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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit h: 2 3 3 5 R,
109 8th Street Suite 303 Assessor's Parcel No.
5.
Glenwood Springs, Colorado 81601 i . ii
Phone (303) 945 -8212 i8
This does not constitute P
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. 1,1
PROPERTY 4
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Owner's Name Mark & Martha Allan Present Address Carbondale, CO Phone_.
System Location 0501 Wooden Deer Road, Lot 12, Carbondale
Legal Description of Assessor's Parcel No. . 11
SYSTEM DESIGN
/ 1
! 1 /) l 1 Septic Tank Capacity (gallon) Other 1 k
/ �� /n -.vi Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 •
t
a' Q le ti 9.',1 C ,1' `� X c es ' 4 IT c ('
Required Absorption Area - See Attached -1•1"
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1/ 41 ? i 'ty it a�) t.n . �7 � .PAu i• ill { „� ) r'.€ P.C1,f c g � 1 • •
Special Setback Requirements: .✓<'• cq r', n Al a S r , t , C ",� 1 1
7 ` / . 7 f
Date 7 _, / e '� Inspector c - - ~. / / ,
� /'[-t} ?/ ✓l. /L„ 8
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation i
System Installer -5 6 41.4 o ( Yailettc C F I�0> Q ill C- / S er Z-...) F
Septic Tank Capacity 14,9 S
Septic Tank Manufacturer or Trade Name ( d f't RXIOt y `
r
Septic Tank Access within 8" of surface T l3
Absorption Area -1 1 / es P
Absorption Area Type and /or Manufacturer or Trade N / il. , 7 ME; LT/zetftetes c? (0..t , 1
Adequate compliance with County and State regulations /requirements 1 C #.
1 .
1.
Other
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Date / p? 7 " " / Inspector _.
RETAIN WITH RECEIPT RECORDS AT CONSTR / TION SITE
*CONDITIONS: t
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter • t;
25, Article 10 C.R.S. 1973, Revised 1984.
1
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- 1
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. i
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 Class I, Petty Offense ($500.00 fine — 6 --
months in )ail or both). t
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Applicant: Green Copy Department: Pink Copyy, 4
.; Application
1NJ)IVIDIJAt SEWAGE DISPOSAT, SYSTEM APPLICATION Approval By
County Official
OWNER $/ t lW rH/4- gtceb)
.ADDRESS / V. D /5-4° C. PHONE /
DNTRACTOR GAR H
' ' ADDRESS 0157 f9l,eaH9V Mille" CS GOLD PHONE 9VVG6s`V
LIRMIT REQUEST FOR: (lrNew Installation () Alteration () Repair
ttach separate sheets or report showing entire area with respect to surrounding areas, topography of area,
.tbitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes
;ee page 4).
OCATION OF PROPOSED F,A II •I� : County G» tC F I C 1 fear what City or Town (� te6 Lot Size 5, n3zl f9cRec
egal Description t-or JZ &DOOED De v9 V rsiix-
/ASTES TYPE : (Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non - domestic Wastes
(:) Other - Describe
;UILDING OR SERVICE TYPE: re ES Der 4)CE
lumber of bedrooms 4 Number of persons 3
) Garbage grinder (4- Automatic Washer ( 'rDishwasher
OURCE AND TYPF. OF WATER SI IPPJ.Y; ( ) well ( ) spring () strewn or creek
live depth of all wells within 180 feet of system: ��� OE v/�O f V / S/
f supplied by conmunity water, give name of supplier:
MOUND CONDITIONS;
)epth to bedrock: la N) I? 11)0100
)epth to first Ground Water Table:. 1) n.) g vounu
'ercent ground slope: V A2 r &s .9llef ox /09a
)ISTANCETO NEAREST COMMUNITY SEWER SYSTEM,:_ Nn m //- e'
lS
Vas an effort made to connect to community system?
!'YPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(kV Septic Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
() Chemical Toilet ( ) Other - Describe:
i D SPOSAL BY:
(9 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? QUO
IL PERCOLATION TEST RESi1 ,TS: (To be completed by Registered Professional Engineer)
i 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. _
me, address and telephone of RPE who made soil absorption tests:
me, 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 � / Signed C'- '`y� "K'�-
PLEASE. DE AW AN ACCURATE MAP TO Y01 fit PROPERTY
•
•
p 1,QT PLAN AND DESIGN FRATTlRES
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.
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