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Home My WebLink About02548 , GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 548 109 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 Owner's Name Paul Bagley Present Address 1073 CR 260: Silt Phone_ 876'2279 42- / 73 System Location t bs County Road 266, Antlers Orchard, Tract 3, Silt T Legal Description of Assessor's Parcel No.. SYSTEM DESIGN / /OR ea R, cc I"; LF Aro. L /sfr, /GDO (1b14 1 /✓r /c-Y�t /TT.� &C a . 43Wic $ — Drl rth EA ' Other 1I1 i'•- m'Sercolation Rate (minutes /inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: It s 9L Inspect74 feu. b . FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before � Covering Installation System Installer_ i " s.. — .f If 1 / Septic Tank Capacity / v v o o Septic Tank Manufacturer or Trade Name f ^�. - Septic Tank Access within / 8" of surface / Absorption Area '/ X ry f Absorption Area Type and /or Manufacturer or Trade Name / /, v�Cy1 . — 41A — et t C - , Adequate compliance with County and State regulations /requirements v� Other (� C/ C Date ,3 �- D / / Inspector z � RETAIN 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 Class I, Petty Offense ($500.00 fine —6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT s. r • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER__/j _ ,3 • / t / ADDRESS 'a •C ... • : • 0 Oi. ' C .• PHONE 6„.26 2 : CONTRACTOR OW �- ADDRESS PIIONE PERMIT REQUEST FOlt -NEW INSTALLA'T'ION ( ) 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 itt test 1 les (See page 4). LOCATION OF PROPOSED F CIL TY: COUNTY re .-c ' e ,(1 Near what City or "I 'own_ _`-II / Size of Lot re Legal Description or Address lot iut,sI' P 6" sou e 36 AT %y lent ° Ac (C55'. 067D C 1 P a m akH 5 ; , e , . WAS'T'ES TYPE: DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - / DE E r SCRILIE r BUILDING Olt SERVICE TYPE: 4IAnI) Ae40(C 1�orn Number of Bedrooms 3 Number of Persons_ 5 ( ) Garbage Grinder ( Automatic Washer (X Dishwasher SOURCE AND TYPE OF WATER SUPPLY (X) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: _ If supplied by Community Water, give name of supplier a p j L. 597 GROUND CONDITIONS_ Depth to bedrock: (5-6.5- S 6 � ✓ Depth to first Ground Water Table f-, t T r , , , t_ _ 11 L Percent Ground Slope � F'�' DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: z `r _ Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPO n4„) /Y -- 4,2/t�l ( SEPTIC TANK ( ) AERATION PLANT 1 " ' // ' VI ( ) VAULT PRIVY ( ) COMPOSTING TOILET t (5O / C l`i . 49 1 ( ) PIT PRIVY ( ) INCINERATION TOILE 13 / c 73 G P a 4 i ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE _ FINAL DISPOSAL BY: (9- ABSORP'T'ION TRENCI I, BED OR PIT ( ) EVAPOTRANSPIRATION (C) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) O'I'LIER- DESCRIBE s/ WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? /6 2 • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER /I►'Y) ,� • %c� ADDRESS 'a .' • • 0 ' i . C • PHONE ' -- 2_ CONTRACTOR 0 64- 4-1C ADDRESS PHONE PERMIT REQUEST FOR }ANEW INS'T'ALLATION ( ) ALTERATION ERATION ( ) 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 ii test h les (See page 4). LOCATION OF PRO' ED F CIE TY: COUNTY Cp I� Near what City or Town_ ` tW s Siz of Lot i_� ✓e Legal Description or Address �.: • , ' • " • Win • ' See 'on 35 AT %y (f .3 • F F�Di4 :. " • t (e$ '. 0. 1 • G . . WASTES TYPE: V) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - D__E� 3E BUILDING OR SERVICE TYPE:__l/WaiefoCCd home Number of Bedrooms 3 Number of Persons 5 ( ) Garbage Grinder (}t.) Automatic Washer ( X) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (X) WELL ( ) SPRING ( ) STREAM OR CREEK (live depth of all wells within 180 feet of system: /Vit If supplied by Community Water, give name of supplier At 11 GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table_ Percent Ground Slope DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /1/n Was an effort made to connect to community system? ( ) YES ( ) NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ci.4 SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PTT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTIIER IJSE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAL. DISPOSAL BY: (} ABSORPTION TRENCI I, BED OR PIT ( ) EVAPOTRANSPIRATION t4) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER- DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 2 PERCOLATION TrUi RESUI:rS; (To be completed by Registered Professional Engineer) Minutes _ per inch in hole No. I Minutes per inch in hole No. 3 Minutes -- per inch in bole 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. Signeda!1_. i 1, / Date / 3 � �1 ii PLEASE DRAW AN ACCURATE M P 1 3 YOUR PROPERTY!! 4 pro perk Cr . ea; 233 w 3