HomeMy WebLinkAbout02405 C. t, c.• \\ Ai +}?".4:
i
' , „T F
GARFIELD COUNTY BUILDWO AND 4NItATION DEPARTMENT " \
Permit 'N.. `4 5
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601 _
Phone (303) Q45-8214, 4 r ,s\, - 2..
, _!� This does not constitute yy;�
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. k ii
PROPERTY t) \ ,k 00 t
Owner's Name Richard ?.I Fuller Present Addr�ss -P.O. $ox.2 , ay-Castle le phone_ 876 °56
System Location /2 `/ County Road 233, Silt
Legal Description of Assessor's Parcel No. km \��� 0 11, ■ • ■ �Y'1`'�
SYSTEM DESIGN 3 / L 19
7 _ 7
f
Fs
1�. Septic Tank Capacity (gallon) (. Other -`- ._.._ f
! ri;. ! w "triton { ' P( 4", , eAdi 0 9 g C C N fir✓ 2!
arc la ion Rate (minutes /inch) u mber B -- roo m s (` other
Required Absorption Area - See Attached '/ .- 3 n ✓ ' .' Ch 4- '/C . -` 1 CA-- f #
Vi .7n ,;x;2r,i ,,Ta /
Special Setback Requirements: 3 d 8 r G - ;-�/ ,g r- „ 0k IS 1'1(
Date .'R.' Q— ' . Inspector _. ✓� i»
I r
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) 1 \\
Call for Inspection (24 hours notice) Before Covering Installation "t \' ;; 1/2 Ii
System Installer 1- ULLe lL l .- i
Septic Tank Capacity /Onfl 1 F
Septic Tank Manufacturer or Trade Name Aye w7 w a
E
L
Septic Tank Access within 8” of surface Vt_S i
C/ 1 ,) r. \,
Absorption Area &7,.
Absorption Area Type and /or Manufacturer or Trade Name 8 7 &"' . /r- - f / � b
474/P0 sir P" •
Adequate compliance with County and State regulations/requirements (94-c
1
Other i
Date B - //e -95 Inspector #v g-c. I,
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE 1
*CONDITIONS: i
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-
nectiontoorusewithanydwellingorstructuresnotapprovedbytheBuildingandZoningofficeshallautomaticallybeaviolationor
requirement of the permit and cause for both legal action and revocati�bn 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
variation from the terms or specifications contained in the application pf permit commits a Class I, Petty Offense ($500.00 fine — e'
months in Jail or both). i A
f t
Applicant: Green Copy Department: Pink Copy I y
III'
li
i:i ` Application
I INDIVII)t JAI .SRWACGE DISPOSAI. SYSTEM APPLICATION Approval By
AL County Official
L O WNER � b t �UR C�inl F u . 1�4� �a a3D
ADDRESS '?O 60,4 -(O Na x.) CAZL -E gb FCt( -1 PHONE 3o9•o &e'$ f ra.
DNTRACTOR• rt ra a� PHONE�1 /
ADDRESS
IRMIT REQUEST FOR: (tiNew Installation () Alteration () Repair
Mach separate sheets or report showing entire area with respect to surrounding areas, topography of area,
bitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes
ice page 4). /1
OC.ATION OF PROPOSED FACILITY : County L�AR. e- t
fear what City or Town S ; LT Lot Size 10 $kcRE5
egal Description Iowa s� . w 5 So tsT� R• 0( a `Ao Z n-�- (��' Rai
Sar ` 3S t.oET 35 Inc- vmtY.1T 3 "? SEt /,.(nl /4 SE. 14
I ASTES TYPE : (VI Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non - domestic Wastes
(:) Other - Describe
:UILDING OR SERVICE TYPE: lin
lumber of bedrooms Number of persons
wr Garbage grinder (9' Automatic Washer ( {Dishwasher
OT IRCR, ANT) TYPE OF WATER St IPPLY; (✓' well () spring () stream or creek
live depth of all wells within 180 feet of system:
['supplied by community water, give name of supplier:
;ROUND CONDITIONS;
)epth to bedrock:
)epth to first Ground Water Table:
'ercent ground slope:
)ISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_
Vas an effort made to connect to community system?
CYPE 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:
;ANAL DISPOSAL BY:
(>4 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? t°
• M
ii
IL PERCOLATION TEST R ESI II •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. _
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 t ?e 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 subntted 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 pa' d pplication and in legal
action for perjury as provided bylaw.
L. :� i
Date o -- IS CIS Signed
PLEASE DRAW AN ACCI IRATE MAP TO YOUR PROPERTY
,_