HomeMy WebLinkAbout02634 . GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2634
109 8th Street �uIte 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
, Phone (303) 945 -8212 ,
' I This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building .or permit.
PROPERTY . ' ; , (
John H. Doden ,
Present Address P.O. Box \2Q1, Debeque, COPhoi�e283 -5327
Owner's Name Present
System Location I ' County Road . 222, Parachute
Legal Description of Assessor's Parcel No.
4
SYSTEM DESIGN
/
- "v ere Septi Tank Capacity (9LIIorA) -
fry /.l 3
/U /4 Percolation Rate (minutes /inch) ' NumVer of Bedrooms (d. OtA )' ‘ A
Required Absorption Area - See Attached
Special Setback Requirements:
� �� Date / - a9 yG Inspector = -e• ∎ a r ' -
I `
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) 1/1
Call for Inspection (24 hours notice) Before Covering Installation
System Installer. NM )
Septic Tank Capacity 600 ? , -1
•
Septic Tank Manufacturer or Trade Name g
3 L P ` 45
Septic Tank Access within 8" of surface E 3 i I
/ '. --
4
Absorption Area a q4 ` I , . t
_ I
Absorption Area Type and /or Manufacturer or Trade Name - SE s I r /Li 0ty70A' , V Al i 7
A.IN
Adequate comp with County and State regulations /requirements s .
1
.1 \.1 ;
Other 7 --
Date 9 -di'' 94 Inspector Fj L-7r4 r./ii. /0/ i� 1 [ �i
RETAIN WITH RECEIPT RECORDS AT CO RUCTION SITE 7
..
I
•CONDITIONS: i '
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
• INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
•
OWNER OHA1 d 2 C''Ci/ �y
ADDRESS /E)0 . & a 9/ > �� /P9wt c� PHONE 4K5 -S"3a 7
CONTRACTOR
ADDRESS PHONE
PERMIT REQUEST FOR ( ) 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 PROPOSE ACILITY; n C OUNTY
Near what City or Town $A' ul eD • Size of Lot l ez b A Ci2C5
Legal Description or Address lac 1 I tG^—a S T %y NCO % / (6 T 2 {z r5 L
e Fe
WASTES TYPE:
(?)/ DWELLING ( ) TRANSIENT USE
COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:
Number of Bedrooms Number of Persons Z
( v/Garbage Grinder ( l)- Washer ( 4 —Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK
Give depth of all wells within 180 feet of system: H/4
If supplied by Community Water, give name of supplier k1/4
GROUND CONDITIONS
Depth to bedrock: /
Depth to first Ground Water Table /t ? s4J ` � C t
Percent Ground Slope p� jy • 1 /// 96 UU
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: !Lu
Was an effort made to connect to community system? ( ) YES (y) NO
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(v{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:
a 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? ti
2
• 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.
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 fiunished 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 ofthe application or revocation of any
permit granted based upon said application and in legal action for perjury as provided by law.
D /(
Signed J �J t Date 29 - Ito
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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