HomeMy WebLinkAbout02348 , r - k ' *'matRt 14•4nFxgIP13I7e lyk,nMltry'. 14 k 4 71'Se'i " 5 TM r1 r�r. a _._
.
AA I
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 1`_. 2 3 4 4 :, i
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81801
Phone (303) 945 -8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. 1
PROPERTY
Owner's Name Daniel K. Trautman Present Address Y.O. Box 2026, Basalt phone_ 927--4455
System Location 0113 Crystal River Road, Rock Creek Subdivision, Lot 2, Carbondale
Legal Description of Assessor's Parcel No.
H 64.. ervkr_ - g, ? r C L t e Y % - 0'�C u,, ✓ . 0 '. t, rr R'6 r , " . l� .
SYSTEM DESIGN 1;
r � 71J//"�� 7
/,2 J 0 Septic Tank Capacity (gallon) Other - / 1
t te,r. ; C / � An' Percolation Rate (minutes /inch) Nuum ber Bedrooms (gr other) 1 / % t .
ilk 3 re Required Absorption Area - See Method 4 9 S( f� 1 oc.� -/ * ' 4 ^ '" _. / 1 " a' ' ' , �
Att
Special Setback Requirements:
T +
Date /6-04°—(7 ' Inspector" = ,j_ t �'-iJ�, , E% '� C
E
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
4
Call for Inspection (24 hours notice) Before Covering Installation ,
{: 4
System installer n k v-y1-- r
k ''
Septic Tank Capacity / 0 r) -.
Septic Tank Manufacturer or Trade Name CC34 1' 7k /r !'cI P... - "
1
Septic Tank Access within 8" of surface
l� i
C •- ∎1 {'
Absorption Area 2 1 I
Absorption Area Type and /or Manufacturer or Trade Name 1 / ` A r \ 1 4 i r ,
* 1
Adequate compliance with County and State regulations /requirements / '1 -
Other
y'
Date / ? - - ' / Inspector ` : ._ -a ( ,1 ' +.
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
r '
•CONDITIONS: .l
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter C
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 k.
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). i
Applicant: Green Copy Department: Pink Copy
Application
JNDIVIDT JAT, SEWACTE. DTSPOSAT. SYSTEM APPI .ICATION Approval By
County Official
OWNER A rr: r / /r( Tan inian o
quo` ..
ADDRESS A .any eatag f! /6Z/ PHONE
CONTRACTOR Q amp r
ADDRESS PHONE
PERMIT REQUEST FOR: (4New 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, soil percolation test holes, soil profiles in test holes
(See page 4).
J.00ATION OF PROPOSED) FACILITY • County A7 e /r
Near what City or Town C do le Lot Size 5
4 l d
Legal Description Aa f 1 /fat ,F (Ca v k .S u /i /r):0
WASTES TYPE • (welling ( ) Transient Use
( ) Commercial or Institutional ( ) Non - domestic Wastes
() Other - Describe
BUILDING OR SERVICE TYPPJ; /Q• 'claw fit l st
Number of bedrooms 7 7 Number of persons
( ) Garbage grinder ( Automatic Washer 04—Dishwasher
,SOT JRCE ANT) TYPE OF WATER SI JPPT ,Y; (Well () spring () stream or creek
Give depth of all wells within 180 feet of system: /1 a q e
If supplied by community water, give name of supplier: /40c.. h CCe e 4
CiRO!JNI) CONDITIONS;
Depth to bedrock:
Depth to first Ground Water Table:
Percent ground slope: A0 JO i
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM_AoA+
Was an effort made to connect to community system? Ad
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
Or 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:
(iY 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? d
is • t • : • . r, : (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. _
Name, address and telephone of RPE 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 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 y /$' /q y Signed ca --
pi ,EASE DRAW AN ACCT JR ATE MAP TO YOT JR PROPERTY