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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N. ' 2 4 8 8
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 945-8212 S". � ; "" � '.
INDIVIDUAL SEWAGE DISPOSAL PERMIT ��•_.
PROPERTY
Portia Carlson Estate c/o Colors N t:' 3. ,Dank 330$-�i584-4386
Owner's Name Present Address rPt�ortB_
System Location 16704 Nighvay 82, Carbondale
Legal Description of Assessor's Parcel No. rtk 'Zr.. tot�'
This does not constitute
bLtilding ori r e.permi1;
SYSTEM DESIGN
i
�Seeptic Tank Capacity (gallon) Other
" r 1 Percolation Rate (minutes/inch) Number of Bedrooms (or other) 4 (Tri-plex)
PORI- 7r`k'Z r F cu Mat, /i UST
Ceti A.A4 '-AS v5 711E41,
Required Absorption Area - See Attached
Special Setback Requirements:
Date 9.. -- ys
Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer y ,'2Lie T/C`f=/
Septic Tank Capacity /2 �7_)(- A -
Septic Tank Manufacturer or Trade Name —
Septic Tank Access within 8" of surface
Absorption Area 9 �J�/t - u y� / ? ".5-1A10,
Absorption Area Type and/or Manufacturer or Trade Name #ocx e
Adequate compliance with County and State regulatiory#equirements yes - '; /->' -e f'-= / •%..,cfs_.,1
Other ri.ti
Date / - J�= Inspector 4rAkF
0,
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
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 10 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
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6
months in jail or both).
Applicant: Green Copy Department: Pink Copy
INET.YIDUAL_SEWAGILDISM. AL_SYST_ENLAPPi,ICATION
OWNER EA—kc,— ( g v \ soy\ Le -1r Coork o (1PC)(AtwSkern e '6\ V---)
ADDRESS 14u -1c'4 NWy BZ C cAPHONE Aom�
CONTRACTOR 1(Jt11e-c V c-' v - ‘e___
Ai)I)ItESS %5S 1°-4l�O.v-1O COPHONE °1(v 5•--- 9'15-8
PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION (4 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).
LOt'AI'1l)N_ W PROPOSED. CIL17'Y: COUNTY (aa7.,c ie_ACI
Near whirl City or Town Ort ctotsk cS 60\nai.w,M I
Legal Description uJo 4i- i- v4i `67_ look'€. c �.
1 .L.crC' S C�.��dr, 3 Q>'ca.
WAS'CES "LY_P_E: (X) Dwelling ( ) Transient Use
( ) Commercial or Industrial ( ) Non-domestic Wastes
( ) 011ier - Describe
BUILDING OR SERVICE TYPE: Tr -t plte x
Number of bedrooms: _4- Number of persons (17
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
SOUIICI AND_TY_P_E_D1? WATElt_SUPP_LY: IA WELL ( ) SPRING () STREAM OR CREEK
Give depth of all wells within 180 feet of system: ,none
If supplied by communtiy water, give name of supplier:
GROUNI� CONDITIONS:
Depth to bedrock: 500
TR -
Depth lo first Ground Water Table: PQ
i
Percent Groirncl Slope: v‘cAyle_.
DISTANCE'TO NEAREST COMMUNITY SEWER
Watt an effort made 10 connect to community system?
TYPE OF INDIVIDUAL SEWAGE DISPOSAL, SYS
s Septic Tank ( ) Aeration Plant
( ) Vault Privy ( ) Composting 'Toilet
( ) Pit Privy ( ) Incineration 'Toilet
( ) Chemical "Toilet ( ) Other - Describe:
FINAL DISPOSAL BY:
( ) Absorption "french, lied or Pit
Underground Dispersal
( ) Above Ground Dispersal
( ) Other - Describe:
SYSTEM: ��-1 mvS,e- vvctire- (1))i.se ire -etre
no re.1i0.1/4,f" (66?Nt5A-tv�r
TERM PROPOSED:
( ) Vault
( ) Recycling, potable use
( ) Recycling, other use
>p�tL `-C`G�n1Z 1 ZDOO ic_L
( ) Evapotranspiration
( ) Sand Filler
( ) Wastewater Pond
WILL EFFLUENT BE DISCI IARGI:1) i)IR ECI'LY INTO WATERS O1-' rf IE STATE? J (?
!'_1?RCQLAT]QINLTEST_RY?SLL'1 : (To be completed by Registered Professional Engineer)
' Minutes per inch in hole No. I Minutes per inch in 1:-lole No. 3
Minutes per inch in hole No. 2 Mingles per inch in Hole No.
Nance, address and telephone of R PE who made soil absorption tests:
Nance, address and telephone of RPL responsible for design of the system:
Applicant acknowledges that the completeness of theappliction is conditional upon such further mandatory
and additional tests and reports as may be required by the local health department to he made and furnished
by the applicant or by the local health department for purposes of the evaluation of the application; and the
issuance of the permit is subject to such terms and conditions as deemed necessary to inirsre compliance with
rules and regulations adopted tinder Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby
certifies that all statements make, information and reports submitted herewith and required to be submitted
by the applicant are or will he represented 10 he true incl correct to the best of my knowledge and belief and
are designed to bre relied on by the local department of health in evluating the same fro purposes of issuing
the permit applied for herein. 1 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
Dale 5-- LS -9 5
PLEASE.121tA1'Y_ANACC1 ltAT _MAlAD_ YnLl_l'RO_P1:RTN.
+nv% "1- .
C
15,7 mile
rLQTILANAN Di) f S l UIiEEATLR ES
include by measured distance location of wells, springs, Notable water supply lines, cisterns, buildings,
properly lines, subsoil drains, lake, watercourse, stream, dry gulch and show location of proposed system by
direction and distance from dwelling or other Fixed reference object, and additional submissions in support
of this application such as data, plans, specifications statements and commitments.
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NOIN£ER'ING
High Country Engineering, Inc.
923 Cooper Avenue
Glenwood Springs, CO 81601
303-945-8676 • FAX 303-945-2555
TO IttAlf (164APti-Alif Ail,
ATTNftiU4)
JOB NO. 9501 4. .
FAX NO Sheet—of —
We are sending the folbwing: 0 Herewith 0 Under separate cover
❑ Photocopies 0 Prints 0 Documents ❑ Mylars ❑ Shop Drawings
0
NO. OF
COPIES
1
ITEM
*via& _di ifideze
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LATEST ITEM
DATED
REMARKS
ribfry
If material received is not listed above, kindly notify us at once.
Transmitted by:
❑ First class mail
❑ U.P.S. Next Day Air
❑ Federal Express
❑ U.S. Express Mail
❑ U,P.S. Std. Service
essenger
❑ Pickup
❑ FAX
By
/43194C
[)AVID NIPPY CONS! RUC I ION, INC
David (tippy, President
WW1 Alpine Conn
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