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Home My WebLink About02519 , w.MTnwIfl °'1nqWE d.4WSifl 7r *W W9iCeMrFi'mc'dr',Ytwv nmctgG,m, ,�. � .. 3 . n. ... ..,..yid ,. Olt I t 4 fi GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit L 51 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Sprngs, Colorado 81601 Phone(303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name David Wanzelr'" Present Address P.O. Box 411, C4dale Phone 963 -3031 ,3 9777 /Act d y Highway 6 & 24, Silt System Location Legal Description of Assessor's Parcel No. (1940 ta?w•A.,Ifo F7oex$4F.vc.+ .eo (Na t4fe4fr: L) s p) SYSTEM DESIGN 74/1 d r /vr/47,,g7oR s, .QA al l7i fs'Wt V2la h4O /F/'4 r /57)0 Septic Tank Capacity (gallon) Other f� / /43 /S Percolation Rate (minutes /inch) Number of Bedrooms (or other) 5 Required Absorption Area - See Attached _ - _ - (I ° Special Setback Requirements: • 1 Date/ /' /S -1S" Inspector ar.., n. FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 tiburs notice) Before Covering Installation System Installer V/D 4 44'tek Oa-wi k Septic Tank Capacity /.T a444.9)." • 43/M,7- Septic Tank Manufacturer or Trade Name Z.4.0 • Septic Tank Accesg within 8" of surface 16:5 4 Absorption Area ,36 X31 - /A Y 4 Absorption Area Type and /or Manufacturer or Trade Name /Q.'r.x `W// fe» ,o / 5cv'ss1 Adequate compliance with County and State regulations/requirements )/c3 Other OK TD CO//P.e Tat I '. Date a - 13 - 71 Inspector TJ 2Ke 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;r.(,tgn- nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violationfl 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 4 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER a.,( W / ADDRESS PRONE 9/03 3v 1 CONTRACTOR,44-t t ADDRESS PHONE PERMIT REQUEST FOR 24 NEW 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)rofiles in tff st holes (See page 4). LOCATION OF PROPOSED FACILITY' COUNTY 2 Near what City or Town !2e 1: Size of Lot .S ?.c4 Q!. Legal Description or Address - • - i ��. •.. WAS "1'IiS TYPE: 5, DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDIJSTRIAI. ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE 'TYPE:_ pyv—C,_ Number of Bedrooms s Number of Persons_ (�3 Garbage Grinder ( ) Automatic Washer sx Dishwasher SOURCE AND TYPE OF WATER SUPPLY: WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: if supplied by Community Water, give name of supplier GROUND CONDITIONS: Depth to bedrock: � Depth to first Ground Water Table Percent Ground Slope DIS'T'ANCE "f0 NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? ( ) YES pel NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: p4 SEPTIC TANK ( ) AERATION PLANT ( ) VAULT • ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAI. DISPOSAI, 13Y: / ABSORPTION TRIFNCI I, BED 01( P11' ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL" ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTLWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 1101/4 2 • • IDi.RCOI.ATION TEST' Ri StJl, iii (To be completed by Registered Professional Engineer) Minutes per inch in hole No. 1 Minutes per inch in bole 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 application is conditional upon such further mandatory and additional tests and reports as may be required by the local health department to be made and famished 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 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 proposes of issuing the permit applied for herein. 1 fu understand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit gra • based upon said applica ion and in legal action for perjury as provided by law. Signed Mb _40. , / 4 / //L _ Date / / 7V 9c • PLEASE DRAW AN ACCURATE MAP TO YOUR PROPER'T'Y!! 3 .. ! -t Xr 1b J N. �� l/'vg 9; +S ,_ 9gS 3600 ..1, 6 c - 4 / 4 1 ID 4 /G o f S 7t ti 7 (/ 6 ` , e1 `f 7T 3 : /b . G e p /` O /L , a �/ .. 4 i4 / J 7 �-'c, -)c c 0744) = 14.: / S u� i I /N /Sm /.v r i NMI Oa i di