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Home My WebLink About03921' : .• -~ ......... • ---·-..... , G~RFIE~1 CdlJNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-~2 , Permit N~ 3921 Assessor's Parcel No. 1 INDIVIDUAL SEWAGE DISPOSAL PERMIT This does not constitute a building or use permit. <! PROPERTY ~ Owner'sNamJ.o n('~ ,0bo110ob PresentAddress?t>G..)todb)'rd \Q~hono9Y5-~~' DD~ 'J:)l \l~t 1~ \ o Kc 05$ q4s-o((t)~ ' 1· System Location I Legal Description of Assessor's Parcel No. d ( ~5-Cf;).) -0 0 -0 ..:!fi ' ' fl SYSTE.f'oESIGN I ! l j ' • • i ; l i I l ;. i 1 ' l ; r ~ \ t?ro Septic Tank Capacity (gallon) ______ Other -~/-'0"----Percolation Rate (minutes/inch) Number of Bedrooms (or other) __ ../_,__ __ _ Required Absorption Area -See Attached Special Setback Requirements: 3q yc±J J ~ p<!5 4 7 8 dJ J-~ p«.-~ 1/7 r P1 J /_'I ~s Date __ )j~-~2 .... ~.,.__--o<-j__,. ___ Inspector .:...g;;.-J.44oQ. ... :;;;r;-A6'1<C~ff';;..co_'.,,._f~----------- FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer ~ /1 !'!./( )AL'?"Jl/J/h-H Septic Tank Capaci1y_,_/-''"''--"""'"-"'-',_..J./2CJ...o)n;;._,_=,y'---'--" /t~----------------------------- Septic Tank Manufacturer or Tr~;;;N~me '!i,l/f)€K. ~"--;,~----------------------------- Septic Tank Access within 8" of surface --!~=------------------------------ Absorption Area...,__,e()'--"''-------------------------------------- Absorption Area Type and/or Manufacturer or Trade Name ~ .. .,....,,,~..,7'4Lh-....,~=~&ka°"""'"~--------------- Adequate compliance with County and State regulations/requirements,_p_,,.=------------------- Othe• ---------------------;f--:;,,-:,,-~,,__ _________________ _ Date 1-IO-oc/ •CONDITIONS: 1. All installation must comply with all requirements of the Colorado State Board of Health lndivfdual 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 materfal 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 Yeflow -DEPARTMENT • • ' ' I l ' ' ' • I .\ ' l , I ' , . ; ! ' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER c ho..r-1~ _s Lo. V\ c ~ :=::,,o~gf!h~~·'mkt·/a:~ONE Cf'fS-Ji'fS>' ADDRESS CJ)., (pr-C~1J Rar!I I 1 PHONE CJyJ-Of-OP G-1-t> VI (A) rn Spvrllf, (() ;'-! (i;d) PERMITREQUESTFOR (X) NpWINSTALLATIQN r ( )ALTERATION ( )REPAIR ( ~.:e.o 101. <.e me.rct' ,,..,. CJld..s:..,~ Attach separate sheets or report showing'entire area with respect to surtO'Widfu'g 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 PROPOSE~ FACILITY: , 1 NearwhatCityofTown (T/enweiad..f:;rUJt £ SizeofLot X Ac<~ Legal Description or Address OCJ?o lJ1 /d!lf ood Ufle1 C-fenword.Jf>r117F WASTES TYPE: (Xj' DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ()OTHER-DESCRIBE _______________ _ BUILDINGORSERVICETYPE:.___.63~e.~f~~~J~~~t7-'---'--'C..=-.::~=----------------~ Nwnber ofBedrooms _ _,__ __________ Nwnber of Persons._,,3..,_ __ _ ( ) Garbage Grinder Q() Automatic Washer (lO Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: Alo nqme Wa ~ .Sys~ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: NIA '-'-~7µ_"'----------~ Was an effort made to connect to the Community System? _,_N~/,-'--A_.__ __________ _ I A site plan is required to be submitted that indicates the followin2 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 YOURINDMDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table. ______________________ _ PercentGroundSlope U42 'fh0rz s.x; ? ' ' -,..I' ..... ' TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (xJ SEPTIC TANK ( ) AERATION PLANT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) CHEMICAL TOILET( ) OTHER-DESCRIBE FINAL DISPOSAL BY: ( ) ABSORPTION TRENCH, BED OR PIT ( ) UNDERGROUND DISPERSAL ( ) VAULT ( ) RECYCLING, POTABLE USE ( ) RECYCLING, OTHER USE ( ) EV APOTRANSPIRATION ( ) SAND FILTER ( ) ( "\) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND OTHER-DESCRIBE /11 B/kcP._-hv Lea ck S'0.r.>Gzrz / WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? /llo PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, ifthe Engineer does the Percolation Test) Minutes ____ _yer inch in hole No. 1 Minutes _____ _,,er. inch in hole No. 3 Minutes per inch in hole No. 2 Minutes er inch in hole No. Name, address and telephone of RPE who made soil absorption tests: ------------- Name, address and telephone ofRPE 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 bemade 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 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. _. CA~c, . omo <J/~r_ PLEASE DRAW~ TEMAP TO YOUR PROPERTY!l' ? ~ ' ~ .. l " ?· " \ •,, ,, .. -"i ... ,, Designate North Arrow Your Neighbor's Name & Address Your Plot -Shape to Fit -o (No Scale) j ~' . ~ ~~ j \.i ' ).\ ~~ •J:) e"" -"' ... ~~~ .... Locate well, all streams, irrigation ditchs, and any water 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) GtloCJ .B.J..-V/11 ~d l3A) ' l, Your Neighbor's Name & Address ' ::;-.1;.::-"' ; . Improvement Location Certificate . I : ~ • 8 s . & f :z; : ' . . ' s as· 1a·oo·e: ...... 120.so· :· .. : · .. ; · .. . : ... . ··. GRAVEL l>RIVE I J-::-24::-.-:-, ":" . ...J-;-, 1;"5,";z:-:"· -d:=::..::~;;+-XL..A.:..-1 · 1 24. I• T'llO STORY FRAME 64.4' DECK ABOVE SCALE 1·-30· --------- N 88' 18'00"'11 ; PIN FOUND 120.so· PIN FOUND I PROPERTY DESCRIPTION SEE PAGE TWO IMPROVEMENT LOCA'l'ION CERTIFICATE I HEREBY CERTIFY THAT THIS IMPROVEMENT LOCATION CERTIFICATE WAS PRE- PARED FOR CHARLES W. & CHRISTINE A. LANCI , THAT IT JS NOT A LANO SURVEY PLAT OR IMPROVEMENT SURVEY PLAT, AND THAT IT IS NOT TO BE RELIED UPON FOR THE ESTABLISHMENT OF FENCE, BUILDING, OR OTHER FUTURE IMPROVEMENT LINES. I FURTHER CERTIFY THAT TtlE IMPROVEMENTS ON THE ABOVE DESCRIBED PARCEL ON THIS DATE, 11/06/92 , EXCEPT UTILITY CONNECTIONS, 6.PC:: 'l:l'l.t""r1i>crv \V,TUt""I "rUC' nA1t"'lr..11.nrrC'> ,....,.. 'Y"r•r ,.,, ..... -... ~ .,...,.,..,..._,......_ ...... -.......... .