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Home My WebLink About02568 7 r °. ..may d 11 : 1 1 V�� A , , 1 � �•� 4,. i ,', .,, / 2568 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 109 8th Street Suite 303 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 / , rt^! Owner's Name Jeffery 6 Address 195 Orchard Lane, G.S. Phone_ 945 -9631 _ ono S •- fil4e5 i,tcA° - /11 ?N 5:/e, s / System Location Geuay- d-424., Mountain Springs Ranch. Lot 33, Glenwodd Springs Legal Description of Assessor's Parcel No. SYSTEM DESIGN 7 5 Septic Tank Capacity (gallon) Other 4 ,4„... 1 / i�°0 A+ Percolation Rate (minutes/Inch) Number of Bedrooms (or other) 2 FA / d. ••• 0 W Ihle le Met do e. i,9/r+ it, ea ed SystP Required Absorption Area - See Attached 4 • Special Setback Requirem'ants: , - Date 4- ` 7 4' Inspector cKE FINAL SYSTEM INSPE1TION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer ,k a /n'' 6/4.57 • Septic Tank Capacity /000 ,541 .y Septic Tank Manufacturer or Trade Name GDPeLATIO Septic Tank Access within 8" of surface pi ,i� Absorption Area 7/D *GtA 7 /f-> // se4et'•RAri C / _ 590 0 ,Sn9rVO �s1 I De 50 Absorption Area Type and /or Manufacturer or Trade Name G.PA /./e / I5l NC 2 (Deli l Adequate compliance with County and State regulations/requirements pc, Other Pie 72 47dp< T Date 9 -7 Inspector T . RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE •CONDITIONS: r1 1. All installation must comp) t requirements of the Oolorado State Board of Health Individual Sewage Disposal Systems Chapter 25, Article 10 C.R.S. 1973, 1984. ' ' 2. This permit is valid only for connection to structures w i ch have fully complied with County zoning and building requirements. Con - nection to or use with any dwelling or structures not a roved by the Building and Zoning office shall automatically be a violation or a requirement of the permit and cause for both legal ction and revocation of the permit. 3. Any person who constructs, alters, or installs an indivibual sewage disposal system in a manner which involves a knowing and material variation from the terms or specifications contained )n the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 months in )ail or both). White - APPLICANT Yellow - DEPARTMENT ••, 4 • INDIVIDUAL SEWAGE DISPOSAL, SYSTEM APPLICATION OWNER l EFftl aV laa,a,w 3Ao ADDRESS 15 S c ha .L# ,u£.. 42bs:k & Spy (n. PRONE a 95 - - 96 Si CONTRACTOR-VelicR,Ey Rzatnia ADDRESS i95 ozc/,nab 6-400-300.4 Spe in PHONE 9 VS- 943/ PERMIT REQUEST FOR (K) 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 in test holes (See page 4). LOCATION OF PROPOSED FACILITY: COUNTY G Near what City or Town 6' ysOcocf,S , Colo Size of Lot 3 S; 0? ctu2CS t Legal Description or Address /of 46- 33 mokadni 3 ,Sac u bo / ( — 3, "MAWS 4 49,4c. WASTES TYPE: (X) DWELLINC ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WAS'T'ES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: _ a.Sme is.L Home. Number of Bedrooms 71.0c Number of Persons 3 (X) Garbage Grinder (X) 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: Thy AAC NJ 0• Ji . If supplied by Community Water, give name of supplier GROUND CON _PIONS: Depth to Rd ck__ Depth to s Ground Water Table Pence Groun lope__ 1)1 'AWE TO NEAREST COMMUNITY SEWER SYSTEM: /1// Was an ellort made to connect to community system? ( ) YES Q 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, O'I'I[Nt USE ( ) CHEMICAL TOILET ( ) OTHER- DESCRIBE_ FINAL. DISPOSAL BY: (X) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER- DESCRIBE _ '/ WII.L EFFLUENT BE DISCI IARGED DIRECTLY INTO WATERS OF TILE STATE? NO 2 1120 A'1'ION TEST RESULTS: TS: (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 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 terns 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 _ __ I , % it Date a - a1 - Y‘ . 4 e/eser �. fret 4 { PLEASE DRAW AN ACCURATE MAP TO YOUR PROPER1'Y!! - 77 W 0 A-1)6 y T IN A A �♦ n 71Inlet S 7:0 Sps O � of 1/km 14 e 1 P q7 t P e p 1^ t 1 Hk dl 'F r " J � ,•- t -t E 4 `y` err (pf COVL .tt C . t oCt -r•,e- ., 3 w T Cf/Y" / 4 3 START Tian, 5 � / N Maw l8 han 77, - g3.9l Ze,,e 72-fec S4e oil A /2S AS re X5- T 41, 6F 34 a i _ i3 =15 33o =2YO = Z Fgic D lin . , r P RCOLA TIONZIES1IRESLL1'S: ("1'o he completed by Registered Professional Engineer) Minutes per inch in hole No. I neer) j Minutes per inch in hole No. 2 Minutes per inch in Hole No. 3 Minutes per inch in Hole No. Name, address and telephone of R PE who made soil ;absorption tests: Nance, address and telephone of RPE responsible for design of the system: Applicant acknowledges that the completeness of1heappliclion isconditional upon such further mandatory and additional tests and reports as may he required by the Iocal 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 inusre compliance with rules and regulations adopted under Article 10, "Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements make, 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 bre relied on by the Iocal department of health in evluating the same fro 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 haw. Signed . ,,7 , , - Date / `/ 9� P_LEASEDRAW _AN_ACCLIKATE MAP_T4 YQLIR_PRO_PERTY_ v w 7 \ y ) ��ir O z � 7 t it- ,, F