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HomeMy WebLinkAbout02624 r Yx�N 1 j . , •t , i GARFIELD COU TY•BUI,!DIN DEPARTMEN Petrrtlt` 262'4 t `� t 109 8t4,Street , Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 \\ 4 ' , \ Phone j303) 445-8212..,1 ^" S - \ This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT 1\ a buildlog or dse'perrelt. PROPERTY ` Owner's Name. Cliff Vashus Present Address P.O. Box 229, N.C. Phone li System Location 0156 Comanchero, Elk Crehk Sub, Lot 10, New Castle Legal Description of Assessor's Parcel No. SYSTEM DESIGN /CL:10 Septic Tank Capacity (gallon) Other G 3 / /r,l 60 Percolation Rate (minutes/inch) Number of r oth r) d / o r' AOP.'° %, pe �4 Bedrooms ./Aroi /,a 6�. Required Absorption Area - See Attached 120- t it T.v F/L 7Q4 T6 £ 0 It 4 O t 6 . . la* 1/4 - DI FrPACCP Ot .9O ft.s. Special Setback Requirements: .•• 6 ", Date •' • 21.46 Inspector WO✓j,..1 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24,hours notice) / Be � foore Covering Installation System Installer Ow r ° re Septic Tank Capacity 5 boo C, P 1_/J -"1d Septic Tank Manufacturesor Trade Name 0 Y Septic Tank Access within 8" of surface / & S Absorption Area )2 ilk ITS Absorption Area Type and /or Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements ' it Other !!! Date 6 9 ^ ` ` • ‘ • Inspector /i at t . 61f. C.-/ 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 — 6 months In jail or both). White - APPLICANT Yellow - DEPARTMENT • j. INDTVTDIJAL SEWAGE DISPOSAL SYSTEM APPT,TCATION owNER 1idAS (.!� Vier ADDRESS # /®6/17:f4 hr�cn � F.I � f fiS, j, PHONE CONTRACTOR a,// ('Au n f n 1 � ADDRESS i _, • , , 2 SHONE X / 3SZ PERMIT REQUEST FOR NEW INSTALL' TION () ALTERATION ( ) REPAIR Attach separate sheets or reports owing 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 (t ✓ B /CL Near what City or Town 2%G) (t < ilk Lot Legal Description WASTES TYPE: )(Dwelling ( ) Transient Use .: ( ) Commercial or Industrial ( ) Non - domestic Wastes () Other - Describe BUILDING OR SERVICE TYPE: /27Gnsc is»?,2 Number of' bedrooms: 3 " Number of persons Q4Garbage Grinder 54-Automatic Washer Dishwasher SOT IRCF AND TYPE. OF WATER SI IPPLY: () WELL ( ) SPRING () STREAM OR CREEK Give depth of all wells within 180 feet of system: ' If supplied by communtiy water, give name of supplier: . 0 " _- CIROIIND CONDITIONS: Depth to bedrock: £.&/ aer/ _ Depth to first Ground Water Table: A4 4 o l� ✓ 9 — Percent Ground Slope: 7p1,0 „ 0o/rats DISTANCE TO NEAREST COMMUNITY SEWER SY Was an effort made to connect to community system? _ (9 /Porno e fix TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTE 3,3v *i13 Y' Septic Tank () Aeration Plant ( ` rn --- --- () Vault Privy () Composting Toilet ( /ivs/1 o,,e__�rid ( ) Pit Privy ( ) Incineration Toilet ( = ZZ liw�i�p ) Chemical Toilet () Other - Describe: D 2y42 2 FINAL DISPOSAL BY: 44 Absorption Trench, Bed or Pit ( ) Underground Dispersal ( ) Above Ground Dispersal ( ) Wastewater Fona () Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 44 J • . INDIVIDI IAL SEWAGE DISPOSAL SYSTEM APPT JCATION OWNER .I. LS C ./ /f� / Area ADDRESS -#/49 � 4 h / <4 �1��FIA k, PHONE CONTRACTOR 81.— / (,nr /er - P,S ADDRESS i • , '4 . ' 'HONE 3S71 PERMIT REQUEST FOR NEW INSTALL • TION () ALTERATION () REPAIR Attach separate sheets or reports owing 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 FACTTdTY: COUNTY "-lea Near what City or Town A/Elr) d .c Lot Legal Description WASTES TYPE: >Dwelling ( ) Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes () Other - Describe "(Ante- BUILDING OR SERVICE TYPE: ' "t Pns "(A e- • Number of bedrooms: - 3 Number of persons .4Garbage Grinder S4lutomatic Washer `Dishwasher SOTIRCE AND TYPE. OF WATER SI IPPT.Y: ( ) WELL () SPRING () STREAM OR CREEK Give depth of all wells within 180 feet of system: If supplied by communtiy water, give name of supplier: .. C CIRO'IND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent Ground Slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: .0 /4 Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: $ 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: I4421 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? 44 r r J ;OIL 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. _ game, 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. ' 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. Date �/� t Signed l i / l p1 ,EASE 17RA AN ACCT IRATE MAP TO YOi1R PROPER grs6 qua 0 ' A — 7 _© r 4-J f/L _ g ,, N ate+ 1 — 4 9 z S ?cage 4 L t vr,4 ,,,_24_,:.3 4 i SLrNGLIPal rAg - [.R- 4,0 ea r\ L 4 / • • C2/142.4"-141 1 JNDIVIDIJAT, SEWAGE DISPOSAT. SYSTEM APPT.TCATION OWNER /5 14 .S r f�sr ADDRESS / / C9..).4 / � C.:/ i} h /'IcP�Y F, /�f�l�� ��1i, PHONE l/ CONTRACTOR' a <'n. vt ht%t' .{ , o ADDRESS .0 # , /,, . t /e C DAB H �,, ONE 3S71 PERMIT REQUEST FOR NEW INSTALLATION ) ALTERATION ( ) REPAIR Attach separate sheets or report s owing 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 FACTT,TTY: COUNTY C Tit, — /te Near what City or Town 24/1) (a < He-- -Lot Legal Description • WASTES TYPE.: 'Dwelling ( ) Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes () Other - Describe BUILDING OR SERVICE TYPE: a , .5/4/4 Number of bedrooms: di� f4-#.1 ! " Number of persons )Garbage Grinders Automatic Washer Dishwasher SOTJRCE AND TYPE OF ATER SIMPLY: () WELL ( ) SPRING () STREAM OR CREEK Give depth of all wells within 180 feet of system: If supplied by communtiy water, give name of supplier: D . _ I_ GROTINT) CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent Ground Slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: .0/4 Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: , 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: 04 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? Ai SOIL PERCOLATION TEST REST D NS: (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. 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. Date /`� Signed teal. p1 .EASE PRA AN ACCI TRATE MAP T() YOI TR PROPER • ... — ... .... . - . „ . • • . • / . • - . — -• --- •,- • .• .F... :'' 4 2. - .' ,:! .".'` ;-.!.... ... . L. . . . , -.- :',' --' :. .'• .!;: f ... c'-'' 4, ' .” '''.- 7 -....., ''. ' i`C.. -, -‘1,.' ':.' ...r .;;., ;e ZA .:r.p. '1 .c.i.I.,:1 4 ',..‘;:i V..4)' 4 eal,W1.- 1 ,; ..,;:, .. 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