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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N - 2 4 5 1
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81801
Phone (303) 945-8212
ThIs does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
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PROPERTY
Owner's Name David K. Danciger Present Address 1644 Prince Creek, C'dale Phone_ 963 -1391 )
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System Location • . , • . ' ' F
Legal Description of Assessor's Parcel No. '3
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SYSTEM DESIGN E'
/ l +l - ' ( Septic Tank Capacity (gallon) Other J ,
/ , / 'i' hl 're riolation Rate (minutes /inch) Number of Bedrooms (or other) 4 (' . f ,/
t! 7 ;r t r? .r, k t ( ._ K . 1 l l • / ( , r 7 , , t.
Required Absorption Area - See Attached ( — , / 11 ` • 7 - .-
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Special Setback Requirements: ,7 c /, ! f , , ,} . . . 1 /
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Date r / i Inspector ? , /." • n i G
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FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
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Call for Inspection (24 hours notice) Before Covering Installation
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System Installer_ 01S r; L. Ya Al i' J
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Septic Tank Capacity 1 C n0
Septic Tank Manufacturer or Trade Name , p /YLP, 1 r
Septic Tank Access within 8" of surface '+'" j II
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Absorption Area � � Q� . . i
Absorption Area Type and /or Manufacturer or Trade Name 7X y ` t t /�i f'l \ / ,: t,. 1 `' t 't / t 11 , V m ,I
Adequate compliance with County and State regulations /requirements 4. ,c -`,.
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Other
' Date (c, ' 1 �( . C AC Inspector 14 i - -. , s , Y
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE 0
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•CONDITIONS:
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-
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
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine 6
months in jail or both).
Applicant: Green Copy Department: Pink Copy _
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INP_IVI I) UALSEWA GILDISPnSAI._SYSTTIYLABP1'ICATLON
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OWNER ✓r PIIONE /
ADDRESS r ' z ' ' ' A l2
CONTRACTOR • • ' • C " ° e PC L . P iIONE 4G 2 3833
ADDRESS 7 e•1 6` Caa3ouDA _ 8162 ALTERATION OREPAIR
PER
se a s he et FOR N NEW INSTALLATION respect O o ra h of area,
habit l e bui ding, loca ion of pot; i le wat t r wells, soilhpercolationt pro test holes, soil files g in t t holes re area
(Se
habitable 4). G. LACL aL.b StPnC. 5ysltl
(See Page Q). �P •
LOCATON Cdr PI ;OPOSED_EACILIT_Y: COUNTY
Lot Near what City or Town %?1 r�4 P e A. yl
Legal Description //79 Coo r ' 3 O.
_ & .
_ 14 O'll�ansienl Use VIASI'IiS_LY_Pli: Pc)
(welling Non - domestic Wastes
( ) Commercial or Industrial ( )
() Other - Describe
BUILDING OR SERVICE TYPE: Number of persons
Number of bedrooms: 00 Dishwasher Z
(IC) Garbage Grinder z (X) Automatic Washer2 SPRING O STREAM OR CREEK
SOURC13 _ANLTYP_EDE W_A TER_ SUPP_[ Y: !I1'1 WELL ( )
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Give depth of all wells within 1811 feet of system: N SA
If supplied by communtiy water, give name of supplier:
C_.GROUNI).0
Depth to bedrock:-__ —
Depth to first Ground Water Table:
Percent Ground Slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: �7PR °x• tees
Was an effort made to connect to community system?
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(-A Septic Tank ( ) Aeration Plant ( ) Vault potable use
Composting ( ) Vault Privy ( Toilet ( ) Recycling, p P Recycling, ( Pit Privy ( Incineration Toilet O cling, other use y
( Chemical Toilet ( Other - Describe:
FINAL DISPOSAL. BY: Evapotranspiration
( ) Absorption "french, Bed or Pit ( vapotram
{4 ( ) Sand Underground Dispersal ( Sa lter Pond
( ) Above Ground Dispersal
( ) Other - Describe: , �
WILL EFFLUENT BE DISCI IARGED DIRECTLY INTO WATERS OF THE STATE?
W4 . ...
PlE CoLAT1ON TES _RES1JLTS: (To he completed by Registered Professional Engineer)
Minutes per inch in Hole No. 3
Minutes per inch in hole No. I r inch in dole No.
Minutes per inch in hole No. 2 Minutes pe
Name, address and telephone of RPF, who made soil absorption tests:
Name, address and telephone of EWE responsible for design of the system:
and addi t acta °w and reports as m< yl , r competeness of
be required thelocal health department such further
and furnished
ayteaitioca tests
by the applicant o h ter nit the local
suchlte purposes of
the evaluation of
necessary to he sr compliance application;
with ,
issuance re t i
certifies and regulations s;o 1ements make, informatio and reports submitted herewith required to be submitted , Title 25,
by the I pli all
are tde i to bre will be
byte local department health in evinating the same fro purposes of issuing
are designed la
the permit applied for or further understand
t granted based upon said application and result
n legal
the denial of the application
action for perjury as provided by haw.
Date iSr Q�
Signed • .
Pl_uASI _DRAYLAN_AcCi! RATIO _MAP_TD_YDAIR_P_Rnl'_I:R`LY_
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