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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 284 9
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
Owner's Name Barrett Resources Present Add ress 120 N. Railroad. Perg rhttrp Phone 9 8K- 4377___
1058 County Road 215, Parachute
System Location - - --
C
Legal Description of Assessor's Parcel No. --
SYSTEM DESIGN
ADM Septic Tank Capacity (gallon) Other
Percolation Rate (minutes /inch) Number of Bedrooms (or other) 15 person
Required Absorption Area - See Attached
Special Setback Requirements: -- �{ /'�/
Date 9- /1-14. Inspector 21A'r 4 (� /1.4100.1. - -- .
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer_ M'll - 5 *a U t c. C - -- - --
Septic Tank Capacity q 164,4 ern, /V An o e a
Septic Tank Manufacturer or Trade Name `7P-/1 /"Gd — )9 vd /LAO
Septic Tank Access within 8" of surfaceE . -.— -- - -
Absorption Area `
�p
Absorption Area Type and /or Manufacturer or Trade Name ROCK t / EsaCW 1g X rJ f lee
Adequate compliance with yrz5
� l County and State regulations /requirements
Other L• /A.10LN — i ao Imo. 9 vi� /
Date 9 - r /'' 6 Inspector / s_sco 4.0 f.-c✓.Vf'
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 revodation 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 ($500.00 fine —6
months in jail or both).
While - APPLICANT Yellow - DEPARTMENT
Y • •
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER Bcoryet% PesourC -eS
ADDRESS 11-0 ¥ - Pima Toad `SA G PHONE (410 285 -g311
CONTRACTOR fiord CcrY,�s&uL�tntl CD
ADDRESS — NH ArrnuXS{ Qc, (a !n Br-n5 PHONE Len 245 IM3
PERMIT REQUEST FOR ($ 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; COUNTY &at Re la
Near what City or To Thyctth t t'C Size of Lot (.O r 13 QLYGS
Legal Description or Address IOSfS Cot- Avats oad 215
WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE
(X) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: O fctce
Number of Bedrooms 0 Number of Persons /s-
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
SOURCE AND TYPE OF WATER S(1PPLY• ( ) WELL ( ) SPRING ( ) STREAM OR CREEK
Give depth of all wells within 180 feet of system:
If supplied by Community Water, give name of supplier 1 (>J4ider D ISh(IGk
GROUND CONDITIONS. 1 ,
Depth to bedrock: (scale( c&a \o'
Depth to first Ground Water Tahle (nett \t1( ttrCxtl to
Percent Ground Slope b . 2 %
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: l t(e M t IeS
Was an effort made to connect to community system? ( ) YES (y) NO
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( 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:
(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? }JD
I PfR C OI PERCOLATION TEST RESIILTS;�o be completed by Registered Profess, Engineer)
Minutes 3 G' 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.
Goei94Ifeol vo /ate vse0l- Ovl /y one persk /-e S/ - ho /e alas
c d on -1-o r a b e.L Sy S Ae r r r - , S / / 5 l4 f4 ac A e of ,
Name, address and telephone of RPE who made soil absorption tests: Walla LIze C
57Lo 25 (La on ti 25 ) G,J co f 1 (coo) 2V 1 — 1129
Name, address and telephone of RPE responsible for design of the system: O 1C r&.S above_
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 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 piles 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 tnie 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.
Siened i/ i 4 • _ PF PL S /41/!3 Date 7 //h /96
i
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
Ce e g7L LoC he / N'1,1 - 6- /
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