The URL can be used to link to this page

Home My WebLink About02660 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 266 0 \ 109 8th Street Suite 303 Assessor's Parcel No Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Robert Niealanik 0828 CR 165, Carbondale Phone 963 Owner's Name fres@p1 System Location__ _ 43J9 ,,c Blue Heron Lane, Carbondale Legal Description of Assessor's Parcel No. SYSTEM DESIGN - Septic Tank Capacity (gallon) _Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) 4 persona Required Absorption Area - See Attached Special Setback Requirements: Date Inspector _ - -- FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer S CeS // / J�6 LMty F�,_ _ _ Septic Tank Capacity 00 /OA° Septic Tank Manufacturer or Trade Name an rceinAlt, Septic Tank Access within 8" of surface uc�-.S r i' - Absorption Area • ■ - -- Absorption Area Type and /or Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements Other /OP° f AL ii t / / % it) K 1 j'&2 . 6 Ee Date /O — Is - 0 Inspector frig-seti 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 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER /90BEn / ,..f -. • , t •,dwn ADDRESS 0128 Romp 45 ffRBoNOA[E PHONE 9'3 - 2Y35 CONTRACTOR ..5 NF.3/49n///c ADDRESS Dao /6s (navOALE PHONE 963 -//3/ PERMIT REQUEST FOR X) 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 G1RBocJnze Size of Lot Legal Description or Address Lo7 2 St 39 ezak HER&N 414/5 WASTES TYPE: ( DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: 2 «6 Number of Bedrooms / 6449 oteitAi Number of Persons ( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY (X) 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? go A site plan is required to be submitted that indicates the following MINIMUM distances; 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 WILI, NOT BE ISSUED WITHOUT A SITE PLAN. GROI JND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 'TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: k ) 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: ( ) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER (X) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? No PERCOLATION TEST RESI1LTS; (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 taw. Signed �� /lam/ / (/CK Date 06 /7y‘ PLEASE DRAW AN ACCURATE MAY TO YOUR PROPERTY!! 3 1 SEPTIC TANK SERVICE Portable Toilet Rental 0 Service I 1555 HIGHWAY 133•CARBONDALE,COLORADO 81623- PHONE 963.3814 OR 963-2340 October 5, 1996 Diane Nieslanik 0560 Rd. 165 Carbondale, Colorado 81623 Dear Diane, Concerning the septic tank on Blue Heron, we will agree to pump the tank when needed. We understand the tank is going to be monitored by you as when it is needed to be pumped. We thank you for this opportunity to serve you. If you have any questions concerning this matter, please feel free to call anytime. Sincerely, /{ o Le Linda Maynard U \ B & R Septic Service /O N% — 54,1f idelJ/kj OCT- 4 -96 FRI 8:48 COPELAND CONCRETE 9706251110 P.01 . I "PRAISE THE LORD" COPELAND CIICFETE I I C 28803 U.S. Hwy. 6 & 24 Rifle, CO 81650 j303)6251112 we 16 h-1- /J-1 `1 70 /h TOP "VIEW f 8' -4" 1 - 1- o ^,cck l I I I 20 dia. I 6' -6" 1 20" dia. I 1 1 I I 1 L _ — _ _ -1 ____ E i 20" SIDE VIEW n,; - II T o 4 4, ' :.e --) < - 4" 4 1 -1" a' 4 . A. q.. A 1 n4eG 4 :-4 _ C Mxlel D.Z. 1000 gailrn eaptic talc. Ompeassive sl:mxjlh 4000 psi• an3'ele bettan ani sick lads teintotuad with 6-6 10-10 nasb plus 6 seer in tattan. '11.p meiniotned with 6-6 6-6 mash and 63/8 taker Digjilg specs: 7'-6" wide. 9'-4" lag. FYan tle wtside bilton to miter of inlet hole is 4' - eel outlet is 3' -10" fmn lx tton. Ihawin2 PDT 32 1