HomeMy WebLinkAbout02203 + f GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit Iv.. 2 2 0 3
109 8th Street Suite 303 Assessor's Parcel No. i
Glenwood Springs, Colorado 81801
Phone (303) 945 -8212 t
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY 1
943288
Owner's Name Barry 8 Jana Till Present Address 3315 Road 119, Carbondale Phone
System Location 0206 Cotton Hollow Lane. Cottonwood Hollow. Lot 9, Carbondale r Y
•
Legal Description of Assessor's Parcel No.
i
SYSTEM DESIGN '
Mite war/tett d - 0
/000 Septic Tank Capacity (gallon) 44-fi!inufM1' Other 4y
0 i
Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3
•
04 X v 1 t. y / 'd t P.W.
Required Absorption Area - See Attached �1 r , 5 9s- 4' or nit 1
`
Special Setback Requirements: p 2,- / 5 �Cs 0 iffeiel / /dN nil q '
9 /75 X 3'./6 c 412 7 .•'&7 I
Date , / Inspector `t f it' Fr x3/ 10 '
rhPrw 702 4 r
FINAL SYSTEM INSPECTION AND APPROVAL (as installs
`
Call for Inspection (24 hours notice) Before Covering Installation 840 362 b- / r S —
System I /laller 7% .r. "' . A I --- l ' SI t
/
Septic Tank Capacity au Ca a b / ?b6 i
Septic Tank Manufacturer or Trade Name Lt )esto R
Septic Tank Access within 8" of surface h- ' t A
Absorption Area
Absorption Area Type and /or Manufacturer or Trade Name ---0 j . � . t rC�l ate . e ii
Adequate compliance with County and State regulations/requirements 5'�` 1 / '
Other 111
Date 4 - es - 4.,g - Inspector t ( • - . - .., q
RETAIN WITH RECEIPT RECORDS AT CON SITE 1
•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. i
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 office shall automatically be a violation or a
requirement of the permit and cause for both legal action and revocation of the permit. 1
3. Any person who constructs, alters, or installs an Individual sewage disposal system in a manner which involves a knowing and material A
+ variation from . the Wm} or specifications containeQ.l the application of permit commits a Close I, Petty Offense (85 fi —6 , '..
months In all or hMh):
�nwi i i Applicant: Green Oopy Department: Pink Copy
Application
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
4 County Official:
OWNER F5c* t'rr � st Jnne. 171
ADDRESS 4 333 S — Road 113 PHONE 94/6-jcp 88 777__ ` 50 �.
CONTRACTOR OrA ✓,StiVCS
ADDRESS PHONE
PERMIT REQUEST FOR: (el' 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 (3 r.6
Near what City of Town Gprhanctie. Lot Size 1•.&Q acre
Legal Description 1 a / ' i S P 93 b7
WASTES TYPE: ( ✓) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe !_
BUILDING OR SERVICE TYPE: h o,ry,
Number of bedrooms Number of persons 2
( ) Garbage grinder ('Automatic washer (IA Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (1/1 well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system:' ht well Is tj,rox u c • I7 i t a-c.4 Otto')
If supplied by community water, give name or supplier:+' scPNc.. "Jell is irio'F4 - J h '' 9
GROUND CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table: _ T
Percent ground slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to community system? S o
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? J\fa
Page 2
' 1• 1
SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.)
Minutes per per inch in hole No. 1 Minutes /5 per inch in hole No. 3
Minutes /1) per inch in hole No. 2 Minutes per inch in hole Mo._
Name, address and telephone of RPE who made soil absorption tests: Uq ve A • Yo N n
Chen Nfor +kern So80 RcL. 15q elent.ono;l Spr;nijs , co qt /5 g 50
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 permit 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 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 aas_
sprovided by law.
D
Date 4442-0 L 4- /g94 Signed it )0VVLt l /.
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY (J
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