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Home My WebLink About02097 1 ,. GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N r 2 0 91 r^ 109 8th Street Suite 309 Assessor's Parcel No. I 1! -1 '' `1 Glenwood Spiings, Colorado 81601 + Phone (303) 945 -8212 ' I This does not constitute t P, �. INDIVIDUAL SEWAGE DISPOSAL PERMIT a buudmg or use permit. • PROPERTY .. ,I r. • � Owner's NameRiChard & Masada StophMURresent Address 0083 Lone Oak Rd, Carbonda d fe 92071569 r. System Location 0083 Lone Oak Road Carboadale (1. r.c ` � , 0 r ; . it _ Legal Description of Assessor's Parcel No. I SYSTEM DESIGN • r /hQ Septic Tank Capacity (gallon) Other - ire e Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 1 r - Required Absorption Area - See Attached f , t '\ pedal Setback Re ulrements: / 4 ate Inspecto IifY o // FINAL" YSTEM INSPECTION AND APPRQV (as inst led)" - Call for Inspection. (24 hours notice) Before 0 'vering In I f liation - I , System Installer 1/4- . /+ ? g@ F Septic Tank Capacity /230 A' Al -nAJ 1 1 Septic Tank Manufacturer or Trade Name ` 7 Q QAl �' \ CA p.'t 1on) � t\ I I''C S eptic Ta cces - vrtthm'8" of surface s / ....... ». Absorption Area s Absorption Area Type and /or Manufacturer or Trade Name ` 7 RAO ? - / i�! - qq L . d Adequate compliance with County and State regulations/requirements ✓ i Other , : ; 6 /.;sp Date Inspector 1 _ s RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE I i *CONDITIONS: i 1. All Installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter , fI 25, Article 10 C.R.S. 1973, Revised 1984. . it I 2. This permit Is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- F nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a I, requirement of the permit and cause for both legal action and revocation of the permit. f 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 IA the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 1 months In )ail or both). n 3 Applicant: Green Copy Department: Pink Copy Application INDIVIDUAL SEWAGE DISP05RL SYSTEM APPLICATION Approval by ., County Official: OWNER (IGMA(to 4- 11MPrNUA STEPI{CUS 1 7 ADDRESS oo %3 1-04)C OAK RAap CARB67044E PHONE 920 1669 ' 0 CONTRACTOR 644/ g Iset ADDRESS 0187 FAMwi y untie G.S PHONE 94 - 5 --666 2 1. 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 WRtz.FI E:I) Near what City of Town GA28nAJD6-1-E Lot Size 3t Legal Description P&?cF c - Heine - 5715v Est, - rcS _ WASTES TYPE: ( Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe OR SERVICE TYPE: SINGLE FAM /'-Y e6 /OEruc i Number of bedrooms 3 -1. Number of persons '4- ( ) Garbage grinder (x) Automatic washer ( X) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( X) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: VincwOWL) C Dc O(L IL4 [0 WITI+IU X'I' k1GL'K� If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: - - -- Depth to first Ground Water Table:i__ — Percent ground slope: /O% 12% APP la DX DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: / -E'S ____ Was an effort made to connect to community system ? MO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (-1 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: (4—I.—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? ND 1 Page 2 PLOT PLAN AND DESIGN FEATURES: Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, water course, streams, 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. PF}R GEL Z j-57 Ls7 4TES PRoPosED G/ELL: LOcAlian. 5C oPF • \ \ b a ,_ 100t FEET FRrnn, wEw ` Ho° ro 5Ewce. 5 ysrcm� GRkA L SEOT Ic / LkRG+/ F IEctD Page 4 SOlt 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 peSmitit <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 °rut /1j/9 Signed sla " PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY Page 3 r • y i /4/ -- ?"7.7 4 L3vi-1 /7/ i-, s ,_.3 7 .v, 7 /, // 3 LI i )/ �� 7 U / / il 12(1 3,O lit i/ 'l a 13 /1 1 AIRI 1 r L r r k r l �� L . - 1 _ . LJ 11