The URL can be used to link to this page

Home My WebLink About02492 t GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit h: 2 4 9 2 P 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 is Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY .. ci 11 ,. - 1 (-I (" C :; V t. , 2. i A J .' /\ �_. sses Monca d i Vi Owner's Name Present Address 0152 CR 137. G.S. Phone_ 945-1333 ' ' System Location i I. i (- 0 " O ilk- Legal Description of Assessor's Parcel No. k. i•; • ( 6, I. C a ' - C ' / / I\ SYSTEM DESIGN ( r A a, C t., r. i . ,, ( , ,- • ( (r 1 Lai • • r r/ ' j ( I i. 7 �..,�' C is . < ;- ')V, r, 1'� Septic Tank Capac (gallon) Ot9rer - C I 1 • - ' I Percolation Rate (minutes /inch) Number of Bedroems (or ottfer)r 3. ( / 1 y n(.....) �1 1.. Required Absorption Area - See Attached 4 � p� G - i n (/ C A --( ( / / L i' t Special Setback Requirements: . A I � r ' ) I r A. , Date c' �' �, Inspector A \ ni p ` (i; 1 ._ i4 i` FINAL SYSTEM INSPECTION AND APPROVAL (as installed ( l �- - 1 .1i -. % ( , } Call for Inspection (24 hours notice) Before Covering Installation ( ( ii ( d': S Installer_ C) t.4/ j ` ' Septic Tank Capacity ( I7 f) 0 Septic Tank Manufacturer or Trade Name Cs ' J- it P ( i - I '1 ! F6:4et. 4 Septic Tank Access within 8" of surface - Absorption Area X �. . r ,c. / / 4 L ,k (" 1/e I 0 / 9 1 1 s )4- , /.4 ., .1 f 1( 1 o r f / L 7 A " b / i �. 0. / ( Absorp Area Type and /or Manufacturer or Trade Name 1 }} Adequate compliance with add State regulationsfrpr�iremapts f J v j y Other t: 1, . ( A / f1 ti �� i ^ ' /(r .. Date ((' 'V ' In sprictori i 4 q Y t" l., n 1, f r r RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION 1ITE ( ✓ I •CONDITIONS: Aq f s 1. All installation must c6'1pry '' litd'all requir4eri4,df 9ilv Colorado Sta.e 9ga(d of Health) di Sewage Disposal Systems Chapter 4 i 25, Article 10 C.R.S. 1973, Revised 1984. - l (. ' ( i I ; , P 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirementt. Cb j i - nectiontoor use with( snyy dv/,elr))n�gpr structures,�notapproved by the Building and Zoning office shall automatically be a violation 6 a } requirement of the perrrlit and'tauae for both Aega).action(gn(f revocation of he perT7,�n, i 3. Any person who constructs, alters, or installs an individual sewage disposalsysfam ih'a(nanherwtrich involveqssa lIy5nnowing and material 1 variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offe6se 050610 tine —6 ([�. months in jail or both). ' C o f (- ,l .. . Applicant: Green Copy Department: Pink Copy f , GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit P\. 2 4 9 7 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY System Location ` 1 l f I ! Add ress Q1 ' CK 137 ( P1 Phone_ �� /' `' "' " Owner's Name ,Jnlc'e1, F Monica n Vi P ' dd�..1 .� •" _�.t7 , 11.( �1 i y...f '' � �- iA.� .) � '.; i � C . 1 A d:i ", C f \2111 utlea Vp1 thg Legal Description of Assessor's Parcel No. SYSTEM DESIGN Septic Tank Capacity (gallon) Other . l - Percolation Rate (minutes /inch) Number of Bedrooms (or other) Required Absorption Area • See Attached Special Setback Requirements: Date Inspector 1\ ' ^ ') FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer ( ) l -4f f..-I ( . Septic Tank Capacity l'<,> .) Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface `,..... �^ Absorption Area Absorption Area Type and /or Manufacturer or Trade Name i t ( T i ' /y C Adequate compliance with County and State regulations/requirements Other Date t {) () Inspector A • ` - ) / (%) RETAIN WITH RECEIPT RECORDS 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. 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 months in Jail or both). Applicant: Green Copy Department: Pink Copy ''( INUIVIDUALSEWAQE DISPOSAL. SYSTEM APPLICATION OWNER 'JAf esS .l /Panteo. V .. / ADDRESS 0/5.1_ / A7 . Pr! ✓ PHONE 45x5 /333 CONTRACTOR .SC /-P ADDRESS Gfenc4.Snr'lc/ Sport (n 1116,0/ PI - LONE PERMIT REQUEST FOR ( /NEW INSTALLATION () ALTERATION O 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). r .eic - ./o S Id Qlro.r.vri LOCATION_OE.'-ROPDSED FACILITY_: COUNTY CcYlh, is .�' Near what City or Town IP.FI. SP9o. Lot UU Legal Description ( .u�Lvn t {-II a ol .� /2.it tnear tad- WASTES TYPE: (welling ( ) Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms: E 5 Number of persons ( ) Garbage Grinder (..'Automatic Washer (✓.Dishwasher SOURCE AND TYPE OF WATER_SUPPLY: (W'CVELL () SPRING () STREAM OR CREEK. Give depth of all wells within 180 feel of system: u n d s . ple o il If supplied by communtiy 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: (►.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: (C4 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? '00 PERCOLATION TEST RESIILTS: (To be 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 telephone of RPE who made soil absorption tests: Name, address and telephone of RPE responsible for design of the system: Applicant 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 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 C i�'rn/n(.t Date /996-- ELEASE AN DRAW ACCURATILMA TO YOUR PROPERTY (((JJJ • LICA_ map PLOT P .AILANJ) DF,SIGN FEATt RES 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 commitments. *cap