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Home My WebLink About02687 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2687 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 Andre Charttet 1022 Main St., Carbondale 963 -1574 Owner's Name Present Address Phone 4300 Grass Mesa Road, Grass Mesa, Lot 53, Rifle System Location Legal Description of Assessor's Parcel No. SYSTEM DESIGN /00 Septic Tank Capacity (gallon) /' l ant. Other 3 Percolation Rete (minutes /inch) Number of Bedrooms (or other Required Absorption Area - See Attached OC /6 vy n B,c' Drs' -,/sef oft /.vlit 42z = $OT O Special Setback Requirements: Date /0 7 _ 57 "'" Inspector r t FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation L / System Installer 4A ' Septic Tank Capacity / � � / Septic Tank Manufacturer or Trade Name 1 VV� / / r2� �� ` Septic Tank Acoess within 8' of surface Absorption Area 37 0 Absorption Area Type and /or Manufacturer or Trade Name � c -� f ' A Adequate compliance with County and State regulations/requirements /r Other cam/ may Date / 6 Inspector i ,,n, W-,!_42 ct -n 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 _- y�/� e t t/I` i j .- d/'zarh er ADDRESS /Do2o2 nut n 3f' I t. aj bunt ti .6 /�o &SHONE gl1 -/,S7 CONTRACTOR 318,/c 7 MI 9/14 ADDRESS „2 46 �0 > S�7 PHONE 9 71 1/457O 1 / 40 7" 6J, to Cj /5t6- 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 PROPOSER FACILITY. mo o Near what City of Town /1 Pi Size of L % 7 afiz6 Legal Description or Address ) ( d 11 1 - / e ' Ui /D WASTES TYPE: (X DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: /490. U {�� • �'I • I ►t )a,r Number of Bedrooms .3 Number of Persons ( ) Garbage Grinder QQ Automatic Washer 06 Dishwasher 501 JRCE AND TYPE OF WATER SIMPLY: 06 WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: r DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: fJMknOlDi I Was an effort made to connect to the Community System? 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 WILL. NOT BE ISSUED WITHOUT A SITE PLAN, GROI IND CONDITIONS: /� Depth to first Ground Water Table ' el U F ac Percent Ground Slope 2 • t' E qF 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: (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? MD PERCOLATION TEST REST 11,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 understan at any falsification or misrepresentation may result in the denial of the application or revocation of any permit rante sed upon sail ..placation a td in legal action for perjury as provided by law. 9/516 --.411/4 n Signed • Date 7 PLEASE DRAW AN ACCURATE MAY TO YOUR PROP Y!! f - F GYwss eSs / 24 nitre �>. 1 jolt �m %e5 r` l. /0 /'6o56 ( /c/ %p e/l �L 1 nug1( 3 7 7 :c ) 7 70 /o , S/ . r /o-_ 2,t4> 1 / Z. S T /rze afJ d 7% q 3 38 80 7 /e /eV' 2 38 rld 3/ 1 /A 71/ 2,3,3 3 X70, G 6 ZS 7 p /61 4e 0 8 3 7e, /6o =Z3.3 7 7 Z3 3 /� O /� = $074