HomeMy WebLinkAbout02828 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT _ Permit .2 28
109 8th Street Suite 303 , Assessor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303)145-8812
This.does not constitute • INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Greg Mohl c/o Prime West Builders \ 963 -3931
Owner's Name Present Address Phone_
COW `OIOO Heather Lane, Chrieteleit, Lot B, Glenwood Springs
System Location
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN -
alb �Seeptic Tank Capacity (gallon) Other -
4 Ii.) /1:3M f4colation Rate (minutes/inch) Number of Bedrooms (or other) 3
Roc e, i1..+a/v ease s98 ,iT�
Required Absorption Area - See Attached iF /'TRA yea 3sgt* iq
uo
/ O 0/Ffats tt 3 4 - 9.' o- /9 IV in
Special Setback Requirements:
Date 9`/7- 97 Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer OW N FK
Septic Tank Capacity
t ,
Septic Tank Manufacturer or Trade Name Q /�� 4it
Septic Tank Access withipf surface w
Absorption Area 3•s�r sc _`�e�
Absorption Area Type and /or Manufacturer or Trade Name cot 3 S5
Adequate compliance with County and State regulations/requirements vES
Other fr 4 0Sf ti Sc KticTa 1B IT 11 f>v - rH ,r R :so geRnrt
DateA 97 Inspector to✓( �c IsZi
RETAIN WITH RECEIPT RECORDS AT CO 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 off ice 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 ($500.00 fine —8
months in )ail or both).
White - APPLICANT Yellow - DEPARTMENT
• .
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER (y,QFG "lest
ADDRESS Po Q -V 5, Carbor:9 C° R'/C) 3 PHONE 9& 3 -- S /Va --
CONTRAC' R t$ �in r h45' so
�t�e c, 7/V
ADDRESSEOY /¢rn G' Ewivega PHONE Q6,3- dace;
_ - -
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 FACILITY' COUNTY G4Rst_aa
Near what City or Town t truteda Ga SP/4 //\) (r Size of Lot /0
Legal Description or Address *fee' Q Ce t gLsir- fZ, htidand
W -1% .y M fr Et
WASTES TYPE: (AL DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: JT . i ■ect E — ry/■••1/4- r
Number of Bedrooms t a . Number of Persons__ j
( tor-Garbage Grinder ('Automatic Washer ( tor Dishwasher
SOURCE AND TYPE OF WATER SUPPLY (WELL ( ) SPRING ( STREAM OR CREEK
Give depth of all wells within 180 feet of system: • 'er 'n I r'i Ihih•
If supplied by Community Water, give name of supplier —
GROUND CONDITIONS
Depth to bedrock:
Depth to first Ground Water Table
Percent Ground Slope 20 %
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: r 44 n e
Was an effort made to connect to community system? ( ) YES ( ) NO NV/ti
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
24 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
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? MO
2
PE1kC0I.ATION TEST RESULTS; (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.
Nance, address and telephone of APE 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 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. 1 further
understand that any falsification or misrepresentation may result in the denial of the application or revocation of any
pennit granted based upon said application and in legal action for perjury as provided by law.
Signed Date 7 10/9 1 7
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PLEASE DRAW AN ACCURATE MAP '1'0 YOUR PROPERTY!!
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