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Home My WebLink About03783f GARFIELD COUNTY BUILDING AND SANITATION DEPAl'ITMENT I Permit N: 3781 AsseHor's Parcel No. ' i 109 8th Street ~ Suite 303 , Glenwood Springs, Colorado 81601 Phonll" (303) 945·8212 --------' a INDIVIDUAL SEWAGE DISPOSAL PERMIT - This does not constitute a building or use permit. ' ( P~OPERTY . N\h r -I~ Ol\t< v ·-rf"' ~er d.o '~ ... ~ .,__ ~;-«.e GJ~ll>?"o i O~ner's Name f!lU On j ''« Present Address -----~=_,._ll'-'--_-'-'__J[S'-"'---Phone ' 1 i System Location ________ ~:;a-=-LrVl.=€-~0~~=-----'a"-'0'--'o'--"v--'~=---------------- ~ ~gal Description of Assessor's Parcel No. -----------===----T---.,------~----~-- 1 ' IN+:t fr/'/1-TJ:I'/ "11 ~ f,,L_ ~ I I : SYSTEM DESIGN rv1. 'Jll-f: V?1 f ~ ?~ (L.il.5 ~ # / ~O Septic Tank Capacity (gallon) ______ Other j /II -'2{ l .'.l ~ Percolation Rate (minutes/inch) Number of Bedrooms (or other) _.5 ___ _ t ~ 1 (. ' • Required Absorption Area • See Attached Spec)'I Setback Requirements: I, !) Date .::;I ~I If'-O°i lnspecto~k~/d£;- i, ~· I I ~ j ~+ t I ., ,; FINAL SYSTEM INSPECTION AND APPROVAL (as installed) .c.:, ! Call for Inspection (24 hours notice) Before ,?overing Installation I l l' i ' i I i l ' ' j " t I " System lnstaller· __ ..(;2'-"ILJ!.l.<'=:::::..---~--------------------------t Septic Tank Capacity {7 c;T> t j' ' e -i< 4~~ , • • I -'-· t· ~ Septic Tank ~anufacturer ~r T~de Name __ Q""'/)?-<A==-'°---~-· --';ff----------------------1·"0· \ ,, \. .' I Septic Tank Acc8$.s Within 8" of s_urface ~ ,, \-~ f ;--;--( ) /I' / Absorption Area ,} S' ,u.. . ) ;"""~Ly/\ , ·3 t.(',... tk -q -I a -1-~ I . f '/-/-;, .. )/--10/ I Absorption Area Type and/or Manufacturer or Trade Name ,{),~t(lf71.. /_:. _ ; I Adequate compliance with County and State regulatlons/requirements--1..~:::.,._::::__· _______________ _ Other __ --r-f--+-------------.,.-,c----.~-------,,.,_------------ Date ?>udo 3 inspector /Jri,dj 72w}Z 7 RETAIN WITH R5Cf!l/,PJ RECORDS AT CONSTRUCTION SITE •CONDITIONS: 1. All lnstallatiorlinust 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. .1 2. This permit Is valid only for connection to structures whlcflL~ave fully complied with County zoning and building requirements. Con- nection to or use with any dwelling or structures noliP'P('6\.ed by the Building and Zoning office shall automatically be a violation or a requirement of the permit and cause for both legal ac ion and revocation of the permit. 3. Any person who constructs, alters, or Installs a~rJnOivl(IUpl ·~~-Jisposal system In a manner which· involves a knowing and material variation from the terms or specifications contalried 1n the-'a'ptillrla1ion of permit commits a Class I, Petty Offense ($50Q_.OO fine - 6 months in jail or both). White. APPLICANT Yellow. DEPARTMENT f GARFIELD COUNTY BUILDING AND SANITATION DEPAl'ITMENT I Permit N: 3781 AsseHor's Parcel No. ' i 109 8th Street ~ Suite 303 , Glenwood Springs, Colorado 81601 Phonll" (303) 945·8212 --------' a INDIVIDUAL SEWAGE DISPOSAL PERMIT - This does not constitute a building or use permit. ' ( P~OPERTY . N\h r -I~ Ol\t< v ·-rf"' ~er d.o '~ ... ~ .,__ ~;-«.e GJ~ll>?"o i O~ner's Name f!lU On j ''« Present Address -----~=_,._ll'-'--_-'-'__J[S'-"'---Phone ' 1 i System Location ________ ~:;a-=-LrVl.=€-~0~~=-----'a"-'0'--'o'--"v--'~=---------------- ~ ~gal Description of Assessor's Parcel No. -----------===----T---.,------~----~-- 1 ' IN+:t fr/'/1-TJ:I'/ "11 ~ f,,L_ ~ I I : SYSTEM DESIGN rv1. 'Jll-f: V?1 f ~ ?~ (L.il.5 ~ # / ~O Septic Tank Capacity (gallon) ______ Other j /II -'2{ l .'