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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81801
Phone (303) 945·8212
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Permit N;; 3650
AsaeHor'a Parcel No.
, I IN~IVIDUAL SEWAGE DISPOSAL PERMIT
, P PEATY
This does not const1114e
a building or use permit.
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11·-D I JCL ~ I . . Su1.0.\/\i't. ,.,,, ''"" <!1 r ·\ 1'.n. c ~ go~IO 3o3 7~ -o?.>11 i t O~ r's Name I'~ I OYll'\ L.0.Vl j\ I Present Addres~\21:::> • l.:>1 ,Pi fl IJ'(V\'it f · Phone • I
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L~~I Description of Assessor's Parcel No. Jo.jo tdJ. we Neo... '.
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..., 7 "' ),~ b i
41..8~h·JS14""7~ .llz:..,
____ •Other 3?\'.)s,FT 2.l u'HrJ·~f:;
__ _,_/_J,_ Percolation Rate (minutes/inch) Num~er of Bedrooms (or other)~:tl.R · 1' fl
Required Absorption Area-See Attachedi'Ql' rAPI mu.} 1 ·o;.;····-'!:¥ ,,
s;o' F'tlo .. CA~~·( ~ J3m-,, IA-11~' "Fiuo ' ---· 1·Z 0 , .r-!:."'_;:;'IJ1 rr'"""" l
Special Setback Requirements: 'f~• r;•M ~ LiNI\. 1'i.( Jl.,11 , -r-«, M"-J> (, i~'/l~~,.,lt<.P f
Date i-S·t>l. Al't.;,ector°'llll:. Wrt1't:«. ' • I
~~tic Tank Capacity (gallon)
NJ.u ; .. C'cri4U 111 t}~ ,-~ m 'T.<t1<1u ~{;Miffltlf..t -0, R <t=J1::o£ A:~ 9
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) , )
Call lor Inspection (24 hours notice) Before Covering lnstallatio~'"'_,,,, s~ "''4.-1 !
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System Installer 'JZ,,n:1z.c, 12.u, {,1 (' ,,,....67 , 1 .· 1. 'J,11. ·:p 4.>. I
4·ll·OZ.. /t'P f 'I 'Yi,o' ;.J<l"I , I
Septic Tank Capacity futR) '4 ·Q ). /Nl "11 fi.1'!1 JFi HoYJ£.> l
Septic Tank Manufacturer or Trade Name _(l~Cf=-li=<-"'f\..tt?"""'-"---------+-------------
Septic Tank Access within 8" of surface -1y...c.!c.2.----------,----------------
Absorption Area------------------------------------
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Absorption Area Type and/or Manufacturer or Trade Name __,2"'5"'"---3=-_•..,(,,'--'-' .,,_t
1_QW,,,,,,""''------------' "' {)11.1v'1w7 i Adequate compliance with County and State regulations/requirements t(-,:5 " 2 ' H <ff (._,J[>i(.
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---'----"-------Inspector · 1
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE rll'Af;' I~ ?.OO"l.. 1'
•CONDITIONS: ~ fl/~. f'3':!tl. tf,~ !
1. All Installation must comply with all requirements of the Colorado State Board of Health Individual SewageOisposal Systems 6*apter ~
25, Article 10 C.R.S. 1973, Revised 1984. I
2. This permit Is valid only for connection to structures which have fully complied with County zoning and bulldlng 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
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).
White -.APPLICANT Yellow· DEPARTMENT
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7~02 10:51
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FROM: SSC 303-2933977 T0:9703843470
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER .JO/I'; 1'1 "f: @.(1'\I.. od J\II:Al'IG'I' { !...tr l{"trJ
ADDRESS 2 (, 4.£ $!. G-1L....f1..I 1 l?tjlf11-:ft
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<."U.f•";\./O PHONE(~C73)-7.:t,;2-0~17
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CONTRACTOR~~....,.,~""'-""~~~~~~~~-~~-~~~~~~~~~Y
PERMITREQUESTFOR ( ) NEWINSTALLATION P<')ALTERATION ( )REPAIR
Attach separate &beets 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 FACILITY· 'h iHdt'
Near what CityofTown NII /VK1-1Y 11#
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cx§wwo:>o ff'R~(tJ SizeofLot <.. l'l t 1.11 "'6 (f. )(
Legal Description or Address (4.U Mt11.6 W) 0 0 55 .(..k})~_..yy. .><
WASTES TYPE: (X) DWF.LUNG ( ) TRANS SE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER-DESCRIBE.~---~----~-~----~
BUJLDING OR SERVICE TYPE: _ _,b:z.N..:..;lf.=-··........oM,,,w;tr,.IAl,._,/.b.LJWv""l"-'E',,__..:;~::...:....::"'--"'0:...:N"'-'t=~·___,4-~· O~f<,.,flM:..:..:.0¢...__ ___ _
NumberofBedrooms __ 3~------~--~-NumberofPersons--'A""------
( ) Garbage Grinder ()<f Automatic Washer ~ Dishwasher
SOURCE ANP TYPE OF WATER SPPPLY: ( ) WEll ( ) SPRING ( ) STREAM OR CREEK
If supplied by Commtmity Water, give name of supplier: /If() N IMI[ CA'M( ~ Bu dqMiV(ll
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: (fLE'l't 'Ml'\!>"'"' ffl> Pt 1rf(1 £ '.< No IL~
Was an effort made to connect to the COJlltnunity System? __ .L..'"------------~
A altt plan is mulm1 t1 bs 111bmltte4 that Indicates the follewlnr MINIMUM dlst111m; .
