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HomeMy WebLinkAbout02594 c „ -" '`q7; "- "7.77 W- 44' Y 'W 1 :111t71.S. ,w'*';FN a �. g d,� • Y T� 1 X11. ... `... ::� \ * ` GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2594 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colored() 81801 Phone (303) 945 -8212 , This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY owner's Name Jeff & Denise Lange present Address Box 28622, El Jebel CO Phone_ 963 -8583 System Location 0406 Arrowhead Trail, Grass Mesa, Lot 46, Rifle Legal Description of Assessor's Parcel No. SYSTEM DESIGN /000 Septic Tank Capacity (gallon) ,4 /N Other No 6.448ns " aeros2 3 3 P ercolation Rate (minutes /inch) Number of Bedrooms (or other) /,i ,N 3o Art, 4-7e3 /03s ,2crx /emu/ Bap Required Absorption Area - See Attached oR 6aT / ,56 5'o A�.rrcisE'.e 33 /) /saes Special Setback Requirements: 02 AZ/ ¥ /i✓f%s . 414 77. 33 ,n'ces - Date / ''e Inspector YeC FINAL - SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation � r System Installer 4 S..er,r�,T' Q Septic Tank Capacity /2 . 0 l I !� Septic Tank Manufacturer or Trade Name C M '" 1 Septic Tank Access within 8" of surface Absorption Area e .Z f 1 / ( Absorption Area Type and /or Manufacturer or Trade Name /Yt /t� �C i^ r'� "w 3 Pe-t.4.4. ( T 1 / Adequate compliance with County and State regulations /requirements Other /�l �� „,�A Data - 7t / 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 violatbn 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 specif ications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 months in jail or both). white- APPLICANT Yellow - DEPARTMENT ITN )IVIDIJAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER_ yf / Pcfi ,Ia� ADDRESS y r2f / # ,7 i /je ee' /, ec-) . ?/l)� PHONE x176) 9G 3 CON'T'RACTOR ADDRESS PROM: PERMIT REQUEST FOR (v(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). 1 OCAT'lQNOEjNtOPOSED I ACIl,1TY: COUNTY ler otg/Ve /s' Near what City or Town ,/� /r Size of Lot 4 /IGs Legal Description or Address <44 rC ec. To.< ,973 w WAS'T'ES TYPE: (!'DWELLING l ( ) TRANSIENT USE • ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: 4/93 S9'A/ .C.Y/j /e /e4 /lase Number of Bedrooms__ .T`/�"e0 Nuinber of Persons_ Three- ) Garbage Grinder ( /''Automatic Washer ( t bishwasher SOURCE AND TYPE OF WATER SUPPLY' ( *WELL. ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: /SO `I If supplied by Community Water, give name of supplier £IROUND CONDITIONS Depth to bedrock: Depth to first Ground Water Table Percent Ground Slope DISTANCE TO•NEAREST COMMUNITY SEWER SYSTEM: Was an effort trade to connect to community system? ( ) YES ( NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( 1.3' SEP'T'IC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER IJSE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAL DISPOSAL BY: (✓ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER- DESCIBE Alt 2 • PERCOLATION 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 ofRPE who made soil absorption tests: Name, address and telephone ofRPE 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 fiunished 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 niy 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. G 2 w Cr K — Date / - yo ei#74° PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 • •r k: irenAt ti =� p � (J 7 / /n< S n . / �ri�.l S' "`cc' os_ Logop: 8 0 /0 48 3 EneiVAt 7/ 16/2el / 6o46 -a / rig - 67 ;L 3 = 02 , 3 3 Z z .36>M1/o s a 5O • 8 = /1P1 ©,e z 2/a/3 '8 x x 3o ,%4t is `y ,e tiezAt � 6a / C /i✓.taTk'/J7 - # 02 /3/0 - D /A= fus - fe,c 3.3 ON /73