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Home My WebLink About03063 r_. 4 . , GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N2 1 0 c s F q w 109 8th Street Suite 303 A ssessor's Parcel No. 1 a Glenwood Springs, Colorado 81801 ;, i o a . Phone (303) 945-8212 1 F 1 6 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. ( I. ,1 it !' a PROPERTY ( r 1 Of s S 6, Oof <9ac Q 3 3 / 1 \ Owner's Name � h �P r lA IT Present Address ( ( H M S i pt. • - Phone 1 0 151 D 01v ( ' P s+ -I ve C441 W t b r ( 5o121� s CC ( k / System Location 1 f a a ` Legal Description of Assessor's Parcel No. �� f ` k n 4( ' 0 `�'s ) u I UI Sup I, 'J. ii p,oC.lc_ L.6AC K 1 ce -D r1II S � . . I ,E ACF1 C HAM (3Cv- O3' u 8OA <, SYSTEM DESIGN 2 4.,- v T tiE !JC KES '2,, l 1 1 R T _'— y0I I v 8 ) q i 1 ! J v Septic Tank Ca (gallon) Other I I 1 /"1�i' - i ;; Percolation Rate (minutes/inch) Number of Bedrooms (or other) / ` ` Required Absorption Area - See Attached r • t r } Special Setback Requirements: . t ^ x i O; Date I^ (q —Q R Inspe ctor t` CL N O , I 1 FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) 1 1 'y Call for Inspection (24 hours notice) Before Covering Installation d ' G ' System Installer h i v k ( Septic Tank Capacity ' `' /� /n ! t Septic Tank Manufacturer or Trade Name o t� c N� i `' � .n 3 4 Septic Tank Access within 8" of surface r ^7 A 4. E i Absorption Area e' 3 T ,` Ems( H CS Q 1 1 V A C H , i IN1 fLT � QrJ' t a A bsorption Area Type and /or Manufacturer or Trade Name it I d : k ) Adequate compliance w County and State regulations/requirements 7 Other t /� ) Date ( ( —� eN - 9 e Inspector r ` I� +. e RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE j •CONDITIONS: i 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter v 25, Article 10 C.R.S. 1973, Revised 1984. I ` 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- l e { 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. 1 i 3. Any person wh constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material 1 i variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 Y ) months in jail or both). f 4 r White - APPLICANT Yellow - DEPARTMENT _. INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION aNER YV t } fiuteAryl (� ^"'- _ /ADDRESS t9 JS / rj �D' e'' PHONE got g 9 3 3 / / /1 l CONTRACTOR i+nw p . ADDRESS / 9O //S 4 ad g /60/ PHONE gy5 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). Near what City of Town /� �, ' Size of Lot ' � • Legal Description or Address 0 /'/ rno- k- x- Lh - i I4k? cce FWD / WASTES TYPE: 64 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: R-3 Number of Bedrooms 3 Number of Persons a ( ) Garbage Grinder in Automatic Washer Dishwasher SOI TRCE AND TYPE OF WATER SI TPPI Y: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: ice'.._ is— _ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 10 n y u.Qa -a Was an effort made to connect to the Community System? a/ A A site plan is 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 WlLL NOT BE ISSUED WITHOUT A SITE P1.AN. GROI IND CONDITIONS: 5-- Depth to first Ground Water Table Percent Ground Slope 7 / 2 PE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: Y" 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: %i 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? n.4" pPRCOT.ATION TEST REST TI .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 ooh ed by Ia application or revocation of any permit granted based upon said application and in legal action for perjury as p y Signed PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 � / � , CD § CO ! n ± ƒ \ � / / ::1 / / r ` o E. �\ -3 / \ \ ® k k \\% § () a Y cr ; \ƒ .z . Ca. \ \ \} eat' / o ` % Iii \ \ � / ^ � � ra 4 9 - q y §'; !. [ m 2 2§\, � E t /' CD ; 17.1 % Q § k \ / f ). k SS ° ® / 7 la / \ a l A k0 5 )% et k/ B \