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Home My WebLink About02655 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 6 J J 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 Kristin Thompson Present Address 42 Oro Ct.. Parachute Phone_ fl2__ System Location_____— __ Our 16413 I. P: r - Legal Descr(ption of Assessor's Parcel No. - - -- SYSTEM DESIGN .,..• I /ODD Septic Tank Capacity (gallon) Other i a 7 M •M Percolation Rate (minutes /inch) D umber of Be s (or other) 3 S a SAO °Ro k 4tenc. ri I? set w / D,,aposac ADO .a Ali /6 O Required Absorption Area - See Attached 6-911 A :r c rem r it /9 bus n ,5'9d 4 ago UrrrutflE I9 QNvyt S Special Setback Requirements: / Date - ia- i Inspector /401-- � 6 ed FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation Systerwinstaller, !' ' 4 .qQ.4tWug a_ 3 Septic Tank Capacity / 0•e, /1 Septic Tank Manufacturer or Trade Name `�Q'' (- Septic Tank Aocesswithin 8" of surface 9 CS - -- 4 — / 7 Absorption Areal 1 b — , Absorption Aree and /or Manufacturer or Trade Name `� /`� y Air /4 - fiNr9.t / L' 7:-5 Adequate compliance with County and State regulations/requirements CEO Other Date 9 1- / Inspector 12,t, L. RETAIN WITH RE T RECORDS AT CONSTRUCTION SITE *CONDITIONS: 1. All Installation must comply with all requirements of tfjC6tdrado 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 ($500.00 fine —6 months in )ail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER _ Air/ :57 2/0/114, - 5!09 ADDRESS, /2 (7 / Ie r/v PHONE 2 S^ CONTRACTOR ADDRESS PHONE PERMIT REQUEST FOR ('NEW INSTALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PROPOSED FACILITY: Near what City of Town PG r4,- - -//f a° Size of Lot 5 ,9 rr.e-s Legal Description or Address,li o, 4'i %4 / .Sec S5 %a 7 .S. Fay, 7, 41 WASTES TYPE: 'DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: the //7o4, /j a Number of Bedrooms ,1 Number of Persons V o p e Garbage Grinder) Automatic Washer( Dishwasher SOURCE AND TYPE OF WATER STIFFLY: )4 WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 6, �i Was an effort made to connect to the Community System? A/c � 1;1 1 • • 1 1 . . 1 11 ' • 1 1 � • I I . . • . ! • i 1 : i • 11 .. ► 1/_ 1l 1 l i ' • Leach Field to Well: 100 feet Septic Tank to Well: 50 feet Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet Septic System to Property Lines: 10 feet YOI ' IN 1 IVIDUAJ, SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE IS$IJED WITHOUT A SITE PLAN,. —GM ND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 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: J (4 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? A/O PERCOI.ATION TEST RFSI I1.TS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) 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 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 ��Z Date 4% PLEASE DRAW AN ACCURATE MAY TO YOUR PROPERTY!! ? -7n F ✓f aye P. nargrawn sac, 5 9 k Sidle 3 e� �� - , O �9 c s , Ro co. w . C A o 0. o o (� 0 `ea" • o O G. .. r z '' w w 2 n N �S 'Oo# o O is \ O "'y H G O rn -1 (h C Z w / •.. s ci w = Z. P„ R. on 1 -< z rn w " o 0 DD' o 3 n; -, CD • c G n ^ "V c = ,a 0 1,, w B S 0 v7 C rn O. w =' o•v. G w to w ..o o w ( -n CD w . " O Cr n w c) y O = • Q CD Q. N 9 rn f f be = o CO c P e .t,' S (� 10 O w cn CD w 0 � t% 411 0 " n N y. • � , i g, , 3 0 - 9.� 69 a 6 #7? , iv 1 04,1 -- 77_ t. 8 2 8 74 8 g - .30 au d l' ir x 1', /N 7m D 1 O 0 N. ck- c