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Home My WebLink About02849 ees. : ' a;' .rW' °'- •'h-cw,^ ' -,.. ,- R.wvr 'l;"'% "" f^� -w ; :.¢w }vrr� - - •. , p n 176a'9A�' �Va��98FLtFalAr•IC• °� GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2849 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 Owner's Name Friedemann Ammer Present Address PO BOX 2129. Eagle Phone 328 -1430 • System Location • • Conn ' oad 0 P _ . a t - Legal Description of Assessor's Parcel No. u ft-_ C EA° 4 - Q 60 tole eaG SYSTEM DESIGN tit PI ECES 1f C H A "A Q - G EO S " 32 2 tt ( t t ern EKe �tE S c A 4000 ' ' t° Ti tt tr !r N l3 S ptic Tank Capacity gallons Other , St, It S F• 04 Percolation Rate (minutes /inch) • Number of Bedrooms (or other) 3 Required Absorption Area -,See Attached Special Setback Requirements: Date q 1 q 7 Inspector • A 2 t 5 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Befqre Covering Installation • System Installer 614€. /4 2 . «.L0 /S Septic Tank Capacity /0.40 Septic Tank Manufacturer or Trade Name aPel- git400 Septic Tank Access within 8" of surface te Absorption Area 4LZ 7 r J/ a/l.i de's ,Absorption Area Type and /or Manufacturer or Trade Name. Jt /L7Q4/7 n P --� Adequate compliance with County and State regulations /requirements VCS Other (� / Date c 4 - y'A Inspector.. 7 ? phi n -Q -' RETAIN WITH RECEIPT RECORD AT CONSTRO 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 oTthe 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 1, Petty Offense ($500.00 fine — 6 months In )ail or both). White - APPLICANT Yellow - DEPARTMENT • INDIVIDUAL SEWAGE J DISPOSAL SYSTEM APPI,ICATION OWNER FriQd i an n 11. Alen mar- ADDRESS C 30( PHONE .�yg — f¢3D CONTRACTOR OA ADDRESS P 0 •PDX Z/Z1 �-v PHONE it-e — / 4' 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: Near what City of Town 4 .) ( i $ Q t Size of Lot Acre. . Legal Description or Address T 7 t R.q I !o {>'1 p. M . See g : •511//4 SO y. WASTES TYPE: pi< DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms ' Number of Persons (✓r Garbage Grinder ( 1Automatic Washer (t%tishwasher SOI JRCE AND TYPE OF WATER SUPPLY: (✓ " WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? i • i.. i •I _ir . I I• •s h: •11' • h• ft_1.41 uINIu. M'• :n • • 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 Percent Ground Slope 2 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: ( ) 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? pERCOL,ATION TEST RESTI1(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 � :_..�� ... Date OA- 07 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 1320.00' • o prv° 0 o �L.O cot 4 c'� T7,R94WSEC6 GARFIELD COUNTY • COLO. 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