HomeMy WebLinkAbout02438 .W . f1 a (f 38
. • GARFIELD N
COUNTY BUILDING AND SANITATION DEPARTMENT Permit N. 2 4 3 3
• • 109 8th Street Suite 303 Assessor's Parcel No. !"
Glenwood Springs, Colorado 81601
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Phone (303) 945-8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
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PROPERTY '
Lll J ?' 1, f. h'� � .
Owner's Name Phili T awkina P resent Add ress f 'tea 7" l a Phone 625 -2347
System Location / 7 8' / County Road 210. Silt
Legal Description of Assessor's Parcel No. " {''/
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SYSTEM DESIGN 7 r i
`,2 E O Septic Tank Capacity (gallon), Other (. C� , , I ' 7 I l °
r , :, / ' r '; y' - 2_O '% ,1 p Y ` t G /4 M p A 6v A .0
t 4 Percolation Rate (minutes /inch Number of Bedrooms (or other) _. .. J � r h li
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"/ or p f& c c k -4 -' /_ e c C h t: k, , .}. #�.
Required Absorption Area - See Attached E !— ri r ( l' 1, -5', 7 2 Y+ ,/o rt , Y ,2,, c2 i t- f • ,..i 1/40
/7 H r' 17 13 / o - rD r -49 rt s < f rn• ;Z. - 1 f' i c .. :
Special Setback Requirements: ., It
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Date 1. / el l " 7 r ,Inspector 4 � - en - I �.t / f-Q.n 1
it
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation j
System Installer_ /OW /ll rtt lt, j ,
' . Septic Tank Capacity /•R 1:' -; Septic Tank Manufacturer or Trade Name em i pe_si f 1-'
Septic Tank Access within of surface v CC �.• - -- f �Ur / 6J Ki
8" a79) I'
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Absorption Area Sr 4 C.
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Absorption Area Type and /or Manufacturer or Trade Name . � / q pas • • _ _ tip/ L'r�✓I.re, k
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Adequate compliance with County and State regulations /requirements `Yf C
Other
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Date G. - i o'' / 5 Inspector j,/ +ice ;. LO ; 77'—e-
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\ RETAIN WITH RECEIPT RECORDS AT CONStPUCTION SITE
*CONDITIONS: t)
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. 1
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- '
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a f 1
requirement of the permit and cause for both legal action and revocation of the permit. . i
3. Any person who constructs, alters, or installs an individual sewage disposal system In a manner which involves a knowing and material it {
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 a il
months in )ail or both).
Applicant: Green Copy Department: Pink Copy �. {
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INPIYIDUnI�sr:WArr nISPOsAL _sYST�cIYtAr_r�.ICATIOr�
OWNER N: '. _' .:. —
-
ADDRESS PIIONE
CONTRACTOR 6 " `-S- Pi]ONC r 'z' 2341
ADDRESS 1 � - = =� '' � ALTP.RATION O REPAIR
PERMIT REQUEST FOR (›E) NEW INSTALLATION O
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area,
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habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes
(See page 4). ^ RFtEt -T --
LOCATIONO►=PROPOSEI)_EACIL1T_Y: COUNTY Lot
Near what City or Town r-
Legal Description
Dwelling O Transient Use
WAS'1'I:S_LYI'_li: (7t)
( Commercial or Industrial ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: Number of persons
Number of bedrooms: (4n Dishwasher
(X) Garbage Grinder (>;;) Automatic Washer
SOURCE_ANL'CY_r_r OF WATEICSUPP_LY: V) NoN�
WELL O SPRiN O STREAM OR CREEK
Give depth of all wells within ISO feet of system:
If supplied by communtiy water, give name of supplier:
UUB.OUNUrONI)IT IONS: T
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Depth to bedrock: U D t.
Depth to list Ground Water Table: UN 0 WN ES - i - (..co
Percent Groitnd Slope: 3°1° ur iKr towN (£5K z' r"`�
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: :
Was an effort made to connect to community sy
TYPE OF INDIVIDUAL, SEWAGE DISPOSAL SYSTEM PROPOSED:
Septic Tank ( ) Aeration Plant ( ) V ul c tin olable use
( ) Vault Privy ( ) Composting Toilet ( ) clin other use
( ) Pit Privy ( ) Incineration Toilet
( Recy y g•
( ) Chemical Toilet ( Other - Describe:
FINAL DISPOSAL BY: ) Evapotranspiration
S9 Absorption Trench, Bed or Pit ( Sand inr
( ) Underground Dispersal ( ( ) t e Wastewater Pond
( ) Above Ground Dispersal
( Other - Describe: 1J _. —
WILT. EFFLUENT BE DISCI 'ARCED DIRECTLY INTO WATERS OF THE STATE? ---
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• f o be completed by Registered Pro en gineer) 3
Pl:►i�4Lnu1 e s TP.S'►'_per itich L in hole ole No. 1 � Minutes per inch in Hole No. 3
Minutes per in in per inch in Hole No.._
Minutes per inch in hole No. 2 Minutes le
Name, address and telephone of RPE who made soil absorption tests
Name, address and telephone of RPE responsible for design of the system:
and Appliang a t acknowledn d reports as may required t by the local health cdepartment to such
e made and furnished
d
and t te P
is the applicant
of the emit is sutiject such terms and t conditions s as deemed necessary to he srecompl compliance with
issuance of the ►
C.R.S. 1973, as amended. The undersigned hereby
rules and regulations adopted under Article 10, Title 25,
certifies that all statements
re resented be true and to herewith and required to be
best of my knowledge and belief of and .
are tde re des ignped to o b re e el w P same fro purposes of issuing •
aiged tee or here I further t cin lei sla department
health
or misrepresentation
the permit srepresent ton may result in .
l applied f of the appliention or revotation of any permit application and in legal
the denial ermil granted based upon said app
action for perjury as provided by law.
0 • Tate � •
_
Signed, _ a . 1 ".
P_LEASE_t3RAY _AN_AC'C URATEMAP_Tn DUR_PROPrli`T_Y_ .-
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