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Home My WebLink About02353 `? '?!rMRRR7a•'a+M13 "" "p°'•X64+�RMC�"„ '�°°Qep°'F':s' m�a[ " , ' "..;.?m.sr.:%A- - ^sw ' *� .. r:. . i f • Iv GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit tvl 2 3 5 3 i ! 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 s Phone (303) 945 -8212 f This does not constitute ; INDIVIDUAL SEWA DISPOSAL PERMIT a building or use permit. v PROPERTY ' 4 6 aA t Robert P. & Eula M. Johnsoppp 0027 149 Rd, Glenwood Spge 928 -9798 Owner's Name rient Address Phone_ it 4 System Location 0027 149 Road, Chelyn Acres, Lot 20, Glenwood Springs 'I, Legal Description of Assessor's Parcel No. fl / t SYSTEM DESIGN ,` • 4 no Q Septic Tank Capacity (gallon) Other - .2 r` , f ,r < = / / 0 -' L ri ciA!ci , a '"/i /,,. -1- 3 (A, f. r, t ' 1 Percolation Rate (minutes/inch) Number of - Bedrooms (or other) ,} / Z < ((yy " r4 ' r � -1- 4 :' s. r' (,? ;.,' Required Absorption Area - See Attached / ,t i 7 4 " / Irii , . Y f • '1 `� ry''' y y .. l''' ..d l_ Special Setback Requirements: 7 ? 4 47 <;, .. a? ? Oki , C„ r;✓ I/ . -., p- ,r F .. .t Z li Date 7/' i r- 1 it „..... __ Inspector ( t.. y4 A 'it - i FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before. Covering Installation $ f System Installer id /fl / % (in- T Septic Tank Capacity / 1 ' 0 P. & Septic Tank Manufacturer or Trade Name C ("I (!t? 41.T [ h [ E Septic Tank Access within 8” of surface I ! Absorption Area 7 1 / 2 /v,''.n c / ( _4 . :• , /'i■ , • r: (1 / j) i 1 � Absorption Area Type and /or Manufacturer or Trade Name jr-en . r .. l - ! rr; t 1 _....._.— --- Adequate compliance with County and State regulations /requirements Other 4 Date / r "' ! _. 7 / �._�..._.� �, .• \ _ t,,/ (%>•. • Inspector , • I RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE y, .r *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. t 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con - .t nection to or use with any dwelling or structures not approved by the Building and Zoning off ice shall automatically be a violation or e requirement of the permit and cause for both legal action and revocation of the permit. . t 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 1, Petty Offense ($500.00 fine —6 months in jail or both). t M Applicant: Green Copy Department: Pink Copy 'p IOW . f tEDEItir AUG 2 3 1994 1 ---_ Application JNDIVficiff i *R riE DISPOSAL. SYSTEM APPJ.ICATION Approval By County Official R OWNER n A617 te- ,Cu14 2 ANi,�N ADDRESS ea? c .. .4 'at 'Cr Co PHONE 9a8 " 7799 ",SD , DONTRACTOR 0 C -7 An 0 a..4 65 v.477 AR; ADDRESS 1 7 liS3 Nw/ P z / (AAA o. d.4 /F i C7 PHONEf6 —/ 'ERMIT REQUEST FOR: ( New Installation () Alteration () Repair kttach separate sheets or report showing entire area with respect to surrounding areas, topography of area, iabitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes "See page 4). LOCATION OF PROPOSED FACH .ITY : County 6 ' A-4 4 e ( d Near what City or Town 67e w w o o n SP/-t iv S Lot Size e ,4 c . Fs Legal Description (NBC y orki Ac2FS / Tr2467 2-0 / ,A ,SSC s Sots fs LC -2/es - 3 - no -nor., WASTES TYPE : Q Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Since /l E„4,-,, i /', Pes, €-,✓cC- Number of bedrooms q Number of persons Z C) Garbage grinder ('C) Automatic Washer (74 Dishwasher SOT JRCB AND TYPE OF WATER SI JPPJ.Y: 90 well () spring () stream or creek Give depth of all wells within 180 feet of system: g5 p. if supplied by community water, give name of supplier: !Q GROT IND CONDITIONS: Depth to bedrock: i /Wile ,vatiin/ Depth to first Ground Water Table: 0 ro k n /ON /,i Percent ground slope: /4 P PW Y %7 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM. 7i^/k'vo4) A/ Was an effort made to connect to community system? Al 0 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 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: Q9 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 NMI ;OTT. PERCOT.ATION TEST REST IT 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. _ game, address and telephone of RPE who made soil absorption tests: game, 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 locaPhealth 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. o , , Date f� /Z /9I T z Signed f� i� r� ! 2 to c PLEASE DRAW AN ACCT JRATE MAP TO YOTJR PROPERTY tri 1 15 7121 $T.Lff ccr i 7,9de ohle /9 d maw co. ?d . /y rm, (p &&et ®= - 0027 nil W71- CD ` ` f ' „ )r 8 l^_J /Q y t r 0 4 �, „ s. * '/ -r $0\45 3 s' 3 i/, 4 7 3 c r aY V 34 / "A 3 ay "1444