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Home My WebLink About02521 • 4 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2521 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owners Name June Pasternak /Harold E1?4ax tAddress 1334 Road 56 E., Appllo, one 412 - 478 -4156 System Loca(ion 1853 County Road 109, Teller Springs, Lot 2, Glenwood Springs Legal Description of Assessor's Parcel No. SYSTEM DESIGN MOO Septic Tank Capacity (gallon) Other UcP 09r/•s Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached Special Setback Requirements: Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer OL0/1.› Septic Tank Capacity /R6 O Septic Tank Manufacturer or Trade Name 9 vrLAx-oc. T Septic Tank Access within 8" of surface LS. Absorption Area • 3 0sZ� fl Absorption Area Type and /or Manufacturer or Trade Name 3Oa r et#14.712nT6tS / Z 6s Adequate compliance with County and State regulations/requirements Y F Other Date // /6 - 9 C Inspector +/i01.1 4 t�y¢`�tti RETAIN WITH RECEIPT RECORDS AT CON S 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 ($500.00 fine — 6 months in Jail or both). White - APPLICANT Yellow - DEPARTMENT .t IN DI V_I DUALSEWAG LD1SPDSALSYSTEMJsP_PLICATTON OWNER U C I eS rett$ML 1 os.tt,wo EU . A er - ADDRESS 1344- Ro -S(e r eu -o ,PA- PHONE 412- y - CONTRACTOR T 11�,,. -. ,. LA tse013 ADDRESS t14F p,.Su3g00 Co,S PHONE 45 3iq »7 u PERMIT REQUEST FOR (v4NEW 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). /� LOCATION D D FACILITY: CILITY: COUNTY 64.2 rzletb Near what City or Town 6c aafWcor) Sep Lot Z- I.egal IJescriplion /653 t en, n /fl - , Po .1 5+,(;1% ill s inA1 WASTES:CYPE: 04 ( ) Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms: 3 Number of persons v (.'Garbage Grinder (t. Automatic Washer ( v)*Dishwasher soURCI AND TYPCkOI WATEILSUP_P_LY: () WELL () SPRING () STREAM OR CREEK Give depth of all wells within I KO feel of system: 0 i If supplied by communtiy water, give name of supplier: ' I .ptu:tis -5vB.Ofttis/iv3 GROUNDrONDITIQNS: Depth to bedrock: 8-g Depth to first Ground Water Table: Ai/,a(- T Percent Ground Slope: 4• - ra 7 °In DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Z f' - Sm ite3s 40410 E I Was an effort made to connect to community system? AJo TYPE Of INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (vrseptic 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: (Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: f WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ties PERCOLAT14N 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 ier inch in Hole No. - P 6 - Name, address and telephone of RPE who made soil absorption tests: .>.l . Name, address and telephone of RPE responsible for design of the system: li1/at aVIST72 j ?Fr je 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 submitted herewith and required to be submitted by the applicant are or will be represented to be true and correct to the hest 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. 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. �—� mi l_ `j� Date tt— 1"CiJ Signed PLEASE __DRAW _ _1 Cal RA'1'E_MAP_T4 Y_OUI _PROP_ERTY ... Zee- ft it m. '-e s w`I -ae i.si - b.(3. flit ,v S .