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HomeMy WebLinkAbout03579 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Pe N° - 3 5 7 q • 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 r " Phone (303) 945 -8212 • r This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT T� /' a building or use permit. ', PROPERTY (a.rizndd I�' Name F Q N - ism d Present Address 1 C /25 (!t JOS OD . ( )OS- o13 Owner's 1 •C / /'� �Jj1 O Phone . System Location a J &/ d• %o CartundaJe, 6 e ( Legal Description of Assessor's Parcel No. , SYSTEM DESIGN sak/c A Septic Tank Capacity (gallon) Other + 1 g Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3c�,)-2 39- >7 •f(ocu Z. 1-;rca • 7 Required Absorption Area - See Atta had 0) " " �L C y 7 a :. /,�5 _ ,? ) yµ7$ � it °( , p • Special Setback Repuiate rem nts — 26 yf.47$ /� � 3 ' y 6 / AO .a • Date 7'� '�� ?� Inspector A - " t FINAL SYSTEM INSPPPPPCTION AND APPROVAL (as installed) , Call for Inspection (24 hours notice) Before Covering Installation , System Installer S ads..iS. 1 - ° Septic Tank Capacity 1 5b() I , Septic Tank Manufacturer or Trade Name 6 V t e-`� -- I Septic Tank Access within 8 of s ®�)Z- 1 I Absorption Area 21 LtAi } � S r X' V y (AN '^�R y 4y / F w, Absorption Area Type and /or Manufacturer or Trade Name -- ` 1� 4. `'d 1 A ; r 1 Adequate compliance with County and State regulations/requirements L ` Q Other /n't Date (..)( (I D� Inspect I t- >' 0 . 4 if a \ {' I�. Q -. - -- RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE r ' *CONDITIONS: 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter t 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- ' 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. �� 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material i - variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 , II months in jail or both). 1 1 1 While- A Yellow- DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER Fra c 0 ,042sD') ADDRESS / 601,12)- ,q /03 / PHONE 922-- 0/ 3 S CONTRACTOR _nadir CmJir c 7�'`�3 � >: $ ©, rSV 7o ,3� ADDRESS Gc 3 a� � e� f�k - E'rSao PHONE 7 < 0.p(; as0 -/ 93y 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). J,OCATION OF PROPOSED FACILITY: Near what City of Town l .A shot ol�t/ e. Size of Lot t R 4C r e$ Legal Description or Address V � � e • r• a AS // u)e5" dP 69; WASTES TYPE: �Q DWELLING ( ) TRANSIENT USE R'�tic No !oK ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: II . s to ! • .. • • . • Number of Bedrooms ? Number of Persons ca ( ) Garbage Grinder (x) Automatic Washer b() Dishwasher • • E AND TYPE • F ATER 'PLY: 9`r WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: C WOO' I OS Was an effort made to connect to the Community System? 4)0 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