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Home My WebLink About02406 ye p„ t « N ‘. , Gf GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 2 4 0 6 i � o . 109 8th Street Suite 303 Assessor's Parcel No. P 'a Glenwood Springs, Colorado 81601 tj Phone (303) 945-8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY . ‘„ Owner's Name Larry G Pat Tiffany Present Address P.O. BOX 68, Silt Phone_ 876 -6511 f 8 System Location . / County Road 233, Antlers Orchard. Lot 51. Silt Legal Description of Assessor's Parcel No. r SYSTEM DESIGN M1 1 U () O Septic Tank Capacity (gallon) • Other i - , 1 3 i / Li , 1 Percolation Rate (minutes /inch) Number of Bedrooms (or other) ^ C Required Absorption Area - See Attached r , • ! / 1 ' ` ', _ , ) - - . . , r 2 I - , c r . , Special Setback Requirements: / i ii / r -I 1 I t « r. 0 , , A. t,_, E✓ 1` f, 0 r & 8 p Date // ry " 7 ^ • Inspector 49- ' cni t ,,, c nt /`y P FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation jj System Installer C (.' ''%' I R Septic Tank Capacity i f) 0 O //^^ Septic Tank Manufacturer or Trade Name \ . 0 V✓ C-' '. c. O it Il Septic Tank Access within 8" of surface I it s Absorption Area y ./4 � Y. i / r � Absorption Area Type and /Or Manufacturer or Trade Name ([1 (: 'Ci l t a Adequate compliance with County and State regulations/requirements , – t Other 1 Date ) / 4' c ' 1.'" Inspector J - � &di''<rf f. l_.,r. -Ai im�!s RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE ' *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 - a p nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a 1 requirement of the permit and cause for both legal action and revocation of the permit. 6. . 3. Any person who constructs, alters, or Installs an individual sewage disposal system in a manner which involves a knowing and material 1 "y variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine —6 i months in )ail or both). Applicant: Green Copy Department: Pink Copy 1 4 Application JNI�IVIT)[ IAT, SEWACIE DISPOSAT. SYSTEM APPI,ICATION' Approval By County Official OWNER 4AAR y D t PAT r-1. T, FFsN ADDRESS PD Rene .48 S; !t Co. f1 /I6SL PHONE7o3l874-5szo 0 :ONTRACTOR L "saa y 1), r, PPnN y / ADDRESS PO. flox /.R silt re) 8/6 SL PHONE 27642zo 'ERMIT REQUEST FOR: QQ New Installation () Alteration () Repair attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, tabitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes See page 4). ,OCATION OF PROPOSED FACILITY : County GARP /c /d gear what City or Town Si f' Lot Size /6 ACRE' .egal Description Trier .5i Setno,v 25, Townsl„p 5 sold , RaNyc 92 co,. 5r o4' The 4Th P.M. as show#/ o n/ r9NTLaR Oszc AARef WASTES TYPE : (x) Dwelling () Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe 3UILDING OR SERVICE TYPE: s r of b4rooms 3 Number of persons if `N arge grinder Q() Automatic Washer Q() Dishwasher [MCP. AND TYPE OF WATER ST TPPI .Y; (X) well () spring () stream or creek _live depth of all wells within 180 feet of system: _/o NC f supplied by community water, give name of supplier: — 1ROT IND CONDITIONS; )epth to bedrock: )epth to first Ground Water Table: 'ercent ground slope: 3ISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:—) S /nil ss Has an effort made to connect to community system? No CYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: Q() 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: QQ 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? Al0 y - f . OIT. PE.RCOL.ATION TEST REST TI TES: (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. _ fame, address and telephone of RPE who made soil absorption tests; fame, 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 .3/495 Signed � - - // : - - p1,F.ASE DRAW AN ACCTJRATR MAP TO YOT IR PROPERTY H -i x opeary e QI A of _ \ K .e.„,,iy L� _ z C L ■ Ac :5 " I --. N 1 s-- h TO < ( - C < RIFLE SILT, Co.. J . pi .OT PLAN AND DRSIGN FRATI 1RES 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. pi( II moo, o M 3 / � D l�ctst li pRvpa5 A 46x60 inapt( Pik x nE j A , . ti i it 0 ... ___---- ---___ n . i t 1+6- C o � ��rA u if J it g 6 3