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Home My WebLink About02132 ! 0' H ' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT PermIt tY. 2 � 3 2 109 8th Street Suite 309 Assessor's Parcel No I t Glenwood Springs, Colorado 81601 Phone (903) 945-8212 This does not constitute r INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. i PROPERTY • 4 Owner's Name Joel 6 'Usti Hato Present Address P•0• Box 2855, Glenwood Phone 927 -9300 System Location 0834 Rings Row Avenue, Rings Row, Carbondale R • Legal Description of Assessor's Parcel No. SYSTEM DESIGN t Septic Tank Capacity (gallon) Other Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 4 r , Required Absorption Area - See Attached C" Special Setback Requirements: C . ('i t `-" r ' - y� ' 1i Date Inspector LIZ •• irn - r: F <ter(- -1; 3 i et FINAL SYSTEM INSPECTION AND APPROVAL (as installed) 1 Call for Inspection (24 hours notice) Before Covering Installation System Installer Are 0-)d L l Septic Tank Capacity / L9 Septic Tank Manufacturer or Trade Neme / V '� I , Septic Tank Access within 8" of surface Y �) i Ai Absorption Area - Al. �` -r - 1 - . � Zi a- y./ Absorption Area Type and/or Manufacturer or Trade Name cirn . ✓t! . s' Adequate corn • Hance with County and State regulations/requirements I r 1 • Other 111 iA •1 _ a/ / .a e _ nt ..� =Ji- Date /! -44-47 3 Inspector J Q U! " i 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 1 1 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 — 6 4 months in Jail or both). Applicant. Green Copy Department: Pink Copy itp I IGd (.1011 INDIVIDUAL SEWAGE DISPOSAL SYS1EM APPLICATION Approval by — — — County Official: OWNER R _ ei nAtN \DURESS__,.! 34, A _ f_l_ PHONE 4e7 :ONTRACiOR_ >//o[ 644410rnm iit.tAnztay r g __ bSS _oW.S__ foot - -- I'N OHE 927 - 1. 00 'ERMIT REQUEST FOR: (/f New installation ( ) Alteration ( ) Repair U:tach separate sheets or report showing entire area with respect to surrounding areas, opography of area, habitable building, location of potable water wells, soil percolation Lest holes, soil profiles in test holes. (See // page 4.) OCATION_OF PROPOSED FACiLIiY: County Ga,2tfF�l _— Iear what City of Town L _ Lot Size 'egal Description___ 'TASTES TYPE: Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe 1 1UILUING OR SERVICE IYPE:LL.))i`` Dumber of bedrooms ,3 Number of persons (//) Garbage grinder ( /) Automatic washer (/) Dishwasher ';OURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek C' 4imeonih give depth of all wells within 180 feet of system:; --a _ If supplied by community water, give name or supplier: ,i`,.,3 t`2.0 ContlAlw% r- GROUND CONDITIONS: Depth to bedrock: — ___ _ — Depth to first Ground Water Percent ground slope: DISTANCE 10 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: (,'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? No • 1 • • • Pane 2 • 9 1L.II'&RUJLA IOI1,1EST RESUL1S: (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.__ mne, address and telephone of RPE who made soil absorption tests: nme, address and telephone of RPE responsible for design of the system: pplicant acknowledges that the completeness of the application is conditional upon such urther mandatory and additional tests and reports as may be required by the local health npartment to be made and furnished by the applicant or by the local health department for urposes of the evaluation of the application; and the issuance of the pernrft,i3 subject to uch terms and conditions as deemed necessary to insure compliance with rules and regulations dopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies hat all statements made, information and reports submitted herewith and required to be ubmitted by the applicant are or will he represented to be true and correct to the best f my knowledge and belief and are designed to be relied on by the local. department of health n evaluating the same for purposes of issuing the permit applied for herein. I further under - Land that any falsification or misrepresentation may result in the denial of the application Jr revocation of any permit granted based upon said application and in legal action for per- jury as provide d by law. 'ate — z3 i t _." / 13 — — _ - Signed A 'LEASE GRAN AND ACCURATE MAP 10 YOUR PROPERTY • Page 3