HomeMy WebLinkAbout02604 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2604
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
Granville & Glenda Farnum P.O. Box 954, Glenwood 945 -7189
Owner's Name Present Address Phone
System Location County Road 204, Parachute
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
1.50 Septic Tank Capacity (gallon) Other
/ • / ii 9 /n n.Percolation Rate (mina e s/inch) Number of Bedrooms (or other) 2
/Pr POCK #«-n /•//3 0.I0 fr9 e a.- D/P°
Required Absorption Area - See Attached (8 9 j y roagrr.Q5 /O 12 4
Special Setback Requirements:
Date S -fo tt. Inspector /rc -; /rn ij'.G�'Ki
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) (l
Call for Inspection (24 hours notice) Before Covering Installation
System Installer_ et.240 P
Septic Tank Capacity / 0
Septic Tank Manufacturer or Trade Name Li AP- toe ST /'.A
Septic Tank Access within 8" of surface yers
Absorption Area /$ 41
Absorption Area Type and /or Manufacturer or Trade Name / 8 7 $ /U .- pi CF-acs re / 3 alt
Adequate compliance with County and State regulations/requirements Q€.5
Other
Date - o2+-t(- Inspector
RETAIN WITH RECEIPT RECORDS AT C NSTR TION 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 fail or both).
White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER C; 11 U.) . ! 6 Lwt L.�"c�
ADDRESS t• (�(13 a'y q ('(zutund Co s s /bO I?FIONE 970 -WS- 9605(6)/4) 995- 71846n,)
CONTRACTOR itlwts 0
ADDRESS &GnM,e PHONE
PERMIT REQUEST FOR (X) 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 Gf'
aretr1
Near what City or Town :DP 1 TAR, Size of Lot zeU A ches
Legal Description or Address 0 (Ste 011 0eke c Lt dMeM� )
WASTES TYPE: (X) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:
Number of Bedrooms 2 + L t Number of Persons Z
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: 00 WELL ( ) SPRING ( ) STREAM OR CREEK
Give depth of all wells within 180 feet of system:
If supplied by Community Water, give name of supplier
_ GROUND CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table
Percent Ground Slope
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 2z /.t'je 5
Was an effort made to connect to community system? ( ) YES (X) NO
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(w SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE
FINAL 4ISPOSAL BY:
( ) ABSORPTION 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? AJ
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 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. 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.
Sign d / ii. ,_. ' tJ//., - Date 0-4 0
PLEASE DRAW AN ACCiURATE MAP TO YOUR PROPERTY!!
5,,1995 1:31PM STEWART TITLE GLNWOD No. 9003 P. 2/2
scREDULEA
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C✓ah��l�2 if- Vl u 1,n
Order Mather: 95024760
LEGAL DESCRIPTION
TRACT 53
082018A3,5! 131801221.112 Ae
A PORSIO11 or
81 /282,YZSI AND MN OF BSCTI0X 20:
THAT PART O1 TRACT 67
O2IOI11ALL! D2801I82D AS;
SAWN OF BSCTIOY 28 MW 21 /2112 StCTIO11 29:
ALL IN TONWSKIP 6 BOOTH, RAMOS 99 CST 07 T112 621 P.Y.
EZCSPT THAT 102770% OF TRACT 53 COWS!ID TO 22111 Born OP COUNT! COMML911I01RR8
OF OAR3'ISLD COUNTY 8! DOCUMIDIT AMU= 21 BOOT 96 AT PACT 822 AS SJCHPTIOUN
710. 55401
Comm! OF OARlIfD
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