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HomeMy WebLinkAbout02555 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 5 5 5 109 8th Street Suite 903 Assessor's Parcel No. Glenwood springs, Colorado 81601 • Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Kent Hudson Present Address 0449 CR 223 Rifle phone 963 -0269 (w) System Location 0188 Shoshoni, Mineotat Estates, Lot 20, Filing 2, Silt Legal Description of Assessor's Parcel No. SYSTEM DESIGN A1P /N/MU/►1 J000 Septic Tank Capacity (gallon) Other Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 - ',' /NLN ini o Z‘/M'AvareS .cam quiired Absorption Area - See Attached Aiwa B .E». — 'e�eJ SyS7r.n /2(L 7 Sale ,j eo*1 tbagk Requirements: • N ( Date ' .3t 4 f < Inspector %MACE FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) ' Call for Inspection (24 hours notice) Before Covering Installation System Installer CJY4ftL /e / ea/ / 5 Septic Tank CapacitySYD 1 Septic Tank Manufacturer or Trade Name 1/447 Septic Tank Access within 8" of surface yF5 Absorption Area /O3a.Q 2efikAtefinedvr 4:SPY .5.51r47-re Absorption Area Type and /or Manufacturer or Trade Neme Sew SeeilkoeS ,e") Adequate compliance with County and State regulaticns/requirements y Other / / aZ fl? � — Date `�' % /L� I nspector :ride 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 — 8 months in Jail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER e2N-t-- pv,retr.. So'n ADDRESS c . U t c [ 717 6 (a..w o> c e(40;)- PHONE 6 2 r- 3.) e g CONTRACTOR lwwr - (v s g ADDRESS PHONE PERMIT REQUEST FOR (vjNEW 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: Near what City or Town sr 14- Act Legal Description or Address 722 c 5 6Ls - " ///�/�e� WASTES TYPE: ( DWELLING v w JSE ( ) COMMERCIA Ala . "4 TIC WASTES ( ) OTHER - DD. BUILDING OR SERVICE TYPE: (t1c•-0. Number of Bedrooms 3 3 ( Garbage Grinder (,3 Automa SOURCE AND TYPE OF WATER SUPPLY: 4 OR CREEK Give depth of all wells within 180 feet of system:_ rAtar 0 If supplied by Community Water, give name ofsupp GROUND CONDITIONS: Depth to bedrock: �o Depth to first Ground Water Table Percent Ground Slope .1 T DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? ( ) YES (A) 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 DISP L BY: ( krABSORPTION 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? w 2 INDlVfDIJAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER eerit J n) Wi o -n ADDRESS Q•0 . afK (717 G (u,woo £ a( 0A- PHONE G 2 r ' 3 ) 8 g c i r CONTRACTOR kW" A+. 7/54 — (v S 8 ADDRESS PHONE PERMIT REQUEST FOR WI 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 Near what City or Town S% /1- Size of Lot 13 Legal Description or Address 712 /A/eo-o ES /'ct J �°s WAS'IS TYPE: ( DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: fl1 tk 0fl--c Number of Bedrooms 3 Number of Persons_ 3 ( Garbage Grinder (4 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 Comm /2/ R Community Water, give name of supplier JG4 -1 GROUND CONDITIONS Depth to bedrock: a o Depth to first Ground Water Table Percent Ground Slope ,f 4 1 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 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 DISP 1. BY: ( ABSORPTION TRENCII, 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? w 