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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 1\.- 2 4 h 5 i 7t 109 8th Street Suite 303 Assessor's Parcel No. k
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212 ti
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This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. }
PROPERTY
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P.O. Box 331, Carbondale 963 -1280 t !.
Owner's Name Jolene Singer Present Address Phone c
System Location Block 7, Parcel C. Cooperton, REMISIDI Carbondale e "
Legal Description of As essors Parcel No. g /v ;
ir, ,fphh / t°h' //7 /S TO �//r /1//r y 7/ I-4 . tto t ., _r
SYSTEM DESIGN -" fr rea- pm! /O /t' AITry or P/16PoW ' ,L_Oerces, r/%GQ i !'
fL fPd 7 --,win s ys'74 -i - /S (9 tvt a MO ' Fa o,' / /ry wr. / t- •
Z 0 Septic Tank Capacity (gallon) Other '+
/ Ai n^+s't t - 8
/ . + r �. Attt Percolation Rate (minutes /inch) Number of Bedrooms (or other), 2 " t
2)7 -'t 1 1'Y/ .42,,,,,, is aa..'
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)required Absorption Area - See Attached i
1 1 ■ S
Special SetbackRequitements: 1 S
y —Ai—
1 t Cn.,, pr
Date / V / ^� Inspector " �'I`T• !'D`� r t,J C Y "
FINAL SYSTEM INSPECTIO�J AND APPROVAL (as installed) r
Call for Inspection (24 hours' notice) Before Covering Installation
System Installer_/eJ LH f rc . ,
Septic Tank Capacity r / C Op , t
Septic Tank Manufacturer or Trade Name eCP4-1t7Jeg- 1 1
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Septic Tank Access Within 8" of Surface 4S
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Absorption Area ' 5 X'14 -x /4 ,
Absorption Area Type and /or Manufacturer or Trade Name elf L Rpl it N - K ti q 1 S,
-41-0 ! K 4 - p
Adequate compliance with Count and State regulations /requirements `!
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Other 9 Date 9 . 3 i -- q ._ Inspector 1' f C.. ; 4r%.7.
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RETAIN WITH RECEIPT RECORDS AT CONSTCTION SITE "
*CONDITIONS: 1. installation must coin I with all requirements of thCC
p y wi .... q r olorado State Board of Health Individual Sege Disposal (iystems 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- ",
nect ion to or use With any dwelling or structures not approved by the Building and Zoning office shall ar be a violation or a J
requirement of the permit and pause for both legal action and revocation of the permit. !!
3. Any person who constructs,alters,' installs an indi4( dualseWage disposal system in a manner which involves a knowing and material I, S
variation from the terms or specif [cations contained in the application of permit commits a Class I, Petty Offense ($500.00 fine —6 )r
months in jail or both). I
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Applicant: Green Copy Department: Pink Copy 4 f
INDIVIDUALSEWAGE DISPnSAL SY,STEMLAP_P_LICATION
OWNER SIticDe
ADDRESS ISm 13 'St I CAM-G CO PHONE XLA - 1x436
CONTRACTOR U- L y e o✓cs- ,
ADDRESS POl3 333 CAN 1\L5 Co PHONE 0 163 -\ \f3
PERMIT REQUEST FOR (4 NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area,
habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes
(See page 4).
LOCA17ON_OI? PROPOSIIDJ COUNTY Mkt IELD
Near what Cityor'l'own 0ArakAouAAI_E Lot PARCEL e
Legal Description —__ C K ^1 A fs n 63 cD SA. - c - oft) - To p.n., S s-1 c /1
PP CC y
WAS'I'ESJIYPE: PA Dwelling ( )'Transient Use
( ) Commercial or Industrial ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: Re-- k4eIst's
Number of bedrooms: T v00 Number of persons (>Ou RZ
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
SOT! RCI: -ANDITX_P IOEWA ER SUPP_LY_: () WELL () SPRING () STREAM OR CREEK
Give depth of all wells within 180 feet of system:
If supplied by commtinliy water, give name of supplier: C. ARtt ititz Is$ . 6 C ot
OROUND_CONDITJONS:
Depth to bedrock:
7
Depth to first Ground Water Table:
Percent Grciiind Slope: n /o
DISTANCE TO NEAREST COMMUNI'T'Y 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 BY:
Q4 Absorption 'french, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filler
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCI 'ARCED DIRECTLY INTO WATERS OF THE STATE?
PER : (To he completed by Registered Professional Engineer)
Minutes per inch in hole No. I Minutes
Minutes per inch in Hole No. 3
per inch in hole No. 2 Minutes per inch in Hole No.
Name, address and telephone of I1PE who made soil absorption tests:
Name, address and telephone of It PE responsible for design of the system:
Applicant acknowledges that the completeness of the appliclion is conditional upon such further mandatory
and additional tests and reports as may he 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 inusrecompliance 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 he represented to he 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.
Signed °f P Date
P-LEASE.LRAW AN_ACCURATE_MAP_T4 QUILPROPERTY.
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David A. Powell
P.O. Box 631
Carbondale, CO 81623
963 -9869
August 29, 1995
Mr. Art Hougland
Chief Building Official
Garfield County Building and Planning
109 8th Street, Suite 303
Glenwood Springs, Colorado 81601
Re: Singer Residence
1171 County Road 106
Permit No. 5606
Garfield County, CO
Dear Mr. Hoagland:
Percolation tests performed under my direction in the seepage pit
test hole show that the average percolation rate for this system
is 7 minutes.
A profile hole was dug adjacent to the proposed system location
and no anomalies were found.
Seepage pit sizing based upon the percolation testste'quires that
the pit be sized 11' x 11' in width and 8' deep.
If you have any questions please call me at 303- 963 -9869.
Sincerel .
r0pPAD0AF,
Gcr' � ; p cya 4
David A. Powell, PE J
Colo. Reg. No. 2585 ' 49p r i
4. $ /2-7/
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