' ' i ! I ' l .,_/,..,.(?~C2-'-'(),,,__ Septic Tank Capacity (gallon) ______ .Other _.d"'-_?->_,_ __ Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 + Required Absorption Area· See Attached 10'87 dJ Ra:ok l"""""J.. Fttn-P ~ l/<I C!J L "'"'° /, ('h,...,ij "'< ,;2/1 pc>s s X!) (, <; _;$ ltl l "' ocfi. Cfi ,.._, t3 ~ I'? ;:, :r p P !> 3 )( r,, l l'r'"<'H 13~1> () .. D Special Setback Requirements: {, S 3 &J;;:;. L ,_,..,_h (".,/,,....,.ti• a, ,OP<' s ,). ><if Date 1 -II-03 \, \ "/!}~P~?!~(_J.,/e-~.<?>,./(.,4'4ta~,, .... ~~~""· ~,£',.. ____________ _ FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) Call for Inspection (24 hours notice) Before Covering Installation / System lnstaller·_J'.L;,"-:U.llc::.4'.:_ ______________________________ _ Septic Tank Capaclty•_/:_.::'L""-"'-..,.-rz _______________________________ _ I · , I Absorption Area Type and/or Manufacturej pr il'radJ.fllarb~ _ .. '"', ·-· .,,Jh/,_4,_2 c,£c-/,,,,u~{"''"'-+Jo""'R"'-~-'--------------- '·· Adequate com~l/a.· nee wl/'\ cp,lpty and State regulatlon~./~quir~~ent7ff;;l-:;/-'a.,..:;_,,.'-------------------- }, \ ' :,. {{/)/ t' '--.. Other -, .• .,.,. Date 0J ';2 f3 · Q 3' lnspecto~---i+<k"'-';;l.~;>o-2£~'9~""'-'~"-"""'Lf"""'~----------- RETAIN WITH RECEIPT RECORDS AT ~ITE •CONDITIONS: . I . . / 1. All lnstallatio.n mu··· st col]). plyw~~all requi~ln~ntsiol, f the Co~ra~o St~te Board of Health Individual Sewage Disposal Systems Chapter 25, Article 10 C.R.St1973. Revl"('d 1984. (_ . · 2. This permit IS:,'alld nly.for connection to tructures which have fully complied with County zoning and building requirements. Con· nection toot uSe wl h an\tdwelllng or structures not approved by the Build Ing and Zoning office shall automatically be a violation or a requlremenf.of the permit and cause for both legal action and revocation of the permit. I 3. Any person who constructs, alters, or installs an individual sewage dispO$Sil 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 ($500.00 fine -6 months In jail or both). W~ite, APPLICANT Yellow. DEPARTMENT / i' ' \ i I t ' , ! i "/ . ,. ' ~ I \ ) • ' I j l I t . t f '• ' t ~ r· ·r .... ~.~~~ !·~~a~ '· ; ".' '"lJ I I • ' . '(?} GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N'.: 3774 t -« 109 8th Street Suite 303 ~ A88e88or's Parcel No. . ~· Glenwood Springs, Colorado 81601 Phone (303) 945·8212 ,. --------' ~I I INDIVIDUAL SEWAOE DISPOSAL PERMIT J PROPERTY This does not constitute a building or use permit. ~ ·,. t • i ) u i Owner's Name8to • ~--::bhQ Present Addre:.:Po ,L\ 75 5 Q J-.= 1 System Location C-if:... C}/c{tJ Z? >fZj SL.LJ..: 0 ( ~O Phone(e>dcQ'-~\ I.~} I Dov.i-r~(R., ~ ! : Legal Description of Assessor's Parcel No.-------------------------------- • ~ SYSTEM DESIGN I· " ~ I ·I . f ;i ' I i l ' • l I f j ! ! i • ~ >, \ ' ' i ! I ' l .,_/,..,.(?~C2-'-'(),,,__ Septic Tank Capacity (gallon) ______ .Other _.d"'-_?->_,_ __ Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 + Required Absorption Area· See Attached 10'87 dJ Ra:ok l"""""J.. Fttn-P ~ l/<I C!J L "'"'° /, ('h,...,ij "'< ,;2/1 pc>s s X!) (, <; _;$ ltl l "' ocfi. Cfi ,.._, t3 ~ I'? ;:, :r p P !> 3 )( r,, l l'r'"<'H 13~1> () .. D Special Setback Requirements: {, S 3 &J;;:;. L ,_,..,_h (".,/,,....,.ti• a, ,OP<' s ,). ><if Date 1 -II-03 \, \ "/!}~P~?!~(_J.,/e-~.<?>,./(.,4'4ta~,, .... ~~~""· ~,£',.. ____________ _ FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) Call for Inspection (24 hours notice) Before Covering Installation / System lnstaller·_J'.L;,"-:U.llc::.4'.:_ ______________________________ _ Septic Tank Capaclty•_/:_.::'L""-"'-..,.-rz _______________________________ _ I · , I Absorption Area Type and/or Manufacturej pr il'radJ.fllarb~ _ .. '"', ·-· .,,Jh/,_4,_2 c,£c-/,,,,u~{"''"'-+Jo""'R"'-~-'--------------- '·· Adequate com~l/a.· nee wl/'\ cp,lpty and State regulatlon~./~quir~~ent7ff;;l-:;/-'a.,..:;_,,.'-------------------- }, \ ' :,. {{/)/ t' '--.. Other -, .• .,.,. Date 0J ';2 f3 · Q 3' lnspecto~---i+<k"'-';;l.~;>o-2£~'9~""'-'~"-"""'Lf"""'~----------- RETAIN WITH RECEIPT RECORDS AT ~ITE •CONDITIONS: . I . . / 1. All lnstallatio.n mu··· st col]). plyw~~all requi~ln~ntsiol, f the Co~ra~o St~te Board of Health Individual Sewage Disposal Systems Chapter 25, Article 10 C.R.St1973. Revl"('d 1984. (_ . · 2. This permit IS:,'alld nly.for connection to tructures which have fully complied with County zoning and building requirements. Con· nection toot uSe wl h an\tdwelllng or structures not approved by the Build Ing and Zoning office shall automatically be a violation or a requlremenf.of the permit and cause for both legal action and revocation of the permit. I 3. Any person who constructs, alters, or installs an individual sewage dispO$Sil 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). W~ite, APPLICANT Yellow. DEPARTMENT / i' ' \ i I t ' , ! i "/ . ,. ' ~ I \ ) • ' I j l I t . t f '• ' t ~ t I INDIVIDUAL SEW AGE DISPOSAL SYSTEM APPLICATION OWNER Jt)lf-r{ Jrr 111q r I f.o .bv£Lf 15 ~ ADDREss j:t; & i~e Rn /75.