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Home My WebLink About02500 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit I 2 J G 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 Owner's Name r Dzyulldao». Present Address 1831 Railroad Rtfie Phone_ 625 -337o System Location Cot)) it Road 329, W fte. Legal Description of Assessor's Parcel No. SYSTEM DESIGN • • Septic Tank Capacity (gallon) - Other e ) 0 Percolation Rate (minutes /inch) Number of Bedroom9 ..(or other) - 2 rf Required Absorption Area - See Attached , Special Setback Requirements: Date '..ti Inspector P. .i -'. : FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Cali for Inspection (24 hours notice) Before Covering Installation System Installer -' 0 L ' a ' 1 f' Ir'i Septic Tank Capacity / 0 0 0 Septic Tank Manufacturer or Trade Name C 03 ) r) ">> Septic Tank Access within 8" of surface __IV 7 Y 1 a I I I ! (7 / Absorption Area if � �r y �. �y r- c e f' to l} Is 1S Absorption Area Type and /or Manufacturer or Trade Name _DR / 11/ f' 7 -. 2. Adequate compliance with County and State regulations /requirements Other Date • , laY — � Inspector p. are, _ ," RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SI E •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 P. . I . IN DWI 1?UALSI WACIli t?ISPnSAL_SYS'LENLAP- P_LIOATIOI3 OWNER - R at - es ADDRESS a _ : kit w PHONE u at' 37o CONTRACTOR IS -&a Prue t ADDRESS Vint PHONE, CI ZS' 53'74 PERMIT REQUEST FOR KNEW 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 '1). LOCA1ION_oi. rROpusliD FACT J 1 \' COUNTY GLar Near what City or Town _ 1.01 �A *� Legal Description ! _ _R _ �� vT '-f (J "^ p jA - Sea) 0144 Ie _4tsIlH S w! - Sec. l7 E'/ �SE by WAS STYeE: JI)welling ( ) Transient Use t-/2 1 /9 ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Desi:rihe BUILDING OR SERVICE TYPE: Number of bedrooms: __ - . - . - - - -- _ Number of persons / ( ) Garbage Grinder ( ) Automatic Washer ( )Dishwasher SOURCJLANI?'LYPE OIL WATEit suPPLY: ( ) WILL (SO SPRING ( ) STREAM OR CREEK Give depth of all wells within IRO feet of system: If supplied by com munliy water, give Hanle of supplier: GROUND OI 111).11QNS: n s • Depth to bedrock: .( — _ Dept, to first Ground wa ter "fable: _-- ___ --- -- — Percent Groiuul Slope: __ - DISI'ANCE NEAR EST COMMUNITY SEWER SYSTEM: / /e Was an effort made to connect to community system? TYPE OF INDIVIDIJAI. SEWAGE. DISPOSAL SYSTEM PROPOSED: Yt' 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: o q, Absorption 'french, Red or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand filler ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: __pi: 4jQ C I WII.I. EFFLUENT BE I)ISCI!AIt�I?D Dllt l?CI'I.Y INTO WATERS OF THE STATE? F., 0 t 1 PI RCOLATIQN -TEST RESULTS: ('t'o be completed by Registered Professional Engineer) 1 Minutes / 0 per inch in hole No. I Minutes per inch in Hole No. 3 Minutes / 2 per inch in hole No. 2 Minutes per inch in Hole No. Name, addres and lelephon • of RPE who made soil absorption esis: poke �313et O/u - au 4 I en fft Nance, address and telephone of ItPli responsible for design of the system: A pplic nt acknowledges that thecompleteness oldie appliction is conditional upon such further mandatory and additional tests and reports as may be required by the local health department to he 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 inusreco$-npliance 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 reportssubniitted 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 hre 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 ,. 9 -i3 "'9S .?"e--1/4________- __,,,A7/e - -- - -- Dale 1 '_ 1 .LASE.1?RAW_AN_A(-'c RA17. MAP_TO_YOUR__PROI'I RTY- [..... 3�v �ah;,cr is a pr�x A �, 30 , h; ?Jab t, - 10 a � , a wA c rO- S�r"� P C tP elk •. , igen / % Y -1-e iN+J ; y+ a Pr dA �� Std C� • afro ur. i1c cis ..., s 1 690 e ��' gjg P \ . PLOLPLAN_ANP DESICiN_I?EATUIt Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, watercourse, 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. ?r' a (3C cab 349 a send .0e p�c y " pvc 1 o ^ 00) c) 0 I --f ct T i.5' w� l �2 ( DIV ''. 0/ roe " ��. -r .' 0 • • % - " �a 1 / 2 0 aP 9t yid 0