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Home My WebLink About02131 1- mp.m- � .nlR . g,, s. rfiQ{ rf. S'. .:•^�' o': • a;ri'TR! - mNZ «,..A. .nrmp2:.xm..:� ' 1..:. «. ... �.. t GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 2 1 3 1 , t 109 Bth Street Suite 303 Assessor's Parcel No. ( Glenwood Springs, Colorado 81601 `I Phone (303) 945-8212 This does not constitute 1 INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY 1 Owner's Name Stephan & Phyllis Stailteesent Address 2755 103 Rd. Carbondale Phone 963 -1314 System Location 2755 103 Road, Carbondale 11y Legal Description of Assessor's Parcel No. SYSTEM DESIGN 1 t ..1. 7 5 O Septic Tank Capacity (gallon) Other 1 • m -M Percolation Rate (minutes/inch) Number of Bedrooms (or other) 2 c'2, f� r / . i Required Absorption Area - Se t o 3 / / ! o r- ? 1-2-02.4 e 4 /� ^ v li ! ,2, I Ai 17 r :1 l t! ! z. r e 'I err err // " _C G'.r.. i Special Setback Requirements: 17 a - . I l/ r CAP t- ;C/t O / fi ef.. L"cti. i Date ? " i0 — 3 Inspector" j am' ` - 4 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ' t Call for Inspection (24 hours notice) Before Covering Installation S System Installer 0 14 ) 1 v .-- Septic Tank Capacity /) ( C r Septic Tank Manufacturer or Trade Name l /'- 0 2. r) "7> t Septic Tank Access within 8" of surface / Absorption Area / 2 I)'r <'.r c n ' [f Absorption Area Type and /or Manufacturer or Trade Name Carr) til...ra+.n.... enl--" Adequate compliance with County and State regulations/requirements Other Date / () - -' X 73 Inspector C — C.., Thr"I ( ( ( JAC f%1 • 4 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 I, Petty Offense ($500.00 fine —8 4 months in Jail or both). Applicant: Green Copy Department: Pink Copy • � O1"l�l �I ` r 1 Application I � r _ . 1 " ` INDIVIDUAL SEWAGE DISPOSAL SYSTE j?'P I ATION ,j Approval by ' i I 1993 Li 11 County Official: OWNER � ∎a tl �s N Ali :. _ 1 � , / ADDRESS 77fl /a7 .-c C -t ee •4FWINEL[a J ilY* CONTRACTOR_ G/L -__IkHfl.0 r/ • ADDRESS CdetSkp�/('"L,�� PHONE %'237" PERMIT REQUEST FOR: (ti) 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: Countyf'/ Near what City of Town —moo _i ,e4—z — Lot Size Legal Description —. WASTES TYPE: ( kelDwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other /- Describe , BUILDING OR SERVICE TYPE: I____ as 4/ � /` Nu ber of bedrooms Number of persons 7 ( Garbage grinder (N9 Automatic washer ( (V) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( I/) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: •----- If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: — Depth to first Ground Water Table: 2.mo -F • Percent ground slope: 2 -3 Vo DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? TYPE OF INDJ.VIDUAL 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: (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 THE STATE? N4 , • • . 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 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 pernift.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 for per- jury as provided by law. Date 7 /9 7 Signed Asi PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY r . Page 3 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 conmitments. • Page 4 r, • l 1 I II I - � C I, / rste that the residential structure built under building permit # /° W � 1 is the primary singl family dwelling on the property. Further that the other dwelling unit(s) on the property is an employee housing unit(s). An employee housing unit being a dwelling unit provided to an individual(s) and /or his/her family, who derives the majority of their income from work on the property and pays no rent. It is agreed that this unit will not be used for residential occupancy for any person and/or family that is not employed on the property. o!I, Proof of employment of individuals residing in said additional dwelling unit(s), which is the appropriate signed IRS Form 1099 andgefiNaMiallailWiRMISiatirmismee for each person employed shall be provided upon request by the Garfield County Building and Planning Department. It is further agreed that this property will not be sold to another party without representing that the additional dwelling unit is for employees only and cannot be used as a guest house or rental ry unit. _ ZZ (q 3 Date I j Witness ,I c zC" � I, l I