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Home My WebLink About02291 T - -r r ♦ ni..,...v^+ 'l . 'n T.Mngq'OS. }l,I�x }rt. VM' TI Niw'GI`ri FF^ 'V,rF.rn"1TPP.;... ry r, _ _ i - -. ._ _... } 4-- jj a GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 2 2 91 109 8th Street Suite 303 Assessor's Parcel No. t Glenwood Springs, Colorado 81601 Phone (303) 945 k This does not constitute INDIVIDUAL. SEWAGE DISPOSAL PERMIT a building or use permit. iR PROPERTY Donald M. Chaplin Box 550, Vail, CO Owner's Name Present Address Phone_ nt� A System Location 4023 li iew a ye 214, Silt Legal Description of Assessor's Parcel No. SYSTEM DESIGN / f Septic Tank Capacity (gallon) Other r J ' � " ,r., .. Perc Rate ` r' r t Y / p „ e �.� ; � (minutes /inch) Number of Bedrooms (or other) 3 � � � L . . , -is ,rl o x r�;.: Re uired Absorption Area - See Attached '.,) A . f. f °' q P / p G fit / � f n' 1a P� r.y Special Setback Requirements: ,� �. f V"' " - ' � ` e''' " // .,) F' r r C.P !? i_ n , Date 7 Inspector — $7:1 ' {� 7 Il FINAL SYSTEM AND APPROVAL (as installed) y Call for Inspection (24 hours notice) Before Covering Installation System Installer at4-'t' a . , f II Septic Tank Capacity / 6 0 Septic Tank Manufacturer or Trade Name • r/ 1 4 fi Septic Tank Access within 8" of surface L-- -- R i i Absorption Area .S g-0-14r0 c.)\ 1 0 ± / Arco t Absorption Area Type and /or Manufacturer or Trade Name � — "`71t. 1- 't^`U `"td'Y R , Adequate compliance with County and State regulations/requirements [lll[[////// L/ i f° Other Date T' / 6 - 9 1 Inspector ; a ar �. L.1 i A RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE •CONDITIONS: 0 • 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter '$ 25, Article 10 C.R.S. 1973, Revised 1984. r. 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con - F t 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 individualseWage disposal system in a manner which involves a knowing and materiel S variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense (8500.00 fine —6 S+ 4 months in jail or both). F A Applicant: Green Copy Department: Pink Copy Application • ".' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by OWNER ' '7`'T� -�„ M, c4RP ', ' County Official: i -NCO SIB. PNONE 3 CONTRACTOR _ CE%' ADDRESS ('S,O, (Ler _312a &kc.) � J �PHONE ggemos/ PERMIT REQUEST FOR: ( ) New Installation ( ) ?ation (k) 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_ Near what City of Town _— Lot Size 1 Pr Legal Description JON; '.._ 2I WASTES TYPE: OO Dwelling ( ) Transient Use ( ) Counercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe _ BUILDING OR SERVICE TYPE: 954WAIX. 44)hella ! S112E:Wl . Number of bedrooms • 3. Number of persons prey ( ) Garbage grinder (%) Automatic washer ( ) Dishwasher y etheo SOURCE AND TYPE OF WATER SUPPLY: (X) well ( ) spring ( ) stream or creek - Give depth of all wells within 180 feet of system: 1NA,�'O , IWJ If supplied by community water, give name or supplier: 4. GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: • _ • Percent ground slope: • _ i e3 Q/ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: ' t4 J past) Was an effort tirade to connect to community system? O 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: (X) Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED D1RECTLY INTO WATERS OF TIIE STATE? IyE:) rnOOP 2 ,S01L PERCOLATION TEST RESULTS: (To be completed by Reg isiere(' Professional Engineer.) Minutes per filch in hol e No. 1 Minutes _ per inch in hole Mo. 3 Minutes per inch in hol e No. 2 Minutes per inch in hole Mo. Name, address and telephone of !WE who made soil absorption tests: 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 periiat,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 .deparlinent of health in evaluating the same for purposes of issuing the permit appl ied for herein. I further under- stand that any falsification or misrepresentation may result in the denial of the application or revocation of any penal granted based upon said application and in legal action for per- jury as provided by law. Date D- 4- 01 S igned O 1A iI ../ . . . •1 PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY e . t, • N i nr - -P { f, vii R d y 5k • Clite 4 , 1.. • 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 slow location of proposed system by direction and distance from dwelling or other fixed reference object, and additional submissions in support of thi s application such as data, plans, specifications, statements and conmi Unents. \ b , t • • I • r S� . 1 S abc. .(AI ti \F H O ! kg . a E y ,r , 4 M / i e u y RA, Page 5 • ..., fie as -e r .5p=>1 i 0,'3 / 1 4.0 1 t( 0- 1! 4 7 is l it 3 9 � u t fi r, _. F 1 a 1 i eg . It, 0 - „/1 08 g ir r- i" 3 i C a, I