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Home My WebLink AboutApplication r �_ -+d ,.�.n.. ...fie. .++r..r - ... �: w ...:. :,... ♦.- .:..,. , <, ,u...,... _ _ _ � •? 2 0 4 t ! 1 Iv GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit _ • 109 8th Street Suite 303 Assessor's Parcel No. 1 t Glenwood Springs, Colorado 81601 Phone (303) 945-8212 This does not constitute 7 INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. it PROPERTY 8 R Mtn. Natural G 0096 County Rd. 116 G•S• 945 -8617 Ci Owner's Name y P89ent Address Phone System Location 0096 Count Road 116 Glenwood Springs Legal Description of Assessor's Parcel No. SYSTEM DESIGN 7 r O Septic Tank Capacity (gallon) 1 Other ,^t Percolation Rate (minutes /inch) Number of Bedrooms (or other) '1/ /t t S ee 05 /iv c A z / e" erA 4/ /,, 7 / s Required Absorption Area -See Attached „2,7 5 /^ ` 7 1 Special Setback Requirements: / 6 °sue 0 1 t C s.) ;:., I it? l;7 //t r/ / 4." 0 fr / 4,.o r ( /raP i t 9{ i. C.) I r c 7 ! ,. r Date /AV, 3 Mapectof r FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ( Cr 1 Call for Inspection (24 hours notice) Before Covering v Installation '- -- System Installer 61 %,. ` rc, 1 t T /- r. r c Te 1 r v s Septic Tank Capacity ) r - ' . - t ` . • i v r r a Septic Tank Manufacturer or Trade Name C e /u-• -■ t / 1 p 8" of surface 1/ 0 V Septic Tank Access with / / n ° _ 71 / L . 4 FT / 7 / /Orr l� ,,/ L /7 7 ` C /T / e 71 ,..• l / /l.S :7/ '/ Absorption Area ' (( � Absorption Area Type and /or Manufacturer or Trade Name 1 / 7 /�T • 11 1 - // T 1 Adequate compliance with County and State regulations/requirements <J A Other Date / / OA ) Inspector (1 / lam'"'' `r � / / /�it,y -s , / RETAIN WITH RECEIPT RED RDS AT CONSTRUCTION SITE *CONDITIONS: • v 1 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 (5500.00 fine — 8 months In )ail or both). Applicant: Green Copy Department: Pink Copy 0 iir , ,, r 7 ec A ,,,,, rl v' , i- (7 i, ii, , FE 9 C » Iv s � . M AM pi w ' vin -- n-r-1 ion t 11 ;4. lo wt tt cm, T6 Date / Time WHILE YOU ERE OUT M of Phone - ' Area Code Number Extension TELEPHONED . PLEASE CALL • CALLED TOSEE YOU ■ WILL CALL AGAIN ■ WANTS TO SEE YOU URGENT ■ RETURNED YOUR CALL ■ Message / — l A r : tor" SSSSb/® RC - 300W l ( . 23 / ` r' /v � f /, c-f • s ✓e r ' l / -7 "fr; /0 ' I OK t C Y 7 1 '71/ ,/,',7 // '—? / : -- - /o '..3 / / /D/3( , t i0 ^' /7 / y7 _ ._. t 4/ I i \ / -X i /i. l i U, IN 1-) /, l/ I L - - r / 4/A, L. , i __. i .._ C.�S_ ; /z n Grave I30t/ _ __ y-75-11- / 6 s ,.... e a c e _1, ,"t /'1 e «s CohTac of = ('l0 piece 3 . R3 e i r aK/ r � o 1 o l"' r Fi Cky°A, ,,d,0,4C` P )serf, --Raiff / X - iA' //, < ,/ , , y 6 9 1 w � -G/% / / % !is.- iv '/7 ? /U 77V -s! w ' s g ./o � 1 57� /7, '7 // / 1\ I .std �/� �,�ri,i gin_ /810 . eili a/ if . it i 01 /‘, Auld iSC , 1 Z x 23 GtciVt_l (3�r� t , j ¢ /Qr / ` 61 G�,. r p I i :7,:n.79, -;.,. L C" p/ e c: e. s II C yhT4C 1 (°k 4.: o _ p.rt ce ._s Application . INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by - — — County Official: OWNER /i ocKy M ov1v - P , N lfAtvmt _ C;AC Copys*i/ IDAESS_ jJy? 27 ;MEAT PHONE 9'15 Oil MUM_ '1DDRESS____ __.- __--- • - - - PHONE v 'CRMIT REQUEST FOR: (J) New Installation ( ) Alteration ( ) Repair Ittach 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 GAR FIELD tear what City of Town . (',Le ona fpRWjS Lot Size , , ( AC , Legal Description oo 9G, CO,,mly P. il6 WASTES TYPE: ( ) Dwelling ( ) Transient Use (1✓) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe _ RUILDING OR SERVICE TYPE: P 7 - U J /_. ' 4 I/S - (lumber of bedrooms Nu ,ber of persons / 2 3 - M Gf / (41 Garbage grinder N Automatic washer tlk) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (x ) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: /2; FEET If supplied by community water, give name or supplier: y ( /,l / p✓? 1/1) GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table:___ 1 L c /9 .a.- — Percent ground slope: — DISTANCE TO NEAREST COMMUNITY SEWER S pt/71 r a,.// /16 r — Was an effort made to connect to connn ____ TYPE OF INDIVIDUAL SEWAGE DISPOSAL SY: / , /2/ Al E (>C) Septic Tank ( / ( ) Vault Privy ( /,ey4 & if a 71" e e f table use ( ) Pit Privy ( ler use ( ) Chemical Toilet ( n — FINAL DISPOSAL BY: (X) Absorption Trench, Bed or ( ) Underground Dispersal ( ) Above Ground Dispersal I ) wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? / \/O 1 • Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: i �. R oc4y plu /igtfr,v,L I, A c ConrA ll \DI!ESS_ ±° 1 2, Pie EAT— PHONE 9 95- 8 617 :ONT RACTOR ,____ ' \UUItESS�_,_�__._ __� PHONE , 'ERMIT REQUEST FOR: (✓) New Installation ( ) Alteration ( ) Repair \ttach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation Lest holes, soil profiles in test holes. (See page 4.) LOCATION OF PROPOSED FACILITY: County GAR P,tLD 1 Tear what City of Town (;(,<irwUOD fPR/N9t Lot Size . .-3 .1 AC ' '.egal Description_ 00 Th Co,udty P. II6 - WASTES TYPE: ( ) Dwelling ( ) Transient Use (1/ ) Conunercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe _ 'WILDING OR SERVICE TYPE:_ 0 3 4 _- A VC Ilumber of bedrooms Wi lber of persons /CCn -76C>< a y Garbage grinder i Automatic washer Q�k) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (X) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: 12 3 FEET If supplied by community water, give name or supplier: 47,,4 / l' ✓ P 1�) GROUND CONDITIONS: Depth to bedrock: — Depth to first Ground Water Table: Sc p ao/\ c eft {-t Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: -r7c7 cf<> v \ Was an effort trade to connect to commmunity system? VI° s (rt_ ) y 07 ) TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 00 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: (X) 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? /V L) 1 • • • Ait MIL.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 Mo.__ lame, address and telephone of RPE who made soil absorption tests: Dune, address and telephone of RPE responsible for design of the systems \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 health Ie_partment 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 periuft.Is subject to .uch 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 , rf 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 qr revocation of any permit granted based upon said application and in legal action for per- jury as provided by law. Date 12 - 1 — 92 Signed /Y ('LEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY ddd • Pants 1 - - —. _