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Home My WebLink About01999 ao *. a>4f GARFIELD COUNTY BUILOI$Q AND SANITATION DEPARTMENT r wa 0' 109 Btlt I reel RAW 803 `J % l i� 71'111 ' ' OlenwoOd n44, ploredo 81801 d Phone 3o3) 1 454 I 1 , '"11r 1 " This does not constitute rv' • ii-t li.34,IVIDUAL SEWAGE DISPOSALPERMIT N- 1999 a building orusepermit + ' IWt1br Vance „Si Linda Gaboasti ti � i , I I stem Location County Road 132, Mitcbi , Creek i7 , " ? rv r ^ I Icns wr eed Installer Siheel: Bn rtr f lAn t �� I p 11 • Conditional Construction approval is hereby granted for 8 / "l� gallon `t ' r ` . „ ^^ a it i . Septic Tank or Aerated treatment it. (f �' t f r ■ 1 } cin Absorption n area I i r com puted - ". a l s d lse tl al area) as follows: , q ni _sq ft, of absorption area per bedroom. / n y r,ll bit �at�, atb otw t t �.,�. minut re uirea a mi Y � 'l06014I� tl I F 4 of I Mr h II - .'I 1 � ` thelip ell tl ( x sq. ft minimum requirement = a total of sq. ft. of absorption area. 1� • " ey we e u9 9 eN ' " f T , ° 1" 1 i d R)p lyi 7 y .k 1 /9 `� ° " / 1 : '. € ; . • ri Uu1!l ; a , " / '� / F' I, . Inspector Y . VIN AL'APP'IiOVAL.OF VSTEM: mll6 EF i �„ lµ'l , , hu p aystagt'a ttalhrvtja to be incompliance with the Salvage Di L aws until the assembled system is approved prior to oI1Vl1 ^ � � ° • all 1 ^ :9 O b ' y'p ,� : 1 �I�q1 A ry yi , Y R V ^�^j dwF l P Septic Tank access for in an d c l e aning within 12" of ground surface or aerated access ports above grou11 "i t : s urface a 2S P� e s coorio ' uu ,u 1 Proper„nlaterials>,nd assembly. I . y +Y ,l °.m ' j1 1 Trade n ame o f sep tic tank o r ae tredtinent unit. latawm a s®� 11... nee" I .� ,1 " 4 d f A t , t 1we ai r �� rmaa mass a- "1 1 ■ ii i ~ '1 a ' �" r Adequat (or dispersal) area, l r =-•t , ° 1 i "' . at r I i i _ Adequate compliance with permit requirements ? % N 1P , Fl, t $pro :T,11,1",111,11,1!, i 7 -j 4 FS • w / a� ^a i1 ,, l . • Adequate compliance with County and State regulations /requirements. DOI e . o ther d M Ill 1: �/ � 1, 5 /" 1�� /// ill f� I ni rl _ Date �/ I sPSCtor , - RETAIN WITH RECEIPT RE AT CONSTRUCTION SITE i 1 . A llnetalletionmust comply with ellrequirement ') of thA otedoStete Solid of Health Individual sewage DieposslSysteme { I � " 1 II r 1 k; l � Ater R3, Article 10 C,R,S. 1973, Revised 1984. 7 � s 1 .. i iq „ ' M u; ^ 2. ,,f) 4 0411,t01 is r Valid only for connection to structu which have fully complied with County zoning and building 2 l , ,x ' J , q rem aflte. Oonnectionto or use with any dwelitn9 r atr(uoturea net approved by the Building and Zoning office shall 1t d M e ticaliy be . a violation of a requirement of fhb' h end Buse for both legal action and revocation of the permit. :e p ' ' 1 `' $ Any person who constructs, afters, or installs an in yl I swage disposal system in a manner whloh Involves a knowing p ' ( ehdmaterial variation from the terms orspeoificatio ns 1 inedintheapplicationofpermitoommlte .PettsrOffense a (2:500.00 ine 8 months In Jail or both.). Ni r . Applicant: Green Copy DaWrtm•nt: Pink Cony Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by 05/77 7 County Official: O NER , i t' L A 4 L ;fia& ° / ADDRESS j>. D. Fxsx cp 'i4_ 4LLsZ�Jc�trn _PHONE Gigs c a0( t / C°.° fiC CONTRACTOR_J, GtSl -t Zet_ L l�" ADDRESS 4irY e Pi c h - r\ D • PHONE 927 9'2Ig PERMIT REQUEST FOR: 4IVew 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: County Gll0Fit / Near what City of Town agent. is t SPRtkc c Lot Size b /{met, Legal Description _ Ni7rti-kflL c a . WASTES TYPE: 4°44 Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - D scribe BUILDING OR SERVICE TYPE: VeS ( OC _ Number of bedrooms Number of persons 1 ( ) Garbage grinder (:0 Automatic washer 044 Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: /ea If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: _ Depth to first Ground Water Table: Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? 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: (1W-1— 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 TIIE STATE? /V , 1 • • SOUL RCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) Or 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. Nance, 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 purposes of the evaluation of the application; and the issuance of the periitt subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements 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 under- stand 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 per- jury as provided by law. ( Date Le ` ' S? e Signed e PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY 7/ - -- jr5 (II � P s 1 673(6. G� 1/ 1 /f / /iiur l f f?)) \\\ Darin 1 __ PLOT PLAN AND DESIGN FEATURES: Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, water course, stream, dry gulch and show location of proposed system by direction and distance from dwelling or other fixed reference object, and additional submissions in support of this application such as data, plans, specifications, statements and commitments. Page 4 c‘ °s s , - Flo GavLgCye ihincter 0&/77 ---, I! 3 iveclr S I / In I 11 gn• Q r we /1 w = 707 /8 >( e /a'� lo c/o er r Yt��'��rc a1� a I 14 ) 4 ir ►ri 4 `' 2 g — t r ecie S 4-, A rave/ is art, c 12p . c ; "7 — /Z ° >c 57X^- eelas Cria—