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Home My WebLink About02007 - ;wrfisnrvw'n F N'3 + F; Ale IMP F -M • M GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N – 2 0 7 4 g � 'i 109 8th Street Suite 303 Assessor's Parcel No. 1 t Glenwood Springs, Colorado 81801 I) s Phone (303) 945-8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. f' PROPERTY • i' Owner's Name Thomas Ttiplat Present Address 6995 County Rd 214 phone 984 -3120 E 6995 County Road 214 (ALTRRATTON /REPLACEMENT) System Location V Legal Description of Assessor's Parcel No. A l SYSTEM DESIGN 0 0 0 Septic Tank Capacity (gallon) Other 41 `f p Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 r. Required Absorption Area - See Attached r Special Setback Requirements: 5 'd-'o in pe f C. // �C • T Date 2- 9/9y Inspector � �- u „ fin � _..... I: FINAL. SYSTEM INSPECTION AND APPROVAL. (as i : ed) r Call for Inspection (24 hours notice) Before Covering Installation System InstalleY 'F4 Septic Tank Capacity /000 SR./ I +'ff P ii Septic Tank Manufacturer or Trade Name yy Septic Tank Access within 8" of surface • 4 - •. , 0 .. a • � : a r. f T Absorption Area .2 • -- r rir. .• Absorption Area Type and /or Manufacturer or Trade Name _ / p h` f trd r ` Adequate compliance with County and State regulations /requirements / i -� i • A 1 Other •- k • •..a . - _ . - / c . • ta.'. f .v •, 1 • 4..1 1 "C.. - ' '„ h Date (Yin Inspector i t � � �� 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 t 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 - 3. nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a t k 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 Ina manner which Involves a knowing and material P variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine —8 , months In )ail or both). k ! ' ` Applicant: Green Copy Department: Pink Copy k ;` Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by . — -- County Official: OWNER Ty r,P /Meir o p ADDRESS 6 its ('0. el 0//f PHONE 78y-1/0 ) CONTRACTOR _ SiJ/Y1L. _ ADDRESS PHONE 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: County G,4,g4;0% Near what City of Town NEw CAin? Lot Size . 7-Cs A c c Q,ttr Legal Description 6Y9s ,2/7 'J WASTES TYPE: ( V)Thwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: f' r� ,u6 " 7,4 g w.� %rd � Number of bedrooms 7/fiQ,?, Numi4r of persons = /y0 (Q) Garbage grinder (y) Automatic washer 01 Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (.\/) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: MAO o�y /AS- 2 If supplied by community water, give name or supplier: 0 GROUND CONDITIONS: _ Depth to bedrock: �wt46"W Gyorfive .-4r9Al� iAle/I' #41,114"/ a / Depth to first Ground Water Table: [.mot // 61.T a -4'Z4t /%Pah Ai,t Y77a ia0.92 Percent ground slope: /97 Sy DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: TNio /L+i/tx Erb Art C'AM Was an effort made to connect to conmuinity system? 0 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (x) 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: x) Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond -� I ( J �'c/ Ar) ( - escri be: NEh-, %mac /N�'/ / 7 e .X WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 4/0 . 1 • SOIL PERCOLATION TEST RESULTS: (To 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 Minutes per inch in hole Mo. 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 purposes of the evaluation of the application; and the issuance of the permttis 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 de 'al of the application or revocation of any permit granted based upon said application and egal actionf r per- jury as provided by law. � � Date ,9 ��i Si c �,� '�• �� PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY ,/ New ai ra 0„ n n 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. • v() /NNi/ %it e ry mM / 000 0 0 0 €A /4 SE�� Tiftik 111��` So > WO. 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