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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2723
23
109 8th Street Suite 303 Assessor's Parcel No.
if • / \ 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
Tom & Cecil LaPrenz Present Address 45855 Hwy 6 & 24, G.S. Phone 928 ■9868
System Location 2000 County Road 237, Silt
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
•
1 000 ,, Septic Tank Capacity (gallon) Other
,r
/ 27 M'Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 ,
Rock- LEACtf rIEL -l- 982 0 _ + 11790
Required Absorption Area - See Attached .2 4 1N F ILT2Afl)AS orL 610 O.FFVSE4S = 708 is e`D
Jr 04 TM EK Ci f ?
Special Setback Requirements: /►
Date 1- 8_ k 7 Inspector A ,v-
r-
. FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer 0&11 Al ea
Septic Tank Capacity AO 52
Septic Tank Manufacturer or Trade Name ��QGP!- d4.+!+C
Septic Tank Access within 8" of surface yfs
Absorption Area '9 0
Absorption Area Type and /or Manufacturer or Trade Name 7i) a TAJF/CTi7.4y/.k'1s
Adequate compliance with County and State regulations /requirements
Other
Date /O — q 7 Inspector -- _ i Ate. ?!•�•
RETAIN WITH RECEIPT RECORDS AT CONS / RUCTION 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 — 8
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
I
OWNER . O h 1!Yar _ _. et- C t • r y p _ C p p.
ADDRESS • t W 4-, �' — a• - . ! 1 PHONE
CONTRACT o h Y\5 a ry1/4_.-- 1 . v. • r
ADDRE S� C--- � O PHONE `� —L
A VYe__ ' / n Sa Yt/ /
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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 FACII,ITY:
Near what City of Town C1 1 CO . Size of Lot 7 1 8 e 0 CYCS
1 oo , . I-1 1
Legal Description c�r � Address 0 �� !► 1 d es. 1
'
WASTES TYPE: ► ) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:
mber of Bedrooms - i Number of Persons
) Garbage Grinder () Automatic Washer X) Dishwasher
SOI IRCE AND TYPE OF WATER SIJPPLY: X WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: A / n
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM / �f7
Was an effort made to connect to the Community System? / T7
A site plan is required to be su itted that indicates the following MINIMUM distances:
Leach Field to Well: 300 100 feet
Septic Tank to Well: „2,'75 50 feet
Leach Field to Irrigation Ditches, Stre r Water Course6OO 50 feet
Septic System to Property Lines 3 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED
WITHOUT A SITE PLAN.
GROIJND CONDITIONS:
Depth to first Ground Water Table
Percent Ground Slope
2
„y
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:
(X) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
( /// ��\) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE f
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? N O
?F.RCOT .ATION TEST RESI T1.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 /ti �'� Date /,} 6 —
e
PLEASE DRAW AN ACCURATE MAP T 411UR PROPERTY!!
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