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Home My WebLink About02500B / �. / GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N- 2 5 6 0 -B 109 8th Street Sulte 303 Assessor's Parcel No. T his does not constitute Glenwood Springs, Colorado 81601 - - - - -- Phone (303) 945 -8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT f a building or use permit. PROPERTY ran Present Address _7 6- _ Cherry_. Lane, Basalt _ Phone__ 927 -4046 Owner's Name Vicki Sea ___ __— - -_ System Location_. 729 _ County _ gaga - 100 _ Carbondale ._ i/ Legal Description of Assessor's Parcel No. -- ! - - - -- • n G E /,r-eit n ov ,945 %� - � bs� SYSTEM DESIGN r3 �d ROCK 99/ • Xi/ F /Cra•>rol .,/ a-re' Sep, :. c , . Capacity (gallon) Other . i N, L ' f•e�olalion Rate (minutes /inch) Number of Bedrooms (or other) _______ 4 • Required Absorption Area - See Attached Special Setback Requirements: s• Date _ - _ Inspector _ _ __ eL - f� '"I� _� . J__ ____ .__ -.. _._ _ - -.._ (T- ? /= l�jn n __._— FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Y Call for Inspection (24 hours notice)) Before Covering Installation System Ins- alloy_ /- u_- '- 1--- _C- LUF -r-- .4- _E5 - - - - Septic Tank Capacity _._SU__.- "`oj • Septic Tank Manufacturer or Trade Name Q PL {Y,y_c(� .. - - - -- - - -- - --- - - - - - -- Septic Tank Access within 8" of surface __t2CS - - - " -- - - -- -- - - ------ - - - - -- - -- -" -- CI Absorption Area 1_ Q _ 77 p� d __ � .__ Adsorption Area Type and /or Manufacturer or Trade Name Re C/ 4_ F! ?C/y_-86 3. ' - . �'eEfer-G g GL= j . . -- 1 O 6 /y p Adequate compliance with County and State regulations /requirements - 1- 5 _ -_ ...- .__- ._- ___._ -_._. _------ .--------- -- - -- Other ___. - Date / L 1 !__S _ -- Inspector __! t4� ' RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: 1. All installation must comply with all requirements of the Colorado Slate Board of Health Individual Sewage Disposal Systems Chapter 25. Article 10 C.R.S. 1973, Revised 1904. 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 of lice 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 011ense ($500.00 fine - 6 months in jail or both). r Applicant: Green Copy Department: Pink Copy - . ems . I 1 SYS_T_ENLAPPI.JCATION OWNER vi , s1,y, ' ADDRESS 1 70 CAeaay /an AsA /, G, I IIONE 9 _ CONTRACTOR rr/�ac / LJl,o / -' Tt 7Zn /ee4ir,i ADDRESS - #. R 4 'i__ A' A / , ! . , PHONE 9'-329J PERMIT REQUEST FOR (VI NEW INSTALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, V- habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCAI'IQN_QI-PROPOSRI? FACILIT _: COUNTY Gfle'4/0 A. Near what City or Town et c/ -cs .F/ Cite Gdndio 2 Lot Legal Description .0 °f 3, ey ser-7L.,n /8 Tw.sA y 7 .5,,a to 'Qmnps. F7 GJ,c / ejlike /ice Pe in a .p 4/ Mr t,d tip /00 ( 1 ,1c /A WASTI S_ IIYIE: (vrowelling ( ) Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Describe BLJILDIt4Q OR SERVICE TYPE: ?es(c s6,a ( Number of bedrooms: Y Number of persons 7 (✓)'Ziarbage Grinder (✓r W 04 SQURCI WATIEItSI jP_P_LY: V WELL () SPRING () STREAM OR CREEK Give depth of all wells within 180 feet of system: If supplied by community water, give name of supplier: N /./0 1 GRQUNICONDITIONS: Depth to bedrock: Depth to first Ground Wa ter Table: _ Percent Grciitnd Slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: ate aSSAIni Alt /1/edE 5/7s Was an effort made to connect to community system? /Jo Af 7%75 -4,n I. 'I'YPIE OF INDIVIDIJAI. SEWAGE DISPOSAL SYSTEM PROPOSED: (v4eplic'l'ank ( ) Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use ( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use ( ) Chemical Toilet ( ) Other - Describe: FINAI. DISPOSAL BY: (Absorption Trench, fled or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filler ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: � W11.1. EFFLUENT BE DISCI IARGED DIR. ICILY INTO WATERS OF THE STATE ? " _ l,7 P _GRCOLAT 1 4N_IfiST_RESLLTS: (To he 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 RPIi who made soil absorption tests: Name, address and Telephone of It 1 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 depa rtment for purposes of the evaluation of the application; and the issuance of the permit is subject to such Ierins and conditions as deemed necessary to inusrecotnpliance 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 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. 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 law. Signed ��3 - ?,.r l //rte _ Dale 9 / aliASF -DRAW! AN_ ACCURA :ERMAP_IO_Y4!!I_P_R4PEICLY eri g own "y /60 o ' 4 k or o- 1-0 o+r 4: 34 $b , rr 0 7l — 6/ L K 7 " _ " 4, 8 a4_,o e-- 3'o / 1, b ni u 7214 VQ4C