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Home My WebLink About02530 .v... -� -- •mil: - ."`.' `lea r,:v87..•Aw. iy' �� a.�. 3 t5 : 21)47:' k ,, .... v -.a1♦ ti 111 r„ .,.,. �../ A • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2530 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945-8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT - a building or use permit. PROPERTY Owned Name Mark Engquiet present Address 6191 CR 233 Silt Phone 876 -2040 System Location 6191 County Road 233, Silt Legal Description of Assessor's Parcel No. • SYSTEM DESIGN ADDITION TO SEPTIC PERMIT #2414 Septic Tank Capacity (gallon) Other 2 Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setb Requirements: Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer_ Septic Tank Capacity Septic Tank Manufacturer or Trade Name , • Septic Tank Access within 8" of surface Absorption Area //3♦/- 7di F /c- TR47tW • 4 Absorption Area Type and /or Manufacturer or Trade Name /12-t J-4, j' /z_ytt/7G.R.. 1 ' • Adequate compliance with County and State regulations/requirements S(5 of/ t Other I i' 'Date IA - tv - 9.5 Inspector ! _ Air RETAIN WITH RECEIPT RECORDS AT CONSTRU ° TION 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 off ice 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 )ail or both). White - APPLICANT Yelbw - DEPARTMENT 4&r_ i 7 So y a INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER 111Atz1c- FO6qu (ST' ADDRESS C -A Co • e 2.33 S CONTRACTOR SL,sMr _ ADDRIiSS 1 7 S a � o-r 3 _ PERMIT' REQUEST FOR ( ) NEW INSTAL 7 / 7 4" Attach separate sheets or report showing entire area habitable building, location of potable water wells, st 4). LOCATION OF PROPOSED FACILITY. / O c� o I7 Near what City or Town 00 — Legal Description or Address - CFA rT G,S , r 3 ' ! 2 2 k ISM tre..� WASTES TYPE: (1Q DWELLING ( ) COMMERCIAL ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms IA Z Number of Persons 1 ( ) Garbage Grinder ( ) 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: 'CI LT Was an effort made to connect to community system? ( ) YES ( ) NO TYPE OF INDIVIDUAL. SEWAGE DISPOSAL SYSTEM PROPOSED: (, SEPTIC TANK ( ) AERATION PLANT ( ) VAULT • ( ) VAULT PRIVY . ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAL Dl POSAL BY: (V) ABSORPTION TRENCI I, BED Olt PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL, ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER-DESCRIBE WILL EFFLUENT BE DISCIIARGED DIRECTLY INTO WATERS OF THE STATE? 2 0 . S0 • e INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER 111AC1'- B%.5 S ,vts T ADDRESS Cent CO. eYs 2-33 St1-1 Co, PRONE a1L Zo CONTRACTOR SMtiIi ADDRESS PI LONE PERMIT REQUEST FOR ( ) NEW INSTALLATION (4 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 OF PROPOSED FACILITY: COUNTY Near what City or Town Size of Lot t O KCg &S Legal Description or Address TI?A c3 AI Tt i%t, o2 CAAktvasro'J WASTES TYPE: 00 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms S 2 _ Number of Persons_ ( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM Olt 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 S'.�, DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: S r t T Was an effort made to connect to community system? ( ) YES ( ) NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( SEPTIC TANK ( ) AERATION PLANT ( ) VAULT • ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL, TOILET ( ) OTHER - DESCRIBE FINAL DI POSAL BY: �( ) ABSORPTION 7RENCII, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL. ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER-DESCRIBE_ WILL EFFLUENT BE DISCI IARGED DIRECTLY INTO WATERS OF TFIE STATE? 2 N'T.R.COLATION TEST RESUL FS• ('ib be completed by Registered Professional Engineer) Minutes per inch in bole 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 fiirnished 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. 1 further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit granted bass 1 uponlsaid ap icati on and in legal action for perjury as provided by law. Signed 1 Date I Z "�1' LV • 1 , 'LEA I: DRA AN AC URATE MA ° '0 YO R PROPERTY 1 3