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Home My WebLink About02626 .- .- .,., a vov7wstiaw wIY nyinr35 4 : -:4 R'$R.'yF'ev. g s z. 1 I GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2620 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 i Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. If PROPERTY Owner's Name Dale A. Weasel present A dd ress P . O . Box 1542. Gle nwoo d Phone 945 -2317 1 System Location 029C County Road 223, Silt _ -.0.i Legal Description of Assessor's Parcel No .. ' /,a . 9 7 , y -d' ` . /t.IQ -2N - 77 "el-d".4( - A?<rc < . �Y`' SYSTEM DESIGN 7J (/ � - c,h 60 n Septic Tank Capacity (Ration) other i 9 0 J l q — 8 H 4 ) -I c t3�1 cad -zo � -0-e ^A; r, 4 3 / �VwC. � 1 _5� Perc Rat (m /inch) Number of Bedroom (r ot her) / / 03( /1CS- ' oLLfl ,_ad / 33 r Required Absorption Area - See Attached i/ .2 H Tk 64-40-4244)411v p �iyetrie C.: 33 (2' C9'" r Special 9—.24/—/797 Setback Requirements: � /�` Data Inspector . FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer tilall C• /‘wis . Sept* Tank Capacity / 0040 A Septic Tank Manufacturer or Trade Name ` rL 4.va 7 - Septic Tank Access within 8" of surface 1145 Absorption Area , 4 4 $ 14 - Absorption Area type and /or Manufacturer or Trade Name4 X y 4%G//I.95'. es .13 • in, /73. Adequate compliance with'Oqunty and State regulations/requirements 964 , Other q / ; Date 7_ a` '7 i Inspector 444 4 �i l � Q ,...4--n-4--- RETAIN WITH RECEIPT RECORDS AT CONSTRl1DTION 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 - nectibn 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 mannerwhich 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 jail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER Th4( (AJESS("Z_ ADDRESS, Ca . ILb MESA PHONE 995— ,231`7 (,JK- CONTRACTOR S Pryvi E ADDRESS PHONE PERMIT REQUEST FOR (4 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 GA - R.r a - 2-6 Near what City or Town 6 (LT Size of I,ot 11) ACae_- Legal Description or Address S 1-E TLE G+4r.' R WASTES TYPE: (x) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms 3 Number of Persons `i O() Garbage Grinder ().C) Automatic Washer (c) Dishwasher SOURCE AND TYPE OF WATER SUPPLY; ()c) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: as o 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: 1 ./ M ; Les Was an effort made to connect to community system? ( ) YES (>) 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 FINAI. DISPOSAL BY: p 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? A 0 2 • ''•PER(ROLATION 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: 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 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 teens 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. Signed l b../ ( �Je Date /ate /9� PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 JUN 24 ;98 10 :22 PROM GLENWOOD SPGS FORD PRGE.001 C. 7 CC - ' l 4.7 El 66 , 2 2.3 , y p - 75f I G i 1 \ DP ) T • SiaY' 1 I n (r� n07 1 -� 1 ( I 4 1 I ` S oo if I w : Rcr of koose I Z LE C. • • - W SEPT L Soo' OR1V •t•J/if Pi Fie'cia'' 5 E/? s6 a-- - I - -- - ► ** TOTAL PfGE.001 ** 10-6- hi, 0)4 Pi—to Ctitst-C. , , i S %t�'g1 og � 771'5 / „ i — Th " ir d if 4i" / :•?-7, 1 0 ,S 4 / 0 0 , , 4.3„ F e ,1 L, v . o 6 (3) , m il o, ! � \ i / , ,, „ow/ f, 7* ^ 7y ' a ,, 4Th -:- 3 /9., ---, AS 0 p p a o 722w,