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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit i\r 2 3 0` GF
109 8th Street Suite 303 Assessor's Parcel No.. . I'
Glenwood Springs, Colorado 81601 THIS PERMIT REPLACES
Phone (303) 945 -8212 PERMIT No. 2040 #'M
Mi
This does not constitute k '' -
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. 6 A
PROPERTY (#
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Owner's Name Barbara Paschin Present Address P.O. Box 126, Carbondale phone_ 963 -2209 (I
System Location 0165 County Road 118, Carbondal
I
Legal Description of Assessor's Parcel No. q
l
SYSTEM DESIGN Y,
i
Septic Tank Capacity (gallon) Other #
Percolation Rate (minutes /inch) Number of Bedrooms (or other) 17
Required Absorption Area - See Attached 4
A
Special Setback Requirements:
Date Inspector y
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ? t
I t i
Call for Inspection (24 hours notice) Before Covering Installation
System Installer . `1 �'t AA7 :°+' 4 �,l1- `" " ', .
Septic Tank Capacity i 0 U t
I
/ 7 ; i
Septic Tank Manufacturer or Trade Name - . } LP_'?+:YIJ�
� //
Septic Tank Access within 8" of surface [/ j
�7 / ` n n I . 1
Absorption Area 11 f J � � ` "` i �� f2+^ ?( /" < .
Absorption Area Type and /or Manufacturer or Trade Name C::.,. f -4 ' ; r
J f' <. / , PP i
Adequate compliance with County and State regulations/requirements L 4
, -- r-." /
Other , n ` r ' C _ .. j,. L - i a t- ' • � . :.
111 7 k Y
Date 1 - 3 — 7 i Inspector i'f" , (i, ... , -? -d
Q
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE o
*CONDITIONS:
1
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter i
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- p
nection to or use with any dwelling or structures not approved by the Building and Zoning off ice shall automatically be a violation or a k ! .
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 d
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). 1'
Applicant: Green Copy Department: Pink Copy i
733 '
... _..... a — . _ _ — -- _
JNT)IVIT)T JAT. SEWAGE DISPOSAL SYSTEM APPT,ICATTON -
OWNER Faschina Haus, Tnr.
ADDRESS 0165 Mt. Sopris Ranrh Ranrh Road PHONE - v) - 963 -2209
CONTRACTOR Earthworks Construrtinn, Tnr.
ADDRESS 744 MPrri 11 Street Carhnnda 1 P PHONE 9Fi3 -72(1R
PERMIT REQUEST FOR (x ) NEW 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 f; a r f 1 co d
Near what City or Town rarhnndala rnlrxado Lot
Legal Description Seim attar hPrl
WASTES TYPE: ()) Dwelling ( ) Transient Use
( ) Commercial or Industrial ( ) Non - domestic Wastes
() Other - Describe
BUILDING OR SERVICE TYPE: Red and RrPakfact RPCnrt - f.nPat rnnmc
Number of bedrooms: /2- -k Number of persons
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
SOT IRCE ANT) TYPE OF WATER ST JPPT.Y: ( ) WELL () SPRING ( ) STREAM OR CREEK
Give depth of all wells within 180 feet of system: Well #1 140 ft . (95 ft to groundwater)
If supplied by communtiy water, give name of supplier: l i 3 u r t. 80 ft to groundwa t er
OROT TNT) CONDITIONS:
Depth to bedrock: Mor than 130 ft.
Depth to first Ground Water Table: SO f t
Percent Ground Slope: 746
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: one m i 1P
Was an effort made to connect to community system? no
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 DIRECTLY INTO WATERS OF THE STATE? nn
s fsre B v et. s /ZEO 70 AGG -e , CIS ,ore 7 „Ex-, "id
ns I/
sNr e0 /F Q 9�Q o ZoV/Nd, W,E,C,� � �
mmo Bbv AA rat mafi Oh lehre deer _ Sep
Cmetuse
/2/3)1
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.
*See plan
Name, address and telephone of' RPE who made soil absorption tests:
High Country Engineering 923 Cooper Ave, Glenwood SpringR, Onto
945 -8676
Name, address and telephone of RPE responsible for design of the system:
same
Applicant acknowledges that the completeness of the appliction 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 inusre compliance with ,
rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby
certifies that all statements make, 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 bre relied on by the local department of health in evluating the same fro 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.
Signe• . 1 . _ r , ! _ . c_. Date 11 (a9
PLEASE DRA ACCT JRA'TF MAP TO YOIJR PROPERTY
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923 Cooper Avenue • Glenwood Springs, CO 81601
Telephone: 303-945-8676 • FAX: 303. 945.2555
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923 Cooper Avenue • Glenwood Springs, CO 81601
Telephone: 303- 945 -8676 • FAX: 303-945-2555