The URL can be used to link to this page

Home My WebLink About02179 R . F .: - • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N:. 2 1 7 109 9th Street Suite 309 A is Parcel No. Glenwood Springs, Colorado 81801 Phone (903) 945-8212 s1 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY � Owner's Name Nan & David Kelly Pr8sent Address 510 Mill Farm Rd., Nobleav1M� Ind. 317 - 773 -1 00 System Location Jc Z County Road 112, Carbondal Legal Description of Assessor's Parcel No. SYSTEM DESIGN g �( ! ?S/'L 1 0 � ' lank 9u p$ia '(Ifr B /i'Jk' /1ti$ Other - GRI ND e R�32 Z ) / 415i rT 2 O 3%' gi L. . !/ i../ . , -en n. 23 Percolation Rate (minutes /inch) Number of Bedrooms (or other) Required Absorption Area - See A ached Special Setback Requirements: L•L=Aw - . ,ac' FRoti zck'r'4 fr 'TG+ wG ' / / � py � +� �/// ILL. Date At/ ay Inspector /fajy" e FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) Call for Inspection (24 hours notice) Before Covering Installation \ System Installer , Septic Tank Capacity / .2 C 0 I $ Septic Tapir MpuleIcturer or Trade Name e.0 ' - CAA -t% I Septic Tank Access within 8" of surface L""` Absorption Area / 4' # )( 7 0 j r p Absorption Area Type and /or Manufacturer or Trade Name gs d, Fan �i r_ gc. Adequate compliance with County and State regulations/requirements 1 . ' Other /1_ /✓ i C �1.•, Date / / Inspector `+ -. )-ean� 1 4/4111.40, 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 l' 25, Article 10 C.R.S. 1973, Revised 1984. 2. This permit is valid only for connection to structures which have fully compiled 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 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 materiel variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($600.00 fine - 8 months In jail or both). Applicant: Green Copy Department: Pink Copy .- Application '�' ` INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: OWNER WA»J 4 I K(LLY ADDRESS SID M1l_I— FAR Ik. • PHONE 317 - 77 3_ 1500 11 - 0. CONTRACTOR Ac,kt r_kRIJ i (_o(' I► ADDRESS Box 13t CaKtewo m-i_ Co. 8162-3 PHONE `j 63 - 0 /l9 PERMIT REQUEST FOR: (A) 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 (.2 A kFI Lc Near what City of Town CPt6OIJI?4LE Lot Size 40 /IctCS Legal Description KivJ "4 Sic. 24 7.5 g8W WASTES TYPE: (7C) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Lo & Number of bedrooms if Number of persons 5 (7<) Garbage grinder (1 Automatic washer (7 Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (7 ) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: 2,6c3' If supplied by community water, give name or supplier: GROUND CONDITIONS: i Depth to bedrock: 2 3 ' Depth to first Ground Water Table: NoT vlsi8t Percent ground slope: 5 90 fi DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /t? to/66 Was an effort made to connect to community system? _ d 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: (2K) Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCIHARGED DIRECTLY INTO WATERS OF THE STATE? K50 N 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 permtt,is 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 Signed PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY I Y P; b 0 n d p R JE °� R1 riZ Nt. #VV / 35� k � �k ad - 41!wy e27 � as t&J 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 from dwelling or other fixed reference object, and additional submissions in support of this application such as data, plans, specifications, statements and connitments. P LPt, S fl��Qv��O Page 4 2%6? ;. °ms s fx e 2 Fos-- 9-#0 z.'a�p Gig � •`s° R 2LE" 7-fig7 ih- yr, - 105 1,91 , y5 o 22. QrjM/A �n 7)