.l ~ Percolation Rate (minutes/inch) Number of Bedrooms (or other) _.5 ___ _ t ~ 1 (. ' • Required Absorption Area • See Attached Spec)'I Setback Requirements: I, !) Date .::;I ~I If'-O°i lnspecto~k~/d£;- i, ~· I I ~ j ~+ t I ., ,; FINAL SYSTEM INSPECTION AND APPROVAL (as installed) .c.:, ! Call for Inspection (24 hours notice) Before ,?overing Installation I l l' i ' i I i l ' ' j " t I " System lnstaller· __ ..(;2'-"ILJ!.l.<'=:::::..---~--------------------------t Septic Tank Capacity {7 c;T> t j' ' e -i< 4~~ , • • I -'-· t· ~ Septic Tank ~anufacturer ~r T~de Name __ Q""'/)?-<A==-'°---~-· --';ff----------------------1·"0· \ ,, \. .' I Septic Tank Acc8$.s Within 8" of s_urface ~ ,, \-~ f ;--;--( ) /I' / Absorption Area ,} S' ,u.. . ) ;"""~Ly/\ , ·3 t.(',... tk -q -I a -1-~ I . f '/-/-;, .. )/--10/ I Absorption Area Type and/or Manufacturer or Trade Name ,{),~t(lf71.. /_:. _ ; I Adequate compliance with County and State regulatlons/requirements--1..~:::.,._::::__· _______________ _ Other __ --r-f--+-------------.,.-,c----.~-------,,.,_------------ Date ?>udo 3 inspector /Jri,dj 72w}Z 7 RETAIN WITH R5Cf!l/,PJ RECORDS AT CONSTRUCTION SITE •CONDITIONS: 1. All lnstallatiorlinust 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. .1 2. This permit Is valid only for connection to structures whlcflL~ave fully complied with County zoning and building requirements. Con- nection to or use with any dwelling or structures noliP'P('6\.ed by the Building and Zoning office shall automatically be a violation or a requirement of the permit and cause for both legal ac ion and revocation of the permit. 3. Any person who constructs, alters, or Installs a~rJnOivl(IUpl ·~~-Jisposal system In a manner which· involves a knowing and material variation from the terms or specifications contalried 1n the-'a'ptillrla1ion of permit commits a Class I, Petty Offense ($50Q_.OO fine - 6 months in jail or both). White. APPLICANT Yellow. DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWN~O\=e.O. M onte-\enne. ADDRESS M&o C.R 433, :Bi£\,,_ PHONE &8-5-51,-/ CONTRACTOR Wa.\tc..r.S Company ADDRESS \11.s= C..R l.S-"I, C"'\WS PHONE 91/~-2...l'S/ PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION (y{(EPAIR 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._::J<_ .... ;~~~l~e...~ ___________ Size of Lot lo Q.c.~:; Legal Description or Address a. 9.:t o ~ 01..3 5 WASTES TYPE: (~DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ()OTHER-DESCRIBE ________________ _ BUILDING OR SERVICE TYPE:._,,,S',__,!n~o \..,.c.~_.\,..__,a.,,.,rn"""-i.\..,,y,___,,,d_'-"w"'--"'e..L\\..,_j-"-'n"'q~----------- Number of Bedrooms J/ \ Number of~ersons .Q_ --'=~-- (~Garbage Grinder (~tomatic Washer ( ..rt5'lshwasher SOURCEANDTYPEOFWATERSUPPLY: (vrWBLL ( )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? --------------- A site plan is required to be submitted that indicates the followin& 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 SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table _______________________ _ Percent Ground Slope ___________________________ _ 2 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: <i> ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRA TION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER-DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ---- PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe Engineer does the Percolation Test) Minutes. ____ -l'er inch in hole No. I Minutes ______ per 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, 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. Date ~ -II-o3 TE MAP TO YOUR PROPERTY!! 3 ! b () rri r '------~!------__, ;o 6 ~NORTH- "'