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Home My WebLink About02395 °s JP 'tweior ve v- irya+.*...v -- „,vim... • n ” 1 12' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N . ' . 2395 14, 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945.8212 This does not constitute li INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. 1 i PROPERTY J i i 7,:3 5zz Owner's Name • Ernest Kollar Present Address ifi& P]tYif_ !Z1fTiver'!aaalt Phone_ 924-9414 . j' a a, System Location 0746 Wooden Deer, Lot 6, Carbondale s. / 4, 3 Legal Description of Assessor's Parcel No. l iil SYSTEM DESIGN K 7 Septic Tank Capacity (gallon) Other 4 ff Percolation Rate (minutes /inch) Number of Bedrooms (or other) y Required Absorption Area - See Attached .- G& „, /re,', 4. 5/ s /eel f t Special Setback Requirements: I Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) I4 Call for Inspection (24 hours notice) Before Covering Installation 1 II System Installer E1 1c ..t.T A, t i 1, $ 7 y Septic Tank Capacity / ' CT '1 ` ' `.' G ` ”" 3 i I t Septic Tank Manufacturer or Trade Name - %- ' 444* 7 o e ' . . rc .I Septic Tank Access within 8" of surface P C' Absorption Area ..' r .� , iS S ' ■ -.,G -! Absorption Area Type and /or Manufacturer or Trade Name ti 2 i ' I Adequate compliance with County and State regulations /requirements y/•.5 Other 72, r' ". �r,i /r:.k } II Date ^ -/'? - 9A Inspector t rAw e i RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE I •CONDITIONS: t 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter S 0, 25, Article 10 C.R.S. 1973, Revised 1984. 'i p 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- y nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a i 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 li variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 : months in jail or both). i Applicant: Green Copy Department: Pink Copy .t ,. • Application INDIV11)T JAI . SEWAGE T)ISPOSAT, SYSTEM APPT,IC.ATIOIQ Approval By County Official OWNER Ernr4f IC 1Iar g — 00 ADDRESS 'WS dark sl>c, p°/ � (aself / /a 8/6 PHONE 927-9f/7 • CONTRACTOR Sa w,. ADDRESS PHONE PERMIT REQUEST FOR: Q(► 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). Sec .pk►>5 LOCATION OF PROPOSED FACIT,TTY : County (ar4ir JI Near what City or Town Ca vbrnc%a fir. / Lot Size 2 4- ,4 etc; Legal Description Lnf 6, Won leer 5&4cbrr we>. Car.4.6( 4,44 WASTES TYPE • QQ Dwelling () Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Resid.r.,, {,a� Number of bedrooms 4 3 Number of persons 4 ( OT rbage grinder (K). Automatic Washer (4 Dishwasher $ CE, AND TYPE OF WATER 51 JPPT,Y: GO well () spring () stream or creek Give depth of all wells within 180 feet of system: Nan,- If supplied by community water, give name of supplier: 4 cbwlwlun Gj we /l , woods~ (Lcr C;ROTJNJ) CONDITIONS: Depth to bedrock: ) 10 Depth to first Ground Water Table: > I ° 1 Percent ground slope: 287„ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM;; el nulcs Was an effort made to connect to community system? es 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: (v) Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ) Other - Describe: War EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? NO ;,J4-0-6-/ '"" h , 0 . . ' i PRRC.OT.ATION TEST REST JT,TS: (To be completed by Registered Professional Engineer) Wlinutes A per inch in hole No. 1 Minutes /3 per inch in Hole No. 3 Minutes /q per inch in hole No. 2 Minutes per inch in Hole No. _ Name, address and telephone of RPE who made soil absorption tests; Erne sf Kollar 1 PE 117 Hal 5f. , 5.47 Cavloanhae -, to EV623 963 3223 [dame, address and telephone of RPE responsible for design of the system; E &ties t- /4/14r, p E Sec A - bow. 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 a ction for perjury as provided by law. late tl /yeir Signed ins,. /CT& p1 RASE DRAW AN ACCT JRATE MAP TO YOTJR PROPERTY T i1/4) Lo+ � Wootle Geer S ✓bd1U1Slow 000du, attr Rd, 4 ' o to h4W 4/6 0. P4 OP k, ert CA03a t •2.5 9vi t NwS 6) Vlu wA H^P • • pi .0T PLAN AND DESIGN FRATIJRRS 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. S?-c- 'vtU 1 1 3 5 + 6 • 11111