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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 26
.'(09 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 Jack T. Evans present Address 48 Moriing Star, Paracha 285 -9104
System Location a043 County Road 301, /arachute
Legal Description of Assessor's Parcel No.
co RaeK 4 tent'4 Bea- Aac'&A 0,001f0.a6r //9 0.597 =9r1
SYSTEM DESIGN 7 /9 d Z.va/"- 7rf 9Tvfs A9 tiMr ?S
917 /0 J "recia,a's .90 "^'tra
Acb Septic Tank Capacity (gallon) r Other
MIA) 3
r IN ID Percolation Rate (minutes /inch) Number of Bedrooms (or•other)t
Required Absorption Area - See Attached
Special Setback Requirements: z��,',,
Date *wed j0- 8'-q& A Ala,. =��1 J
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
• Call for Inspection (24 hours notice) Before Covering Installation
System Installer Sr - P(/4A/S
Septic Tank Capacity M JcT'
Septic Tank Manufacturer or Trade Name
Septic)nk Access within 8" of surface LAC- 5
i b
Absorption Area 7)
Absorption Area Type and /or Manufacturer or Trade Name T. p ° C L J4J YS j
+ Adequate compliance with County and State regulations/requirements 7S
Other I Q
Date ) / " '�7 96 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— 8
months in )ail or both).
White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER ✓ fIG/! 7T 5/4A/5 Ni/2.
ADDRESS 4 $ 4164iy/n/G jrnfl 494APy /irnPHONE 976 - .21c- 9/O 9
CONTRACTOR .62a"4,e z
ADDRESS /..279 umG4 OBE: flclzwdALc, (.. PHONE 9i0-9G -967 2
PERMIT REQUEST FOR (jO 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 G AFi
RA"G/7
Near what City or 'I'oHn) An N �UTE /A.97lzsAlFNr' %s44ize of Lot .a/). /f .9lt.4Ec
Legal Description or Address G J F.T7 //2 nF rwa NGl AI N/.') «9 nF ,SE477,04U /72 T ? So
RAN,F ?57Jcsr OF 77'E 467A1 /o. m. ( ,f)bN7V in 301
WASTES TYPE: DWEI.LING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:
Number of Bedrooms . 3 Number of Persons o2
(X) Garbage Grinder Ov Automatic Washer 00 Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (70 WELL ( ) SPRING ( ) STREAM OR CREEK
Give depth of all wells within 180 feet of system: NON O.
If supplied by Community Water, give name of supplier 4/ /fit
GROUND CONDITIONS:
Depth to bedrock: (20
Depth to first Ground Water Table //7/4 /SO
/
Percent Ground Slope
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 17 melts
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 TOILET ( ) OTHER - DESCRIBE,
FINAL DISPOSAL BY:
( ) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
(X) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? Na
2
•
1'GRCOI 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 tine 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 con•ect 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 pumoses of issuing the permit applied for herein. I 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.
dir
Signed i s ;i a Date 0 ye
v
PLEASE DRAW AN ACCURATE MAP 7'O YOUR PROPERTY!!
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INSCRIPTION -ACCEP 14.4'47 • N0002'30 "E SET 9 42 E 3 . 87
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AS 114E SW CORN4Yt OF ,18 - / 43883 P.0.8. 50J19'4YE 8.87
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