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Home My WebLink About02434 .. • ' - a ry,M A It I ay GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N.. 2 4 3 4 j ' 109 8th Street Suite 303 Assessor's Parcel No. C, Glenwood Springs, Colorado 81601 ^' Phone (303) 945-8212 t' This does not constitute 1 INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. f PROPERTY 4` . Owner's Name Wayne Cooley Pras: ddress 1116 191neota Dr, Silt Phone_ 876 -2447 J 0 g aGii4 "nese.c System Location GOvuty Reed=051 Sierra Vista Ranch, Lot 11, Silt Legal Description of Assessor's Parcel No. pp 6 SYSTEM DESIGN P `° 4- ii 2 Septic Tank Capacity (gallon) Other It 7 Percolation Rate (minutes /inch) Number o7 Bedrooms (or other) , A / 1 o- t ' t /3 0 G /..: - I-- j . ( A C in / -. / r' 1 1( �< X _ Y ' / Required Absorption Area -See Attached '_ t < s t- , el r t.T1/, 2 / 1::> f e.:47, w p X 6 0 r 1 , ?, it, 1 1, / 1 /_ a , • t Special Setback Requirements: 7O 0 i, C t r f 3 t Date j :<, `/ S Inspector ...�� e"`1 n.if C,M. , FINAL SYSTEM INSPECTION AND APPROVAL (as installed) 1 Call for Inspection (24 hours notice) Before Covering Installation 4 ' System Installer_ l ).Ltr s -✓" ) i ! Septic Tank Capacity / y) 0 (e) �1 Septic Tank Manufacturer or Trade Name _t,23.10 -i !"per^" , Septic Tank Access within JJ,,,/// of surface /-�-f— l Absorption Ar9 6F r /i5 t'"-U- 6 II 4, 4— 5 t`3-1 - ., A„r1 . / T • /,` , � .t. l.l.RC,f Absorption Area Type and /or Manufacturer or Trade Name Adequate compliance with County and State regulations /requirements / -•-- -- Other 4 y h /„ r. Date`' .-. ��'' - Inspector - -MfL1 f ` -eJL I e, RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE 1 *CONDITIONS: 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter • 1{ 25, Article 10 C.R.S. 1973, Revised 1984. 1 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- 0 , nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a requirement of the permit and cause for both legal action and revocation of the permit. 3 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 I, Petty Offense ($500.00 fine — months in jail or both). f ( Applicant: Green Copy Department: Pink Copy s: s INDIVIDI JAL SEWAGE DISPOSAL, SYSTEM APPLICATION k l�nn OWNER I/Ja " S � ADDRESS / / /!. obnsue 64. ale no 5 a PHONE $ - 3 - - G a s'rn CONTRACTOR 0 c .X640 N. rower? ADDRESS i W owl s a-? 4,6,1450 PHONE leas-/gas a PERMIT REQUEST FOR (ANEW 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). / LOCATION OF PROPOSED FACILITY: COUNTY .4 Near what City or Town S Ht Lot xf it S 1-4rra yr sd--t 0 Legal Description La-7` /r F> '?- m•-t- Si" e_r C v ` rt fl y, aG. Airrk try B JJJi- e a t s ti Su 606ur5 ,�� WASTES TYPE: Q4(Dwelling () Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: jhmrf*...Q rkr- tton,*_ ikoetku Number of bedrooms: 2 Number of persons ()Garbage Grinder (.Automatic Washer (> Dishwasher SOT MCP. AND TYPE OF WATER SI JPPJ.Y: 4 WELL () SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: f✓'J i f~r?'tt L Afro ft awa If supplied by communtiy water, give name of supplier: !` U (MOT TNI) CONDITIONS: Depth to bedrock: pa) (Ai 4f,pctvk. So Depth to first Ground Water Table: Aar knotd — e9- Asp - Percent Ground Slope: Do-4' Kor,,,1 A ri x , 8 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Le rhY/t5 Was an effort made to connect to community system? 4 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: QAbsorption 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? /110 • PERCOLATION TEST REST JJ.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. _ Name, address and telephone of RPE who made soil absorption tests: co-r4miN Name, address and telephone of RPE responsible for design of the system: aruisly 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. Signed 0444:4. Date 1 / - q —R Y PLEASE DRAW AN ACCIIRATE MAP TO YOTJR PROPERTY • PI ,OT In AN ANT) DESIGN FEAT( IRF,S 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. ere— pc 1 wo w • ( ao 4 di • • .-... S ---(----- fa,'i 2 1 -C:A71 5 CD A D : I p 2 30/ 44. '' 4 „ K �. zsr ; 3 Le2r fi � b e g P-Q-4 J