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Home My WebLink About03079 r ?1 Y • GARFIELD COUNTY BUILDING AND SANITATION DE PARTMENT Permit N_ 3 0 7 q i T 1, 109 8th Street Suite 903 A ssessor's Parcel No. 604 0 17\ 1 4 41 Glenwood Springs, Colorado 81601 w Phone (303) 945.8212 ) r � 1 t This does not constitute f ' i INDIVIDUAL SEW GE DIS PERMIT a building or use permit. 1 ii f. y: PROPE x I_ � / m (/ p( 8ie a� • '• R (� Vt 'ASo s\ 1 \ �� Present Add r essH33 ��ov1sR1�9(,, M1d(,��P Ale i 1 " i Owner's Name r -'' r� , Q � (� J } System Location D `� k3 borS ( lc 3 Q ` ) ' c 1� d a I. „ t . Q �1 'r i 1 ±i Lega D escr i ption of Assessor's Parcel No. U�S i ` e -e 4, 1 A o n ; '• l x Roorc- C.CAC41h FI e O — r 11po '' t( SYSTEM DESIGN L C Ac Fi - O Al A M tS C.t tS Cp '7 t 1_ c? at H 4 U K f 7 S ' } ✓ r Il Ent c It cS -r G to 6R ' Co 11 ` • • , rt-- S o Septic Tank Capacity (gallon) Other ' l.' I is 2 f 1 1 30 Percolation Rate (minutes /inch) Number of Bedrooms (or other) Required Absorption Area - See Attached 4 e 'li (` f Special Setback Requirements: ; fi i/ oat / AA ' 2- I C -e l a _ I nspector A N N 0 4 tl,U i r p FINAL SYSTEM INSPECTION AND APPROVAL (as installed) k 1 r • Call for Inspection (24 hours notice) Before Covering Installation / > > 0 f. Sys tem Inslallgr / / 1 `1 fY`^ �I \ / � �( Septic Tank Capacity C )� I •-S T 1 , r ` / C ' (2 S 0 a —(9_ ` 4 - { • R Septic Tank Manufacturer or Trade Name 1 N r 1 l T w o "T n ff .�,-,r l----' d 1 f '; Septic Tank Access within 8" of surface a Absorption Area 6o p 0 I S L( t o ( C H LAS o r 1 0 I n — a F ; : t r i q Absorption Area Type and /or Manufacturer or Trade Name 1 A. ( F ( I. et h A 7 0 A % ` C ....0 Adequate compliance with County and State regulations/requirements i 1 Other L /_ — r ° Date I nspector s )i RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE t ); ! :i *CONDITIONS: 1 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. ✓ i 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- F section 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.+. 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material / u { variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense ($500.00 fine -- 8 p , months In Jail or both). i ' f White - APPLICANT Yellow - DEPARTMENT t • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION - 30'7 9 OWNER __ a4 Ro(//JSo)J ADDRESS O' /S3 Li°"s R(O6F RA Gfl01- tF Co PHONE 9(03' ;& /(, CONTRACTOR M M CONS Nail( i7o N ADDRESS 7e)(1 I A N Y l SPQ/»u6S (0 PHONE X 9 1 /9 7)73 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 C (4-aJ, o7 0v, L Size of Lot 2 • t 1 S = /fry ) Legal Description or Address 1 0 Om • (- fn. '- c» ( 0 WASTES TYPE: (4 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Id0 TYNE Number of Bedrooms ' Number of Persons ( )Q Garbage Grinder (X) Automatic Washer (X) Dishwasher $OIJRCE AND TYPE OF WATER SIMPLY: (K) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: L.roNis It rn(+r rde owoa) /dsSc( /04> A>.- DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: g »' u LC s Was an effort made to connect to the Community System? N A site plan is required to be submitted that indicates the following MINIMLJM 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 INDIVIDLJAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT RE ISSUED WITHOUT A SITE PI AN,. GROL JND CONDITIONS: Depth to first Ground Water Table t /O I ± Percent Ground Slope oa 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: (X) 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? )JO PERCOLATION TEST REST 1I.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 �� 1 73 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 �� 1 , \ , , rJ( 1J`t2 I /77 L r I o .g 5 1 . 963 sV /fr' q 14111 ; / s \ �f f OF Ca' "j ',' 'c' s SCALE I = 50 ° I UTILIIY O Street Address: EASEMENTS S 1 . I / 0453 Lions Ridge Road 12.0 a \ Carbondale, Colorado • Note: The real property described Y ; � ,�- \ hereon does not lie within thd lim- 1 , 0 ' 4 , \ \ �C � its of a 100 Year Flood Hazard Bonn. <�. Y• LO 3 ' )conc,etkwa N -- Lai o- sto y brick. ho 0 4 /{ %,„, \ I �\ ■ / � V LN 21 °406" sI Q� e� � . , R 7- 370.00' r+1 I 1 - � . / rot 4) • 2.45 Ac.± O N / w P OWER LINE �� F- CD O 4f ar 1 `,r„ __ ^ EASEMENT La Q 1 F 1. 0 1_� : 4 " j 0 O 0 0333 Lrolo ft ov (U� _ ` J. : -- • - INDICATES FOUND RE BAR �� I hereby certify that this Improvement Location Certificate of Lot 10, Lions Ridge Estates, Garfield County, Colorado, was prepared under my direct supervision, that it is not a'land survey plat or improvement or other that it is not the lines. ' 1 further certify that v mppem e nts on� the above described parcel on this date,.18 June 1981, atct P are entirely within the boundaries of the Im rov___ement Location Certificate i to parcel, except as shown, that there are nc P encroachments upon the described premises Lot 10, Lions Ridge Estates by improvements on any adjoining premises, Garfield County. Colorado except as indicated, and that there is no 5Y SINES /N SPACE apparent evidence or sign of any easement crossing or burdening any of said parcel, except /s noted. l ,2.evisea- 6417187 SYDNEY LINCICOME(L.S. / i BOX 121 CARBONDALE COLO. 303-963 - 385. • By; S(. • - {i . rcame SCALE I °= L i - /o 1 -1 /v5 : ( e �®