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Home My WebLink About02152 �..5 �naPr +r'�9Rs Ir - w" ` r-.�. �-.. ....... -. n s f R G ARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N - 2 1 5 ':• 109 Mb Street Suite 309 Assessor's Parcel No. M '-• Glenwood Sptings; Colorado 81801 Phone (303) 9454212 .! This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT 8 building or use permit. PROPERTY Owner's Name Phil & Sally Ntllsr Present Address 5347 County Road 100, CIda}p 963 -0330 System Location 5347 County Road 100, Carbondals Legal Description of Assessor's Parcel No. SYSTEM DESIGN 4200 Septic Tank Capacity (gallon) Other 0 0) Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached (3C P " loft = TA/ tN Cr /7 � Special Setback Requirements: '� I q / 0� :4 p rr ^ 13 1-0 ea / Date Inspector �/ - tt is FINAL SYS *M INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer 47,2 ,9y ?/174'/' ' ( Septic Tank Capacity l 2 3 o - - Septic Tank Manufacturer or Trade Name (Ode /, 4 r" " ( Septic Tank Access within 8" of surface /,' 5 Absorption Area l .290 ¥ -t Absorption Area Type and /or Manufacturer or Trade 'Name 62//9/./. Q-- Adequate compliance with County and State regulttions/requirements /K " K S Other /� /.....1 / / ,. Date /7 - 9j Inspector I S./ e. - 1 RETAIN WITH RECEIPT RECORDS AT CONS RUCTION 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. 1 9 This permit is valid only for connection to structures %Soh have fully complied with County zoning and building requirements. Con - nectiontoorusewithanydwellingorstructuresnot roved 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 Ina mannerwhloh Involves a knowing and material ,. variation from the terms or specifications contained In the application of permit commits a Glees I, Petty Offense ($50900 tine — 8 months In (all or both). _ y ,, Applicant: Green Copy Department: Pink Copy Application ,'r a` 'a' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: OWNER �/� /t i7, I - 9 ■ y - ZnaZabZ ADDRESS ,C3 Y 7 - -/i-S7Y ,..codi /Co PHONE 99 z -611. . ONTRACTOR c t e> /S6-4/I 51 ---A- 5 O'zi ;OGRESS PHONE91 3 2Jr0 (° 'ERMIT 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. ( page 4.) _OCATION OF PROPOSED FACILITY: County Cv AtLi e IT Near what City of Town C Gw 6 rn 0 S Lot Sizel 7t 4 ec d.S Legal Description WASTES TYPE: (t / /)Dwelling ( )'Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms 3 Number of persons (arbage grinder ( 1 -/iutomatic washer ( kishwasher SOURCE AND TYPE OF WATER SUPPLY: ( k6ell ( ) spring , ( ) stream or creek Give depth of all wells within 180 feet of system:, a cO C)'4 If supplied by community water, give name or supplier: / 2V ),27 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? • -4" ; /s-5 'c-c ' TYPE OF INDI9DUAL 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 Y: ( 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 ?__L_K_ _ • . ... Patio 9 .. _. :O1L 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. Jame, address and telephone of RPE who made soil absorption tests: Jame, address and telephone of RPE responsible for design of the system: 1pplicant 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 _ epartment to be made and furnished by the applicant or by the local health department for iurposes of the evaluation of the application; and the issuance of the perviift,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 niy 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 ap )4cat1on d in legal action for per- jury as provided by law. / Date 9 Z 3 Signed C� PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY • • • Pane 3__ V 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. /00 0 Cet r'aNn M r N pertc. = YG 3 etroAoo /w roc rn.r9TOn T/?ONCht pireci- h ce, pia: co." 399' 3Z ?/7 3ff Page 4 Gyz e*'-..- , 64 2,r, 3.--4-ez,‘,3 r,� z ;sr q % z 0 z st S - 2, 3i(S,7, / y .,.y y& i;eci.5 • g ,..?,/c4 '�° a� 2 r �, / 0 i. /l� F7! r . 0UJ n, 3� „ w1 v • N N. i. \ \', Ilp T 4 x .X ..r