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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 3 2 U 7
I 109 8th Street Suite 303 Assessor's Parcel No
' ? f' F . , ', / f Glenwood Springs, Colorado 811301 •
i f l+ t ( t c I i) t \ ` Phone (303) 945.8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY I yy] y��1 �// lap /f/I ' OP -2
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Owner's Name d Presentt Addrress Ile 3 b0 Y--- ' Ph ne W- ) c
System Location Ilel C1?-- too ) ` I` o l t)
Legal Description of Assessor's Parcel No. —
SYSTEM DESIGN
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes /inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer 0 Lv 14 E vt- --
Septic Tank Capacity 1 SO 0 ^
Septic Tank Manufacturer or Trade Name . ` O P t CA N f J
\ f
Septic Tank Access within 8" of surface __I 0 i S 0 F g v H 1 r i DC H � '-
f
Absorption Area G)12OWS OFIU) OHMS £', II-I A aEn fLO(, K
Absorption Area Type and /or Manufacturer or Trade Name 1 N F / L- r & R- to l
Adequate compliance with County and State regulations/requirements
Other
Date ` _ Inspector A A- rf a I ji m c-y // & � WOF&r
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE 15ec Q. 9- -(s-Co
i
•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 Offense ($500.00 fine -6
months In jail or both).
White - APPLICANT Yellow - DEPARTMENT
P409 -02 -99 09:21,0,/ 1' A • _ P.02
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION •
OWNER „-.. 4 LG - uI°AtoiL- C _
ADDRESS 1 b7(, it>c HOMO PIi.ONE 9 €' 3 - c f7W
CONTRACTOR c t!Lc e L G C_.o•ldb r„J • -
ADDRESS 0 rf 98 gaS�. l_wJ� __. _ �_ PHONE 96 3 - `P . . .
PERMIT REQUEST FOR (W 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 ten holes, $oil profiles in test holes (See page 4).
LOCATION OFPROPOSED FACILITY:
Near what City of Town C: A• Z9civt / Cr4ti -t - C. J Size of l.ot _
Legal Description or Address f to/ 6 ( fl r'. WASTES TYPE: C j DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC. WASTES
( ) OTHER - DESCRIBE -
BUILDING OR SERVICE TYPE__S2E - FIc C pjv,((- etAA,.t #3 "' cc11
Number of Bedrooms Number of Persons 5t 4'04, - c t
({Garbage Grinder (y - Automatic Washer (-1
SOURCE AND TYPE OF WATF.K SUPPLY .(t -'*ELL ( ) SPRING ( ) STREAM OR CREEK
if supplied by Community Water, give name of supplier.
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM! 3 M + ce -- ) _
Was an effort made to connect to the Community System? !'4
A site »Ian >s rewired to be aubotltted that indicates the following MINIMUM distances&
Leath Field to Wellt 100 feet
Septic Tank to Well: 50 feet -
Leach Field to Irrigation Ditches, Stream or Water Course; 50 feet
Septic System to Property Lines: l0 feet
YOUR INDIVIDUAL SEWAGE DISPOSA4 SYSTEM J$RMIT WILL NOT $E ISSUED WITRQUT
A SJTE PLAN.
GROUND CONDITIONS;
Depth to first Ground Water Table -_ ;t faUsJ — Percent Ground Slope, i 7r:
L`� ►�lt�`J z
`
,Aug -Od -99 09:22A 1 i P.03
1 . TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( I/fJ / SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLENG, POTABLE USE
( ) P11' PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE
FINAL DISPOSAL BY
(VC 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? W 'b
FERMI ATINN TEST RI?SI LTS, (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test)
Minutes 1. per inch in hole No. 1 Minutes 2 Z per inch in hole NO. 3
Minutes_ 40 per inch in hole No. 2 Minutes per inch in hole NO. _
Name, address and telephone of RPE who made soil absorption tests.. IbA. Utn A • Pb4-/-3 Q ( I 1 R b, go3c 63/
GW2tt',4Oo .0 1 Cn Sl!o23�_. °I `e. _ - -
Name, address and telephone of RPE responsible for design of the system: S tt- t.ce
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. I
Signe@
r,h�,w t .y 4 C.1- L� v -C-c Date Sl ZJ 47
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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