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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit IV.. 2 2 0 4
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81801
Phone (303) 945 -8212 , ,
This does not constitute f
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. F
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PROPERTY, 4
1 Owner's Name Peter 6 Barbara Lyle Present Address 16695 Rey 82 Carbondale Phone
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System Location 2009 County Road 112, Carbondale 1
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Legal Description of Assessor's Parcel No. s
SYSTEM DESIGN 4
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/na.0 _ Septic Tank Capacity (gallon) Other 1
rt 4 Percolation Rate (minutes/inch) Number of Bedrooms (or other) 9
Required Absorption Area - See Attached t
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Special Setback Requirements: y J / �''"
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' Date Viii Inspector / � / � 01 *j
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FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before f Covering Installation
System Installer .. I AA $as' ( , .2 / t) �, -1.?.. , ,,, �( •
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Septic Tank Capacity / �,/ I S
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Septic Tank Manufacturer or Trade Name ..�f i ny ` n .•
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Septic Tank Access within 8" of surface r + tit —T. r ,
Absorption Area a� y'�
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Absorption Area Type and /or Manufacturer or Trade Name cy^ 4< d :' ( e \ -- Y
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Adequate compliance with County and State reguletlanalr •= L.-t ' 7 t
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Other (
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Date ._ 1:e ` y .Insp @oto7 . -. , '' n' 1J r: LI C!I t Q
RETAIN WITH RECEIPT ;,: RECORDS AT CONSTRUCTION SITE ' , \
•CONDITIONS:
1. All installation must comply with all requirements of thetolorado 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 -r,
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 I
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 $
I1�beri l r a s F'>'It Ap
INDIVIDUAL SUWAGE_UUIIS SSYSTEI1 AI'I'LI • pproval by
OWNER ' �t/� /1 w �� c� [w� �/,P '^ _ n i 1 4 1994 ` j molly Uf f is la :
ADDRESS eVD .?/ e< 1 ( / /, ad of PiloilEC=.z+ii ';L=LD 6
C)UNTY
cowrIIAC OIt_ c i" �` / ,44/ _ _ _ /- )
ADDRESS /5 f {U/ 2/c`jl, roo iN S I'I'iui 9 020 ' - 5 0 I
PERMIT REQUEST FOIL: ( new Inslallalion ( ) Al1era1iou ( ) Repair
Attach separate sheets or report showing entire area with respect Lo surrounding areas,
topography of area, habitable building, location of potable water wells, soil percolation
Lest holes, soil profiles in Lest holes. (See page 4.)
LOCATION OF PROPOSED FACILITY: County _6474e1 - --
Near what City of Town Carhott di --- -- - --- - _ -- - Lot Size /QA
Legal Description ------ _ —_ - -- ----- _ —_ - --
WASTES TYPE: ( Dwelling - - - - ( )bans leaf Use _-- _- - - -` —
( ) Commercial or Institutional ( ) lion- domestic Wastes
( ) Other - Describe _ - - --
BUILDING OR SERVICE TYPE:
ilumbe' f bedrooms '—j - /Number of persons S
( Pr Garbage grinder ( Automatic wasi ( l/I — —
SOURCE AND TYPE OF WATER SUPPLY: ( Gerwell ( ) spring ( ) scream or creek
Give depth of all wells within WO feet of system:___ 1 bD _ _ _ `_
If supplied by con water, give name or supplier:__ 1
GROUND CONDITIONS:
Depth to bedrock: _ -- _----
Depth to first Ground Water Table: ___ ____
I'ercent ground slope: �— --- ----- -- -_ --
DISTAIICE 10 NEAREST COMMUNITY SEWER SYSILM: 1 Al
Was an effort made Lo connect to community sysiem7_ • _
TYPE OF MIDI UAL SEWAGE DISPOSAL SYS1E1i PROPOSED:
( Septic Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
( ) Chem al Toilet ( ) Other - Describe:
FINAL U1SI'O . BY:
( Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand filter
( ) Above Ground dispersal ( ) Wastewater fond
( ) Other - Describe: ----- _-- __ —._ -- WILL EFFLUENT EFFLUEIIT BE DISCHARGED DIRECTLY 11110 WATERS OF 111E SIA1L7 ( --
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, 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
iiiiutes ' per inch in hole No. 2 Minutes __ per Inch in hole No._
Name, address and telephone of W'L w made soil absorption tests:
Name, address and telephone of itl'E 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 pernat.is •subJect to
such terms and conditions as deemed necessary to insure compliance with rules and regulations
adopted under Article 10, Title 25, C.N.S. 1973, as amended. The undersigned hereby certifies
that all statements nude, information and reports submitted (herewith and required to be
submitted by the applicant are or will be represented to be true and correct Lo the best
of my knowledge and belief and are designed to be relied on by the 1oca1.depariment of health
in evaluating the same for purposes of issuing the permit applied for herein. 1 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 «0 7* Signe c if _ • f f
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PLEASE DRAW AND ACCURATE MAP TO YOUR I'ROI'EItIY
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