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Home My WebLink About3898^e GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY 3 Owner's Name 3ici? ( Permit N: 3 8 Q 8 Assessor's Parcel No. if/�l'sr/� , �`, i Present Addressat � tielL n Q4/+("� " System Location OW l fit J4C) &as_• Cog/b,5 ' Legal Description of Assessor's Parcel No t k SYSTEM DESIGN 6N0 -7-04/-p -On\ Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedroos (or r other) ,S v'. {1e ri67 = / //4 r 7( 43 c. Required Absorption Area - See Attached Special Setback Requirements: L1-I-uc1 Date This does not constitute a building or use permit. Phone s?•9Ra /2 . Inspector A4 51. bitne1C FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer (- I ' `'`ttvi i Septic Tank Capacity ki (1 Dp Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface (1 QQ t Absorption Area II (I` \• \ 1-4-e 2" LI \ fiL01.1 Absorption Area Type and/or Manufacturer or Trade Name " Adequate compliance with County and State regulations/requirements 11�� Other Date II%(r Inspecto RETAIN WITH RECE *CONDITIONS: 1. All installation must comply with all requirements of 25, Article 10 C.R.S. 1973, Revised 1984. 2. This permit is valid only for connection to structure nection to or use with any dwelling or structures not • Y requirement of the permit and cause for both leg 3. Any person who constructs, alters, or installs an indi variation from the terms or specifications containe months in jail or both). r CORDS AT CONSTRUCTION SITE e ColorgdAState Board of Health Individual Sewage Disposal Systems Chapter hich have fully complied with County zoning and building requirements. Con- pproved by the Building and Zoning office shall automatically be a violation or a action and revocation of the permit. 'dual sewage disposal system in a manner which involves a knowing and material r t in the application of permit commits a Class I, Petty Offense ($500.00 fine —8 White - APPLICANT Yellow - DEPARTMENT N✓/ INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER Sa (1G+SO ADDRESS 9(t &sr.-, Cr 61e(QI 2 PHONEZ&7 - Reg 9yi2. CONTRACTOR ADDRESS PHONE PERMIT REQUEST FOR 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 ewnea* M4SA Q Size of Lot / J . cV 4cvee )T, Legal Description or Address See irete.n 54t.99 3- 7 -9( ' ! 71,4 4 fi Lt it4or so N p i14 aici Th col 3119 WASTES TYPE: >4 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER—DESCRIBE BUILDING OR SERVICE TYPE: IC e.S.Jthr 41 /Ioe✓ea4f a^ 2 CI r r Number of Bedrooms I Number of Persons 2— ( ( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 3 n.,1e s Was an effort made to connect to the Community System? AD 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 SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 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: pQ ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER -DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? Ac'] PERCOLATION TEST RESULTS: (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 . -i Date I2-/12- 0 3 PLEASE 1 ' W AN ACCURATE MAP TO YOUR PROPERTY!! RAND M NALLY 4- emPrt eSA www.ran4mcnally.com Disk Use the print feature in your browser to print this page. CO Akese tac.,t;\ { f }ra C arty Patsy d 301 Atarr:Scra 'Race/ 150 a1 500 it;t Find it in the 2004 Road Urias 'Page 21, grid section H-12 40 rights reserved. Use subject to Iice ser . 9 2003 randmalafy.00m Inc MAV : ect. :/tnrc.randacaally.com/rots/ducciion/dirpriseap sptcof-colorda-adldA-adidC- dl&S-COdZwalidQatdtp%3a%21%limaps.r®urvers.co ... 1