2 • t ' PI3RCOLATiON TEST RESULTS; (To be completed by Registered Professional Engineer) Minutes per inch in Bole 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 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 pennit granted based upon said application and in legal action for perjury as provided by law. Signed Date a ^ rr fr _ c&Ce:2--- PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 r / )5P5.0 2533 J *-'PSPN N1 o 89 G mwe /D� .304f/A/ r 7 c/ " 3 = 9/ rte 40.0,0 !li a y , 0 M iiport 1 y .. , I' ' ,( 1 '� t i 173 J lc:, t' x=[‘ 1 I I k I t 1 1 , 1 i 'i S, , t , t - ) I r , t , i ( 1 I, d ., ! t 'i t i h 1 fi„ if k) n1 ° {,� � IC 1 4, 1 i � . 1 ' i , r° , , 1 1 I { ,I , { R M . : ih I r 1 G ARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT I Permit 2 5 5 5 ' j 1 09,.81h Street ' I Suite 303 ; •, I 1 . 1 Aesessor'e' , Parcel iNo. Glenwood Springs, Colorado 81601 ' t 1 ' Phone (303) , `i 1 ;It it �. , I Ili I , ' Thls does, not constitute, + l I .1't INDIVIDUAL SEWAGE DISPOSAL PERMIT '; k 1 i', li 1 �,: li ii I a building or use permit. , 1 1�j ,v n,, lil I I I , t I I L {� 1 1 PROPERTY 1 1 I II V 4 I Owner's Name Kent Hudson P resent Address 0449 CR 223 Rifle Phone 963 -0269 (w) . I 'iy I' I ' 1 )'t'I y II I System Location 0188 Shoshoni, Mineotat Estates, Lot 20, Filing 2, Silt lig , I, , I I � II j i; I it e rl , . Legal. Description of Assessor's Parcel No. f �, 1 . SYSTEM DESIGN , 001 Septic Tank Capacity (gallon) Other I ; r ; / I ad Percolation Rate (minutes/inch) , Number of Bedrooms (or other) 3 , ! 1 1 Required Absorption Area - See Attached i " 13e 4 ieofilet'/too S S7e�n »LE 7- SO f I + t ' 1 k is • Special Setback Requirements: [ I y l , t^ Date .3 --62 - 7 1 Inspector v ilk i ' FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) re Call for Inspection (24 hours notice) Before Covering In System Installer ✓ �� - I £ 4✓M- �46Z ,e' C 1 1 1! ' I 7 r'i I Septic, Tank Capacity 9744,2s7 7`i's3 I i� I 1 1I113 Mil/ 1 Tenk Manufacturer I t * ' T { I;' �I!- ?9 ©S77 4 • � r Septic turer or Trade Name [[c l {R{I I �, 3 , ) {, , I I, I 1 , t,,, ' ;, i. , �1! ' I.1 It +' Xl '� : . 1 t i c Tank Acbess II I 1 1 ) I t ' '-� I , Sep t i within 8' of surface f , * ,( • '.I I rlll'PI 1 i '' �. ,' { 1 Il ! r1. l 14 1 !iti � { I 1 Absorption Area r . i I j i+ ', ,f ' 1 _ (i! j f 1 I P7 O FlF �ri' Absorption Area Type and/or Manufacturer ortTradeh + + a I� �° lYt It 1 I t1111114 ' t !. , Adequate compliance with County and State ! gulatio — I T, { !I:,1 `t I � '1 k Other p 1 III li 1 II:' 11 �1,M ` I 6 v` Date 1 1 I Inspector T ' r T ,-- „r -_.. ,.. ,�., 1 A - .- f of fr i I :. • S 13 in h I E ' RETAIN WITH RECEIPT AT CONSTRUCTION SITE I 'r r' 1 . t, Oil ,t G, 11 i 1 + i t� 'H I HI , 1;;', *CONDITIONS: t r i I .. 1 ' I j', t r i k � 11 11 , ' i I 1'i All Installation mu c with all n t equiremea m ofthe C ol o rado State Boar of Health Individual Sewage Disposal Systes Chapr� ' Article iO C.R.S. 1973, Revised 1984 11,1 It la ; i ! IllI 'III I '” ) I 1`1 ' 1 - Il II 1 ■ [17, I�, , ' �; Y 2. This permit is valid only for connection to structureswhich have fullycomplied with County zoning,and building requirements. Con ' nectlon to or use with any dwelling or structures not Approved b the Building and Zoning office shall automat be a violation or a' ' a1zo } : requirement of the permit cause forr bo hlegel an d per �i`, fl *1 . t,rl'h l iii l i , + ,_=:.