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Home My WebLink About02230 ,. =km _ . v u � r � j GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 1�. 223 0 ; 109 8th Street Suite 303 A re Parcel No. t Glenwood Springs, Colorado 81801 ' Phone (303) 9454212 This does not constitute ` INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Scott M Henke Present Address 17696 Rwy 82, Carbondale phone 969 -3488 System Location 0668 County Road 170, Carbondale Legal Description of Assessor's Parcel No. .. ' SYSTEM DESIGN 7 i / Septic Tank Capacity (gallon) Other � ? 7 ( R 7,3.2 � /� o c i � /� e 8 A U 17 L o 7 �, t . � � k I r d1 rK Perco Rate (minutes/inch) Number of Bedrooms (or other) 9 < f' yr_ u • 1 r y . 9 /In il AeAchtged— /,2 '< Required Absorption Area - See Ad akad ' ' { .S y 44 7 hi 17 TAA 76 Ii 6.nr 2 4( p . ( gtr.',J . Special Setback Requirements: C a y "PI C o ->1 1 A- c.7 O V one 3 / r_ l- t -Ci.? Date I/. f 7- 2 "/ Inspector 447± + (0. CA+-.I - y � FINAL SYSTEM INSPECTION AND APPROVAL (as installed) t Cell for Inspection (24 hours notice) Before Covering Installation 3 k t i System Installer O Lv 'f!') `e -}— F 4i Septic Tank Capacity /2 - 9 . Septic Tank Manufacturer or Trade Name _ air .„ Septic Tank Access within 8" of surface ' � Absorption Area 6, L/ Q ) Absorption Area Type and /or Manufacturer or Trade Name -- N Pi) t PC /f rn 6 �. )1 D to 0 Oh/ - i Adequate compliance with County and State regulations/requirements s Other f (/.s � } � + �� Date /�'�,� —711 Inspector �J"�vl 62 vr.-- '{_/hQ 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 [ P 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 mateial variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine —8 months In Jail or both). ----. Applicant: Green Copy Department: Pink Copy - p - - ---- --- - - - - -- • r ' • f t Application INDIVIDJIAJ. SEWAGE. DJSPOSAI. SYSTEM APPI JCATION Approval By County Official OWNER r 4 Hk,A;RE ADDRESS (g May Az.- (}4 - e604) b4l6 COR) - 8I t 2 -3 PHONE 90 3'3 /5 'ONTRACTOR O W ltfk.l� ADDRESS PHONE ERMIT REQUEST FOR: QQ New Installation () Alteration () Repair Mach separate sheets or report showing entire area with respect to surrounding areas, topography of area, abitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes See page 4). ; A � / k � i� ,OCATION OF PROPOSED FACILITY : County . dear what City or Town O A c3 ow D» I C Lot Size - .egalDescription .4/ F l, 17 low NJlI1P �J 4 1)04rrfl � 2n,� - 67 evf;vr' G in Er/ Iv/ .?).a, 0 IA iv GRPf71 h Onveii Y- VASTES TYPE : 00 Dwelling / () Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe IUILDING OR SERVICE TYPE: /\ h l n1- ;U7 v °II%k' PA in mil -- lumber of bedrooms, Nuiiiber of persons .3 aQ Garbage grinder (4 Automatic Washer (<1 Dishwasher ;OI MCP. ANT) TYPE OF WATER SUPPLY: 64 well spjing () stream or creek Jive depth of all wells within 180 feet of system: ' 0 f supplied by community water, give name of supplier: ;ROIJNI) CONDITIONS: ,- Depth to bedrock: )epth to first Ground Water Table: 3 'ercent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM,:_ b M t g4/Unek174 Was an effort made to connect to community system? gib [TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: Q() 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: (sO 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? A��' • OH. PERCOLATION TEST RESt1iTS: (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. lame, address and telephone of RPE who made soil absorption tests; lame, 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 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 understand 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 perjury as provided by law. Date 3 / Z Z.. / `t / Signed ,S/' ,l2 €94 /07, 1/4 PLEASE, DRAW AN ACCURATE MAP TO YOUR PRQPERTY p/t.94 L_C) u fti /: 170 l] iH A3 ,o Q � ° �` ° � t a d io° 1 . + .Y pi.nT PLAN AND DESIC:N PRATT IRKS 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 commitments. 5 ;\-Tr-h c tl E p R--4 N5 7 • X r • • )145 LU. I , z - 3 - ti ribetrae r 1