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Home My WebLink About02011 . GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit Nr 2011 1 109 8th Street Suite 303 Assessor's Parcel No. 1 . Glenwood Springs, Colorado 81601 1863 212 00 069 it Phone (303) 945-8212 This does not constitute 1 • INDIVIDUAL SEWAGE DISPOSAL PERMIT a build or use pe rmit. i PROPERTY 1212 B. Air Depot k Owner's Name Edward 3 . Car Present AddressNid eat Cttya OK 73110 Phone 405 -737 -7100 k System Location' Legal Description of Assessor's Parcel No. Seca. 20 & 21, T38, Ran/ s SYSTEM DESIGN /000 Septic Tank Capacity (gallon) Other tl k 'U Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 t' le fi Required Absorption Area i See Attached k S{(ecial Setback Requirements: , t A %t J /4110-2 1, j � : ' Date; J / � y J Inspector .(, p !i .. A r FINAL SYSTEM INSPECTION AND APPROVAL (as installed) , Call for Inspection (24 hours notice) Before Covering Installation r System Installer_ _.,cP�l, nj - Septic Tank Capacity /n'x'i 6:1120// /JJ.iO I� , 1 • S Se Tank Manufacturer or Trade Name e • Septic Tank Access within 8" of surface y/ Absorption Area • y ) /'S + 1 _ Absorption Area Type and /or Manufacturer or Trade Name - i 4/A T /i7 k , t Adequate compliance with County and State regulations /requirements Other Date 3 Inspector 7 _ „ ,./ At/ 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 tor connection to structures which have fully complied with County zoning and building requirements. Con- p, nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a s 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 al ril variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense ($500.00 ff 6 months in )ail or both). t Applicant: Green Copy Department: Pink Copy • Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: OWNER b2. EDlv,afD J. CAKO.1 73/10 ADDRESS 1 Jo'TN AIRIpUT; MIAU .ST (307 01‹. PHONE(%0737 -7/00 l5 0 o 0 CONTRACTOR ADDRESS PHONE PERMIT REQUEST FOR: ( yi 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 cS4R9'lED Near what City of Town V , 1 ( J W tjD 'J3( > contour (a 100.3 Lot Size c.* ■ Legal Description c c'fr Arr4r.ftc1 /dt 1'a'.t_ e_I 2i4-` J /iw slt,j,,s jrdc /s 1:1 sees. z o a s/ 71? s K s 7 Hi WASTES TYPE: ( Y) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe _ BUILDING OR SERVICE TYPE: FZ1r."-ICYIJGZr:" Number of bedrooms Number of persons it (N/) Garbage grinder r ( ) Aut iatic washer ( V') Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (r') well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: If supplied by community water, give name or supplier: AM GROUND CONDITIONS: 4 3t=t QTINCTIEA) '; - rVfr,/ RE:Pn2j Depth to bedrock: Q n k --- Depth to first Ground Water Table: (A 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: (V) 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: ( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration (1/) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF TIIE STATE? NO • • t T 14% • SOIL PEROOLATION 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 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 purposes 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 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 per- jury as provided by law. 11 Date Si • � _, 4 t % — arr - � �� PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY , ALE A /TA cite (), »1E pLAAJ, p „p _ TAUS JOIST CORPORATION a division of 1 international . t -+ `" a PACIF INLAND O PERATIONS - WESTERN SLOPE S oFICE `M "- 201 Centennial Street • Suite 1070 • Glenwood Springs, CO 81601 74:ii 1. 303/945-5763 DAVID SACK .. Technical rlepresentative o% / /',i ce" /Dp� / /ice as / <. ,? Cox' // P ,i1,? /2,1":6 /// 672 P / ' / / / I:/.rl , ' 1 - 0 I JOB NAME: _. JOB r LOCATION: _ —! 1 - - -- SHEET — _— OF SALESMAN: _ __. — BY —. -- __ DATE: ________ � r. "-ef J7rtn r� f� rcoago 5 ' 7 1. 1 .2,2 ems r • /0/76 7 /) � 4 td/1/.1 f irk /0 ;30 to , 9 /,Gy -1 !Ice) 3, r/ 2b IC) (Rio?)