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Home My WebLink About02180 1�11 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit tv� 218 109 8th Street Suite 303 A is Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY • Owner's Name Stephen 11. Callicotte Present Address 2369 CR 103, Carbondale Phone 963 -2264 System Location 2369 County Road 103, Carbondale Legal Description of Assessor's Parcel No. SYSTEM DESIGN J/) .'((d septic Tank Capacity (gallon) Other ( 3 .. Percolation Rate (minutes/Inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: C • Date11 /ir 2 /0 Inspector A/ r/fa' FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer B'"'1 ,.1 R� Septic Tank Capacity / 0 0 V Septic Tank Manufacturer or Trade Name- "k -n•4 I rt . Septic Tank Access within 8" of surface • — Absorption Area ? N't`. t ) @ d l ,. -• / r .r t•U" J - Absorption Area Type and /or Manufacturer or Trade Name S'i. -r �7 �l 'rc-'I -f- v Adequate compliance with County and State regulations/requirements Other nn 2 'a ,!{ /"{ Date / c - < 7 c/ ? Inspector (- --f > L,1 L t /0. .. 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 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 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). is Applicant: Green Copy Department: Pink Copy Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: OWNER S rEPftei t 0A4 1_ 1 C 07 - 7 .' f ADDRESS 2 3 6 q R., 1oa, O 'da /_. _ PHONE ?III ,/ y CONTRACTOR R0,e Al AA' 7 - y,c/ ADDRESS PHONE 96 3 2 2 ?V 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, sail profiles in test holes. (See page 4.) LOCATION OF PROPOSED FACILITY: County G ft R Ft EL. Near what City of Town C A103 D14- __ Lot Size ‘`14C • Legal Description /V4.4 ,l/ E ept- WASTES TYPE: (' ) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: _rd Number of bedrooms 3 _- Number of persons e ( ) Garbage grinder ( ) Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( )C.) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: / g0 /_.pie 4,0,4 If supplied by community water, give name or supplier: GROUND CONDITIONS: L ,4 k' .s H A - t E APO 64sPet t'eL \ Depth to bedrock: 57b PE/I fa ( f gap ('Qe l c' ,a sOC/ J Depth to first Ground Water Table: / Fr Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_s It 6 CS : 5 Was an effort made to connect to community system? V() • 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: pc) Absorption Trench, Bed or Pit ( ) Evapotranspiration (x) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT DE DISCHARGED DIRECTLY INTO WATERS OF TIIE STATE? ay ,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._ Nance, address and telephone of RPE who made soil absorption tests:_ Name, address and telephone of RPE responsible for design of the system: Ice,(/ /!A/t 4v1 5TE PiF C ti N C 6 r -� I C oprr 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 pernift.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 my knowledge and belief and are designed to be relied on by the local department of health in evaluating the sane 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. �y- p Date - /OAP [ r 79 Signed „Q rie492. %!%� �L+i ' PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY �� C N -� � 2 7- 5 R,1 � / Q< acs • w �� W ttt. l 0 6° j{,:_) Koose / f'TV TAM< wtZJ- i3E tA) S % o F go tl t A I)o t -'r ! r fif ANP • _ _—.� 4 8 s» R P I l o A.2 T /Z e c w iy I v Co 12 r - — , 5rCay z o ` 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 conwitments. • Page 4 q/ 3,•/3 7 3 7 5 v f / CIP 3= ,41` 4, 3;s C7 i AA /72) ;� , // :v. €4 I 3W 32.7 in %11n ■ `l' ica r