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Home My WebLink About02092 _ �.. ... r .... ..;.Rosy- wl- .a'9^.n✓� ^'iRl ... r. / : ,¢F.v rr7 -n a t -r c... xr -.. . .. •r . fi a r ei v ) 4 + , GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N= 2 0 9 '` 1 - , 109 8th Street Suite 303 A r's Parcel No. = Glenwood Springs, Colorado 81601 . -- Phone (303) 945 -6212 4 This does not constitute ' 4 - INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit, ' 1 PROPERTY Am, .,, Ho G s e Owner's Name Bill b Kathy WLLUSass Present Address 5011 CR 117 Olamrood Sprinn 945-0164 0 T. System Location 501A County Road 117 Olsnvood Springs p Legal Description of Assessor's Parcelyo. r 1- ��►Q 7re Roc? A e ac N' = SYSTEM DE81Q . y 5- y T . ,�r.� /2 A t 022 04,-- u �; • .)-y, t _eC�j i b on C! Septic Tank Ca p a cit y (gallon) - Other "� -1 � 1tv• C a 7 O "t te't �/ /YvuM ..." / 23 Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 Required Absorption Area • SesdMM Mad 'P Special Setback Requirements: 4 4 ` Date 7 7 — / , inspector ` 't'( `� --�"" - ' `^�— e FINAL SYSTEM INSPECTION AND'APPROVAL (as installed) / Call for Inspection (24 hours notice) Before Covering Installation u r System Installer TI %r " ., e ! I \, Septic Tank Capacity / r v N �Xn T V Septic Tank Manufacturer or Trade Name 4 } S Septic Tank Access within 8" of surface 1 lieil pp 1' e' Absorption Area ' 0.3 o45 4 O i , p 0 . Absorption Area Type and /or Manufacturer or Trade Ngme �`'1 I ,T I Adequate compliance with County and State regulations/requirements s �` S _ Other 7 y cy � @ Dat / — f 7 " / 3— inspector `�"F7a �I (y g RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE f *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- c i nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a ( y. requirement of the permit and cause for both legal action and revocation of the permit. 3. y person o ontruos, rs, e individ swge dispsoal sysennrwhl Involveswing and material variation fro the cs terms o specalteificationorinats :tools an ined In ual the e app of permit tem commIn8mits 8 e Class c I, Petty Offense 8kno ( 1 ine —6 months In )ell or both). It 1 An Applicant: Green Copy. Department: Pink Copy 1, • is . .. Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: OWNER �'L \ et,(„, 1 ...4 .4 ! , / ADDRESS /c9AO :C: . , _ t a ► A .� _, PHONE gAt5- o64 CONTRACTOR_ 4 st _ „Au 0 ..t L � • ADDRESS 1/4.4 ► , a 0. ! PHONE 9.14(2.;-.750; PERMIT REQUEST FOR: ( 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 (k ./ � Near what City of Town kb " A..1 � . \��s.__�a Lot Size -Y c .C - Q,(I ) ifI/7', Legal Description • a ! e _ WASTES TYPE: ( ✓5' Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non-domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: L h l4 . Number of bedrooms Number of persons ( /1 Garbage grinder ( Automatic washer ( 'I SOURCE AND TYPE OF WATER SUPPLY: ( 7) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: If supplied by community water, give name 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 THE 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 pernitt 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 niy 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 J' /9-93 Signeds.__AL k-- PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY 4110 ' 1 4 dam il iQC.1°P° atdLA 041) ca 4 ►7AD cz c 1 — et sa a b e • • k f Page 3 4 MOLL ci tt0.