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Home My WebLink About02523 per,., ' w+a In r 7- 7rar Werr47;Fr n 7ov4 77 "7 7 ' 7 , 7 7 'w 7 wir m1 ,m F a ct .. rr . e / ',G 2 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2523 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 Owner's Name Eyerot Jewtstl Present Address 31/11 County Road 233 Phone_45,4',92 System Location 1103 259 Road 9 Rifle Legal Description of Assessor's Parcel No. SYSTEM DESIGN - /000 Septic Tank Capacity (gallon) Other PS 4o e 7U Air o.4.9646F 3 y0 Percolation Rate (minutes /inch) Number of Bedrooms (or other) Required Absorption Area - See Attached /V3 y 7' R�K cc�cw Lae FvA , [ 3 e4 3 43.02 86r, /irfie nets e = "Ai O /e €0 Special Setback Requirements: g‘1/44 &o - lJ'/A' -J Q y6 " /eve --S Date /.Z - /1 1S Inspector Jio FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer 4/40/JeP Septic Tank Capacity /PAP nn Septic Tank Manufacturer or Trade Name 5AD Septic Tank Access within 8" of surface 5'? Absorption Area 2?(,.. !j ¢ Absorption Area Type and /or Manufacturer or Trade Name bag- J _ C / l i r rcl ` foie -S' $G an- Adequate compliance with County and State regulations/requirements yes Other Date__' - Inspector g d-✓ ' a,4 ,4 GC RETAIN WITH RECEIPT RECOR SD 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 Cully 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. w • 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 (ail o both). White - APPLICANT Yellow - DEPARTMENk.• • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER g v of' IA)? J r ADDRESS 3/+41 ate. 933 Lole- PHONE tio25 •oZt/ CON7'RACI'OR, ADDRESS PHONE PERMIT REQUEST FOR (/) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography ofarea, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PROPOSED FACILITY: COUNTY r° 46-Qrie D Near what City or Town /L /FLC /I Size of Lot / 4 C- Legal Description or Address //o 3 e2 S 9 /C-6 , /C /77° WASTES TYPE: (✓' DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms_ 1 1, e e Number of Persons_ 7c -c,CJ ( iYGarbage Grinder (c4 Automatic Washer 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_ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: , /,e Was an effort made to connect to community system? ( ) YES (ENO TYPE OF I DIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (✓SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAUUI' PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL. TOILET ( ) OTHER - DESCRIBE FINAL DISP SAL BY: ('5 ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER-DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF TIIE STATE? 7e 2 P1`RCOLATION 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 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 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 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. I 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 A e . � .. Date /� i / 9 5 r ,/, A PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERT 0 tt 3 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 1 his dons not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT , a budding or use permit. PROPERTY Owner's Name_._.._ _._ Present Address Phone __ __.. System Location. Legal Description of Assessor's Parcel No - • SYSTEM DESIGN ,w.Naww, • //'4 6 h000 Septic Tank Capacity (gallon) ' Other e .nt_ Percolation Ratb (minitesfinch) Number of Bedrooms (or other) 3 _ 18' ,. O ' ✓ _ /.""• 'Iz„• Required Absorption Area - See Atiached' / /fS f 20X Oi 4 _ e • D �f ma' = 41 # I- a � ' n•N at 86790 , f.1..='. <nq.,»¢ .: -V6 f Special Setback Requirements: j,rl jo y eta -I9',9xSB2 -r � /�i Aeze_s Dale/.2 - 17 Is— - -- Inspector - l tr J` w.� 7 G - FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation • System Installer - .. - ____ ._ - .. • - • • _ - • • l • Septic Tank Capacity Septic Tank Manufacturer or Trade Name Septic Tank Access within 6" of surface • • • Absorption Area __ __ _- _.. • _. _ _ -. • Absorption Area Type and /or Manufacturer or trade Name , Adequate compliance with County and State regulations /requirements - Other Date- _ _.. ___. __. __ -.... Inspector RETAIN WITII RECEIP1 RECORDS AT CONSTf1UC1 ION SIZE *CONDITIONS: 1. All installation must comply with all requirements of the Colorado Stale Board of Health Individual Sewage Disposal Systems Chapter 25, Article 10 C.A.S. 1973, Revised 1904. 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 rnaterial variation from the terms or specifications contained in the application of perrnit connnils a Class I, Potty Of fens° ($500.00 fine -6 months in jail or both). While - APPLICANT Yellow - DLPAR IMEN rF3 9 .Sys ..040p ■ nine /0 4I aZ 7/a r 74 G » thoo 6 /yi /91-aeose 3 m'- 3 mates $ Yes' �sri,.v caps Area nme r . -welG ,, 6 ,... <3 0 $1 , 4' 5'O L ^ 5'O iuv?e-s e ire 9",0'1 3 aept /ifs- Pow /4,„„( zaX asst , X /.z. = /rs y.L7 Ane lar4 /#37 = gd Y.d /,uCue d0 at v,�,r-