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Home My WebLink About02643 4.w GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 264 J 109 8th Street Suite 303 r issessor'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 Derek Vondette & Traci F 47e3Jn t Address 214 S. 9th, Rifle k phone 625 -3437 System Location OBYD County Road 229, Silt Legal Description of Assessor's Parcel No. - - -- 4 . rcei $ t6afc,/ 8 4& — SYSTEM DESIGNy.. a7S yf , ;OF /h744 /4 - A " 754- r }} et> De FrasE.a S 110-"EA /ate Septic Tank Capacity (gallon) Ain 4>,uZgA r_OtherPAVV0A' L S A9'*"ercolation Rate (minutes /inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached Special Setback Requirements: Date Inspector r 41 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) 4/ Call for Inspection (24 hours notice) Before Covering Installation . ` -�\ X/ System Installer_a2.40 ff t - -- Septic Tank Capacity I2-5O Septic Tank Manufacturer or Trade Name Qtt' rat Septic Tank Access within 8" of surface 9F' — — Absorption Area ra g" Absorption Area Type and /or Manufacturer or Trade Name e2-5 /Li thin 6 t _! N r'LT DA17 F$ Adequate compliance with County and State regulations/requirements s Uf--C Other p �• Date 8- t 4- Q6 Inspector 4c,,...��i ri/N'h 4/ /o ff' 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 1964. 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 OWN ERirQ�NlrnclSMI/__ a �c1 — Cro . ■7_ 11 ADDRESS' '\ S. • 53c • %.Ct CD •111/5o PHONE ISa5- 3i-13 - 7 CONTRACTOR •e.‘c ADDRESS PRONE PERMIT REQUEST FOR OO 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 Gy sv' \c\ Near what Cit or Town Size of Lot 3.5 fC.cP.S Legal Description or Address P k x aA WASTES "TYPE: fl() DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE 13111L1)ING OR SERVICE TYPE: �/ be of Bedrooms Number of Persons 7 / litl .('arbage Grinder (X) Automatic Washer (k) Dishwasher SOURCE AND TYPE OF WATER SUPPLY• (X) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: 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: a:Y, rrActs Was an effort made to connect to community system? ( ) YES (X) 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 FINAI. DISPOSAL BY: (x) 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? tiro 2 YOI.ATION 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 thriller 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 teems 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 fiuther 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. Signg -, \•*•-vitreelarS%( Date ' -ha-Stn, PLEASE DRA A AN ACCURATE MAP TO YO JR ROPERTY!! C2 -N5 C5t\ o> t a \ »k 0%. \ S .4- • � Q °C iU d C J d t a \fie o s 3 5 :6 9 -36 ..:2-e m, ,_, w o e /?-- 290 S k 3 is ao 4rl /� L 7 _ 16a 4.3a esf s /' nu .S M/.V 14) (6L Is a66 f CFf7 422' gffcXG 4 Z- Ertc. I.Rck_ 1 .7- Rent .5 0 nre , W r giP r r . � S� / 4- kAe H tit N r4 0 kx., 0-7 C3 n