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Home My WebLink About02216 a — .... •1 • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N: 2216 109 6th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (903) 945-8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Floyd Collins Present Address 6702 Edgings)? 82 s Gleavo*Ahone 945 -4079 System Location 6702 Highway 82 Glenwood Springs Legal Description of Assessor's Parcel No. SYSTEM DESIGN l 7' f ) Septic Tank Capacity (gallon) Other � • � / Percolation 2 persons Rate (minutes/inch) Number of Bedrooms (or other) l 1 Required Absorption Area - See Attached ��r: r^ f -1,4 i",; 7ov / Special Setback Requirements: Date it 4 ' 7 I,r Inspector . � , {- .: r!-nr, 1 r -o ' f, . FINAL. SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation ¢ System Installer - , d �, r Septic Tank Capacity /� ' ? 'J Septic Tank Manufacturer or Trade Name ( '� Septic Tank Access within 8" of surface Absorption Area / {- f' {. Absorption Area Type and /or Manufacturer or Trade Name 1 • Adequate compliance with County and State regulations /requirements Other • Date ;) � Inspector .� ;r,1 , ( ?. t /`_ 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 office 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 Claes I, Petty Offense ($500.00 fine — 6 months in )ail or both). Applicant: Green Copy Department: Pink Copy r '; Application ; IN IVIUUN_ SEWAGE DISPOSAL SYSILII API'LICAIION Approval by OWNER fG b Mist) -- - - - - - County Official: _ -�7 _ ADDRESS 1p7 w 1/ 15� - _ /l _-- __I'IIUH[ CONTRACTUH /'t s / _ —_— ADDRESS _�d tr55iQ 72,, __ Ilium: 9 5-Van" q ,, PERMIT REQUEST FUit: OO 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, sail percolation test holes, soil profiles in test holes. See gage 4.) LOCATION U1= PROPOSED FACILITY: County_ { eK" Near what City of Town (1.,vutopsi_ _ __ Lot Size /1 7 ? C, Legal Description -- - -• -- - - - ^-- ---- - -__ -_ WASTES TYPE: ( ) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Lion- domestic Wastes ( n ) Other - Describe__________ _____ - - -- -- - - -- - BUILDING OR SERVICE TYPE: Humber of bedrooms - -_ — — Number of persons (44.10.4.41,2144 ( ) Garbage grinder ( ) Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ,(y..) well ( ) spring ( ) stream or creek Give depth of all wells within 100 feet of system: __D6'_ _ If If supplied by community water, give name or supplier: _ - - ___ _ _____ _____ GROUND CONDITIONS: Depth to bedrock: �0.-D --- -• - ___ j . -_. -- - Depth to first Ground Water Table: � � -_- Percent ground slope: ' 1 .- a,d , ------- - - - _- ----- J __ - -- -_ UISTAIICE 10 NEAREST COMMUNITY SEWIIIt SYS1Ch1: _ ____ - -_____ Was an effort made to connect to community systeul7__ 4 _ ,fg _ __� _ - -_ TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSi[11 PROPOSED: (K) Septic Tank ( ) Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use ( ) Pit Privy ( ) Incineration loilet ( ) Recycling, other use ( ) Chemical Toilet ( ) Other - Describe: - ` - _ - _ FINAL DISPOSAL BY: OO Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Saud Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: -- - _ - _ - ..-__-.- WILL EFFLUENT BE DISCHARGED DIRECTLY 11110 WATLItS OF THE S1AlE7 1 1 1':,nr-. 2 - - •SOILI'ERCOLATIOU TEST RESULTS: (To be completed by Registered Professional Engineer.) Minutes per inch In hole No. 1 Minutes __per inch in hole Ilo. 3 Minutes per inch in hole Ho. 2 Minutes _ per inch In hole No. Name, address and telephone of RI'E who made soil absorption tests: Nance, address and telephone of IIPE 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 peniitt.is'subject to such terms and conditions as deemed necessary La insure compliance with rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. 1he 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 lo 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. 1 further under- stand that any falsification or misrepresentation may result in the denial of Lhe application or revocation of any permit granted based upon said application and in legal action for per - jury as provided bylaw. Dale Signc � d / e PLEASE ORAN AHD ACCURATE MAP 10 YOUR PROPERTY • • • • • • Page 3 PLOI PLAN MID DESIGN ULAIUIIES: Include by measured distance location of wells, springs, potable water supply 1 Ines , cis terns , buildings, property I Ines , subsoil drains, lake , traler course, stream, dry gulch and show location of proposed system by direction and distance front dwelling or other fixed reference object, and add 111onal submissions in support of ibis appl ication such as da la , plans, specif ications , sLaLenrents and conon I Linen is . • Page 4