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Home My WebLink About02647 , GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2647 109 8th Street Suite 303 Assessor'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 --- To v /Mii✓gj cY,s yY/ /S` Owner's Name William Kaufman Jr. Present Address - rcila:la Phone i4 -` tr_— �� ._t t v -: /o System Location Legal Description of Assessor's Parcel No. 9'.)6 7` Nr n>7 / - /%Jens > 7'/c SYSTEM DESIGN FU// p� �i�e T de lei /,) - - //�' %o Septic Tank Capacity (gallon) Other " c,Y a 4. "r Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached �^ Special Setback Requirements: (51)-'n f Date / /4 / y -. r ! Inspector LT-12.. YN2.(' .(�'/v -, lr+ A, FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer_ Q Lv N tf - - -� Septic Tank Capacity 00 0 Septic Tank Manufacturer or Trade Name C ot f- {1 ,N (') Septic Tank Access within 8" of surface "/ L' S - Absorption Area - 7 4 0 F 7 2 Absorption Area Type and /or Manufacturer or Trade Name L V ' � Port /\ 1 16 FI 100 AI Adequate compliance with County and State regulations/requirements C e A ((`f - (. (W tr F (N C E ^ ? O use H L7 F7 C. C'c2 Other A Date ( 2 S - (1 / Inspector A n- h( () 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 at • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER _IA / f k wW■ ADDRESS 40 I 2-3 '5°)a_ PHONE 9 - 2-39 4 CONTRACTOR ADDRESS PHONE 5 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 PROPOSED FACILITY: Near what City of Town 1 2 i Size of Lot Y 54 a ^-€ S' Legal Description or Address WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms 3 Number of Persons 5 (X) Garbage Grinder 90 Automatic Washer p Dishwasher SOI TRCE AND TYPE OF WATER SI JPPLY: pO WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? • • • i ti • • I . • • 1 1 1 , 1 1 L - •1 t ! • i _ • . • : • i • i _ i . ' i . u_ . _ \ . U • • Leach Field to Well: 100 feet Septic Tank to Well: 50 feet Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet Septic System to Property Lines: 10 feet YOUR INDIVIDUAL. SEWAGE DISPOSAL SYSTEM PERMIT WILI1 NOT BE ISSUED WITHOIJT A SITE PLAN, GROI JND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 a,TYlt 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 FINAL DISPOSAL BY: 9) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE 1 WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? I \ i o pF.RCO1,ATION TEST RFS1 T1,TS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes per inch in hole No. I 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 purposed 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 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. Signed / �� Date 7' Z 9 /of ,5/ M K a L ow—c% PLEASE DRAW AN ACCURATE MAY TO YOUR PROPERTY!! p er, Lt- ago- r-� 0 -0149‘. it)-1 girt ditv 3 • JEROME GAMBA & ASSOCIATES, INC. �� CONSULTING ENGINEERS & LAND SURVEYORS '� J 1� � `Ir. 113 9TH STREET. SUITE 214 1 P BOX 1458 GLENLENWO SPRINGS, COLORADO 81602-1458 - ) PHONE'. (970) 945-2550 FAX: (970) 945 -1410 �/ /! ] 4535 D]gD][0 PROJECT NAME: K.�_ ;tfiril�M" + T 6OS /y" PROJECT N: DATE: / - �T - q7 IF ENCLOSURES ARE NOT AS NOTED, PLEASE INFORM US IMMEDIATELY. TO: N 1 1492k. Pv P.nn riAtaFip7n (had IF CHECKED BELOW, PLEASE: ida l are ( ) ACKNOWLEDGE RECEIPT OF ENCLOSURES. ( ) RETURN ENCLOSURES TO US. WE TRANSMIT: )4HEREWITH 1 ) UNDER SEPARATE COVER VIA 1 I IN ACCORDANCE WITH YOUR REQUEST FOR YOUR: K APPROVAL ( ) DISTRIBUTION TO PARTIES ( 1 INFORMATION REVIEW & COMMENT ( ) RECORD ( ) USE 1 , THE FOLLO ING: RAWINGS ( ) DRAWING PRINTS 1 I SAMPLES ( ) SPECIFICATIONS 1 ) PRODUCT LITERATURE 1 ) CHANGE ORDER 11 — COPIES DATE DESCRIPTION ACTION CODE 5 ed ere Z Qm/tse? ner /- A - pizif e rafrewer en ACTION: A. ACTION INDICATED ON ITEM(S) TRANSMITTED D. FOR SIGNATURE AND FORWARDING B. NO ACTION REQUIRED AS NOTED BELOW UNDER "REMARKS" C. FOR SIGNATURE AND RETURN TO THIS OFFICE E. SEE "REMARKS" BELOW REMARKS: ************** *****fttt1t******kti•••************************* *** ** ttt•ftt* *li * ********** ** ***** COPIES TO: (WITH ENCLOSUREIS) 1 1 J 11 ) 95999 \TRANS.WP6 0 11,9/11 y -aE AVec f,77/L' wee re - A47,/i,✓G nj TPST 0 • JEROME GAMBA & ASSOCIATES, INC. � CONSULTING ENGINEERS & LAND SURVEYORS I J 1� N u 113 9TH STREET, SUITE 214 GNWOODSPRINGS, � �}$ PO OX LE COLORADO 81602 -1458 $ 5 PHONE. (970) 945-2550 FAX' (970)945-1410 / 9X9pI9[� • PROJECT NAME:LAUFMA//0 - S425 PROJECT N: 1710 535 J AI( AR I 7 / /_[-L 7 IF ENCLOSURES ARE NOT AS NOTED, PLEASE INFORM TO: M {, -Q,� US IMMEDIATELY. 1v2-v 13e 116-/ • , . i `/ IF CHECKED BELOW, PLEASE: 1 ) ACKNOWLEDGE RECEIPT OF ENCLOSURES. 1 1 RETURN ENCLOSURES TO US. WE TRANSIT: HEREWITH 1 ) UNDER SEPARATE COVER VIA ( 1 ACCORDANCE WITH YOUR REQUEST FOR YOUR: ( APPROVAL ( ) DISTRIBUTION TO PARTIES ( 1 INFORMATION ( 1 REVIEW & COMMENT ( ) RECORD ( 1 USE ) THE FOLLOWING: DRAWINGS ( ) DRAWING PRINTS ( ) SAMPLES 1 1 SPECIFICATIONS ( ) PRODUCT LITERATURE ( ) CHANGE ORDER 11 COPIES DATE DESCRIPTION - ACTION CODE OT z Xsa ims wo,i ( .&1/65ft) ACTION: A. ACTION INDICATED ON ITEM(S) TRANSMITTED D. FOR SIGNATURE AND FORWARDING B. NO ACTION REQUIRED AS NOTED BELOW UNDER "REMARKS" y� C. FOR SIGNATURE AND RETURN TO THIS OFFICE / - E. SEE "REMARKS" BELOW /,, REMARKS: t2r'u_/& a c0 cSIE'//� ufaf'T it-ti.S �/L 5CLt7 '-}iD veo iii/Sy -€ciQ 07 rP /1f1 -in AA ru SG-tcc � o�auA /6 7 y //Iea) /3 C ye COPIES TO: (WITH ENCLOSURE(S) ) 1 1 1 1BY: / • t .00 95999 \TRANS.WP6