The URL can be used to link to this page

Home My WebLink About02052 -I r • v # d GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N: 2 0 5 2 C , 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 / Phone (903) 945-8212 i ThIs does not constitute r INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. C PROPERTY Patrick Kluaustre P.O. Box 266, Banat 927 -9373 s Owner's Name ,, Present Address Phone_ System Location "' 'tty Road 226, t Legal Description of Assessor's Parcel,,NO. ? i SYSTEM DESIGN ) 1 i //iv ' Septic Tank Capacity (gallon) Other .i 1 ) ,,,,4 2 0 Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 S Hs" ca 4 - A a &r /9 sc' k 74.3 ' Required Absorption Area - See Attached 4-0711 , t P, ?+ or nt ' or a 7 p -c. 'e4 x Special Setback Requirements: x'07 Al d„ i1RWF ap 0,- 3 0 ed'.d-�@.to411. t '. Date 4 y. / — 73 Inspector �1 (,�(/ "" • FINAL SYSTF,7II INSPECTION AND APPROVAL (as installed) t Cali for Inspection (24 hours notice) Before Covering Installation p1 System Installer._. /1 Septic Tank Capacity !l DO / 0 Septic Tank Manufacturer or Trade Name -(_' 1 ( s� Septic Tank Access within 8" of surface I / � Absorption Area / G gl xY SO f X 3 04 r ,4 -2' -Y Absorption Area Type and /or Manufacturer or Trade Name gri c f? 1 e=_ a C h 13 '<nl(l. {rAA- ,J1 : A i Adequate compliance with County and State regulations/requirements `/, hA5T sj elj Pare INTO scrt'c.7 K SLr 0 nee St Other A y To+ co inn/ C�inr. � A' ,o RDh?e wt Date __.r ', 9- Inspector -' rj'1 l t-e,frill ,} RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: a 1. All Installation must comply with all requirements of t Colorado State Board of Health Individual Sewage Disposal Systems Chapter f 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 1 variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense (5500.001ine — 8 , months in jail or both). Applicant: Green Copy Department: Pink Copy Application " . INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by ,4Ilt� k KlvsniR� County Official: OWNER J IDORESS___PU_ 6ok 266 /3,454l/ `, P /Gzl PHONE 927- 9373 :oNTRACTOR_ ryaelA - — - - - -- ADDRESS -- ------ --____ — — — — I'llorJE 'LIMIT REQUEST TOR: ( t.--(New Installation ( ) Alteration ( ) Repair lttach separate streets 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 (roles. (See page 4.) '.00ATION OF PROPOSED FACILITY: County 6AR 'E/of ea - lear what City of Town_ Y11EL_ n New Castle- Lot Size 1 1. 025 Acres /7,724) 54n. 'egal Descripti on A PII2ce/ is 4' s%z NJ-yy ( a 7--4,a Ru 92 west -6l Pit — 2 0202{ - _ - IIAS1ES TYPE: ( ✓) Dwelling ( ) Transient Use ( ) Comore ial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe _ nuILDING 012 SERVICE TYPE: - - -_--..._ Number of bedrooms .Z _ V ' Number of persons / ( ) Garbage grinder (r4' Au'. : - - Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ✓) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system u �A�PR!✓JL / DcvP If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: ? _ — I)epth to first Ground Water Table: r • Percent ground slope: _ ______ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: miles Was an effort made to connect to coannunity system? ft/ TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( ✓f 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 TUE STATE? No r •. _ - -- r_.. -- • - -- — _- • ,I)1L 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. lance, address and telephone of PPE who made soil absorption tests: • lame, 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 lepartment 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 pernial't.is'subject to each terms and conditions as deemed necessary to insure compliance with rules and regulations idopted 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 if 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 n ' revocation of any permit granted based upon said application and in legal action for per- jury as provided by law. nate Signed PLEASE DRAW ANU ACCURATE MAP TO YOUR PROPERTY inz Pane 3 • PLOT PLAN AND DESIGN FEATURES: Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, later 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. • • • Page 4 N ; ,( fl j .Le } 6 j ; iI . /: i l II ' 1 f ? L.; N a :': f P f l ( rl 111 , nN .. '/ � N a m //3 ,; ,1 , i Q � '� / h .� a )1t 41 ,r 4 r t 1 7"1! .1, r r J^• ' . 7 4 1 , aM.1 , 1' 1 7 R a a I y ,.•• J y, a 11 ,,iz, In i . +, I r l 1 1 1 � 1 , ',it- 1 , ,t, r Y i r it , ,, 3 1 r I !it.," ' • ,f1 , , 1 a Vi , , t• ' T (J n , i I i .f( `'l ,1 ! 1. . \ Ir r � ti f 1 . ' i Ip - .�' a" 1, = iiii , . 1 a Y � f ff 3- N ' . I, , a F , 1 : `s J „ nth r' h;t, .