HomeMy WebLinkAbout02044 �. � , .
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Pe 11 / N: - , 2 0 4 4 1
109 8th Street Sulte 303 A essor's Parcel No.
Glenwood Springs, Colorado 81801 2391 174 - - 048
Phone (309) 945.9212
This does not constitute ',
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY C
Owner's Neme Lance 6 Pamela Allae Present Address 931 Colorado r Glenwood Spri e 945 -
System Location 0024 Sunlight Drive, Panorama Ranches, Carbondale
Legal Desoription of Assessor's Parcel No. 6
SYSTEM DESIGN
/hl X) Septic Tank Capacity (gallon) Other
�� 5 Percolation Rate (minutes/inch) Number of Bedrooms (or other) / / /
Required Absorption Area - See Attached 30 2 f '� 1 / / X , 5 `' / r i I '
I/r nr. 4/5-tit 5 l
Special Setback Requirements: .,,. . ) _,
yv�c / %a a ll
Date_ /7/ /c, Inspector OZ... L e �n...
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
9
Call for Inspection (24 hours notice) Before Covering Installation
System Installer / nit ih , (6/2,S:T i r)a• \,.1.1' j
Septic Tank Capacity /1' Y> r'//114 -jiI
Septic Tank Manufacturer or Trade Name - re/.• % ,4N)J r , /v('r{. ?F
Septic Tank Access within 8" of surface ✓ ¢J
Absorption Area i) 4 /�'/! - e "' i'r ' jUr / rd r'r i
Absorption Area Type and /or Manufacturer or Trade Name /l Z
Adequate compliance with County and State regulations/requirements ✓ '(
Other / jj
ro
Date /fr/ / 'n f 3' Inspector,' .ry/ ' J / ;. '
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
'CONDITIONS:
1. All installation must 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.
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con -
nection to 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 ($500.00 fine —8
months in Jail or both). ` i
Applicant: Green Copy Department: Pink Copy
npll l IUd L I Ull
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
County Official:
Eli L e4cS P M °
z� 9 9 21_Cet o (_n\L 1V q CCPHHONE 9$ -M9)) 1j 0
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- �. - ---- - - - - --
WORM PHONE
'ERMIT REQUEST FOR: New Installation ( ) Alteration ( ) Repair
U:tach separate sheets or report showing entire area with respect to surrounding areas,
'opography of area, habitable building, location of potable water wells, soil percolation
Lest holes, soil profiles in test holes. (See page 4.)
OCATION OF PROPOSED FACILITY: County 0
!ear what City of Town __ Lot Size,
' egal Description____ - (oQ'sM/ 12- (',N(5'' _
'TASTES TYPE: (,'") Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non - domestic Wastes
( ) Other - Describe
8ULLDING OR SERVICE TYPE:_ 907( c — tmal,11 of bedrooms cj Number of persons ro
(i) Garbage grinder (/)- Automatic washer V) Dishwasher
';OURCE AND TYPE OF WATER SUPPLY: ( 11 ( ) spring ( ) stream or creek
'give depth of all wells within 180 feet of system:___
If supplied by community water, give name or supplier: hi�S7J AiLL�st �2 C�� �i
(GROUND CONDITIONS: HOnleXaVefbc
Depth to bedrock:
Depth to first Ground Water Table: _
Percent ground slope: -
OISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Np
Was an effort made to connect to community system?
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:
( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe: (NCI
UILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?______________
•
•
Noe 2 ..
9 ' PERCOLATION ZEST 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.
mie, address and telephone of RPE who made soil absorption tests:
line, address and telephone of RPE responsible for design of the system:
pplicant acknowledges that the completeness of the application is conditional upon such
urther mandatory and additional tests and reports as may be required by the local heal th
apartment to be made and furnished by the applicant or by the local health department for
urposes of the evaluation of the application; and the issuance of the perinit.is subject to
itch terms and conditions as deemed necessary to insure compliance with rules and regulations
dopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies
hat all statements made, information and reports submitted herewith and required to be
ubmitted by the applicant are or will be represented to be true and correct to the best
, f niy knowl edge and belief and are designed to be relied on by the local .department of heal th
n evaluating the same for purposes of issuing the permit applied for herein. I further under -
tand that any falsification or misrepresentation may result in the denial of the application
a• revocation of any permit granted based upon said application and in legal action for per -
iury as provided by law.
'ate ///3.97q -ad - Signed - a , —'e
'LEASE DRAW AND ACCURATE MAP 10 YOUR PROPERTY
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