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Home My WebLink About02051 — 4ttiS. .1 y am • 'kit l I,J r- d . e 1 ss11 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit IV: 205 li i • 109 8th A re Parcel No. Street Suite 903 , 2395 - 094— oo—OG2 1 Glenwood Springs, Colorado 81601 Phone (903) 945-8212 This does not cori titute 1 INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. ? , PROPERTY , Guest HQa S C' a 1 GUl4L,9rt/5, 111 .4 h� @ F Ranch 1220 Bennett C .S. P hone _ 9 -0164 Owner's Name rese Address s 1. 5011 C Road 117. Glenwood Springs System Location k Legal Description of Assessor's Parcel No. ri 9 SYSTEM DESIGN /` /Ca ' Septic Tank Capa ity (gallon) Other r / �'k a Percolation Rate (minutes/inch) Number of Bedrooms (or other) r 1 r 4 Roc- r id {, /,eRcH fpc1 --- /S X. t"- - C ' 4' I t 'i Required Absorption Area - See Atlaehed en' k 04 . .'h hi_ v,u- TaYS)' tc -1,1- 2 /t'ie - ,et5 (� r Special Setback Requirements: , 1.-C ._. Q ,/ c; e /) (j� / �O /'�'' �1 ( �A I V { ` _ �/ (. , 'yYf f �'� /'e Date it -- / " � 3 Inspector `-'a- 6 . 4P ' IA \ 4 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation- System Installer 227 -4 nt C'h .>/ s - t Septic Tank Capacity /.P CO �^ p - 7 d s Septic Tank Manufacturer or Trade Name y p 1 ">l Septic Tank Access within 8" of surface ✓ 0 Absorption Area .7 A FS 0 re-1yr 4 tit' Q. Absorption Area Type and /or Manufacturer or Trade Name /1801/g: Adequate compliance with County and State regulations/requirements 4. other ' — ,., 1 - . . - , . `'. --- f)1 4/4 /7r.A 3 ? l Gc> ✓u!t , Date Inspector - 1/ , e / <� . 2.1 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 — 6 months in Jail or both). Applicant: Green Copy Department: Pink Copy r Appl ica tioi; INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: OWNER Bill & Kathy Williams ADDRESS _PHONE CONTRACTOR DM Neuman Construction ADDRESS PO Box 2317, Glenwood Springs PHONE 945 - 7502 PERMIT REQUEST FOR: (x ) 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 Garfield Near what City of Town Glenwood Springs Lot Size Legal Description WASTES TYPE: ( x ) Dwelling ( ) Transient Use ( ) Conmiercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms 13' * Number of persons 4 ( x) Garbage grinder ( x) Automatic washer (x ) Dishwa SOURCE AND TYPE OF WATER SUPPLY: ( x ) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: If supplied by community water, give naive or supplier: GROUND CONDITIONS: Depth to bedrock: — Depth to first Ground Water Table: Percent ground slope:, ► DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 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: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF TIIE STATE? • •: 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 pernift.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 sane 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 • 3 (, Si ►JL _.„lA1 PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY • • • • • p Pine 1