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Home My WebLink About02589 _ y GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Pefmlt 2 5 3 9 109 ,8th Street Suite 303 Assessor's Parcel No. Glenw6od Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute INDIVIDUAL DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name n t i 6 n e va. Present Address 2158 CR 250, Silt Phone_ 886 -2693 System Location 2160 County Road 250 Silt Legal Description of Assessor's Parcel No. ° ■ / /a7 1 '. 2 0'd 3 1.3 ; SYSTEM DESIGN = ke-ch rd /S XS-'12/yes N t!' = Pea L444 a SL i - y /,moo Septic Tank Capacity (gallon) 14 nf &t L C. Other At . , A,,,* 04 30 .),R,..4ent pf.0 ' 3 7'y., (�. Percolation Rate (minutes /inch) Number of Bedrooms (or other) //' IN 0 2, f9 Jam/ =. -. J... :+ , 2e Required Absorption Area - See Attached — i Special Setback Requirements: pwyzns "J2"i 7L'SD Date 47 - ij 16 Inspector C/71/ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer 0 CO C 4 Septic Tank Capacity 1 J O 0 CO 16 EL Pt A-t0 ,il 2 Septic Tank Manufacturer or Trade Name .^ - _ Septic Tank Access within 8" ofsurface S Absorption Area ' ✓ nS J 2 /� t��- Absorption Area Type and /or Manufacturer or Trade Name l2_o (^ �/- t &- 4 C r ( E Adequate compliance with County and State regulations/requirements • L( i Other 2- 3 `� Date O Inspector 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 (ail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OW NIat $Qil—S__l`1ase_ -- - - - - -- ADDRFSS 915: • ..:.. • ; et RItij)PI ZONE P76 -2193 CONTRACTOR t Q II Q! m y- ADDRESS Sa_.____ PHONE ,'fan,Q PERMIT REQUEST FOR (V) NEW INSTALLATION ( ) AL'T'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 in test holes (See page 4). LOCATION Of PROPOSED FACILITY' COUNTY awesiQ H Near what City or Town 5; Li' Size of Lot 3. I57 /1C1/5 Legal Description or Address EAS+ Y2 A1 F IA ME 1 /4 , .SPOfiDYn 3 1 t linOnSitip 5 51, WASTE of 4-he 1prh Win?. WASTE ' TYPE: (1/j DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER DESCRIBE (BUILDING OR. SERVI E TYPE: Rt5id4 f2 NAy t _ Number of Bedrooms__ ___4_12\ntac Number of Persons (4 Garbage Grinder ��` (L-) Automatic Washer 01 Dishwasher SOURCE AND TYPE OF WATER SUPPLY (✓) WELL ( ) SPRING ( ) STREAM OR CREEK (five depth of all wells within 180 feet of system: ' CMS ` N Da — .— If supplied by Community Water, give name of supplier (jROUNS) CONDITIONS: Depth to bedrock: Depth to first Ground Water Table Percent Ground Slope DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 3 wades - -_ Was an effort made to connect to community system? ( ) YES (4 NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (4 SEPTIC fANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE__ FINAL. DISPOSAL BY: ('4 ABSORPTION TRENCI i, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) (UNDERGROUND DISPERSAL. ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE__ - -- — WILI, EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 00 2 1 i 173ST RESULTS: SU LTS: ('ib be completed by Registered Professional Engineer) Minutes per inch in hole No. 1 Minutes per inch in bole 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 Iocal 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 Iocal 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 S - Date 3 -z 2- ` PLEASE DRAW AN ACCURATE MAP To YOUR PROPERTY!! 250 Road 4 Silt Mesa Sunrise Peach Subdivision Valley Tunis Tools Main Street • SILT ) ( 76 -2693 "� / e /o ,\ S /Acr /p 5� GA✓ / 77m e- = 020 ,*/A! 2.4t 1 / % 8 Me/mon- 5 / t ,3 %y l? L zy� /v /Zs % „ y e / so _ 3 -6 7 lyyg 9.8114, /6,6 ÷-m. 4-7 = /yy /Po A $,> T / -v2 /”" -.5 NC7 / g fat Uj A ; J 27 ifylr 7 /'/ Y r- S= o , l c, z /5 l,/ 7mittK s a3F i n , 6/./p 6 45 ,tt cZOM/'L - /i aeKi _ //� 7 , ,4,tu /osc-y f ,24920' `-cpo .Srl, /fin = /t'7 4 /Yc'q r«,s ,72 °X ?46V-+- 4C = /;7/ 0 /67/ O = o %oe X 7/ ' t 4 1,e)/ne !JK 16),,o /73- 8/0 /°u ,¢� GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 5 8 9 109 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 Owner's Name u t 1 r n vim...., 3.. Present Address 2158 CR 250, Silt Phone8 -2693 System Location 2160 County Road 250, Silt Legal Description of Assessor's Parcel No. SYSTEM DESIGN Septic Tank Capacity (gallon) Other Percolation Rate (minutes /inch) Number of Bedrooms (or other) 5 Required Absorption Area - See Attached Special Setback Requirements: • • Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer_ Septic Tank Capacity • Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface Absorption Area Absorption Area Type and /or Manufacturer or Trade Name Adequate compliance with County and State regulations /requirements Other Date Inspector 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 off ice 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 varia"!on from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 montns in jail or both). White - APPLICANT Yellow - DEPARTMENT Y 2490 C/,' an Se? fryn ,t-- "/ A at_ emA / A.0 lioJkz j Z-eAtvrtiThr , /3-5"A 141 (Loa ,st-1 o o vb ,ems+- 0- jQ-acA4 c i 3- e9s1 Ocar /O 7 5=-7 4 / 'X73-'7