HomeMy WebLinkAbout02517 •
m S GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 S 17
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81801
Phone (303) 945-8212
Thts does-tr� constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a'6uilding or use permit.
PROPERTY
Owner's Name Joseph Monteleone Present Address 2071 CR 112, Carbondale Phone 963 -8629
System Location algae) Cou my Road 233, Antlers Orchard, Tract 33, Rifle
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
/ 0 b 10 Septic Tank Capacity (gallon) Other
/.. ,,2 () nu., Percolation Rate (minutes/inch) Number of Bedrooms (or other)
/d /p a r h -� (K !��� l � r X .54 i X3' ' knit
Required Absorption Area - See Attached 4 1r 6.Q ' � t
u ,.7 Dr 3 Wit° o-a
Special Setback Requirements: ( ( 6 r� � yL , q- , d,/•(��j-�c/ c-r cry _2
t-uA ,
Date //' 1. — 2' - r C Inspector / en - e ' -
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
I
Call for Inspection (24 hours notice) Before Covering Installation
System Installer nit AWE e, p
Septic Tank Capacity �a.\ d !ry.wi 4 oC i. r + .
t 7 li0i
Septic Tank Manufacturer or Trade Name s .b1i
Septic Tank Access within 8" of surface YES
. 4
Absorption Area � /� Ian
Absorption Area Type and /or Manufacturer or Trade Name
A' /oO Ls A5 .91M
Adequate compliance with County and State regulations/requirements Y S
Other k
Date / — ` 46 Inspector /141- tiLO
RETAIN WITH RECEIPT RECORDS AT COYISTRUCTION 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).
White - APPLICANT Yellow - DEPARTMENT
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INDIVIDUAL_SI W.AGE_DISPOSAI, SYSTEM_AP1YIICATTON
OWNER T ose p , Mon - e \Pevne.
ADDRESS A07/ Ca'n +y ' Rd ll L PHONE 9'43 -89629
CONTRACTOR Be1c- (nrInnnw-t1e, Co 81623
ADDRESS PHONE
PERMIT ItEQ[J13ST FOR ( NIW INSTALLATION ( ) ALTERATION ( ) 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).
LOCAIiON_OI? PROPOSI:1? F11C'ILIT_Y: COUNTY G -narV:e1 a
Near what City or'I'own %c1e, Lot 33 AvMrrt, Or Y nre1 --- X)r../
Legal Description NJ 1//1 _ i 'q .SF ',{
WAS'EI S_T_YPE: ( Dwelling ( )'Transient Use
( ) Commercial or Industrial ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: a .,' _
Number of bedrooms: - ___ - - -- Number of persons o
(t/TharbageGrinder (a'Autonmlic Washer VI
SOURCE_AND IYPEO[ YATER_SUPPI Y: (,) WELL ( ) SPRING ( ) STREAM OR CREEK
Give depth of all wells within 180 feet of system:
If supplied by con water, give name of supplier:
GROUND CONDITIONS:
Depth to bedrock:
Depth 10 first Ground Water Table:
Percent Ground Slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: MA4-
Was an effort made to connect to community system? /JAI
'I'1'PE OF INDIVID[JAI. SEWAGE DISPOSAL SYS'T'EM PROPOSED:
(v/ Septic Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
( ) Chemical Toilet ( ) Other - Describe:
FINAL DJSPOSAL BY:
Absorption 'french, Red or Pit ( ) Evapotranspiration
() Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCI IARGHD DI121 C'I'LY INTO WATERS 01 THE STATE? 00
►r •
P_ERCOLA774N_LEST_RESULTS: (To he completed by Registered Professional Engineer) 1
Minutes per inch in hole No. I Minutes per inch in I - Tole 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 submi(!cc! herewith and required to be submitted
by the applicant are or will be represented to he lane and correct to the best of my knowledge and belief and
are designed to bre relied on by the local department of health in evinating 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 I, 4
Dale 70 /7 ADC
11,13AS 41?RAW! ANACCURA7 YOi11CP_Rnl'1311'L'Y
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A i . a .
PLOLPLAI*AN LLD ES1GN_IFEN1 111 E S
Include by measured dista location of wells springs, potable wafer supply lines, cisterns, buildings,
property lines, subsoil drains, lake, wa tercourse, 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.
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit a (5/2
109 0111 Slreel Suilo 303 Assessor's Pnicol No.
Glenwood Springs, Golconda 01601
Phone (303) 945 -9212
1105 dons not constitute
INDIVIDUAL SEWAGE D • AL - t -IT :1 banding of use permit
PROPERTY '�y,< /1 ���w.�
Owner's sine _. Tor' ' S0AdrieWre nsmd Midi o,ss phrrnr!
System Location_
Legal Description of Assessor's Per col No.
SYSTEM DESIGN
__ - . _ Septic lank Capncily (gallon) plhm
I'elcnlalinn tl:do (minutes /inclg Llumlet of Ilnrllunnls 1,, olhnl) .
/2 -Z - IS -
flowered Absorption Alen - See Attached p�'`'y'�' '+�''�/
Special Setback Hermit men's: Te a- Ifin d t (
Date _._. - - - . .. Inspector Tat, w 'L Mr 'e %
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) '3 e_ J O1 at– 7 r'^ C e
. .
Call for Insn � p ' ect � io / n j (24 notice) 13 elol /e/OLCoN,v /m at ing Installation 0 04- at,/ �. Septic lank Cap city - /Af t e L. -a / - P3 Cam /
Septic Tank Manulaclmm or trade Noma / - /evrj / // 45,e4 /I
--
Se pl is lank Access within 0" oI surlace T / �l�' // �j' " — �� � 7 -
Absorption Area .. _.__- ___... .. _._. , ,e2 f -_
Absorption Area type and /or Manulaclurer a 'Earle Name ..
Adequate compliance with County and Stale 1 cyulalin its /E Oa nuunnnls e
` i � ion � h / /J` � v �
Other _ - - -. _ / Sy.yfj // y �'/ - - _-�/i" . _ -
.
Dale_ _. _. Inspn clm
RETAIN WITH RECEIPT Ill_CORI.)S AI CONST IIUCI ION SIZE
+CONDITIONS:
1 All Installation must comply will( an requireninnts of the Colin ado Slate Board of l loallh Individual Sewagn Disposal Systems Chapin,
25, Article 10 C.R.S. 1973, Revised 1904.
2. This permit is valid only for connection to structures which have fully complied will( County zoning and building requirements. Con-
nection lo or use with any dwelling or slructui es not approved by 111n Building and Zoning ollice shall antomallrnlly be a violation or a
requirement ol the permit and cause for both legal action and revocation of the permit.
3. Any person who conslrucls, ollors, or installs an individual sowago disposal system inn manner which involvns a knowing and material
variation from the terms or specifications cnnlainnd in limo apulicalinn of per nil commits 0 Class!. Polly Uf terse ($500.00 lion — 0
months In jail or 140111).
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