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GARFIELD COUNTY BUILDING AND { SANITATION DEPARTMENT Permit PC \ 21 8 i
109 8th Street Suite 303 A re Parcel No. 1 a
Glenwood Springs, Colorado 81601 4
Phone (303) 945-8212
This does not constitute t
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name Philip 6 Lanes Orgill Present Address P.O. Box 2588 G lenwood Phone_ 984 -0417
System Location 0144 Navajo. Lot 9, Ilk Crekk Subdivision. New Castle
1
Legal Description of Assessor's Parcel No.
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SYSTEM DESIGN 1
on() Septic Tank Capacity (gallon) Other r q S' - r
1 �, • V • ' S trX ADD zD % F O'V G A tl T4 A CM ' i 5� '=-/ ff ! ,
/ L t a---Z Pe co atlon Ra (minutes /inch) Number of Bedrooms (or other) 3 4 1It . / PI( 17 OGk 4- ke A Ll/Qe 4✓ `n4 1f/ f lr l
Required Absorption Area - See Mlasisztd 6 , 93 �,. ! . i, $ , - ) t - rl 4 r , -,. -44) / F //, 1 X y let .t, -7 ((
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Special Setback Requirements: ,, / r to 9 31 r Ct�. t - Ica •v en- 4 , / }�}� e c { ;^
, 73 / r ., I ^ y� � �//�
y .� � _ ' 1 I �.M. , '4.^ „ W S ld O�r i� sLQR. i t`
Date T 7, Inspector GGII(A'�'
FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) i - ---- , t
Call for Inspection (24 hoprs Before Covering Installation
t
(Byetem Installer\ /1 a -. _9 ,. C`3. \
Septic lank cepocit p k \
Septic Tank Manufacturer or Trade Name r + r= i
Septic Tank Amen within 8" of surface £ - « ' . \ '+
ri 7 11
Absorption ., _ <�','. a., ,- _ • r, . \X' - i .,
Absorption Area Type and /or Manufacturer or Trade Name IA t { - - - -r* :t . ..--- ie • - g
Adequate compliance with County and State regulations /requirements ../------
- " - 1
Other 1
' 1 �. �. f
Date �� -.1- ? I nspe c tor :.1— iwr-pQ \ ± 1pl.
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RETAIN WITH REG IPT RECORDVAT SITE 3
•CONDITIONS: I
1. All installation must comply with all requirements of the Colorado State Board o 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- .. 1,
nection to or use with any dwelling or structures not approved by the Building'and Zoning off I" pe shall automatically be a violation or a
requirement of the permit and cause for both legal action and revocation of the permit: k - t
3. Any person who constructs, alters, or Installs an Individual sewage disposal system In a manner which Involves a knowing and material g,,.
variation from the terms or specifications contained in the application of permit commits a Class 1, Petty Offense 000.00 fine — 6 w
months In Jall or both).
Applicant: Green Copy Department: Pink Copy 1
iii
s " ` t Application
1 INDIVIDUAL SEWAGE DI O5" TfMjA ;iCAJI J N Approval by
OWNER
--)1 Y \il +Larn �( t� 3 C1r- fi ... J County O� icial:
Lz, ... 4l
ADDRESS 1 1 Q f • t'J Q) Ca be PNONE 9 -!'8y 7 � ` _
CONTRACTOR [,ey5 n/
ADDRESS 5� 5-f f IV f00 C e atek PNONE `�Ltp3'a r
PERMIT REQUEST FOR: 1/1 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 Gfi r e
Near what City of Town Neu) enlie. � Lot Size LOO � 1''1 116
Legal Description $rock . LAS F & Crr4C c`Vioirvi5ln17
WASTES TYPE: ( ✓)Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: rvibj k ilre
N m of bedrooms 3 Number of persons
( Garbage grinder (Automatic washer (VI—Dishwasher S URCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek CAN Hz.°
Give depth of all wells within 180 feet of system: nIQ
If supplied by community water, give name or supplier: N?e Cache Clt g • ) e ek
GROUND CONDITIONS: De velopment
Depth to bedrock: (AI rL _
Depth to first Ground Water Table: 11\c/i)
Percent ground slope: R C(_;
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to community system ?out a Csf�1/ _�iiNlaES
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 1
(✓) 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:
(1/4 Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCIHARGED DIRECTLY INTO WATERS OF THE STATE?
1
_.. Plnn.
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 Mo._
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 permft.it 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 applicaion and in legal action for per-
jury as provided by law. r-
Date ` e - 1 7 Signe( Alt lS -(;` 61)) 4
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
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