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Home My WebLink About04079.no-Deob -70544c 7- 15- • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY � Owner's Name of V I+ I� `IP Vhf i (}present Address A r '�►1 �,%C System Location OG1%` o1nz_R-NQJ"1 Legal Description of Assessor's Parcel No 74-4: /12(41_4_% Cn 16 { </ 7 )', a n+ rJ ✓ r. P! �' lfa_ r SYSTEM DESIGN 7-.10 Permit 4E,9 Assessor's Parcel No. This does not constitute a building or use permit. Phone 2 1 b JA -o Septic Tank Capacity (gallon) Other li Percolation Rate (minutes/inch) Number of BeQro/4ms o other) Required Absorption Area - See Attached �/ J TT 2 --/-- 1 /,A' 1-rC �' /� / t_ '� r� ,v Special Setback Requirements: Y�Z / - d 2-3/—e--- 3�'� �-- Date - - / - d _S Inspector /(I L,K O 71LP aell— FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer �JCtv1 Septic Tank Capacity '3 .t Septi Tank Manufacturer or Trade Name COC -E� di, -el Septic Tank Access withiri 8'''of surface ''i .— 614 Absorption Area i Q -c 6 V 0 Absorption Area Type and/or Manufacturer or Trade Name --i - I �,,{ ^' (1- — ` Adequate compliance with County and State regulations/requirements Other 1 � Date 7,, )� - 05 Inspector l�,tkU� 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 1, Petty Offense (5500.0011ne — 6 months in jail or both). /r..) GARFIELD COUNTY 9703843470 06/09/06 11:27am P. 007 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER //�/trov,"f+��i�MOOimk` DA/6Tnhia A�Enr ADDRESS /,o% 6, �/ 7'v 4, 5 /nose Cite. -yr iv PHONE fl9 _618-/Z CONTRACTOR `h/%p, Amer J ADDRESS 3 44'97 coy, (o—S,'XT, c'D. PHONE G7v 976-sa00 $/61D— PERMIT REQUEST FOR (L1(EW INSTALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of arca, 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 /2; He Size of Lot 9VIc 2C S Legal Description or Address ADM & &CVAC, M . WASTES TYPE: Q23- WELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER -DESCRIBE BUILDING OR SERVICE TYPE: S 1P Number of Bedrooms 3 Number of Persons ( ) Garbage Grinder ( ) Automatic Washer Dishwasher SOURCE AND TYPE OF WATER SUPPLY: 1.4WELL If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? O 6 ( ) SPRING ( ) STREAM OR CREEK A site plan is required to be submitted that ipdicates the followiatt MINIMUM distances: Lesch 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 LOUR INDJVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHO_i.Q A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table 161" FTT Percent Ground Slope 2 GARFIELD COUNTY 9703943470 09/09/05 11:27am P. 008 TYPE INf5IVIDOAL 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: (7) ABSORPTION TRENCH, BED OR PIT IN F Lj 'L 3 c ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER -DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? p PERCOLATION TEST RESULTS: (To . mple by Registered Professional Engineer, if the Engineer does the Percolation Test) �/ 1 g. b Minutes (• 1/ �(perr n in hole No. 1 Minutes inch in hole No. 3 Minutes ),, 1 jlcrinch in hole No. 2 Minutes 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 or by 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 fiatha understand that any falsification or mis[rpresentati •'. may result in the denial of the application or revocation of any permit granted based upon said appl. cation and in action for perjury as provided by law Signed _ � r .% L � _ Date d -?--a\- PLEASE DRAW AN A rf RATE MAP T a OUR PROPERTY!! 3 7- GARF I EL D COUNTY 9703843470 06/09/05 11:27am P. 009 13 • It o r o ct O • s g Q b V 6 9 d • 0 0 8N V w •. d p) E cd c V O C h y L eatti U U .W4 c `9 • c f.• .t ed d m o In I 0 o 00 u v o W en 81 0 b. -0b 7 E u z County Road (Note the Road Number and Name) a