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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N: 2 4 6 4
109 8th Street Suite 303 A ssessor's Parcel No.
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Glenwood Springs, Colorado 81601 y'
Phone (303) 945 -8212 2.
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This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. � +
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PROPERTY t
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Lee Finnell 319 138 Rd., Glenwood , 945»0567
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Owner's Name Present Address Phone_ 6
System Location 319 138 Road, Glenwood Springs
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Legal Description of Assessor's Parcel No. R
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SYSTEM DESIGN #
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() Septic Tank Capacity (gallon) Other
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/ r ^ J , ;! + i cn.l� percolation Rate (minutes /inch) Number of Bedrooms (or other) 1 / 7 IT' /'f .n .w
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Required Absorption Area - See Attached 9 / r(t t i ' .' / y � / r ,,,,t; 1 : • i!,
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Special Setback Requirements: 3 i o II 4••+ - ! -i^ ?f•'. •• ,. r : ' / i 4v-' ''" '; t!
Date ^,�(4 "' (7 r Inspector may
!^� `.,,C ) L Ai, I ,v, 't 91
7^ 91
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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_ •1 -A' a ` — ..
Septic Tank Capacity 0 0 0
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Septic Tank Manufacturer or Trade Name 412- QGJj 4 ■ t
Septic Tank Access within 8" of surface A' , t r
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Absorption Area W ,, - na- - .e 1;1
Absorption Area Type and/or Manufacturer or Trade Name s2 l CAt -U' / Q r (7; 1.r ` } 1T +•,t c
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Adequate compliance with County and State regulations /requirements '-"-- i
Other f
Date 7 — i' _ 7 S Inspect rn Cc24, (ytQ
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE t
*CONDITIONS:
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter it
25, Article 10 C.R.S. 1973, Revised 1984. ;! 4
2. This permit Is valid only for connection to structures which have fully complied with County zoning and building requirements. Con - 1 rt
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or e 4
requirement of the permit and cause for both legal action and revocation of the permit. ; f
3. Any person who constructs, alters, or installs an individual sewage disposal system In a manner which involves a knowing and material i r
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine —6 # 4
months in )ail or both). f t
Applicant: Green Copy Department: Pink Copy 1, 1
INDIVI DU AL_ SEWAGf :_DISL'OSALSYSTEM_AP_P_LICATION
OWNER 1. 11 /f /X/A/4 — —
ADDRESS / eat' ?fa G 14A/uoaa 1'IIONE 95 _
CoNTRAcrolt se, i t
ADDRESS S7m PIIONE
PERMIT REQUEST FOR (c44I:W INSTALLA'T'ION ( ) 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).
LOCA'I'ION_OF PROPOSED_f?ACILITY: COI JN'TY — G A`R F 14 < r,
Near what City or Town _aX/- .vur°oD /4/ai'/ ryes r rt
Le I)esc ion - - -- -_ _ L OT 3_ .re uCAL m.tsir /f- xI**Fr /a.v / 4f4 A
MI AS'I'ES _TIT E: (1 welling ( )'Transient Use
( ) Commercial or Industrial ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE:
Number of bedrooms: _ / _ Nnntber of persons
( ) Garbage Grinder ( .Automatic Washer ( Priiisliwasiter
SOUR-CLAML_T .01 WATER_StJITLY.: (c1Vtu L ( ) SPRING ( ) STREAM OR CREEK
Give depth of all wells within 1443 feet of system: /Rao k'/'LL_ /S 20 FRam sYSre, hi
If supplied by comnnnrtiy water, give name of supplier: — _
GROUND.CONDITIONS:
Depth to bedrock:
Depth to first Ground Water 'Table: -c
Percent Ground Slope: Z S 7 Skno&
DISTANCE TO NEAREST COMMUNITY SEWER SYS'T'EM: I * Ai /La-5
Was an effort made to connect 10 community system? A/4
TYPE OF INDIVIDUAL. SEWAGE DISPOSAL. SYSTEM PROPOSED:
(V(Septic'I'ank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
( ) Chemical Toilet ( ) Other - Describe:
FINAL DISPOSAL BY:
(Pr Trench, d o 'it ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand tiller
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe: /•Vfl /LTknroi. sisnyff
WI LI- EFFLUENT BE DISCI IAIIGED DIRECTLY INTO WATERS OF TILE STATE? A/0
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PlutCQLA174N I flS.CRES11LTS: (To he completed by Registered Professional Engineer)
Minutes per inch in hole No. 1 Minutes per inch in Mole No. 3
Minutes _ per inch in hole No. 2 Minutes per inch in Hole No.
Name, address and telephone of RPR who made soil absorption tests:
Name, address and telephone of RP1 responsible for design of the system:
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Applicant acknowledges that the completeness of theappliclion 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. 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.
i■eor ` �! y
Signed _ ■ Date I � _
P_LEAS1i.l?RAW AN_ACCURATE.MAP_Tn YO tR_PROPERTY
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