' Leach Field to Wdl: 100 feet
Septic TUik to WeD: . 50 feet
Luch Field to Irrlg1d1111 Ditches, Stream er W1ter Conrse: 50 feet
Septic System to Property Llnf.8: tOfeet
YOPR INDIVIDUAL SEWAGED(§PO§AL SXST£M PERMITWU 1I 1 NOT BE ISSUED.WITHOUT
ASITEPL\N.
GROUND CONDITIONS:
Deplhto first Ground Water Table. ____________________ )\
Percent Ground SI~ JL... tzhr.,, I S> fa )(
2
APR-03-02 10:51 FROM:SSC 303-2933977 T0:9703843470 PAGE:004'007
~OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: •
~ SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING. POTABLE USE
( ) PIT PRIVY ( ) INCINERATION 'TOILET ( ) RECYCLING, OTIIER USE
( ) CHEMICAL TOll.ET ( ) 01HER • DESCRiaE. __________ _
FINAL DISPOSAL BY:
(){) ABSORPTION TRENCH, BED OR PIT
( ) UNDERGROUND DISPERSAL
( ) ABOVE GROUND DISPERSAL
( ) EVAPOTRANSPIRATION
( ) SAND FILTER
( ) WASTEWATER POND
( ) OTHER-DESCRIBE~--------~---~------
Wll.L EFFLUENT BE DISCHAkGED DIRECTLY INTO WATERS OF THE STATE?_~N~IJ....._ __ _
PERCOLAUON TEST BESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test)
Minutes ___ __,per inch in hole No. I Minutes _____ per inch in hole NO. 3
Minutes per inch in hole No. 2 Minutes per inch in hole NO. _
Name, address and telephone ofRPE who made soil absorption tests: ____________ _
Name, address and telephone ofRPE responsible for design of the s)'$tem; __________ ~-
Applicant acknowledges that the comiileteness of the application is conditio~ upon such further mandatory and
additional tests and reports as may be r~ by the local health department to be made and furnished by the applicant,,,
or by the local health department for pu!J>Osed of the evaluation of the application; and the issuance of the permit ih
subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations made,
inf0111111tion and reports sli>mitted herewi1h and required to be submitted by the applicant are or will be represented to
be true ml conecl to the beat of my knowledge and belief and 111e 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
6dsification or misrepiesentation may resuh in the denial of the application or revocation of any permit granted ba-1
upon said application and in legal action for perjwy as provided by law.
PLEASED
• Designate North Arrow
$c.o71" + ~'f~•
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Your Neighbor's
Name & Address
tf~ tJ N».l: . ,,. Your Plot -Shape to Fit
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~well, all streams, irrigation ditchs, and any wat8T courses. Draw in your house,
septic tank & system, detached garages, and driveway.
If a change of location is necessary, you must submit a corrected drawing, before a
Certificate of Occupation will be issued.
County Road (Note the Road Number and Name) l• ~WP» fa .J-). "f_ '·
Oc»i,l''iMU' I ' 'ph:UOG
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Your Neighbor's
Name & Address
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APR-03-02 10•52 FRCl1•SSC 303-2933977 T0•9703843470 ..
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! lt.lPROVE~t~T LOCATION
PR.OPl!RTY Dl!SCll.IPTION
SEEPAGE TWO
CERTIFICATE
IMPROVEMENT LOCATION CERTIFICATE
I HBRBBY CJ!RTJFY niAT nns IMPROVEMBNT LOCATION CERTIFICATE WAS PRE-
FARBD l'OR JOHN T. REAL ANO SUZANNE LAVIN , THAT IT JS NOT A LAND SURVEY
PLAT OR IMPROVEMENT SURVEY PLAT, ANDTilAT IT IS NOT TO llll IU!Ll.'BIHJ?ON
FOR THE ESTABLISHMENT OF FENCE, BUILDING, OR OTHllR FIJJ'URE IMPROVEMENT
LINES.
I FIJRTHE:R CERTIFY THAT THE IMPROVEMENTS ON THE ABOVE DESCRU!ED PARCEL
ON THIS DATE, SEPTEMBER 28, 1993 , .EXCEPT UTILITY CONNECflONS,
ARE ENTIRELY WITHIN THE BOUNDARiES OF THE PARCEL, EXCEPT AS SHOWN,
THAT THERE /IRE NO .CNCROA.CHMENTS UPON TfiE DESCRIBED PREMIS!lS llY IM-
PROVEMl!NTS ON A.NY ADJOINING PRl!MISl!S, BXCEl'T AS INDICATED, AND THAT
THl!R.J; IS NO APPARENT EVIDENCE OR SIGN OF A.NY :EASEMBNT CROSSING OR
BURDENING ANY PART OF SAID PARCEL, EXCEPT AS NOTED.
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NOTE:
•USJECT f'llOl'Elm' IS NOT LOCATE])
W\1'111N !'EMA F1.000 STOOf AREA.
'°''*°".''t-1o111l ,REqt~ "'""' ,s; •• •\ilif,f;,··~~ 'll.···· . """"~---. ' "'
HIGH COUNTRY ENGINEEHiNG, ~C.
!>~ COOPCFI AVEf~tJf
Cl.FHV."000 sr·rllk!CS. co l!h'.(11
LS -19595
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