HomeMy WebLinkAbout02549 GARFIELD COUNTY BUILDING AND SANITATION DEPARTM Permit 2549
109 Bth Street Suite 303 Assessor's Parcel No. '
Glenwood Springs, Colorado 81601 4
. + ` , Phone (303) 945.8 — --, . .
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
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PROPERTY \
Owner's Name Don Si RV* Van Rnnae Present Address 01R9 CR 160. (LS, Phone 945 -5400
System Location , 97'S ' ,
Road _39„ pal ^chute r• `
,Q N.
Legal Description of Assessorb P a cal No.
3S0 E'.btk k tat"
/ti (Am Cd A Rfi i) �
SYSTEM DESIGN - 3 J a r t i . A i , 47 ht 4
Ja in 310- .e7i Ferrs,�RS i9 a4 r
/DOS Septic Tank Capacity (gallon) Other
/ r' i
�A Percolation Rate (minutes /inch) Number of Bedrooms (or other)
Required Apsorption Area - See Attached ,
Special Setback Requirements: )
3�8 �� �. tvt ■
7 Z LL: .\ 1
Date Inspector e �.Drd ,
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) .
Call for Inspection (24 hours notice) Before Covering Installation
System Installer_ AN /itti /712lJ3.A' , ,
•
.3, i Septic Tank Capacity /1,S17 _ - LOOCL ANP
3444
Septic Tank Manufacturer or Trade Name riy 9ZA4.4O - J3 ,.440 i6°wC.t ei't
Septic Tank Access within 8" of surface yrj` �
3 '/Y - %J Absorptiq` Area . O /INf / /NL-/ e2 Ra. t/5 /O 360 4 •t
Tile � '
Absgrption Area Type and /or Manufacturer or Trade Name /NF /t )2' i97vR
Adequate compliance with County and State regulations/requirements 4`
Other 7
�.1 Date -- ,9_% -. / l� Inspector - e.-4-_
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 materiel
variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense ($500.00 tine — 8
months in Jail or both). (
White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL, SEWAGE DISPOSAL. SYSTEM APPLICATION
OWNERfY)J/ I ti (//1 kI 11 0 (IS
ADDRESS C) / ( 1. kO. J Ge (') tol,C.IJUJOOD PHONE gtIJ - J 30 0
CON'T'RACTOR
ADDRESS s A/EI E PHONE 5 A M E
PERMIT REQUEST FOR (X) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or repots showing entire area with respect to surrounding areas, topography of area,
habitable building, location of potable water wells, soil percolation test holes, soil ) in test holes (See page 4).
LOCATION OF PROPOSED FACILITY: COUNTY GA RLj / E L-
Near what City or Town i A K 9\ C-H t.7 E Sim of 1,9A 6. A'-R S
Legal Description or Address N «VEt COV pi_ err-
WASTES 'I'YPI : 9O DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: 5/ lJ G P A MIL"✓ I G M E
Number of Bedrooms ' Number of Persons 'Z
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
IJRCE AND TYPE OF WATER SIJPPLYi ( WELL ( ) SPRING ( ) STREAM OR CREEK
Give deltth,of all wells within 180 feet of system: N b W 6 LL ( -t } (I �} I tU / 6 F 'I
If supplied by Community Water, give name of supplier
GROUND CONDITIONS:
Depth to bedrock: C.t IV k 1U 0 LAJ 7J
Depth to first Ground Water Table ct P R.. lu 8 W N
Percent Ground Slope r L- 4 - r
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: C9 M 1 L E S
Was an effort made to connect to community system? ( ) YES X) NO
TYPE OF INDIVIDUAL. SEWAGE DISPOSAL, SYSTEM PROPOSED:
(x) SEPTIC 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:
(X) ABSORPTION TRENCH, BED OR P11' ( ) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL, ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER-DESCRIBE_
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 1J Q
2
PERCOLATION TEST RESULTS (To be completed by Registered Professional Engineer)
Minutes per inch in bole 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:
Nance, 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 fin' proposes 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 saute for proposes 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 Po' `o iLcv V B-- v„_.,4-` V`-� Date l `
PLEASE DRAW AN ACCURATE MAP '1'0 YOUR PROPERTY!!
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