HomeMy WebLinkAbout02150 ;-4. _ t - i °
. 1
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N_ 2 1 5 c
109 8th Street Suite 303 A r'e Parcel No. to
Glenwood Springs, Colorado 81801 i
Phone (309) 945 - 8212 (!
i " This does not constitute •
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Colorado heat legions'
Owner's Name Mental Health Canter Present Address 2014 Slake Glenwood lipgephone 945 -2241
System Location 6916 Highway 82, Glenwood Syringe
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN 1,
- /(‘'s p
Septic Tank Capacity (gallon) Other b
/ 1 . Percolation Rate (minutes/inch) Number of Bedrooms (or other)
' Required Absorption Area - See Attached
Special Setback Requirements c ,�..``, i `r
C ,-
,_ , Air
Date Inspector w. fi t'.' , i - .:: r'? i 1. j
r
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) 9 /q /93 S,jy r/ /E' p,,-Lff.E N1/=N a r .2 .
Call for Inspection (24 hours notice) Before Covering Installation ici00 GAlb ottf - r74A/K i t, :. NI Tr"r @ ,
1 , r.1 86 t� 3
System Installer —
ii Septic Tank Capacity 0 /? ( ' 1 -`
Septic Tank Manufacturer or Trade Name '
Septic Tank Access within 8" of surface L- - .--''
/ n `,�
Absorption Area / � IA/ C- 9
Absorption Area Type and /or Manufacturer or Trade Name �, < 1 1 ' "`=' " P " ''. '
Adequate compliance with County and State regulations/requirements e —
Ti
Other '1
Date �' *-- / Inspector . a ' _./..,
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 4
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.(0 fine — 8
months In )ail or both).
d
Applicant: Green Copy Department: Pink Copy
•, Application
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
County Official:
OWNER 10U i Wt *r /-t0,a46n.- M6Un,L_ hetAt -en C4+✓��
.DDRESS 20 /LJ fi /Ak / 6 e.V Woodfpriivy5 PHONE 1 79.3 --- 7. 2 y/ 1 - G
:ONTRACTOR /f MPN - /? IvJfde.r, IK` /
1DDRESS 95:S 7 ,611/, 3 6 ) a /eN wood ,5,r//V>J'HONE 9y5 - «f 3
'ERMIT REQUEST FOR: l ) New Installation (7) Alteration ( ) Repair
lttach separate sheets or report showing entire area with respect to surrounding areas,
copography of area, habitable building, location of potable water wells, soil percolation
test holes, soil profiles in test holes. (See page 4.)
_OCATION OF PROPOSED FACILITY: County &s 15t -D
Near what City of Town % .Jos daft -e Lot Size
Legal Description 69 /h9t'lf�l/ ' 2- , �1eNN''OOd 5/2)-;175, Go.
WASTES TYPE: ( ) Dwelling / ( ) Transient Use
(W) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe C-stt G c.CULfl7ONs csi/ Sc%1 )
BUILDING OR SERVICE TYPE: o f >e4_/ /.udnntr7ovirr
Number of bedrooms Ne9 Lat. , € vrt. ) Number of persons N /q- !sea..s.; vL)
( ) Garbage grinder ( V) Automatic washer ( 0 Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (I/) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system:
If supplied by community water, give name or supplier: N�4
GROUND CONDITIONS:
Depth to bedrock: /A/ £.lc! <,ss cf 8 sag-
Depth to first Ground Water Table: /N tiecli4S a 8 T
Percent ground slope: O /p
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /000
Was an effort made to connect to connnunity system? it47
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(X) 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:
(K) 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? WO
OIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.)
Minutes 0 per inch in hole No. 1 Minutes A per inch in hole No. 3
Minutes (o per inch in hole No. 2 Minutes per inch in hole No.
lame, address and telephone of RPE who made soil absorption tests:
F /FtO COta/ ,%t Pet rOc/S 4ttttorne-
lame, address and telephone of RPE responsible for design of the system: ikeeetece S
6/ 44v..r�� ( '/x r1AAV1.5ec da.1b.0 tf_e /00 / GvWO 4-vi • , S tin. z -E
Gte..(uiw.o 5f(rrn/cs , Go e /6 / / Cso3 re: # th,/ sz
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 permtt.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. I 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 / /di / 9) Signed . ; � Q
q
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
69et. SG* ve4t -2 6041
PGAJS Pa Y/0 x-i sIT3.u1,
n4.0 d.11 (Ai / e A-e- 16 cp ' r, td "n9
L■bg q3071\
•
I n
/ ES — tAl ik i t l y C ecif4
4 C , 7 —*— /LC 4, /144/2—,74. 7 / 5 10
4(7 c
7/
/031C '7 C/9/ e anipecili/c Legio' 07s - $ /32 0
it
Of tc7 ( Aie t V (At I / / 6 tAl
e r 5 s dava
fi e / - 4A7 574‘/th C W /4 C / /P ac
k e 0 s 7 ,
( 4 i_Vg4i I A4-%.
,
E
R(/LEA/T/4 - eis e bf,/
14 e
C.. 2- /50o
•
(y77 olaikeisAl --- 3o (15)(AS)
— 6 Cirif
5 7 744 LA 7 7,5 4 /7
a t ,1
„ cienCi t C.ae• 35a< 2700/eb,_
Cx
/06‘"
)LI.1 01-ppr o e ( 4/
3 _
< wC/ p l 1:4
r er7 r t v #- Gei o f �i e i €5.)/) �' C � a n ,4 ;
a x/ e' J / 7F2 v e r�/ 6.f.; a C. e-,Qa f 1 h r t°'
», ,' . / x r( 4 • #(i /et Sy s i"✓F
�� or se d r , Gc n / 4 r 7/-