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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit Ivr 2161.
109 8th Street Suite 303 A re Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY $;
Owner's Name David 6 Carol Echeverriel Address P.O. Box 3461 Glenwood Phone 928 -4077 SSS;
System Location 0100 Rama Plates, tan Diamond e, Glenwood Sprinje
Legal Description of Assessor's Parcel No.
X
SYSTEM DESIGN 'F
Septic Tank Capacity (gallon) Other ;.
Percolation Rate (minutes/inch) Number of Bedrooms (or other) 4
Required Absorption Area - See Attached
Special Setback Requirements: #:
Date • Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer go,JP � )
1
Septic Tank Capacity /3 G/t/ Jfl4/
Septic Tank Manufacturer or Trade Name '% / /
Septic Tank Access within 8" of surface
Z w
Absorption Area u'� // /=`j
Absorption Area Type and /or Manufacturer or Trade Name ./V /I TA - 7 A (.v
Adequate compliance with County and State regulations/requirements
Other
/ 4
Date jit `f. Inspector W> 6 ,(
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 i
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 off Ice shall automatically be a violation or a
r,9b rement of the permit and cause for both legal action and revocation of the permit.
3. Ary'berson 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 (5500.00 fine — 6
months in Jail or both).
Applicant: Green Copy Department: Pink Copy
Application
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
Co my Offici 1:
OWNER AP/ 44 1/.. 1''e et//gq
•
ADDRESS D� e t�t:C PIIONE Z 5/3
CONTRACTOR ,4o 'es)
g / X y 6 4 A Bet P/recni) C •
ADDRESS Poe 3*'67T GIP oqo i;d S PHONE Q2,59- 4
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 4rFt pld
Near what City of Town /p/1WC'c' -p 4 - ;.t55 Lot Size - 2 .5 r a(t( r
Legal Description /,,t (9 Acr ?y / ✓iCPvl7�rlo r 1 f race //7) bar i% e fd C,ovh /
WASTES TYPE: (;x() PJwelling ( ) 'Transient Use
( ) Conuriercial or Institutional ( ) Non-domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: ___
Number of bedrooms y Number of persons y
(XI Garbage grinder ( )<2 Automatic washer (
SOURCE AND TYPE OF WATER SUPPLY: ( ) well ()<) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: Pei
If supplied by community water, give name or supplier: 4q57 y .Jhmooc/' lozleae tekj
GROUND CONDITIONS: / G /91-.C5 c
v
Depth to bedrock: o At/dic/(n
Depth to first Ground Water Table: v o /k.i oW h
Percent ground slope: Sit 4
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: U7(- /er..124
Was an effort made to connect to community system? • /Po •
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(X) 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? I/O
1
OIL PERCOLATION TEST RESULTS: (To be completed by Registered y Professional Engineer.)
Minutes 9 t per inch in hole No. 1 Minutes ( _ per inch in hole No. 3
Minutes 1t. per inch in hole No. 2 Minutes _ per inch in hole No._
:ame, address and telephone of RPE who made soil absorption tests: tgs( &tnjr7roy.
:ame, address and telephone of RPE responsible for design of the system:
%pplicant acknowledges that the completeness of the application is conditional upon such
urther 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
rurposes of the evaluation of the application; and the issuance of the permtt.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
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 2 S igned _�� � et.„-{ .,
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
�N« �M 4" n e e ," " •
x PC
9b'0 'a era S2 �r
co ✓Tijtroet 7 -o V 59f
•
•
Page 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, water course,
stream, dry gulch and show location of proposed system by direction and distance
Troia dwelling or other fixed reference object, and additional submissions in
support of this application such as data, plans, specifications, statements and
commitments.
$? q f/ d q0 c /411
Page 4
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RESULTS OF PERCOLATION TEST JOB , _f30e)y 08 _____
U __ Y "�t_ - � -- - DATE 8_ 1;93 -----
ADDRESS DESCRIPTION_ 0 40
DEPTH AND DIAMETER OF HOLE /1 __" 0 22: 0 #2 -'- - " 0 -7_,C2_ " 0 #3 .2..t_ F 0 . 0
TEST HOLES WERE PRE - SOAKED FROM: (Dole)_ (Time)_____ -_ T0: (Dote)__ H OLE e) 3 w
HOLE #1 R HOLE #2 #
TIME R TO NNK " FALL RATE TIME 70 IMtRK " FALL RATE TIME RR; N20K " FALL RATE
.5 /. 763 37 7.53 S :3£f /, 3Z
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PERCOLATION RATE: if ____ PROFILE HOLE
AND SOIL DESCRIPTION
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