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Home My WebLink About03247 • °r . 3 u } I ( I GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N2 3 9.4 7 t j ( Assessor's Parcel No. 1 1D9 8th Stre�l Suite 303 t Glenwood Springs, Colorado 81801 p' t K Phone (303) 945 -8212 This does not constitute ,) t d t INDIVIDUAL SEWAGE DISPOSAL PERMIT '�; C ( a building or use permit i" 5(b '' r 90" rr * PR • 't �/1 I/ ��YJ( 9 > 1 1/n (y' I [ Owner's Name 1S , C 1 f ` k \ Present Address 4J I 2 St Phone ( o ( O — 5 I I ` f • , System Location . (A �+- '^- " �� r . k Legal Description of Assessor's Parcel No. _ , a / 1 -.epos ,� 6 5� , , SYSTEM DESIGN Jr/VP ( - _ / �� t, t Septic Tank Capacity (gallon) Other / �-ea- Cer ' // /2 P l� /+� y � piee� , 6 ( ✓ erc Lion Rate (minutes /inch) Number of Bedrooms (or otheq `� 'ems- c+ p /od ej I ic I Required Absorption Area - See Attached ' t .,,,, ..✓r , r'r' 9 i e Spabial Setback Requirements: I, 'I ' 9q t o 9V�� , c ; Date Inspector r D A ; FINAL SYSTEM INSPECTION AND APPROVAL (as installed) C all for Inspection (24 hours notice) Before Covering Installation " `' 0 tti X/ Z A System Installer -- P Septic Tank Capacity /0 0 O�t - - -- i . • h Septic Tank Manufacturer or Trade Name ` e %' r' `r , ( `r ^ � Septic Tank Access within 8" of surface L ( �AV / t ' Absorption Area — - 124 J ) r--6 � [ (,� '�! '2' 1 // r , s t Absorption Area Type and /or Manufacturer or Trade Name — ,f hi t ,r iT ;r Adequate compliance with County and State regulations/requirements f �r � .,.� /J g Other � „ t 5 5 .. — Date / D `� / I 4��1/iVI, l �,� - j RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE t ' *CONDITIONS: il 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter a- 25, Article 10 C.R.S. 1973, Revised 1984. C ' 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 beaviolation ore 7i 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 i a m anner which involves a knowing and m aterial , variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense ($500.00 fine —13 S' t 1 months in )ail or both). } y White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION ' nn nt� OWNER, 1�� 6 rtit ADDRESS 5)L I. 133 0,0A A, ma 01„ . Q-14. PHONE g43 - 1192 CONTRACTOR Se IV ADDRESS 934i--. PHONE Sat..,, PERMIT REQUEST FOR (k) 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 FFACILITY: Near what City of Town p Size of Lot b OV % c rt Legal Description or Address aZg4 Ockrr, Ot;\'( J' •C9)_ WASTES TYPE: (k) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: N o c \ s i\n,r Number of Bedrooms Number of Persons ( ) Garbage Grinder (k) Automatic Washer (x) Dishwasher SOURCE 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: I rn∎\cs Was an effort made to connect to the Community System? 11t) A site elan 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 \ D Percent Ground Slope �a 2 r TYPE 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: (k) 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? 11 (1 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 / Date V09 PLEASE DRAW ANA CURATE MAP TO YOUR PROPERTY!! 3 ' -1S99 FR1 04:21 P11 FAX NO. P. 02/03 1 06/04/1999 07:22 8762947 411 RICHHOLSAN PAGE 02 P 1 I I 9 A =272.72' S ire' L1 .oT4n'24 • fr s *• e p oi A - S ers5 54' £ '�' Tel 5.6J' O er M 0' 100' too' 300' L I LEGAL DESCRIPTTON LOTS 1 4934RD S NO MRSIION I SEND f1LIN O o, . 1 I COUNTY OF CORRELD $T OD RADO I I xJ coo' — r I m $ � - - Ise' 1 NI i — Sal,k;. •w..', I , N I In • • tIl t t I ,,, .. r," I (l1ke \ 1 wes�hb . 5 ft. Utility j (;)4SO oc�l'n • Easement 5 Ft. Utility �. 1 ce... Easement I o(li n D.. H£' FARMERS IRRIGITION DITCH I • Rat LS U'!01 50 Ft RIGHT OF WAY "SFUFJ1T 1 I rRRIG4 1 ' �. —�' ~�� I 5' ( s er2e'11 w � � � / & .. FOUND R&C MUHD RAC LS. 59.3J LS 59JJ / .11dr o Ft. Utility eiel C£RT1fC4TION 5 £oxernan( ` hereby earl that fhb Improvement Survey Plot *vs prepared for Mason dr Morse. -1 a hereby I further tort' thot the Improvements on the above described parcel on c" •• dos. May 1 9, except ut/pty eor:neclhne, one entirely within the . 0 L boUndonee of the parcel, except oe shot», thot there are no encroaS H� '•, the described premises by improvements an any adJolning premises, Os re, 1 1 Indicated, and that then Ix no apparent evidence or elan of an - eelS N'.. emceeing or burdening any port of said .1, except o no e , .. • Ls 1 t ily L . ' d . S O2 Richard L. Holton. L.S,13501 o 0 , : �•' l' 4. 1 %. O . L8 7. C. LOTi ASO4RO SI�Iw v SECOND FUND 4773 274 1114 GARPEW coupon COI-DRAW S Y Meese* • MeV 170 atf? AS MC mug OYOn M Cal 8 ' 7 6-294 /7 `/773 a 1y EDi) (1 v ne,� ed1