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HomeMy WebLinkAbout02973 cr4 77 .4,.c , wxarMnsN 4 'i, r /rb' 1 .77,417,41.7,,r rs, 7r1. 'I}' ' at ! P4 i4' ntri#w.. GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2973 • 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945.8212 This does not constitute INDIVIDUAL SEWA E DISPOSAL PERMIT a building or use permit. PROPERTY r} /_{ten y n 1` C /� ^ 1ff / I �p 6 Owner's Name1 `CR WV(S+ ne Preseent Address" J Qxe `e'7w-4 C~ , hobo • �g- -1o�bp System Location o l7 t CC C , \ I Pa1 -C ,Ckt k e ( CO , Legal Description of Assessor's Parcel No. I) t'IOCK- -CA Fret° flG/20q'0 --> I0 G3 IR SYSTEM DESIGN 2 ) if C 1 µ 554 Q c o 3 t/ um t r S -'. Cc( i 4 3 r, n naivete/es -2.9 t' 10 0 0 Septic 1 Capacity (gallon) Other r S 3S "? 1 ! -1 - 2 - Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date 6 — / 9 8 Inspector A R. ArO FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before. Covering Installation System Installer Septic Tank Capacity /6406 Septic Tank Manufacturer or Trade Name `/ Aid Septic Tank Access within 8" of surface _$-. 5 Absorption Area ei / 9 " Absorption Area Type and /or Menufac�er or Trade Name S � -- v F/ tu r: / �/ re- e i1r4ti�� a I ® Adequate compliance with County and State regulations/requirementsYE Other / 9/ Date '7 6(P - 9 Inspector a_ — I - . -_ RETAIN WITH RECEIPT RECORDS A CONSTR is CTION 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 Otfense ($500.00 fine — 6 months in )ail or both). White - APPLICANT Yellow - DEPARTMENT .4 • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER RurS Lcitc5oN Ho Ara Al ADDRESS R 29 Oo✓ r', ho17V ,0/ t e#?nu/F s5 -PHONE x/76 - 285 /68 CONTRACTOR 67,74 (ooK) C nc,cs PRN<HOE .SF gum .F ADDRESS 5 90 4 r fi,A$7Y i2n 3 59 PHONE 976. 25 33.5V PERMIT REQUEST FOR ( ) NEW INSTALLATION (>9 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 2 i xsor! clF rwe.C& Rzat- a ritme su L Size of I nt ACRE..S Legal Description or Address 92 9R r'o:, ?Si v oin) `/3O' a'n Rnrn ur6, r O F3/635 WASTES TYPE: (X) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: PESEPE - tomit J7otiatc -tdzvt /7?oougq,e Number of Bedrooms Number of Persons '/ (09 Garbage Grinder (y Automatic Washer 6C) Dishwasher 501IRCE AND TYPE OF WATER SiTPPI,Y: (t) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /O mztF 5 Was an effort made to connect to the Community System? A- A site plan k required to be submitted 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 Septic System to Property Lines: 10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT RE ISSUED WITHOUT A SITE PLAN, OROI IND CONDITIONS: . Depth to first Ground Water Table Percent Ground Slope /6 ro /,? b 2 • • TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (1() SEPTIC TANK p ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY fEami7 ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PTT PRIVY c , c GAL ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET J ( ) OTHER - DESCRIBE FINAL DISPOSAL BY: (X) ABSORPTION NCH, ED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? nl N PERCOLATION TEST REST'LTS; (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes Der inch in hole No. 1 Nfmutes 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 ✓ aR' PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 " Y, t0 : #r .4, to 40,...„ S'. y *-f 4 • C i o v 0 pp' 2 w z O ed 0 fr CI c rl 0 i ci 0 a g co 1 `^' , CD V. o Pr 0 (' fn• C+, n Z c ° d0 r.g j to G7. �• � -N._. • C C 2 wfi� k p9 I w ( ( 8 0 L m C �^ b r I r z .c co C Ro d Z n1 s p 0- S4 N - Z L Y 1 rn }- -- , - - , I - - - -- — MAP . 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