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Home My WebLink About02170 Y' R , .' • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit ni 2 1 7 t ; . " 109 8th Street Suite 303 A is Parcel No. .r Glenwood Springs, Colorado 81801 ` , Phone (303) 945-8212 • This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Eduard B. 6 Shirley J. "kith Address 065 hideaway Circle, Ngei ver n 674 -5331 — System Location 5 2 1 ) 2.. County Road 313, Nast Divide Creek, Silt , I , Legal Description of Assessor's Parcel No. . -' I) (loc L CAC it -t IC ' Q ---r^ ei X 6 • -•r SYSTEM DESIGN 11 G, e A c N ( - 1 4 n M C I t et. (SC 0 30 01 (cc S ,,,, 1 tG ?' V , ✓ ✓ raeWteges 25' ti 100 0 Septic Tank Capati(y (gallon) Other _,.� 4G3. 1 /I 2. Aq /iv 3 Percolation Rate (minutes /inc Number of Bedrooms (or other) • Required Absorption Area - See Attached Special Setback Requirements: 'Date ` Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) X Call for Inspection (24 hours notice) Before Covering Installation I` System Installer D ' Aj / 1 Septic Tank Capacity A 6 ✓ / :_. t Septic Tank Manufacturer or Trade Name . Septic Tank Access within 8" of surface, /( Absorption Area Rat ' 4 4 so Absorption Area Type and /or Manufacturer or Trade Name { � o k .€� "' �' ( f Adequate compliance with County and State regulations /requirements R 4 } Other Date J s /v ~ 6-0 Inspector 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 10C.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 months In jail or both). ' Applicant: Green Copy Department: Pink Copy A I 1 , 1. .. 6 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit P' _ 2 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Edward E. & Shirley J. iuith Address 1165 hideaway Circle, Evergre (7.0 -'5311 sent System Location 2 _ � 2. County Road 313, East Divide Creek., Si l t Legal Description of Assessor's Parcel No. t) (10( IC- CE.: /I -/ r[ :ct� SYSTEM DESIGN CO ( t A c F - r C• A f 3e r¢ it 30 1- r l < r s CJ Septic Tank Cap (gallon) a., v Other ? i' . r r- f <_ ' / f' C 7 . � r r _ a L „ P I Percolation Rate (minutes /inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation 7,l l System installer � '' / " t 4 ' J r Septic Tank Capacity /- `' it Septic Tank Manufacturer or Trade Name Septic Tank Access within 8' of surface, H ��!', r. Absorption Area 1 " �. 17) �F Absorption Area Type and /or Manufacturer or Trade Name 2\ (1) - k . ` � ��.J'�'�t i.^ Adequate compliance with County and State regulations/requirements / Other Date / e '! % Inspector, 12 . / Ahy r _..- 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 months in jail or both). !PP , . Applicant Green Cpy Department: Pink Copy +� Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: E./u.f rr) J' er.,.ol .(bt•i•!' T ,Sr-utk eS__thataa.4A4kai_aLnf it Affil 1= var N , 6 re,/ //50. TOR ,O w ive > � y nc _ PHONE REQUEST FOR: 06 New Installation ( ) Alteration ( ) Repair ,.h separate sheets or report showing entire area with respect to surrounding areas, pgraphy of area, habitable building, location of potable water wells, soil percolation -.mot holes, soil profiles in test holes. (See page 4.) 1' .JCATION OF PROPOSED FACILITY: County ' - rC)r1J ,/ Near what City of Town 8, / 'r �o Lot Size 0 QC • Legal Description a 7tzt.c4tc — WASTES TYPE: ()( ) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms Jr Number of persons n 7 ( ) Garbage grinder (A/) Automatic washer ()C) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (x ) well ( ) spring ( ) stream or creek • Give depth of all wells within 180 feet of system: / Hrr/I Pre ft •upplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: 40 f T — Depth to first Ground Water Table: j 4.40 Er Percent ground slope: - .74 9„ 65 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /. m i/ s Was an effort made to connect to community system? 4/ TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (>4 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: (>0 Absorption Trench, Bed or Pit ( ) Evapotranspiration - ( ) Underground Dispersal ( ) Sand Filter. ( ) Above Ground Dispersal' ( ) Wastewater Pond- ( ) Other - Describe: ilit EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF TIIE STATE? 14Q • Paae 2 • • ,uLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) Ainutes 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._ .mme, 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 periift,is'subject to such terns 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 Signed 1 7 s - •SE DRAW AND ACCURATE MAP TO YOUR PROPERTY • • • • Page 3