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Home My WebLink About02510 1 _ t 1 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 5 J. 1 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phon 99,,94 -8212 - / /vU This does not constitute - INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Darrell Mason 1210 Midland #1, G.S. 945 -5301 Owner's Name Present Address Phone System Location P Y S3 County Road 245, New Castle Legal Description of Assessor's Parcel No. SYSTEM DESIGN /000 _ ' tic Tank Capacity (gallon) N /Al r //kiMPercolation Rate (minutes/'{nch) flu�of Bedrooms (or ofta[}.,. - - -- S 3S a 'P°c R cc ac >f13 /6.__ gQatesn4! G ,',cd'ae k ya Required Absorption Area - See Attached II �Tyj4j47iPA apt a staff ?8t eve- kvao s$- R. .a Special Setback Requirements: Date /1 — / -9y Inspector i1arr L FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer flAMV Z.- Septic Tank Capacity Septic Tank Manufacturer or Trade Name dePL9? -{e./ Septic Tank Access within 8" of surface pfS Absorption Area o Absorption Area Type and /or Manufacturer or Trade Name • iL m a r ' e -= Adequate compliance with County and State regulations/requirements Other Date 1 / — 1 eir Inspector b t✓ !/ (J � RETAIN WITH RECEIPT RECORDS ATCONSTRUCTION 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 specif ications contained in the application of permit commits a Class I, Petty Offense (5500.00 fine - months in jail or both). White - APPLICANT Yellow - DEPARTMENT 4 INI)IVIDIIAI, SEWAGE DISPOSAL. SYSTEM APPLICATION OWNER 'J ' t I �� o I � SCOM ADDRESS t Z. • ' WW1 L. _A . r HONE SO CONTRACTOR. ii"" A .{ LA i ' _ 7 ADDRESS P `I1 2(xx Ct t-r fl Q PHONE 1 . 00 1 PERMIT REQUEST FOR ( NEW INSTALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or reports lowing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil pro rles in, st hoes (See page 4). LOCATION OF PROPOSED FACILITY / COUNTY C0.(Z.1 (C' IC Near what City or Towu_IV _(;&J AST (e � S / iz of Lol C' Legal Description or Address I ,'n1 ( /� OK I h I tt eotl CS.Ifit 0 t4c eC, 2 LC! . WASTES TYPE: c\-1 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms 3 Number of Persons Z ( ) Garbage Grinder (I) Automatic Washer (1 ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY• 9O WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: /YO If supplied by Community Water, give name of supplier Al 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? ( ) YES (< NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (Al SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTI TER - DESCRIBE FINAL DISPOSAL BY: 00 ABSORPTION TRENCI I, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL. - ( ) WASTEWATER POND ( ) OTHER-DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? A10 2 h tc i PION TEST RESULTS (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 RPt? responsible for design of the system: Applicant acknowledges that the completeness of the application is conditional upon such fiu mandatory and additional tests and reports as may be required by the local health department to be made and fiwrished 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 teens 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 same for purposes of issuing the permit applied for herein. 1 fini.her 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_ Date O\ Z Z l r PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 r 1-/a us TAniK b 3 pa • r/ Ma 9 1 ;27 — /0:03 Sean �tt g g it 7 a 44- ° it $ ?: o2Nfl =� t B�S7 be q r �N 9 kit IN