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Home My WebLink About02481 ' 4 .. I GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit IY. 2 4 8 1 109 8th Street Suite 303 Assessor's Parcel No. i Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Scott J. Minor Present Address 284 Riverside Rd.. C }hone_ 963 -0110 ■ System Location 0384 Wooden Deer Road, Wooden Deer, Lot 17. Carbondale i. Legal Description of Assessor's Parcel No. SYSTEM DESIGN t ERGINEER DESIGNED 4 Septic Tank Capacity (gallon) Other Percolation Rate (minutes /inch) Number of Bedrooms (or other) 4 Required Absorpti6n Area - See Attached Special Setback Requirements: i Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Is Call for Inspection (24 hours notice) Before Covering Installation f System Installer_ ria-",leoe Wc.- "! - Septic Tank Capacity 47 T.64: /c'>c,( Agenea,..!A—. / 4 ).r, /0 '/(: ... L...; f ( Septic Tank Manufacturer or Trade Name 7 1 Septic Tank Access within 8" of surface y'r3 Absorption Area f40./ s l ` g ),r' e /i1... 7 a-^:.. £4v . : ?, / . f .,,, . , ., ^ . ,q ri'K' . 0 Absorption Area Type and /or Manufacturer or Trade Name / %£ . .t '+F" Pi _ • + Adequate compliance with County and State regulations /requirements �*':, " Other C•' ;r 444,...,. /( IP Date 94 Inspector .T e ._d ( o J RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE a " *CONDITIONS: 4 k 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 0 variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine —8 months in jail or both). Applicant: Green Copy Department: Pink Copy • rf I I/ fi V V . I IN DWI DLALSI WAOILDISIOSAI. SYSLT_EIYLAIIPLICATION OWNER /" 1 (/v0K ADIJRESS wer2•5roe /1-0 . 00fraskQPIIONE_ ?03 963 – o0 0 CON'TRACfolt M e ADDRESS PHONE PER l IUE REQUEST FOR (1*NIiW INSTALLATION ( ) ALTERATION ( ) REPAIR Attack 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'11ON_OETROIOSEI) TY: COUNTY 1 Near what City or Town Lot 17 wea96-) 4 SUM 'd'SJo✓ Legal Description - IS L1 _ wco0 - Qee/L AD. /C1}1260,^-)614L-e_ Co. 8/62-5 WASTES: EXIT: (»Nwelling ( )'Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Describe _ BUILDING OR SERVICE TYPE: .5(6-)(>1--e FArn/ /-fo'e Number of bedrooms: / Number of persons it OC)..C;arbage (hinder (>4-Automatic Washer (5") SOUROIs ANLL'YI'_li_Ol_ WA"L'EIt_SUII_LY: (4.WIi1.L ( ) SPICING ( ) STREAM OR CREEK Give depth of all wells within 1 RO feet of system: nee If supplied by con water, give name of supplier: MOeP DO- )time owwr s ASSo". ROUND CoNDIT1ONS: Depth to bedrock: Depth to first Ground Water Table: _ Percent GrOiind Slope: DISTANCE To NEAREST COMMUNITY SEWER SYSTEM: UI -I ✓N Was an effort made to connect to community system? Yes TYPE 01? INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (5r---Septic Tank ( ) Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use ( ) I'it Privy ( ) Incineration Toilet ( ) Recycling, other use ( ) Chemical 'Toilet ( ) Other - Describe: FINAL DISPOSAL BY: ( ) Absorption 'french, Bed or Pit ( ) Evapotranspiration ( Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond () Other - Describe: WILL EFFLUENT DISCI !ARCED DIRECTLY INTO WATERS 0I 'I'I-I ESTATE? t--)0 :. to/ 1 _GRC' ( ThA'1'7 ( ?1Lf7:STRESLLTS: (1'o be completed by Registered Professional Engineer) Minutes per inch in hole No. 1 Minutes Minutes per inch in hole No. 2 per inch in Hole No. 3 Minutes per inch in Dole No. — Name, address and telephone of It P1; who made soil absorption Tests: Name, address and telephone of ItPli responsible for design of the system: Applicant acknowledges that 1hecompleteness oft he 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 inusr'ecotnpliance with rides 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 1lre 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. I 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 Taw. Signed . ..„9-Icaet--) J 7 --- I)ate1/49/2 5 PL.EASE.DRAW AN_ACCURATE _MAP_M_YO! ILEROPER Y_ .6 7 /oa- vecki•J iysRD• 0 wwY 83_ •