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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N. 2 0 6 1 1
109 8th Street Suite 303 A is Parcel No.
Glenwood Springs, Colorado 81601 2185 353 01 004 1 r •
Phone (309) 945-8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
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PROPERTY
I
Owner's Name Steve Stonebouse Present Address 0896 Westbank Rd, 0.8. Phone 945 -6935 g
System Location 'County Road 125, Glenwood Springs i
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Legal Description of Assessor's Parcel No. ll
SYSTEM DESIGN -P I
r i ( 9
i � a 0 0 Septic Tank Capacity'(gallon) Other
J ! t i
I r s;1 / t?' M Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 7
Required Absorption Area - See Attached /.,r V/ q t 1 h 17 ') t k A TO r d" Q 1„ f ttr,.q t �
°f Special Setback Requirements:
/ /1 11 e
Date 1 1/ / " ` / Inspector - r , - , `"'' {M Q !
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation 1
e t
System Installer x
Septic Tank Capacity ` ;
" n
/ P
Septic Tank Manufacturer or Trade Name C- o f ' t2 %t_ � dl
Septic Tank Access within 8 of surface _- 1= �� `/ ) 98
Absorption Area /, Rertiv C T Al et -) 'k ^< <7 !,
T f) t
Absorption Area Type and/or Manufacturer or Trade Name -{ /14
t a' ' '* A
Adequate compliance with County and State regulations/requirements l'-"'
Other • ry j,
Date r ! ' 9* - / -2 Inspector C 7 e'T'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 f
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
Applicati
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
CC — - -- — — County Official:
OWNER E V `` - - - J"'b 11E.. t L.LS
u)DItESS_ c).1, 7 . (0 ( , 1�� _ _8�nk R� PIIOMEg4 (0
:ON IRACTOR ____ -- — - - -_
1 DURESS — — — - -- PHONE ;
'ERrlIT REQUEST FOR: pX) New installation ( ) Alteration ( ) Repair
\ttach separate sheets or report showing entire area with respect to surrounding areas,
I opography of area, habitable building, location of potable water wells, soil percolation
test holes, soil profiles in test holes. (See pa a 4.)
'.00ATION OF PROPOSED FACILITY: County I Q rIE 1--14
lear what City of Town Q Locoa5 ?21v)c.S Lot Size 5.9 I1-fPFS
' egal Description
VIAS1ES TYPE: ( Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe /
RUILOING Olt SEitVICE TYPE: Pt -a
(lumber of bedrooms _ Number of persons 4
( ))arb tinder ' (X) Automatic washer (x) Dishwasher )V /p
,OURCE Alto TYPE Or WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek (1l"; e i
G� cr /4
Give depth of all wells within 180 feet of system:
If supplied by community water, give name or supplier:/41t( D r A 51/4.t wA T,enk-
GROUND CONDITIONS: �/�
Depth to bedrock: k
- fv) r,u )v, _
—
Nenth to first Ground Water Table: viy? k v?ow� —
Percent ground slope:____ ti Olaf
DISTANCE 10 NEAREST COMMUNITY SEWER SYSTEM: - —
Was an effort made to connect to community system?
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(>0 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 8Y:
(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 TIIE STATE? NO
•
•
•
. IL 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.__
lame, address and telephone of RPE who made soil absorption tests:
lame, address and telephone of RPE responsible for design of the system:
1pplicant 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
lepar•tment lo be made and furnished by the applicant or by the local health department for
unirposes of the evaluation of the application; and the issuance of the periift.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. I further under-
stand that any falsification or misrepresentation may re . in the . If the application
nr revocation of any permit granted based upon said a• icati,n an in lega action for per-
jry as provided by law.
nate I — 2 (� 1 — / Z Signed yr /)
('LEASE DRAW AND ACCURATE MAP 10 YOUR PROPERTY
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PLOT PLAN AND DESIGN FEATURES:
Include by measured distance location of wells, springs, potable water supply
lines, cisterns, buildings, property lines, subsoil drains, lake, (gater 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
connitments.
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