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Home My WebLink About02532 , r " . fi t ,. • • t GARFIELD COUNTY BUILDING AND SANI,TATIOt4 DEPARTMENT Permit 2 32 109 8th Street Suite . , Assessor's Parcel No. Glenwood Springs, Colorado 81601 S Phon&(303) 945.B212- This ddes not.constitLte INDIVIDUAL'WAdt DISPO AI,'PERMIt )\ � a building or use permit. L 1 PROPERTY • 361/ .r Owner's Name St 1 7 T0 tL 1� f Present Addres � �PQ �3O 4spen` Phone 923 -5754 r System Location 0300 Seven Oaks Road, Carbondale Legal Description of Assessor's Parcel No. C 27 4 7 S/ 6 gq � RonKf LBnee4 an, r9 PO do % vi n, j SYSTEM DESIGN .y4 9 , r "' F" rat, re; es JI �f 8N l / , � 7 p � ' H-4 ". e/ ° 71sar yr Septic Tank Capacity (gallon) Other • • r /U // m / Percolation Rate (minutes /inch) Number of Bedrooms (or other) � J Required Absorption Ark Seg,Attached ��yy Special Setback Requirements: Date t o -9 (o Inspector *arts ` FINAL SYSTEM INSPECTION AND APPROVAL (as installed) - Call for Inspection (24 hours notice) Before Covering Installation System Installer )4 x—A dy lht4nc7 Septic Tank Capacity / a Se Septic Tank Manufacturer or Trade Name CO Pe-A? Septic Tank Access within 8" of surface UL S Absorption Area Lo a7 d Absorption Area Type and /or Manufacturer or Trade Name 4 q9 1 /yr- W474Cs 3 0 Adequate compliance with County and State regulations/requirements r'rr 1 Other 99 Date /— O(tI" Inspector 2�'✓ c dam_„ RETAIN WITH RECEIPT RECORDS AT CONSTRUTION 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 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 - months in jail or both). White - APPLICANT Yellow - DEPARTMENT _ ___ __ —__ INPIVIDIJAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER OM 4 PAT S'7vd 140.1 ADDRESS (fin /3ox 9 Y4 - I A_t\Pera R/(,t 2-- PHONE 9. sC2,S CONTRACTOR tKerr .0e.d --� (� s 7fuvrzn✓ ADDRESS L PHONE e t t n 8' a-? St PERMIT REQUEST FOR (VEW 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 OF PROPOSED FACILITY: COUNTY 6-4vOt e �� Near what City or Town e r 6n& cJc _ Size of Lot 3 7 - fief' % -Y Legal Description or Address 0 3oO 0 444 1 . WASTES TYPE: t4 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms 3 Number of Persons a (V Garbage Grinder (�utomatic Washer (Yr Dishwasher SOURCE AND TYPE OF WATER SUPPLY; (WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: * 0 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: Was an effort made to connect to community system? ( ) YES ( ) NO TYPE OF ByptIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (\'( EPTIC 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: (YABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER- DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? N p 2 .PC:RCQ 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 penult 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 based upon said application and in legal action for perjury as provided by law. Signed Date 7A-6AJ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! d-o 0 air 2-0 --f I ts h e \9 r oe C e ( 1 ( (( - I( — C 1-1< power LtaeS / 3