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GARFIELD COUNTY BUILDING°dl I SSINDATIbN 4EPA kIENT Permit
• 25xV
• 109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 94j,fl120 £ 4'
�y This does not constitute
a b ilding or us permit.
INDIVIDUAL SEWAGE DISPOSAL PERMIT o - "(j � � .
PROPERTY O�
Owner's Name Bradford & Donna Mastro present Address P.O. Box a4 , New Castle phone_ 984 -2690
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System Location 017/ County Road .New cas \
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
/o'O Septic Tank Capacity (gallon) Other
/ r7 14)'/4. n Ratg,(minutes /inch) Number of Bedrooms (or other) 3 •
94-"C p 4 e.c-,aaM r3 a e 400 4'0 4 Alta. /e Pasr t
Required Absorption Area - See Attached .$44 Q r�yrii_r/2#9 rams c& 9 eA r "`
44 , L , 1 / 6 D i r- r cisW s. Si 9 ele
Special Setback Requirements:
Date 1 / - Q -96 Inspector q3.
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity,/000444/ ON
Septic Tank Manufacturer or Trade Name t- //��
k HAS -
Septic Tank Access within 8" of surface Y e S
Absorption Area .59y ' . U1/4/r'5 /� \;
Absorption Area Type and /or Manufacturer or Trade Name 8nu arA7
Adequate compliance with County and State regulations/requirements .. PS
Other oe 7V anoe
Date y / 9 Inspector TeIK _
RETAIN WITH RECEIPT RECORDS AT CONSTRIJbTION SITE
*CONDITIONS:
1. All installation must comply with all requirements of the Colorado State Boar(I 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 stq.Wlutetwh have fully complied with County zoning and building requirements. Con-
nection to or use with any dwelling or structures not appTbse Building and Zoning off ice shall automatically be a violation or a
requirement of the permit and cause for both legal action and rev cation 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 )ail or both).
White - APPLICANT Yellow - DEPARTMENT
v
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER 8€4 &&o,eP J . Mgs-tzo # /JOiI NA k . /'IAs-ta
ADDRESS P.G. Box 8'�Nem(arm,Cd.S /6T7 PHONE 970 TO ;06
CONTRACTOR QAWOL
ADDRESS PIIONE
PERMIT REQUEST FOR (7) 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).
LOCATION OF PROPOSED FACILITY: COUNTY G flesh
Near what City or Town Nek1 GASfl4 Size of Lot 2.O A e+65
Legal Description or Address
WAS'T'ES TYPE: ( DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:
Number of Bedrooms 3 Number of Persons
()) Garbage (hinder ( Automatic Washer (,/j 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 Community Water, give name of supplier T,,,,./ of A/6 CASTLE
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 IN )IVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(tf 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:
( VI ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE ^/
WILL /l EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? a
2
9ERCOLATION 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:
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 for purposes,of the evaluation ofthe application; and the issuance ofthe
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. 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 ��irr%G_ Date
WAtt- g ` n ncv4 elit s1
PLEASE DRAW AN ACCURATE M TO YOUR PROPERTY!!
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