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HomeMy WebLinkAbout03249 K ,r F 1 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N2 3 2 4 9 r 109 8th Street Sulte 303 A ssessor's Parcel No. • 1 Glenwood Springs, Colorado 81601 • f Phone (303) 945-8712 „ > e ' This does not constitute l f ? INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. r • 1 4 PROPERTY l i /1� 2 ( /� a (e ((°�-`�gaa • i ,Owner Name i� �/ Pr se Address : ) � 3 _ ` Phone ki 1 t, System Location ` / � 1 f ` ., Legal Description of Assessor's Parcel No. - . r 1 1 r.oc LeACH p,eclO e csx R SYSTEM DESIGN .0 ( ,"weft -C AT -6 Ot- 4 - 6E0 (4 J' I � ,AZ Z6 v:N ITS it isz ✓ T 2 CNCF(ES VOI &I 3F91rG�` s 100 a Septic Tank Capacity (gallon) Other ( e / l v (2 /c!` Kitt ' E I 7 Percolation Rate (minutes/inch) Number of Bedrooms (or other) + Y ( Required Absorption Area - See Attached t: r I Special Setback Requirements: Date 2 t_' w c 9 Inspector ___ i f FINAL SYSTEM INSPECTION AND APPRdVACTis.i st la ` 4 4 Cali for Inspection (24 hours notice) Before Covering Installation i 1 System Installer = - - -- r' r1 • r Septic Tank Capacity 0 V '> C x I Si 1_ ■ Septic Tank Manufacturer or Trade Name – ^ t; Septic Tank Access within 8" of surface ••� r r • " Absorption Area 1 8 v Ni 1 1 S i N 2 7 A L tr C At EJ ©I' t 6 ` i [I t /l v t N Absorption Area Type and /or Manufacturer or Trade Name 1 f I� T� A 1 K 5 / Adequate compliance w ith County and State regulations/requirements f 1 4f .t Other ( 'i -- f ^ x(01 A�- L J _ � r, Date q _.� 1 ` Inspector /y c- ! /I' RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE 1 i *CONDITIONS: 4: 1. All installation mute( comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter r 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- 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 6i requirement of the permit and cause for both legal action and revocation of the permit. 1 Ri; 3. Any person who constructs, alters, or installs an individual sewage disposal system In a manner which involves a knowing and material t. y variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 j r months In Jail or both). 'y 1' k. White - APPLICANT Yellow - DEPARTMENT " t Sap- '22 -99 02:42P P.02 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER r Pr/J ry S / ADDRESS • 0 4- . i • f PHONE (9-i egieltr CONTRACTOR IJI qsaa ADDRESS PHONE PERMIT REQUEST FOR ( ) NEW INSTALLATION yi.4ALTERATION ( ) 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 FACJLITY: Near what City of Town CL— (l -f x")./U Dot Size of Lot 46o Acts. Legal Description or Address O ? °1 10 2 `rc U l M I S4ouPLt f{ WASTES TYPE: >Q DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: f I1)IJS�i Number of Bedrooms IS Number of Persons ( ) Garbage Grinder S (4 Automatic Washer Dishwasher SOURCE AND TYPE OF WATER S UPPLY; � WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: (veil FAA) Was an effort made to connect to the Community System? iW • A she nlan is required to be submitted that Imdji:ates 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 Sap =22 799 02:42P P.03 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 9C) 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 NT ( ) EVAPOTRANSPIRATION UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? No 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 niles 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 5 Date 1 r 2 ` / PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 • k, w c V me J JflJuyc. go y( FA W\ D r Q 1.-oC.,Thoiv of c ,F;pr `"•S4cw deep . � O0 , o 2 ■ cm ,L„l, S