+-L-T PHONE GJS-3/13 CONTRACTOR j ft Ym, '<' PHONE ----- PERMIT REQUEST FOR Q{J 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 ofTown~--"xvr~·--'------------·Size of Lot I J.. 816 ~ Legal Description or Address {4 ~ .'.:< (oO l~ 3 C'._~ G:,W'""-°£"-c '" 1 Cf¢Wlf9•,,, WASTES TYPE: ~DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ()OTHER-DESCRIBE _______________ ~ BUILDING OR SERVICE TYPE:_"-'n/1'-evv--=~~fu-..,,__+,~'---'-'--=------------- Number of Bedrooms -----''---------Number of Persons __ a ___ _ ()4' Garbage Grinder (';><!>Automatic Washer ~Dishwasher SOURCEANDTYPEOFWATERSUPPLY: WWELL ( )SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: ' DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_~,r;--~-------- Was an effort made to connect to the Community System? --~!V~~ft~--------- A site plan 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 (septic tank & disposal field) to Property Lines: 10 feet YOUR INDIVIDUAL SEW AGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: I Depth to first Ground Water Table ___ &.._o ___________________ _ Percent Ground Slope __ .:::.()..,__,t.JL ______________________ _ 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 04 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: ~ ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRA TION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER-DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? n/o PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes er inch in hole No. 1 -----r Minutes _____ _,,er inch in hole No. 3 Minutes er inch in hole No. 2 Minutes er inch in hole No. Name, address and telephone ofRPE who made soil absorption tests:------------- Name, address and telephone ofRPE 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, infonnation 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 a . Date I -"g -03 PLEASE RAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 Designate North Arrow Your Neighbor's Name & Address 0 <. yr>. y 14Dtl Your Plot -Shape to Fit (No Scale) :--. 1)1>( o/-r,,.ic l..i:aclt ff. \ \ Locate well, al , · · and any water courses. /Drat in your house, septic tank & system, detached g , If a change of location is necessary, you must submit a corre, Certificate of Occupation will be issued. County Road (Note the Road Number and Name) erie e:\wpwin60\wpdocs'?ot.Joc l 3A) ·\ Your Neighbor's Name & Address t I INDIVIDUAL SEW AGE DISPOSAL SYSTEM APPLICATION OWNER Jt)lf-r{ Jrr 111q r I f.o .bv£Lf 15 ~ ADDREss j:t; & i~e Rn /75.+-L-T PHONE GJS-3/13 CONTRACTOR j ft Ym, '<' PHONE ----- PERMIT REQUEST FOR Q{J 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 ofTown~--"xvr~·--'------------·Size of Lot I J.. 816 ~ Legal Description or Address {4 ~ .'.:< (oO l~ 3 C'._~ G:,W'""-°£"-c '" 1 Cf¢Wlf9•,,, WASTES TYPE: ~DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ()OTHER-DESCRIBE _______________ ~ BUILDING OR SERVICE TYPE:_"-'n/1'-evv--=~~fu-..,,__+,~'---'-'--=------------- Number of Bedrooms -----''---------Number of Persons __ a ___ _ ()4' Garbage Grinder (';><!>Automatic Washer ~Dishwasher SOURCEANDTYPEOFWATERSUPPLY: WWELL ( )SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: ' DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_~,r;--~-------- Was an effort made to connect to the Community System? --~!V~~ft~--------- A site plan 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 (septic tank & disposal field) to Property Lines: 10 feet YOUR INDIVIDUAL SEW AGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: I Depth to first Ground Water Table ___ &.._o ___________________ _ Percent Ground Slope __ .:::.()..,__,t.JL ______________________ _ 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 04 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: ~ ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRA TION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER-DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? n/o PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes er inch in hole No. 1 -----r Minutes _____ _,,er inch in hole No. 3 Minutes er inch in hole No. 2 Minutes er inch in hole No. Name, address and telephone ofRPE who made soil absorption tests:------------- Name, address and telephone ofRPE 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, infonnation 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 a . Date I -"g -03 PLEASE RAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 Designate North Arrow Your Neighbor's Name & Address 0 <. yr>. y 14Dtl Your Plot -Shape to Fit (No Scale) :--. 1)1>( o/-r,,.ic l..i:aclt ff. \ \ Locate well, al , · · and any water courses. /Drat in your house, septic tank & system, detached g , If a change of location is necessary, you must submit a corre, Certificate of Occupation will be issued. County Road (Note the Road Number and Name) erie e:\wpwin60\wpdocs'?ot.Joc l 3A) ·\ Your Neighbor's Name & Address