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HomeMy WebLinkAbout02448 •, ., y 7.s.r.gr. v � -q• ¢AR¢ �:rlPn.^ n.,rm rr� z. -.s ' .r r r 4 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N : 2 4 4 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 \ \ Phone (303) 945-8212 This does not constitute 1 i INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. i PROPERTY Owner's Name Bill Davis Present Address 0930 CR 245, New Castle Phone_ 984 -2266 r , t /�. System Location 0939 County Road 245, New Castle r,• (.�ct.J c Legal Description of Assessor's Parcel No. t SYSTEM DESIGN 1' f ` g. / r ! I n <J Septic Tank Capacity (gallon) Other r /./ " t ' !' tnI Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 ( 3' / 1 Q 5 1i. + / Required Absorption Area •See Attached 103 S 1:r fl d G 14 C3 e O r' I" / W ;/ /X � (! f E c +('- 4a.2 1 r , 1. N f ! ) t 8 If e 0 rt Or - `,) lC? ( .; . t^ o,, 4 Special Setback Requirements: et 2 / .ti /3 / - 0i fi u s e 11 .t ' y• h {,'...r c sy i t. / ,. \ - ! 1 Date f� _' i _ 1 4 . In spector / / x i ... `.` C-t CA-4•4_ • pp / F D / V<` V% 't: t,h c /5u N M 1 )I r/ Il r o, f; ✓a i . ,. FINAL SYSTEM INSPECTION AND APPROVAL (as installed F Y 0 ),t A? ti ,n / c/. - r0 Fti c A/ f w C l c.440 5 Call for Inspection (24 hours notice) Before Covering Installation S (-, p t4 2 J P.; . e 1 f' System Installer } Septic Tank Capacity f t-t r• Y. /' e% i( ' Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface t Absorption Area !.z .' / ' Absorption Area Type and /or Manufacturer or Trade Name . • * p Car . Adequate compliance with County and State regulations /requirements /r LS. 4 1 f Other 1 7 ) Date it, . 4?4. 12C 0 Inspector ,$c i �C�� RETAIN WITH RECEIPT RECORD "C TRUCTION SITE ' e *CONDITIONS: 1 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. ) 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- 1 7 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. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material e 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). Applicant: Green Copy Department: Pink Copy 1 1 N1>_IVIDUAILSEWAGE _DISPOSAL <_SYSTEM_AP_PLICATJGN OWNER 6;11 _ rElav t � _ ADDRESS in Am Co 4Zd .'1- (( S • -- PI IONS 98 ` 3246 CONTR ACTOIt ADDRESS PHONE PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION ( Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, locution of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCA'I'ION_GIL PROPOS FACILITY.: COUNTY 'I' A r�1 j 1 Near what City or Town w EW �St) C. Lot Legal Description — - -- 093 2 n act AlPS WAS11:S_LY_PE: e<Dwelling ( )'Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Describe BUILDING Olt SERVICE TYPE: kes S Cie Number of bedrooms: _ Number of persons 5 ( ) Garbage Grinder fc:). Automatic Washer ( ) Dishwasher SOURCLANLIIVP WA "L'IiIi_SUI'1'LY: ( ) WEL ( ) SPRING ( ) STREAM OR CREEK Give depth of a l l wells within I N feet of system: If supplied by communliy wafer, give name of supplier:_ -- GROU N I)_CONI)TTIONS: Depth to bedrock: Depth to first Ground Water Table: Percent Ground Slope:___ DIS'TANCETO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system'? 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 IIY: Absorption Trench, llcd or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT IIE DISCIIAItGEl) DIR T' ECI,Y INTO WATERS OF TILE STATE? Ath ♦.-1 4 . ♦ l PliRCoLA174N:FES"CRESULTS: (I'o 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. _ Nance, address and telephone of RPE who made soil absorption tests: Name, address and Telephone of RP responsible for design of the system: • 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 cerlilies That all statements make, information and reporlssubmitted 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 evhaating the same fro purposes of issuing , • the permit applied for herein. 1 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 _ 4 g,. ' t-A mate f te 7 1? PLEASE . YOUR_PRDPERTY u/ • • • PL4LPLANANP_P_ES1G N_L'EATURES • Include by measured di Iocalinn of wells, springs, potable water supply lines, cisterns, buildings, properly lines, subsoil drains, lake, watercourse, 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. 7 �,,...04,,--I. /... - \ 1-5°. y " ■ • t CIg5t1 a kiD-' el a ...) "i 1 ` f " ' -, ar, , i\ s-stAz r P et ° Art P it m i ( P‘Aiscil ' � 9 f I 1 ,\ \ '1 \ fi T\ ' C \,:` 2 ' \ k 'I n alat.".-LA. 2I- SYSA4 SA P.. e 1 " 3 C 445'6 In A f 0 ?" —7 i = 1 $ ' /o il q ; y'r r _„y� / .wJ, © 4 A-=st- .3 0 c f i