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Home My WebLink About02608 r •' ,.yy C9 f >c'W. GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 26 r 8 109 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 Miigg Bradv Present Address Box 127, Fruita, CO Phone 858 -3805 System Location County Road 209 (Baugh Creek Road) DeBeque Legal Description of Assessor's Parcel No. SYSTEM DESIGN 75 Septic Tank Capacity (gallon) Other IIJ 9m'eu Percolation Rate (minutes /inch Number of Bedrooms (or other 2 Svc Rbc,< 4 L EACr -1 ( sck /JO am nonfat Oes poa r1 c Required Absorption Area - See Attached dal 4 Tian LTP 4T6R - /.7 EA ,, p7 4 ina b, F6u6 a P$ Special Setback Requirements: � c Date L. " 4"yG Inspector i �" td FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer. CV-IA Septic Tank'Capacity / 266 • Septic Tank Manufacturer or Trade ! f?4R'�° NO V1 CSGO Septic Tank Access within 8" of surface (��S Absorption Area a 9 7 IS . Ft DS E t Absorption Area Type and /or Manufacturer or Trade Name 6- O/6.t4-( 2 Adequate compliance with County and State regulations /requirements 9ES Other Date ($ 1 6 . 96 Inspector 44.a., 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 — 8 months in )ail or both). White - APPLICANT Yellow - DEPARTMENT •� INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER M I K6 B R.A 1) `t' ADDRESS Sag 127 F2urrA On. S/Fia_.1 PHONE &958 — j' O5 .2F36 -9508 CONTRACTOR f) LOAM R. ADDRESS SI31%1F PHONE r i r 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 GAR.FIBL.V) Near what City or Town Size of Lot ij/) AC geS Legal Description or Address WASTES TYPE: (% DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: HE I/O 1 W 0 A fh ltir Number of Bedrooms ? Number of Persons 1 "° in ( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher SOURCE AND TYPE OE WATER SUPPLY; (X) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: `" If supplied by Community Water, give name of supplier N/fl GROUND CONDITIONS: Depth to bedrock: eb Depth to first Ground Water Table 20 Percent Ground Slope /2 - 2.(r) % Hat's-F. PA-0 906 X Zon 1" DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: .96 In t1-EJ Was an effort made to connect to community system? ( ) YES (X) 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, OTHER USE ( ) CHEMICAL TOILE f ( ) OTHER - DESCRIBE FINAL DISPOSAL BY: (k) ABSORPTION TRENCH, 13ED OR PIT ( ) EVAPOTRANSPIRATION (>Q UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE ? /VA 2 -- PERCOLA7•ION 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. Nance, 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 proposes 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 thither 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 `r gad), Date S— 14 -9 lc PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! N / w4 4' / 3 tr: ri4c- fjeo 3 l9i B'A U or] a 2 n c is / Qn /6 -17/44 DOUGt1F S anee 3 ERCOLATION 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 permft,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 sane for purposes of issuing the permit applied for herein. I further under- stand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said applicati9rp and in legal action for per- jury as provided by law. [ a1 /Ais . t Date Yip, .27 /592,_ 5igned5L PLEASE DR W AND ACCURATE MAP TO YOUR PROPERTY `J ) • .ti°3' I L1grncf �!(I 9 '1"\-V J on :Z' 7v ao,m,, to bovy s /A_s Pet 5 -- a, ° - Ar - n_ _._. - — -4 (J //tuna., 139 . 11 ,... .1 W lit ' y,9ys,1' — _-,ISd Rd 021 ow1IG3 v / • C' /..tv 0 roy . 7. ' Es tt Y • A le r_ o� � N J I J x t '� 0001 14 O W MRY -23 -1996 10:39 LPL] 970 858 3353 9708583353 P.01/01 r C i. N Co I . 0 & ft, 'r i - - x o CP Oi n i c ut < p t....1.. , • f A �v a TOTRL P.01