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Home My WebLink About02068 • a GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N ... 2068 n 109 8th Street . Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 f Phone (903) 945 -8212 This does not constitute F. INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. 6 PROPERTY Owner's Name Janet Gnat Basalt, Address Basalt CO Phone 927 -3344 1 • 11 Kings tow Avenue, Carbondale } i ) ' System Location Legal Description of A Parcel No. r sl SYSTEM DES IQ N y` / , I /� O Ogr9c in q' 11 o / p ' /.25 08' 7.79N/1 ; 4-____ / _-- o D / Septic Tank Capacity (gallon) Other '� . /, / / �,, v„ , 2 9 ,"n2..<,K /, / K a' earl . ° 1 a pee /�" ✓ a 3' t i er r Percolation Rate (minutes /inch) Number of Bedrooms (or other) • ' cA C \ ^ fc'a 4, / / / K " St. A._ 4— A e ..e.R a Re '' err / G, ' X l ,.1 k r Required Absorption Area - See Attached p { 47 , r.„ r" r ) t r f+ 7 n r ✓ 3 4 tack,c,.ei • Special Setback Requirements: LF 7/ ' f C f ,. ;r✓ ar "7 O p.t Q o ,,, k Date u — / 6' 7 H Inspector X 44 ` 044 4 ' nt &.. FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Instal tion7 4 System Installer - •t Q„ Y Septic Ta capacity / as o Septic Tank Manufacturer or Trade Name Vel F ✓.Fig/ 'fib am-A- Septic Tank Access within 8" of surface 9 FS Absorption Area /, 4'1$ ` n / Absorption Area Type and /or Manufacturer or Tra R 0L / f X b-2 3 r rr y r. Adequate compliance with County and State regulations /re,gulremegtg�, _ 7 J ) fs4!_.F / 4 6' cS r`-s i �,,. Other .. q / ` r Date / /V ' 9'41" Inspector • >{ h , RETAIN WITH RECEIPT RECORDS AT CbNSTR CTION 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- , k nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a requiremerttof 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 months in )all or both). t Applicant: Green Copy Department: Pink Copy ` • Application Tr- INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by n r Si County Official: OWNER - �C V eo ' / 4' o J ADDRESS PHONE 9M � 7 � J , AA CONTRACTOR pi, it . :,7; _: r ADDRESS 2 n F2 i N • al. PHONE 47 /251- 5 121g PERMIT REQUEST FOR: KL 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 a A ipi eL7 n Near what City of Town erL,JES2RC,� Or>. Lot Size ?.1t(....0 Legal Description L.0T c4G, thnc.S (&o o%Da11 Sf6/) WASTES TYPE: -- Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms2 1- C Number of persons ! Garbage grinder Automatic washer (I D.tshwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: n If supplied by community water, give name or supplier: KinGS IC.Cc..J ? 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: ¢e) 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: 044 Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: r r / AC TD 1C'' ?4/3- WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 1 Pawn 2 H • 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 perniftis'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 3— 2 Signed 4 jf 4( PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY • Iius Fe,op9i2 1A1 A Page 3