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-' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit h _ 2 4 7 9 4
`•' Assessor's Parcel No.
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212 D
This does not constitute 414
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY I
Owner's Name James A. Kalmon Present Address 1210 Midland Ave G.S. Phone_ 945 -6842 f
Syster6 Location NG 117 County Road 311, Silt - .y
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Legal Description of Assessor's Parcel No. S'
1
SYSTEM DESIGN
h96 0 Septic Tank Capacity (gallon) Other i
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Percolation Rate (minutes /inch) Number of Bedrooms (or other) 2 548.
Required Absorption Area - See Attached a a t
Special Setback Requirements: ' i
3
Date Inspector
II,
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) N y
Call for Inspection (24 hours / 4Z7�' notice) Before Covering Installation
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System Installer_ /. ) lti ,&,' p k j t j a
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Septic Tank Capacity 1( 00 c
Septic Tank Manufacturer or Trade Name
a I a `
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Septic Tank Access within 8" of surface' 5 5
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Absorption Area / / 1 0. 4
Absorption Area Type and /or Manufacturer or Trade Name ' ; -I'0 ' P l � r �" - . 6 4 i
Adequate compliance with County and State regulations /requirements 51
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Other
Desis — 1' 9 s Inspector blaze • - Y
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RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE ,(
•CONDITIONS:
1. All installation must comply with all requirements of th6 Colorado State Board of Health Individual Sewage Disposal Systems Chapter { i
25, Article 10 C.R.S. 1973, Revised 1984. a •'
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- ii
nection to or use with any dwelling or structures not approved by the Building and Zoning off ice shall automatically be a violation or a 0
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 1!
months in jail or both). ,1 4
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Applicant: Green Copy Department: Pink Copy 4 ',
Application
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
County Official:
h _u
ID4441440 L ' as C;W S PHONE 945r6R4Z
CONTRACTOR 5.4r+F_ I ,
ADDRESS PHONE
PERMIT REQUEST FOR: (>() 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.)
LOCATION OF PROPOSED FACILITY: County &A R,Faz.D
Near what City of Town S Lot Size 40 /44.
Legal Description Sw Nw%y 4 Z4 - r - 4,S, p.nrz vv, 4 /a. r? Al/.
C AfLF's 11.f, l-0t1.7 r C0(-0 (vas • .
WASTES TYPE: (K ) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: � n -.,c..y .soma_
Number of bedrooms Z Number of persons Z.
(->(). Garbage grinder ( p4 Automatic washer (A Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: q / C
If supplied by community water, give name or supplier: ,w
GROUND CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table:
Percent ground slope: //7o
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: d= ? m ;
Was an effort made to connect to community system? 4.20
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(X) 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:
(X) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCIHARGED DIRECTLY INTO WATERS OF THE STATE? tin
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.SCh L PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.)
Minutes 59 per inch in hole No. 1 Minutes 47 per inch in hole No. 3
Minutes 413 per inch in hole No. 2 Minutes per inch in hole No._
Name, address and telephone of RPE who made soil absorption tests: Sj ,,,0- r-,4, ,st4
4,0p Aswc• • 113 9'-" Sr CWS r 9'45 - z55o
Name, address and telephone of RPE responsible for design of the system:
Sevin
Applicant acknowledges that the completeness of the application 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 1t subject to
such terms and conditions as deemed necessary to insure compliance with rules and regulations
adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies
that all statements made, 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 be relied on by the local department of health
in evaluating the sane for purposes of issuing the permit applied for herein. 1 further under-
stand 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 per-
jury as provided by law.
Date JWAe>w 73 19°16 Signed //�
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
C;SG PAG>L I
--rr2.EP i �Pc_A•.
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PLOT PLAN AND DESIGN FEATURES:
Include by measured distance location of wells, springs, potable water supply
lines, cisterns, buildings, property lines, subsoil drains, lake, water course,
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
coniui tments.
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