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HomeMy WebLinkAbout02278 _ iv s GARFIELD COUNTY BUILDING AND SANIT DEPARTMENT Permit N_ 2 2 7 9t 1 109 8th Street Suite 303 Assessor's Parcel No. t i t Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute p INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. f PROPERTY 1 r. Owner's Name Kim A. Fischer Present Address 1527 130 Rd, G.S. Phone_ 945 -2092 ( System Location 2244 Odin Drive, Silt Legal Description of Assessor's Parcel No. 1 ry SYSTEM DESIGN ) t , y {, t 75 0 Septic Tank Capacity (gallon) Other 10 1- / • 1 , • r • 79 2 OA rs ,'J- O 'Vs `;n/9.cn r r(''' ` , .�F ( , , - / j . 2 J { pn 1/ () - /, Percolation Rate (minutes /inch) Number of Bedrooms (or other) • r . U r / • l �` Q Required Absorption Area - See Attaebed r . .. -r /' l { C ` y ct k i Special Setback Requirements: t/, !�.A^� '�'r`7 e ' s �� / '"v `� � ° 7 P 1, Date 7-/K---21 • -/K-' / 1 I ns pector j -n ) ( ), fl}* .11 i d FINAL SYSTEM INSPECTION AND APPROVAL. (as installed) Call for Inspection (24 hours notice) Before Covering Installation n $l System Installer_ 7) C' 4 12A 1Ay Fit-, 1 i Septic Tank Capacity I00 • 1 j Septic Tank Manufacturer or Trade Name _ `flf tdt. 1 1 ££ Septic Tank 4cess within $'•Z of surface 9e3 - ryry . Absorption Area � D�,� •�. pya' Absorption Area Type and /or Manufacturer or Trade Name , Ai P T247 C 4L€ Pe ' t Adequate compliance with County and State regulations /requirements 9 6_1 . Other t i Date . a - 3 - -94f Inspector /, 4 42.2440 W 7'' ' -L-/ RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION/ SITE r t •CONDITIONS: 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter i if • 25, Article 10 C.R.S. 1973, Revised 1984. f 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 r requirement of the permit and cause tor 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 (•y variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6r, i months in jail or both). 1 3 Applicant: Green Copy Department: Pink Copy t„ ri s ti. Application H INDI VIDI JAI, SF,WAGF DISPOSAI , SYSTEM APPi JCATION Approval By County Official OWNER %<44 , FSrwele `/o // ika Zfity /7t f/246 ADDRESS /S3 / 3o /1e2 47At'CvooD ?4fN(S PHONE 95 /150 0 o ONTRACTOR ADDRESS PHONE ERMIT REQUEST FOR: 90 New Installation ( ) Alteration ( ) Repair attach 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). ,OCATION OF PROPOSED FACII ,ITY • County _ c 0 Tear what City or Town 5/ 1. T Lot Size /D ,5 A C .egal Description aeq V 5' 0 Ito D 2 /L/L 7 .S/ Lr VASTF„S TYPE : Dwelling () Transient Use ( Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe IUILDING OR SERVICE TYPE: RC e5 /PE-i"7 /A Dumber of bedrooms 2- Number of persons )I Garbage grinder (cf Automatic Washer (sr Dishwasher ;Oi MCP AND TYPE OF WATER SI JPPI,Y: 0(} well () spring () stream or creek Jive depth of all wells within 180 feet of system: f supplied by community water, give name of supplier: IROT JND CONDITIONS; )epth to bedrock: )epth to first Ground Water Table: 'ercent ground slope: )ISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_ Nas an effort made to connect to community system? 41/4 CYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (X1 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? NO r' 1 ' PERCOLATION TEST RFS111.TS: (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. _ fame, 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; pid 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 // 7/7V Signed At.. 0 p1 ,EASF. DRAW AN ACCURATE MAP TO YOI IR PROPERTY 7N . t , ©d I r, r{-8 u s -e A 9_y4," /a: l5 30 it 0 r c 5 = /4 :.3 ; 5.33 2 0 1( y' 7 r - C 7 , ' .# r D 8'3 it s (— P