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1 GARFIELD CO UNTY BUILDING AND SANITATION DEPARTMENT Permit 1`t
I 'i 109 8th Street Suite 309 Assessor's Parcel No. $ f
t 9 } Glenwood Springs, Colorado 81601 l l i
I i 5 4 Phone (303) 945-8212 n
4 This does not constitute f r
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i INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. i .
Ii PROPERTY / t 6,
Sus C■ (K, 2 5 C Fla Qo3 - 1 5 1Li I
I II
Owner's Name Present Address C P honC
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0 System Location C3 5 2 .5 Ccc p ' ak Rd. 1 carhold�ale. Co a 11023 . ,'
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/i Legal Description of Assessor's Parcel No. 1 + ,
' R /(-- Fic`h set-"r I as
r SYSTEM DESIGN LEACH CHH1t -Aapt) 1LI z. et 2EI.rCftf
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n i ‘i 'i
S eptic Tank Capacity (gallon) Other i
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. $ 1 Z 3 Percolation Rate (minutes /inch) Number of Bedrooms (or other) 1
ty h t
it ' Required Absorption Area - See Attached t
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p 5 Special Setback Requirements: .. I . t
, s-
aw
y,: Date 0-1� q -/ Inspector i i
it
s ' FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
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• Call for Inspection (24 hours notice) Before Covering Installation
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0 System Installer
Dc) a. At COS Ex C t t
, Septic Tank Capacity 0 /� + - - - -- a '
G C 0 fa C ( . 4N0 , ,
Septic Tank Manufacturer or Trade N ame
6
Septic Tank Access within 8 of surface ,
AA 3 1 x ` ' l Z P P P1 Z s - / y -- s , _ ,
a v Absorption Area 1
1 �
" ' Absorption Area Type and /or Manufacturer or Trade Name 2 k- L L A tel F rl
1 + f
{ •
i '1 Adequate compliance with County and State regulations/requirements I Adequate d
t* C'
Other
E eS --9 i
:, Date / . I nspector a q
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
it ° ' *CONDITIONS: 4;
(. 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chap ter t
' r 25, Article 10 C.R.S. 1973, Revised 1984. , ..
J �' 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- T i,.
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a e
requirement of th,e permit and cause for both legal action and revocation of the permit. t
,1 3. Any person who co?lstructs, alters, or installs an individual sewage disposal system In a manner which involves a knowing and material F t
` variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 I: !
1 N months in jail or both).
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t,- White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER SUS/- K•I}z&
ikDDRESS r2. 2 G� • • TUS t p.crs ICAO PHONE Jo3 • .321 • 'L9`9cj (v.3)
CONTRACTOR (NH KE liaNv J
ADDRESS 0 172- Hzn se PHONE 470 0 127 • 4 •?-arw;
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 PROPOSFT) FAC1TJTY;
Near what City of Town. CAR€ JC P4.6 Size of I nt ) • 7 P'•CP -es
Legal Description or Address 0 2 G/'•CNS FtATs �oAf7
WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:
umber of Bedrooms 1 Number of Persons 2--
(4 Garbage Grinder ( ) Automatic Washer ( (Dishwasher
5OIMCP AND TYPE OF WATER SUPPLY: (WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System?
A site plan is required to be submitted that indicates the following MINIMUM distances:
'Leach Field to Well: 100 feet
peptic Tank to Well: 50 feet
beach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WUJ. NOT BE ISSUED
WITHOUT A SITE PLAN,
(TROT ND CONDITIONS,
Depth to first Ground Water Table
Percent Ground Slope
•
2
. 4
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:
( VrABSORPTION 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
pERCOT,ATION TEST RRST IT.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 a ' 6 I : Lion and in legal action for perjury as provided by law.
Signed 4'7o'
Si ed r<4�_ . ,a11111111__ =, Date
PLEASE DRAW AN A CURATE MAP TO YOUR PROPERTY!!
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A PARCEL 0 =LAND BEING THE WEST 385 FEET -
OF THE EAST 1155 FEET OF THE 5E44, SWY/, •
SECTION 11, T1S, R88W, 6TH P.M., GARIfIEL.D COUNTY
IMPROVEMENT LOCATION`. CERTIFICATE ; •
1 hereby certify that this Improvement Location 'Certificate was prepared for
Brad Davi's , that it is not a' land survey plat or improvement
survey plat, and that it is not to be rel Jed. upon for the establishment of fence, build -
'
ing, or other future improvement lines. r : : -
• IMarch further
21,'1985fy that
the entirelyawiithin boundaries
of the parcel, except as shown, that there are no encroaChments'Upon the described .
premises by improvements on any adjoining premises, exclapt'as' indicated, and thatithere 4 .
is no apparent evidence or sign of any easement car burdening any part of said
parcel,�except as toted. • 1 } •
} ry,? By S p/ ey �..ncicome P.L.S — 14111 i' n�'
t
• " • r !tip' , IMPRO\EMgN "LOC ATION CERTIFIC $
c > • GISti ,. ,.,
• '` A( T12A6T -"t�FbCArt/p'1hinfraHSB%4,SW1 f!
* 4 141 111 ) + seer /%1,x 745, kiereW 6m 6A.efitswi'cO. ,'r,
• f • ! BY • .,r het
_et/ / ' , • L /IVES''llIlt :SPACE i •
sf• . 0 solos - .cam •
, ; f O F cot SYDN L /NC /COME (L.S. / 4 / / /I
I BOX 121 CARBONDALE, COLO. 303.963- -'3852
1 MARCH 21, 1985 1 SCALE :I "• 2O0''` ,
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