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HomeMy WebLinkAbout02678 n e r j;; ;Tir T:tnr"rrre ..e. 7.. F WV I ti T. • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2678 ` t 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 i . /� IQ% .,r.J -1 ) Owner's Name Leon & Betty Green present Address 4186 E. Easter Ave.. Littlpj(,}� 303 -771 - System Location 4368 County Road 100, Carbondale Legal Description of Assessor's Parcel No. ' SYSTEM DESIGN 7 �o C Sept en O pacity (gallon) N GA n 4. Other G Percglation Rate (minutes /inch) Number of Bedrooms (or other) 2 OR 1 1wft 1u MI^ 307 0 kocx Lein. B ap Required Absorption Area - See Attached OR /0 On/ ,/S by/ea r/PAnX o'c ,9o4 /sf ..6€ /es Special Setback ^ Requirements: �[(A , -1 DateC - ! ci Inspectors( � Cam FINAL SYSTEM INSPECTION AND APPROVAL (as installed) • Call for Inspection (24 hours notice) Before Covering Installation System Installer_ 0 1 t..,( E. (& Septic Tank Capacity 100 o > L Septic Tank- M miracle Name ' `"'-s, v • a / �L___,_5 / Pc ' t r Septic Tank bccess within 6" s(rface I , (' v �2_) note- S - ... r lS Absorption Area ' O S 'l Absorption Area Type and /or Manufacturer or Trade Name 1 0 ( N r f (-- v 'r n A r01'� s Adequate compliance with County and State regulations/requirements Other Dur ftik C L E. Atiio L , 30 - le A f1/4(1) Dale— Inspector 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 2 Article 10 C.R.S. 1973, Revised 1984, 2. tf f s permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con - Action 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 it .__ Application INDJVIDT 1AT. SEWAGE DISPOSAT, SYSTEM APPI,CATION Approval By County Official OWNER fliYJR/v7 Lrnm e• se-777 /f CAPeAJ ADDRESS .p 4383 /odfo. �'. AdhoNdA /e, r,,/o. PHONE/V.n/P 2ONTRACTO R R .L/ioi oM td Leec/PrrAll / owNeM) ADDIRESS 4/x6 E. tw 4 1cR Ave • L.772"_7ti„ 0n. 8'01.2 PHONE -3877 'ERMIT REQUEST FOR: ( ) New Installation ( ) Alteration ( ) Repair kttach separate sheets or report showing entire area with respect to surrounding areas, topography of area, iabitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes ;See page 4). LOCATION OF PROPOSED FACILITY : County Near what City or Town CARioddoir Lot Size . 3 ACR S Legal Description 5141 4 N£ 4 Sec 30 Tf 7 5. R w 7 w 6 AM. WASTES TYPE: 4 Dwelling () Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe • BUILDING OR SERVICE TYPE: fin Abet Number of bedrooms 2 Number of persons ( ) Garbage grinder (4 Automatic Washer ( ) Dishwasher SOT MCP, AND TYPE. OF WATER SI IPPT.Y: QQ well ( spring () stream or creek Give depth of all wells within 180 feet of system: /oD If supplied by conununity 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: AA I Lac 2. Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: Yn Septic Tank ( ) Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use O Pit Privy ( ) Incineration Toilet ( ) Recycling, other use ( ) Chemical Toilet ( ) Other - Describe: FINAL DISPOSAL BY: IA 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? /Y0 ;OIL PERCOLATION TEST REST I1.TS: (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. game, address and telephone of RPE who made soil absorption tests; game, 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 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 - 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. 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. Date ,s /6- 90 Signed /r P 1 p1.RASE DRAW AN ACCJ IRATE MAP TO YO1 JR PROPERTY ,57 V 3 /8 3 '° © /4, A s.,— 7 4 20tH('" I i8 (3f l /Is' t 8 YA 31 . 8 a : a7 gi /O 3-'s "S i k / 11 1 At : i l se-d_ In iy 3 ©� p. 12-�c LEAN a C o 2 p (Pt SYS t 2 : x 7.G II 0 2.-. (6 C 13 IKF1c7Ytn7un O - 6(0 o'FF = 10 Umrrs