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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
Permit
4 69
Assessor's Parcel No.
This does not constitute
a building or use permit.
PROPERTY r
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Owner's Name Y (� i Preserit7Cddress � ' jf r�L-i �{ t ( 1 f'�, C t' 1. i L'f K phone / /l� , - -5`
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System Location 11 / / r/\ CY��i 1��- I.c.i 6,3-,7 Ss�
Legal Description of Assessor's Parcel No al 9"/ - 6 ) ( - 0 0 -3 V6
SYSTEM DESIGN
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Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
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FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer /' /' /1/ GtC;8i/
Septic Tank Capacity / IT
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Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
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Absorption Area `"'` A-4"�.�
Absorption Area Type and/or Manufacturer or Trade Name
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Adequate compliance with County and State regulations/requirements /e>
Other
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Date `' �' Inspector %f 4 /1 / L‘-;{
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 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).
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Rpr 13 06 08:11a
Tod Welch
970-963-7449
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
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OWNER / a I — Z00 T7 i. - A'I IY/ d g i e/2 .i.,_ r-er
ADDRESS //,/4 T,e_A✓(b" eprE, 2,06142B/XP IE 9 7o - 9,6...1 —'eV
CONTRACTOR tACG(1 EKCAv,ac-r?AJ3 LNC. s/6 —
ADDRESS p°• Box tool O. (9 1&23 PHONE 4163-2553
371—(2.0
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).
LOCATION OF PROPOSED FACILITY: �(
Near what City of Town 1\ f F (® Size of Loo ✓ &
Legal Description or Address j i %g' (o&wry✓ C8 233 Qr F !e Co
WASTES TYPE: 04 DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER—DESCRIBE
BUILDING OR SERVICE TYPE:
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Numb& of Bedrooms hi Number of Persons 6
Garbage Grinder V1 Automatic Washer 04 Dishwasher
SOURCE AND TYPE OF WATER. SUPPLY: (K) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier.
DISTANCE TO NEAREST COMMUNITY SEWER' SYSTEM: ,4/- -
Was an effort made to connect to the Community System?
A site plan is required to be submitted that indicates the followine 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 CONDH1ONS:
Depth to first Ground Water Table
Parent Ground Slope
Apr 13 06 08:11a Tod Welch
970-963-7449
TYPE OP INDPJIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
NT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
CHEMICAL TOILET( ) OTHER -DESCRIBE
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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? NO
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test) tt .. �}
Minutes W per inch in hole No. 1 Minutes q per inch in hole No. 3
Minutes (/ per inch in hole No. 2 Minutes 7 ao. _
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 teas and reports as
may be required by the local health department to be made andfurnished by the applicant or by the local health department for purposed of the
evaluation ofthe application and the issuance ofthe permit is subject to such tern s and conditions as deemed teary, 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 tare and coned to the best of my knowledge and belief and are designed to be relied on by the local department of health in
evaluatin g the same lbrpuqoses of issuing the permit appliedfor herein. I finther unlerstandthatairyfalsificationormisrepresentationmay
result in the denial of the application or revocation of any permit grantedbased upon said application and in legal action for perjury as provided
by law.
�7l"' f Date /726
164 PL ASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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Apr 13 06 08:10a
1
Tod Welch
OFFICE: 970-963-2553
FAX: 970-963-7449
970-963-7449
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Welch Excavating Inc
698 Merrill Ave. #E-1
P. O. Box 1005
CARBONDALE CO 81623
Confidential
Fax Transmission Cover Sheet
Company Name
Phone Number:
Number of pages:
Regarding:
SHOP: 970-963-4475
CELL: 970-379-1229
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Attention: 02 �( /
Fax Number: Cie& 3._67/69
Date Sent: %/45/
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Thanks,
Tod Welch
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