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Home My WebLink About04289e•r • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT Permit 2 (. 9 t ��1.a Assessor's Parcel No. ml a3 --361.00 — /do This does not constitute a building or use permit. PROPERTY ff� / / f j /J �J� Owner's Name v �� k 1k ( 41(.1"v"‘ Present Address 03 ( 4 (° t 3" Phone / ¥ (- 93 °`-' System Location Legal Description of Assessor's Parcel No. SYSTEM DESIGN 2-7 !�3ic% r !>j`a•, j S. g/ of to+ -? ` -..nor Vr `, Sa. FKer l.O±c)f1 Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) 1 6.41:51-1 r;3 ozows -' ) !Lou„) 6 /\1 e_e o 40A -a d 1 0 -Tea-C.. i A -n r -4 o rz 3 o rZ Is- Quo tel( 41 (!yi 0 Tito ; Required Absorption Area - See Attached Special Setback Requirements: Date "1 air \ Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer 2".eza a rT.?•y'1 e. Septic Tank Capacity ier.vao S ✓-•� j v Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface Absorption Area,04 Absorption Area Type and/or Manufacturer or Trade Name /tom ./rdo. �v Adequate compliance with County and State regulations/requirements /42;:", - Other Date /1144 7'1 2 1 *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 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). !' Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER -1-10 04- a )7 Cart 19i t( ADDRESS a q (D(l4 fy Rd )3 PHONE li-0323 CONTRACTOR }'9R^ -- ADDRESS PHONE PERMIT REQUEST FOR ( ) NEW INSTALLATION (`g 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). LOCATION OF PROPOSED FACILITY: / Near what City of Town N eW C.S tp( / Size of Lot /'1 s 4GNcl J\ Legal Description or Address 311 C )2?/ (y' jni z „ csb(" ^1� S l ( 0 WASTES TYPE: O DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER—DESCRIBE BUILDING OR SERVICE TYPE: � ,66/)e. I (; �'` AACt n S ->u Number of Bedrooms Number of Persons ( ) Garbage Grinder (i() Automatic Washer Oc.) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ()) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: jvi (it Was an effort made to connect to the Community System? 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 (septic tank & disposal field) 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 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 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 PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER -DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 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 orby 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 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 Date /6 /n r 07 PLEASE DRAW AN ACCU • TE MAP TO YOUR PROPERTY!! 1 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N: 24 6 4 109 8th Street Suite 303 Glenwood Springs, Colorado 81801 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Assessor's Parcel No. This does not constitute a building or use permit. Lee Finneii 319 138 Rd., Glenwood . 945-0567 Owner's Name Present Address Phone_ 319 138 Road, Glenwood Spring° System Location Legal Description of Assessor's Parcel No. SYSTEM DE/SIGN {-� ' Septic Tank Capacity (gallon) Other i 1:. rd' ercolation Rate (minutes/inch) Number of Bedrooms (or other) 1 r r,'/JIT' /7rorrt. 4. .}':,r;r; 41.0. . Required Absorption Area - See Attached 9 / A i,(. r . I ' ',"' r r'I 1, ,- Cr f 7 j; ! C Special Setback Requirements: 3 i U PA �t " ` J,�,i;, -' - c— r r / I r:,4....„ �. C12.4. -qt t.,,./1 Data r^�( �� InspectorN..,- FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer � /utne Septic Tank Capacity /,a Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface Absorption Area /t Absorption Area Type and/or Manufacturer or Trade Name .� f&t trt Jr e311 `r.e11--r T, 1 - Adequate compliance with County and State regulations/requirements Other Date - % fir Inspector jlr-.t.r 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 compiled 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 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 I NISI Y.I l?UALSEW AO f_MSP'_OSALSYSIEMLAP_PLICATION OWNER C /f /E F/NN/%ti'- AI)i12ESS PO eat 792, 044.4. 4 PI1ONE 9/Vi-05"6i CONTRACI'Olt SB.�f< ADDRESS 57me PiIONE PERMIT REQUEST FOR (y411.W INS'T'ALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing entire area with respect to sin -rounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATIONol? PROPOSEa EACILCI Y: COUNTY GA -4 !L /4 < 0 Near what City °Crown _a/4Sk'00/1 f N5 w Cyesro 3 legal Description Ayr ) s -amok, m &cot- ling* ends, /°hsr WASTiS:LY_PE: (welling ( }Transient Use ( ) Commercial or Industrial ( ) Non-domestic Wastes ( ) Other - Describe BUILDING Olt SERVICE TYPE: Number of bedrooms: / Number of persons 'a ( ) Garbage Grimier ( ✓—Autounatic Washer ( <15isliwasher SMACi AND7_yl1i.OlI Y.AT1EIt-SIIITLY: (PrtiVEi.1., ( ) SPRING ( } STREAM OR CREEK Give depth of ail wells within 1418 feet of system: 114.6 Iva. LL /5 zSo' ?Rem SYsrs m If supplied by conun intiy water, give name of supplier: { ROUN12.CONDITTONS: Depth to bedrock: Depth to first Ground Water Table: Percent Ground Slope: 7 5' Z 54oP, DISTANCE TONEARESI'COMMUNITY SEWER SYSTEEM:. et Al/c25 Was an effort made to connect to community system? Mo T'YPI? OF INDIVIDUAL SEWAGE DISPOSAL, SYSTEM PROPOSED: (1/"Septic'1'ank ( Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use ( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use ( ) Chemical Toilet ( ) Other - Describe: FINAL DISPOSAL BY: (1lAhsorption'i'ren;h, d o 'it ( ) Evapotranspiration ( ) Undergronnd Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other -Describe: /11it/1714rof4 SYS/+f WILL EFFLUENT RE DISCI IARGED DIRECTLY INTO WATERS OF TI STATE? A/U p_ImcoLA'1'loN 1' 1ST_RESt1L'l'S: (1'o be completed by Registered Professional Engineer) Minutes per inch in hole No. 1 Minutes per inch in hole No. 3 Minutes per inch in hole No..2 Minuses per inch in Bole No. `. Name, address and telephone of RPP, who made soil absorption tests: Name, address and telephone of RPE responsible for design of the system Applicant acknowledges that the completeness of the appliction isconditionalupon 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 pnrposes of the evaluation of the application; and the issuance of the permit is subject to such terms and conditions as deemed necessary to inusre compliance with rides and regulations adopted under 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 au•e or will be represented to be true and correct to the best of my knowledge and belief and are designed to bre relied on by the local department of health in Stinting 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 tj��—er l)aate c P_I EASE.P_IiAW_AN_ACCURATE.MAp_'I'r? Yet! IR.PROPER'L'Y_