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Home My WebLink AboutApplication- PermitGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Whigs, Colorado 81601 Phone It 303) 9454212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Permit N: 2 0 2 4 Assessor's Parcel No. This does not constitute a building or use permit. Brian S Linda Fry 4676 CR 311, New Castle 963-1472 Owner's Name Present Address Phone System Location 4676 County Road 311, Naw Castle Legal Description of Assessor's Parcel No SYSTEM >DESIGN l� Septic Tank Capacity (gallon) Other 4J! q() Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date 7-- .10 4- . - Inspector _,.. ' �.•c:.r-�12 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer .,...1.k, ---v1._ /1--r .(`1,14 i m ---fg, Septic Tank Capacity ' i7 O 0 a .� Septic Tank Manufacturer or Trade Name l (iL1 Septic Tank Accesswi hin 8" of surface Absorption Area ,'^ Absorption Area Type and/or Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements Other Date q -i3-- 73 Inspector COAA 1.sv,-+-1A RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: 1. All Installation must comply with all requirements of tht, 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 10 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 material variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense 0500.00 fine — 6 months In jail or both). Applicant: Green Copy Department: Pink Copy I INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION r� OWNER .1jr 1 an ry f ADDRESS ' Ib ]t fl t C41 '' V .WC(. PHONE /(._)(\-)C_-, CONTRACTOR 13( 1 (V F -Ly ADDRESS 1 PHONE Application Approval by County Official: 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. (Seer page 4.) LOCATION OF PROPOSED FACILITY: County (3 J ( fte I' jj Near what City of Town & 11— Lot Size ' D /' 1 Legal Description Slnf `ILI xj3 s 1tlANSt'Q (c S, Rot36 t: 9- UJ of hG 4A WASTES TYPE: (X) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non-domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: BaSec-rNeA:C. Number of bedrooms ;?..- Number of persons ( ) Garbage grinder ( ) Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: -- If supplied by community GROUND CONDITIONS Depth to bedrock:. Depth to first Gri Percent ground sl DISTANCE TO NEARS, Was an effort math TYPE OF INDIVIDUAL (1<) Septic ( ) Vault / ( ) Pit Pr ( ) Chemi c 1 1 FINAL DISPOSAL BY: (?) Absorption Trench, Bed or Pit ( ) Underground Dispersal (>) Above Ground Dispersal ( ) Other - Describe: water, give name or supplier: --- Oa, 0 3 Cis re -n. It diet Toilet 4ibe: ( ) Vault ( ) Recycling, potable use ( ) Recycling, other use ( ) Evapotranspiration ( ) Sand Filter ( ) Wastewater Pond WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? t ") fi4:3 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER'br { an -(y II ADDRESS Wb 7h fl 4a J J ,l�Cc >t ' PHONE f<SOf__- CONTRACTOR J! a '1 F 3i ADDRESS PHONE PERMIT REQUEST FOR: 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: County b u f {£'Id Near what City of Town,��_� Legal Description Stn3 `r i x_13 y IP (c,S, (.0_0(.1t= 9a- W Or 4D ' vAJN Application Approval by County Official: IllJ/ V o0 l II Lot Si zeL I,) / ` 1 WASTES TYPE: () Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non-domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: ,3Secmei<t Number of bedrooms ;:e- Number of persons3 ( ) Garbage grinder ( ) Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek C13{rrn Give depth of all wells within 180 feet of system: If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: 1 r l Depth to first Ground Water Table: v(*(1r]l4,_7 Percent ground slope: 1 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 3r + +�1 Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ()<) Septic Tank ( ) Vault Privy ( ) Pit Privy ( ) Chemical Toilet FINAL DISPOSAL, BY: (<) Absorption Trench, Bed or Pit ( ) Underground Dispersal (>) Above Ground Dispersal ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? \ff D ( ) Aeration Plant tom) Composting Toilet ( ) Incineration Toilet ( ) Other - Describe: ( ) Vault ( ) Recycling, potable use ( ) Recycling, other use ( ) Evapotranspiration ( ) Sand Filter ( ) Wastewater Pond SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) 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 purposes of the evaluation of the application; and the issuance of the periiii`t,-Is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned) hereby certifies that all statements 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. 1 further under- stand 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 per- jury as provided by law. Date PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY � • C 0 DTVI P ( • ! Sig e PLOT PLAN AND DESIGN FEATURES: Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, water course, stream, dry gulch and show location of proposed system by direction and distance from dwelling or other fixed reference object, and additional submissions in support of this application such as data, plans, specifications, statements and commitments. t? L(5 C 3 W -Pfb 1pO.S e D ac>x3b �. SSU Bose n a J 0 c kV(e R1.1 1.0 roxio 01A5 Page 4 •) -, r