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Home My WebLink About02463 • - GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit P`i.. 2 4 6 3 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945-8212 pi This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. rn( PROPERTY f Owner's Name Michael Bangs Present Address 198 4th St., Carbondale phone_ 963 -•9449 System Location County Road 107, Carbondale Legal Description of Assessor's Parcel No. ¶ SYSTEM DESIGN t" 4�. /4 nil Septic Tank Capacity (gallon) Other f ° 7i+ 1..; Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached Special Setback Requirements: Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) - rr Call for Inspection (24 hours notice) Before Covering Installation System Installer_ C t5 /' Septic Tank Capacity + '^ a / - /AJt / )�- Septic Tank Manufacturer or Trade Name 4'1297 e a (/ ) Septic Tank Access within 8" of surface ye, 5 Absorption Area 7,0 cd 'i. Absorption Area Type and /or Manufacturer or Trade Name 41 / r </- J i i / Adequate compliance with County and State regulations /requirements '-/)( ( it A: t L -. '[:4.7 P it Other Date 0 / C • c. Inspector - y � t RETAIN WITH RECEIPT 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. 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. d, f. 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 '. r. i r7 INDIVIDIIAL_SI:WAGE DISPOSAL SYSTPM.APPI.LCATION j .3 -° • OWNER VVVlct -(A IC. i ADDRESS 1 9 yam` sr. Cart J5 a-t e Co PHONE 943 4 5 CONTRACTOR S Co Tr ADDRESS (o3? - So. jSP- oel -r,ie„a Cn.PIlON13o3 - 15 - gc13 PERMIT REQUEST FOR (X) NEW 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). LOCAT_ION_DFJ'RCP_QSED_PACILITY: COUNTY C4 ,4Z Et £L) Co . Near what City or Town C ,4K o.,,„4u -t F Lot 2 I.cgal Description _ fa- va,+rcn CL- SOlvis'„w t E cirri w --tt' 4 11 z 23 3o 7? f c 4 cn 1 1 9s- ! R-o . , c. - s A C WASTESIY_PE: Dwelling ( ) Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE:Z f.14 C.tysi e 5 . Ia nn4 C, Number of bedrooms: a J Number of persons ( ) Garbage Grinder (A Automatic Washer Dishwasher OURCEAND TYP_ILOF_ ATEI?.SUPPILY: K WELL () SPRING () STREAM OR CREEK lir jive depth of all wells within IRO Fitt of system: If supplied by commnntiy water, give name of supplier: GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: ,- Percent Ground Slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: Xv 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: Y4 Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) 'Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCI IARGED DIRECTLY INTO WATERS OF THE STATE? Ki n • P_ERCOLATIQN TESTRESULTS: (To he 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 I lephone of RPE who made soil absorption tests: Nf.e. W A j s r £ L,.) AT E ,2 C,oI.0 r( S (oao2 k.s 9+.v hMae,k ' A2. SNR,.,,...ts v 1 . 9 3-; Yo ao$ N EL5cu4) Name, address and telephone of' RPE responsible for design of the system: A pplicant 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 hre relied on by the local department of health in evluating 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. -)" , 1 iN r 2@ . s1 SCF 'Mc S hAT f . S igned _ 1 // (-1( k Y Dale (0 PLEASE DRAY AN ACCLRATEMAP_T2YDUUR_PROPJRTY C X e S w- u . o1- Cv . a . ( o' Tb bekv k o)--4 L. 4t— r > D <ts.lC r 2 70-...-3 r)..44. IcL 1 5 t^re l - `� IS -t- Z 3c T. • it) 0 ÷ iaa' a Z ak i k g a l 410 3a g $ ,114) __ min/ 6 011a ..�. t,Pi2fiZi-'r ga 5 3 p. .