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I GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 'Permit u L 8
t 109 8th Street Suite 303 Assessor's Parcel'No.
i
- Glenwood Springs, Colorado 81801
4 Phone (303) 945 -8212
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I ' This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name Britt MrTAn Present Address P.f1,, 11nx 1A New Caatfe Phone 9R4 •(1747
System Location_ County Road 335, Silt
Legal Desc of Assessor's Parcel No.
SYSTEM DESIGN
Mien Septic Tank Capacity (gallon) Other
,.
ru / /vrlio Percolation Rate. 3 (minutes /inch) Number of Bedrooms (or other) L a
/ 6 qiw ea& r/4 Z e • 2 e a so/ NAO 4#0°/ is d'ese. /Rg -Ira
Required Absorption Area- See Attached 7s - A .6 2- n e „ rvav7i is o'4 0
k ate, DM<irsC$QSs t4 ut/1r3
Special Setback Requirements: 7}
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Date / / -A --94.. Inspector /44,..
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer__ _ : /2 S6 01.00.6i •
Septic Tank Capacity_ .4 p4.$ 4 /_”? Cn
Septic Tank Manufacturer or Trade Name r tpLf.r.�
Septic Tank Access within 8" of surface 42 E •'
Absorption Area ? Ca
Absorption Area Type and /or Manufacturer or Trade Name 7 2 eI r,/ 7 p 4_mes
Adequate compliance with County and State regulations/requirements yFS •
Other
k Date 1/- ,J4- `lr4 Inspector Loh am
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS: `.,
1. All installation st comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
25, Article 10 O . 1913, Re'ised 1984.
ei
2. Th Is permit is valit7 only for connection to structures which have fully complied with County zoning and building requirements. Con-
nection to or use viIth 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. r
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 1, Petty Offense ($500.00 fine —6
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
TEL NO.9709840734 Jul 08 96 12:01 P.02
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Jun -2f3• 96 12:14P Stella Archti'leta 970- 945 -]555 P. O]
11\IDL !I)UnC, S WAciEJ1,SIVSAL,SYSIE,M.,AnLICA _ION
OWNI•R (+a1 MO 1-IN
ADDRESS _•o_ "e0X 1 „ 1,ott9 Caki Cs .._. J'! IL)NIs
CONTRACTOR__ S. L_ .- _E.0 K __ .— - .._ -- —
ADUREss. • - ° — ' -- {� °x bS _ i2 rSk .r1� ..._.__1'_u�Nl: __. w 07 3�
PERMIT RIFQ11I.ST FOR ea< NIAN 1NS'IA1.E ( ) ALTERATION ( J REPA
Much scparale sheets or limit shorting entire area wide respect to surrounding areas. topography of nrca,
habitable building, location ofpotable water wells. soil percolation test holes, soil profiles in test holes (See page 4).
M)C&FJON QF t')t.OPO.SL.1 1�A�C-1L! ('OIJN'I' \' !I
Near what City of 'Torun_- r -_. _. -__S.14)0111201._94/. 9 ._NS.l .—
1.cga1 Description or Address.a/ '. .. ^ .___p ° - l8 Taeon44 C gio 9N.ii
6 nige u;_ ^_./ .. _. cithi -/4
WAS1IS TYPE. (>0 DWI:HANG
( )'1'ILANSII :N' 1' 1)Sh
( ) COMMfat('IA1. OR INDl1S•TItIAI, ( ) NON - DOMESTIC WASTES
( ) Oil IER - DESCRIBE_ _. .
Ilt111,DING OK SERVICE TYPI . ._(Prw 'V1M4 / . 4107
Number ol•1lctlrontnti Number of Pei (Xi (iarfiagc (nind<n (Sc) Autom Washer — (.1/4') Dishwasher —
SO(Jll�f�
AND nit (1J.:_WATER :Sl 1J J'I.L P<) 141:1 ( ) SPRING ( ) S'I ItEAM OR CREEK
Give depth of all t%Clls within 18(1 legit 01 system.. lime.
at >uppnco oy t. ou motet, give name 01 supplier - —,
L Ps)l'L1QMfa
. --
119 _...... L2p}
I /.,pll. I. 6.a, Ll. timed Wwi , $ .i c 7 /
Percent Ground Slope_. 02,4 _.._. _
DISTANCE 'In NEAREST COMMtINI l' \' SI WEI( SYS — —
Was au ctlbrt made to connect to (' onu0unity system 0t) YES ( ) NO _ --
•1'1'14: OF INI)IVIDItAI, SEWAGE DISPOSAL SVS'1•EM PROPOSED:
(/ SEPTIC TANK ( ) A)iltA'1•ION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RE(:YCI.IN(i. POTABLE USIt.
( ) PIT I'ItIVY ( ) INCINERATION 1O111:1' ( ) RECYCLING. (MIER 11SIi
( 1 CIR:MICA ( ) Ill'I R• DESCRIBE
INA1. DISPOSAI I1Y•
{xj A11SOI(I'IION'I'RI N('ll.Ill:I) OR. P1'I ( ) EVAPOTRANSPIRATION
( ) IJNI)EIt(i1tOUNI) DISPERSAL ( ) SAND FILTER
( 1 ABOVE. (iROUNI) DISPI'RSAI. ( ) WASTEWATER POND
WII.1.
EFFLUENT Iii{ DISCI IAItGED OIItI( fLY INTO WATERS OF THE STATE? -
2
Jun- 2R -9E, ]2:15P Stella Archulato 970- 945 -1555 P. 02
rl :a1.ATIDN JCS" .ItI Ql,. fS: (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 KI "F \vbu made soil absorption tests:. _.._____-_.
Name, address and telephone (WRIT responsible for design of the system:__ — _
Applicant acknowledges that the completeness of the application i5 conditional upon such Iiulhet mandatory and
additional tests and reports as may be required by the local health deportment lo be made and lilrnished by the
applicant or by the Ideal (health department for 1mm:ees oldie evaluation onto; application; and the issuance oldie
permit is subject 10 such terms and conditions as deemed necessary to insure compliance with rules and regulations
adopted outlet Article 10. Title 25. C.It.S 147:1, as aatended. The undersigned hereby certifies that nil statements
made, information and Icpous submitted herewith and required to be submitted by the applicant are or will be
represented 10 be line and coned to the best of up' knowledge and belief root are designed to be relied on by the
local department of health in evaluating the same for purposes nl' issuing the permit applied lint herein. 1 lull her
understand that any falsification or misrepresentation may result in the denial of 1lre application 01 revocation ul an
pct mil granted based upon said application anti in legal action Gw perjury as provided by law.
Signed _ " -- .— Date_.‘ 6"( o pd
_
PI 1_AS .C)ItAW AN AL.CtfkA'f,-'..MAP Y1.8 11t PR.0111.1k1l!I
> wile-01,41,
TEL NO.9709840734 Jul 08,96 12:01 P.01
BURGE BUILDERS, INC.
299 BUCKTHORN
P.O. 150X 165
NEW CASTLE, CO 81647
PI IONE: 970 - 984 -0739
FAX: 970- 984 -0734
DATE:_. 71>? (1 Co
SEND1O_ 3 +c„,1(a -- Go. o ti���
FAX #: .1S - 1371 - - -- ! Ss —_
FROM: 6 _.,...
RE: Sewac 4s'p .. Y1.{ a Li u
TOTAL * OP PAGES (including cover page): 3
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