= 3. Any person who constructs, alters, or installs antndtvvldual sewage dlsposai system In a manna hich,lnvoves k nowing an m aterial -- !" variation from the terms or. specifications contained in the applIeetion of permit commits a Class 1, Petty Oftanse finet 8, I�!' i t' months In Jell or both). f'I,ti i' i1I ti, Ii; ll t r : l 1 { . ' 'i I 1 i i I t ' ' 1 f i g I ' l l i' t l' T • �, 1 Whito •• APPLICANT Yellow - DEPARTMENT I ' kit t I, . ' habitable building,. location of potable4va.ter ncolatioti test in Rage 4): , itirt . TY:PE OF INDIVIDUAL SEWAGE DisposaLtsx, 7 P101)0SED: :I 1) . It i t ', l 'n 1 :1 11.1 : 1'4 2 :':,, ktt it `iiiiii= .., CI WILL EFFLUENT BE DISCI-IARGED DIRECTLY INTO,WATERS OF l'I-IE STATE? ,,, , ,, , -, i ,, ::;-- • ■ ' I i c I 1I ,1 `f`? i'l111)1•.1li ,1 I i9" r:'1'i Iptii; PE-Ike ATION TEST RESULTS; (To be completed by Registered Professional Engineer) ,I . Minutes ' ' 'per inch in hole No 1 i "' t 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: r 1 sir , Name, address and telephone of RPE responsible for design of the system: I • • • t - rI,ir_ d ,1'ti ,.I, 1 it • t Applicant acknowledges that the completeness of the applicationi is conditional upon such further inardatoiy "and ' additional tests'iind 'reports as maybe r equired by the local health department to be made and fu by I p applicant' or' by the local health department for purposes of the evaluation of the application; and the issuance of the I permit is subject to such terms and conditions as 'deemed necessar to insure compliance with rules and re • adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements ; ,.,, i ,. 1 ! l , fr.I 4 ■ : i n made, information and reports submitted herewith and required to be submitted by the applican are or will be 1 i 14! "I.�. Y.s , \ .'' 1' t ' r O.I. ••Ykirill r,j4 represented to be true and correct to the best of my know + edge and belief and are designe v to b e reed on by the local department of health in evaluating the same for purposes of issuing the permit applied for herein. I ftirther • 1 ! h understand that any falsification or misrepresentation may result•in denial of the application or revocation of • any permit granted based upon said application and in legal action for perjury as provided by 1 ,1 i ,� 1 � ' f k it i , 1 1 4 1 i i. 1n t;;1 i � � Signe ' de ./ , I• • L',l Date ° % ; _'I PLEAS DRAW AN ACCURATE MAP TO YOUI& PROPERTY!! • • 1 i • f • i i • 1 • . 3 I / ' . - ' ; ' ,,'' I I ik -1 1 , li 1, 1,11 ;.,' iii ,c1 • i; ,I 1,I.4 ' 's i,;'1 ...' . t . • . 4 . : , ';''',, ■ : i ' 1,.' i ', . j ' ',' " i 1 i : I. t'rlisCP5.111.ttP?1/4$"5‘) I'!:4.,,i', 1 i.ii 4 '').•••• t .1: i! . ., . . . , . . I.: . 4+ l-lopsi)/v 1 , 1 :',',,',, 4,, ,:s ' '', 1 , j : . , , J..... i :' :•; . i' : . 1 t . . . ,... 1 7 7 n • ., .. i / 74 „, e , . . 1 Wi i r ■ ,,, ,'„ '1.t • 1 1:i , .,.' , i , ,. . . .-.' .: 1 3041/A/ 1 ' , , . ., i . .* : . , 1 • " -,, . I :Hl . . . . .-, , . 1 ,. , ' , C • i ki , ; . ' .! 4 ',', , , . ',','„ . , ; . '' ' i?ri'.' ' : I ", .'' 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