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Home My WebLink About02708 r r� GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 270 8 109 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 Owner's Name Elizabeth C Condidine Present Ada ass 1873 B St Denver Phone 694 -6499 System Location 0472 County Road 153 (Big 4 Ranch)„ Carbondale Legal Description of Assessor's Parcel No. \� SYSTEM DESIGN 06 0 Septic Tank apacity (gallon) Other .,L, a Z 7 _ olation Rate (minutes/inch) Number gedr ms (or other Required Absorption Area - See Attached �-!t c � , /titih� --CSY ,3 2 To ° Ott t O((/'t n AA-9,r s Ate^ Special Setback Requirements: c�- .y4 _ V Date //-- // ' Inspector, °"TS✓I fN Pn,� ,, FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before r Covering Installation m Installer ( 1 r " of C 0A-(57 ptic Tank Capacity / c0 0 Septic Tank Manufacturer or Trade Name C 0 Pc L A NO Septic Tank Access within 8" of surface f - S Absorption Area. ( CY ) Absorption Area Type and /or Manufacturer or Trade Name Li a 1 /N/ r 1 L 1 A /h. 7 () K Adequate compliance with County and State regulations /requirements '1 C S Other Date l-1 Q (, Inspector, RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: stallation must comply with all requirements of the Colorado State Board of Health Individual ,. vid 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 4 , INDIVIDUJAL SEWAGE DISPOSAL SYSTEM APPLICATION � j �'RG SyS7f l A DP OE SS , air_ C Y 12D_153 {ZB M"I DAt Co � . • - Ll iiri6�R. OWNER _ -- � I 4 i ._ TPA Cu ns1 d in� Contpaii�s 3 G94 .649C •DRESS 4 S'. /3r.t1.►�rr; ST Ao222 PHONE 743.91 CONTRACTOR DternoZ Cer strLCncen Co ADDRESS Q-14 Center br. etentosnct sggf PHONE qqf -e 7 2- Co 9'Ll5- /649 pAaew PERMIT REQUEST FOR (V) 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: / eyrsT nr . let MIA- Near what City of Town ( 4,12, Le Size of Lot 80(31- Ac . Legal Description or Address APPRO2c 0472 Coon -A Rd / S3 WASTES TYPE: (✓f DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE 12 Avri "7 BUILDING OR SERVICE TYPE: S /V16&E Fir-mi L RG c FOvmcG J 0 e mber of Bedrooms 3 kut overSltE - 6ysiatA Number of Persons 4 rGarbage Grinder (UY Automatic Washer ( Dishwasher $OI JRCE AND TYPE OF WATER SI JPPLY: 04 WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: MILES . Was an effort made to connect to the Community System? NO A site plan is required to be submitted that indicates the following MINIMUJM 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 JND CONDITIONS: Depth to first Ground Water Table_ s� Percent Ground Slope 8 to to 7, • 2 k • r • 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: ( Nj 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? AID pRRCOT.ATION TEST RF.SIJ!.TS. (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) TEn- 70 SE E'Y GR2P(EG,O cow.) 'Ty 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: ame, 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. -- (I Signed L1'C . rofSbrief72W7 Co. Date WV' 6 , (996 MC., ELI vi-FETH Coa5fa PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! - See L l X L 1. gY i i 06 - 4 ritrc44 paw I1.1Css • cVA ,,dc¢ Ce Co Ce vead o • MINTtte 0 • 3 • 2 cn en /� \ � �[ >. 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