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Home My WebLink About02546 .r�.w IAA ^sr7t'pM : r ,, r11,1..Y, . v 'Th :;T:;�F` i r -, • e GARFIELD COUNTY BUILDINt AND SANITATION DEPARTMENT ' Permit 2546 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81 Phone (303) 945 -8x12 7 SS c, This does.aot constitute INDIVIDUAL SEWAGE DISPOI - PERriIY* 7 - a building or use permit. PROPERTY Owner's Name WM 1 inc. Present AddFels ' ''1877\ 137 8-8. C.S. phone 945 -8540 System Location 1877 County Road 137, Glenwood Springs Legal Description of Assessor's Parcel No. SYSTEM DESIGN /aod Septic Tank Capacity (gallon) Other / ,A7 .17 01174 /Percolation Rate (minutes /inch) Number of Bedrooms (or other) S �fS' Q RoaK4 L6.oer, Sa'cL Nan 4a% 44+ee4 /e O , 5p 6 wL 4 r / Required Absorption Area - See Attached /0 1 -d 7 NFi •-TSR 76e23 >'t5,4 8, /7,e fle Special Setback Requirements: Date 411. 09*. f r `9 /0 Inspector , n� FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer_ R tp Septic Tank Capacity / 11.00 Septic Tank Manufacturer or Trade Name erPed- fad u Septic Tank Access within 8" of surface r WC Absorption Area 14 4 3 Absorption Area Type and /or Manufacturer or Trade Name /Dh3 �( „met /4 tan- Adequate compliance with County and State regulations/requirements 7 r!S Other Date fi - at' t icr Inspector RETAIN WITH 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. 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 bless I, Petty Offense ($500.00 fine — months in jail or both). White APPLICANT Yellow - DEPARTMENT a • INDIVIDUAL SEWAGE DISPOSAL, SYSTEM APPLICATION OWNER Wm' Ino, ADDRESS I?i I37 t C 1 lienuxxx) ;VT PIIONE' 6 1 LH -F5f34O CONTRACTOR 131a rr E. 1 I4F2S ADDRI ss PO. 6 tS)t IV) M u Cn3ltu PHONE 't 4- 013c1 PERMIT REQUEST FOR (X) 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 profiles in test holes (See page 4). LOCA'T'ION OF PROPOSED FACILI'T'Y: COUNTY C fit= Irl Near what City or Town _ Size of Lot Legal Description or Address WASTES TYPE: (x) DWELLING ( ) "TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTIIER- DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms .3 Number of Persons 4 (X) Garbage Grinder ()c) Automatic Washer (X) Dishwasher SOURCE AND "TYPE OF WATER SUPPLY: ( ) WELL (7) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of s 1 f sup plied by Community Water, give name of supplier GROUND CONDITIONS• Depth to bedrock:_ Depth to first Ground Water "fable_ Percent Ground Slope DIS'T'ANCE TO NEAREST COMMUNI'T'Y SEWER SYSTEM: 10 nn t LES Was an effort made to connect to community system? ( ) YES (1C) NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (?C) SEP'T'IC TANK ( ) AERATION PLANT ( ) VAULT • ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) I'I•I' PRIVY ( ) INCINERA'T'ION TOTLE'I' ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTITER - DESCItIIIE FINAL DISPOSAL. BY: (X) ABSORPTION TRENCI I, BET) OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER- DESCRIBE WILL EFFLUENT BE I)ISCIIARGED DIRECTLY INTO WATERS OF THE STATE? M o 2 PERCOLATION TEST RESULTS ('I'o be completed by Registered Professional Engineer) Minutes per inch in hole No. I 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 Ihr purposes of the evaluation of the application; 811(1 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.It.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 petjury as provided by law. Signed I1 . t.t I t 'l. • • Date Ic'al0 PLEASE DRAW AN ACCUItA'I'E MAP 1'0 YOIII& PROPERTY!! 3 ae - /ips• a s -v " - s x 8 g d g 4ol� s 3,7 8 5 0 co re 3 t J z / i N 6 m'4