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HomeMy WebLinkAbout03352 . + \ , cc ,, GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT - Permit I ° _ $ 3 5 ? ; f . Assessor's Parcel No. e 109 8th Street Suite 303 , t t Glenwood Springs, Colorado 81001 -t ,. Phone (303) 945 -8212 f ' 4 This does not constitute f } " -; Y INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. it i + F PROPERTY r i t ; Tefl1 Cffd *deew R`, �C/dia /159006206i a. g63 ' ` resent Address Pho ' n er's Na Na e � 6 Ja / • -!..r . r SA tem Location Co(o7 La Casrfct Rd • Cep? /6 Cf1� b o a e� 8 6?3 ,,.. - • legal Description of Assessor's Parcel No. i; , 48R e 6. bilp F r t j STEM DESIGN ' 113) `� Fr < " .1 -NFX) M I {I Septic Tank Capacity (gallon) Other 0 514 ` I Percolation Rate (minutes/inch) Number of Bedrooms (or other) 5 �.: 4 AV 3a4t. 0' )p- ,. . i' 13. 97 . tr RocMLtscNFltu.O. ; a Required Absorption A rea - See Attached 6q7 39, Fr 4 p cgCrnn'tsq) - 3G um >> /R� / ` , g/'j 5 ; 4 N Chnota'ao - 43 olio Ara = 4 Special Setback Requirements: ` d r (' a ,i t 3 Date G -' i Q � Inspector ` \ z', r ' 1 FINAL SYSTEM INSPECTION AND APPROVALI(as installed) ) I ' ` Call for Inspection (24 hours notice) Before Co tering Installation 1 ■ r System Installer_ aiM1 rR '`, ditAii,orrAi LI 'A -ltt) j a(, 1 Septic Tank Capacity / SCO c It ' ) Septic Tank Manufacturer or Trade Name Tank Acce within 8" of surface Yr r v.= Absorption Area ' ^� C 1 r Absorption Area Type and /or Manufacturer or Trade Name g9 — 3 v 6 N Ar id N /N SNP°, t r I �) 4 ii 1 Ad equate compliance with Co unty an d State regulations/requirements 7�S S i e Other $' rr C. �. Date 0 Inspector ( 4I a RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE , ? *CONDITIONS: ' ' 1. All Installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter j I 28, Article 10 C.R.S. 1973, Revised 1984. r i 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 i f 4 requirement of the permit and cause for both legal action and revocation of the permit. ( r i 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which Involves a know and mater r J variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense (5500.00 fine — 6 4 1 months In (ail or both). `, ,e ! While - APPLI CANT Yellow - DEPARTMENT s • TYPE OF INDIVIDU4L SEWAGE DISPOSAL SYSTEM PROPOSED: • • ( v( 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: (t-' 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? IOC' j'ERCOLATION 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 tnie 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 VS /2o-o'a PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3