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Home My WebLink About02612 se ee GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2612 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 Rodney Vogt Present Address 1857 CR 109, Glenwood Phone 928 -8408 System Location 1857 County Road 109, Teller Springs, Glenwood Springs Legal Description of Assessor's Parcel No. SYSTEM DESIGN Septic Tank Capacity (gallon) Other ENGINEERED Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached ALSO SEE ISDS PERMIT 2139 Special Setback Requirements: If Date Inspector /� FINAL SYSTEM INSPECTION AND APPROVAL (as installed) /Ts /14 Lav6Pvc�e'p P /P/I.S Call for Inspection (24 hours notice) Before Covering Installation System Installer Eva 49,v.7'" Septic Tank Capacity /mC &°t Septic Tank Manufacturer or Trade Name 6-440 0 Septic Tank Access within 8" of surface YES Absorption Area 3RO�.s tr £tw'75.EA5 A/72 --C / a /S , /5 t1211_ Absorption Area Type and /or Manufacturer or Trade Name /NF'C7'C/1 2Z < Adequate compliance with County and State regulations /requirements le Other 6 C./JUrc Date 6 -' -74 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 — months in jail or both). White - APPLICANT Yellow - DEPARTMENT ' • • INDIVIDUAL. SEWAGE DISPOSAL SYSTEM APPLICATION OWNER / D C114 - 00 - ADDRESS _ _. _ /L 1 6 ds. PHONE .FYcsI CONTRACTOR 9 14 I (Ln c - q ADDRESS 5 k 1r . 00 PHONE 9 > 7- ?« / PERMIT REQUEST FOR ( 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 PROPOSEE�.,FACILITY n COUNTY a v /CZ JS (( / " " 4. Near what City or Town ��eu< oA( S / f'i r "' 4 _ 1 4 ,40 Y -e'> Legal Description or Address fro T Y' fr, WASTES TYPE: (L) DWELLING . "�L Q USE ( ) COMMERCI STIC WASTES /� *79 / BUILDING OR SERVICE TYPE: - 5 Number of Bedrooms 4. e ms 1 ( ) Garbage Grinder (te ut • SOURCE AND TYPE OF WATER SUPPLY. :EOM OR CREEK Give depth of all wells within 180 feet of cyst / If supplied by Community Water, give name c lion* -0 Ocovi -0‘, S GROUND CONDITIONS; Depth to bedrock: Depth to first Ground Water Table Percent Ground Slope, DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM Was an effort made to connect to community , ; y' NO TYPE OF IND (DUAL SEWAGE DISPOS Q�w ( SEPTIC TANK ( ) AF y � ( ) VAULT PRIVY ( ) C( ! „tot , / c „1- c ING, POTABLE USE ( ) PIT PRIVY ( ) IN , , .i ■ ING, OTHER USE ( ) CHEMICAL TOILET ( ) 01 Pf)t FINAL DISPOSAL BY: W J ( ) ABSORPTION TRENCH, BED ( tANSPIRATION ( ) UNDERGROUND DISPERSAL .TER ( ) ABOVE GROUND DISPERSAL_ ATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRE( 2 .-* . • ' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER O d l/ o ADDRESS / r / X 1.44. c Q p tact PHONE G � -7-FV °1 CONTRACTOR C /z oi O /lYt ADDRESS . t 5 , /r . 0 , PHONE q > 7" t'`L 7 PERMIT REQUEST FOR ( W 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 PROPOSEEJ /FACILITY: ,° COUNTY as v Ft t. (d / Near what City or Town C( .uftc -sue 5S i ... , Size of Lot /a 5j A A 1r Legal Description or Address / T y 'f�av `? r “ s WASTES TYPE: (L.} DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OR - DESCRIBE BUILDING OR SERVICE TYPE: - a 5 Number of Bedrooms Number of Persons I ( ) Garbage Grinder (t-) utomatic Washer ( 1...)--- SOURCE AND TYPE OF WATER SUPPLY: (y)--WtLL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: w If supplied by Community Water, give name of supplier - / f Fi °-'"u co 'o 5 GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table Percent Ground Slope DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? ( ) YES ( y' NO TYPE OF IN9JVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( yrSEPTIC 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 TRENCII, 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? 2 PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer) Minutes per inch in hole No. I 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 fitrther mandatory and additional tests and reports as may be required by the local health department to be made and famished 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 sane for purposes of issuing the pennit 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 peujury as provided by law. Signed 1 {� Date ^ - 3 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 . .• • el? Ar, tede lire _3 a.a_it • 3 c ter f _ 1 I