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Home My WebLink About02884 v s i ' l GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT .Permit 2884 109 8th Street Suite 303 Assessor's Parcel No, Glenwood Springs, Colorado 81001 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owndr s Name Susan & Gerry Johnston Present Address Box 672, Carbondale Phone_ -1913 Syst L ocation 1244 Satank Road, Carbondale Lege DescrIptiool of Assessor's Parcel No. LOCK— LenGH- C a r o , ..--7 1 49l SYSTEM DESIGN it or PIECES V? i t C ►{At..A0E' 8 a 0 / �� tY94 U ! r L, u u 6' p r T A EA- C Abel 1 500 it rr Sio If I 40rr Lt 74 Septic Tank Capacity (gallon) Other �l .S 5)0 1 fr - *AUi = p &Mwt.1.C- fOCA� = . an .(.4 la are. ISfIS I h 5 I q U Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: d Date I o- . 1-4 - ! A 7 Inspector (l a. 1`f cs FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for I)tspection (24 hours notice) Before Covering Installation System Installer W F c Cn C t C A V 'k T 7 he C' Septic Tank Capacity ( `� ,( Septic Tank Manufacturer or Trade Name C o f E A M 0 Septic Tank Access within 6" of surface Absorption Area I S S 2 (J X Absorption Area Type and /or Manufacturer or Trade Name D n"4 L., cc- t/ Adequate compliance with County and State regulations/requirements Other A Date II — 6 hat 41 (( n e t Inspector ^n n ) I - -C l e ? t' f RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE •CONDITIONS: (% trim- 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 1, Petty Offense ($500.00 fine — 6 months In jail or both). , s I white- APPLICANT Yellow - DEPARTMENT r ' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER S us R\I\ r' Cie v r \) Jo\c\{\S ov' ADDRESS P`)ny b7Z 1441 Ga -ov c. R t, C-6Ste (° \o, PHONE ' l ci 1.3 CONTRACTOR ADDRESS PHONE PERMIT REQUEST FOR ( ) NEW INSTALLATION (t4ALTERATION (PAIR 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 Cron SR le CAD, Size of Lot Legal Description or Address tt?Y b 7 2 , 12. S 0.\ C4\k R� WASTES TYPE: (DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON- DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: /w0 Otaa' / t Or .Ckls i5 Aida 2-3-1)S Number of Bedrooms 6 f i V- Number of Persons ( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher SOT TRCE AND TYPE OF WATER SI TPPLY: (4 WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: .1Was an effort made to connect to the Community System? A site plan is required to be su 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 1 Septic System to Property Lines: 10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN, GROI TND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 .• rp. r TYPE,OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( 4 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? pERCOI,ATION TEST RFSTTr,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 GecaGa . \k kw Date PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 j de$ Address: carbondale, e, C ; a Carbondale, Colozado. 1 j r 4 t, '25 Iii I ( , J e , r t co a , , , fiv + 1 7. _II • Q$ 4f y C J , �f.� / t • ytoc 3' _ _ ;_..._ I..) : ' t : - ua�t cou; U f 0�t ) i ) i 0 (� N N — s �oY 11, 1 M 8 t \ I I ii‘ N Lot , 6 ( ) ),.> 1-0-c..1(._ uel; k I - • 2z oa•• 456 & I r T1 • C kw6=r lb.4,Ats 41— _J Ls 144ii I hereby certify that on October 9, 1980, a survey was conducted under my direct supervision of Lots 19, 20, 21, 22, 23, 24 and the Southerly 4.00 feet of even width of Lot 25, all in Block 13, Amended Plat of the Townsite of Cooperton (being Lots 18 and 19 of Section 28, Township 7 South, Range 88 West of the 6th Principal Meridian), Garfield County, Colorado. A two -story frame house andaa two- storyafiam frame ashedimereifount to be on said lots as shown on teasements and rights -of -way in evidence of all buildings, improvements, knowledge and or known to me and encroachments by or on the premises are accurately shown. This survey is true and correct to the best of my belief. Note: The real property described hereon / / does not lie within the limits of a 100 Ya Flood hazard Boundary. By* r. �. e. ncicome L.S. 1 1' L PtI 2, 5w r\ \\\......„-----Y i 3, Leo re ,K Pb %s e5S W/ i. k kucf o) 5U '�= 4, k IC �C doss WAY b \ \ ,. c ei= \ ,, a `_ i <_ 1 \ __ l ■ � fy \