The URL can be used to link to this page

Home My WebLink About03245 s ,+ trm- faY.aw°.w — Tram ywnwou r ' - ss L; n.r.moo da ?.s.-s ,..7 - YY j'�F ivit. .�:. 'N4 �' i I .. ,; j� p . s V ARFIELD CO UNTY BFfILDING AND SANITATION DEPARTMENT Permit N 3 2 4, O / %r FI , /vv � t / z / l / 109 8th Street Suite 303 i aseasor's Parcel No. 1 ( l / /T J�C Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 9 This does not constitute i 1111 INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. q PR R n Kass (� !( c P Q Owner N ame e 11, ) K14s Present Address ' PO 4L )nK `Fen S% � � l hone O no 51 1 ... t -ra f System Location t3% C 7 V'c VrP.Rn Mai 1 Net;, Cas-F to c g I ( a • Legal Description, of Assessor's Parcel No. . s 0 4 • i 1 SYSTEM DESIGN W 41 C2 sr e4 d`6 t loo ,q r C� %I re R 97 IN q b, i. (N/ Probi k. o / e Pit se. 9' nevi i elCF= - • • ? ' loos , Septic Tank Capacity (gallon) Other pAoFFF /e _ Ho le y 1 /0 Percolation a nutes/inch) Number of Bedrooms (or other) Required Absorption Area • See Attached M Qsr y r ERQ //`(4'F ni `y • • tq ' Special Setback Requirements: t 1i."- a1 - 99 __ _ - k / r Date ) Ins pector ..� --- �1� --emu / � _ _0�� a Deep `. FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ?,ere, 1 �.J Tr ° K 5 1 / a Qa r An. e_ •1. Call for Inspection (24 hours notice) Before Covering Installation / HD /e .'-, .,� /f /a 5D J+( lK 1' system Installer U h f i L ' ` 4w- a� a. -7 3//4 ad `3 s4srq 1pU6 6 Septic Tank Capacity C ( + k Septic Tank Manufacturer or Trade -Name 13 (2 S 0 ^' -' • Septic Tank Access within 8" of surface VVV i () n Absorption Area I - V �I (7' S ((�7 / 1 �1 . o (._. S ( G � F r 3 5 li • Absorption Area Type and /or Manufacturer or Trade Name 1) V ti 1) / F J ` /t 1 Adequate compliance with County and State regulations/requirements ;1 vt, a NEEO EN a it. Pc k . 1 , Other � ,, p� Date Z Inspectors `��-"' RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE sl t 1 •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 t s tructures which have fully complied with County zoning and building requirements. Con - t; 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 . 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material t : variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 i q months in )ail or both). ;M White- APPLICANT -- Yellow- DEPARTMENT :d r, ■ V • A RFIELD COUNTY LDING AND SANITATION DEPARTMENT Permit N 2 3 2 4 ,+-(+. 109 8th Street Suite 303 A ssessor's Parcel No. 414 n Azad fir Glenwood Springs, Colorado 81601 . Phone (303) 945.8212 This does not constitute ,,t INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. : a c. rip PROPERTY �� I g 5 4, '3 .l f Q p 1 V- b SOX ( 1'6D g ho e� g'7,6 -5 9r) ('. {` " t lJ uR1A �e \ 1 ) Kass � Present Address Owner's Name 1- t } e System Location tpd3? I4 CO/CAC`e.i .O Mai 1 N e W Cas ( 0) gi (0 V 7 9, ) i Legal Descrlptioryof Assessor's Parcel No. —+- ° ■ w — rt a te - rcoo >f /6�I, W �re R sy4N)/N7 k 1 SYSTEM DESIGN I , l Tro61 14 O 1e 1 4. 9' nerN S a i 4-CF F: Moo Septic Tank Capacity (gallon) Other , Ho (e j; 1 : 1 " ' f� 1 �'{+ I ° � - � 1 JA/ w µ Per�ation'Rdte / (tmnutes /inch) Number of Bedrooms (or other) " (, I ' Required Absorption Area - See Attached AA J5r .Pg 0,NQ'w eE ke • -4 ° ` I ; . • :: Special Setback Requirements: • •• ' / iF r f t Date ) /' 23)•• 7 7 Inspector _rL -- ' >11 //4 _ =t( 'v , t 4) FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Pt re. � o it.-5 it.-5 K s prof / s D F m Qd !' Attie, „, i Cali for Inspection (24 hours notice) Before Covering Installation , )• System Installer /46 / ze, a = 3/,(, /.v J 0 NA / /V t i ! 1 Septic Tank Capacity - - - - - -- a Septic Tank Manufacturer or Trade tlame ti Septic Tank Access within 8" of surface A ' Absorption Area ° i, ' ` Absorption Area Type and /or Manufacturer or Trade Name -- . I{ 1 ! Adequate compliance vlith County and State regulations /requirements ' ( 1 i . 1' Other - Date Inspector ` ! RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE k r t '' 4 S • •CONDITIONS: f 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter .i " ` 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- r nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a ; ri requirement of the permit and cause for both legal action and revocation of the permit. 1 ' f 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material ,' t variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 , ; ' e months in Jail or both). r ) 1 1 White - APPLICANT Yellow - DEPARTMENT • . • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER LPtia�.S2�� a its cSuRvJe.1I ADDRESS P-0 . An)( c 0 PHONE 7 (o - 5776 CONTRACTOR ) ll !7 7 SS U V ADDRESS N.. q- ( 0 . PHONE / 770 - kS K 7'7lla PERMIT REQUEST FOR ( ) NEW INSTALLATION (TERATION ( ) 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 (.) 4- Siz - r f Lot s 900 Legal Description or Address 02- 2- t' la (.N tWAJ 114 C b9- PNIAL, C o ti WASTES TYPE: (WELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms Numb r of Persons 3 ( ) Garbage Grinder (�utomatic Washer ((shwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: O W Cta SH r . v �( W141- DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: v2 wt ( (4, Was an effort made to connect to the Community System? (V 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 WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: CF.) 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: ( ) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ` ( ) WASTEWATER POND ( ) OTHER - DESCRIBE \--)(2._\t \ O F I \ "e X I ,SH n5 THE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF HE STATE? PERCOLATION TEST RESULTS: (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 4-4_124'7 1 6U4Lt -v( /1/ Date /' 0 21 - / PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 7 n 't J2 /E / /lav° 02;3Z . e le, --` As k pi,...) -S if L. c V 4, S ° 0 4 4--. 41_y _I' g w co- 4 N 2) NI I a ipfr II ) A/ i 0 c5E4 pr, 6 1 C 6c F4 Co— a vt 4- 1-c,zo R