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HomeMy WebLinkAbout02217 t 1 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit jt 4` 2 i 7 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945-8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY \ Owner's Name Psent Addr Phone_ a System Location t' 3 0 v Q e » L Present y } c / r 3 Q 4 Legal Description of Assessor's Parcel No. SYSTEM DESIGN te te if 9� c7 6 1 / 0 60 0 Septic Tank Capacity (gallon) they / h — � , 2 LI/' 2 % % /� X5, 9.24 t. / at 2 N✓"P Rate (minutes /inch) " Number of Bedrooms (or other) 3 1 , / � Required Absorption Area - See Attached // , f , GU / ` Special Setback Requirements: ) T Q r Y4 3 et`a Date 2 "JO ---7 %J Inspector . �� FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer_ C/1i1 Y14� Septic Tank Capacity /j f 0 C Septic Tank Manufacturer or Trade Name C- Septic Tank Access within 8" of surface Absorption Area D O _f SS/ ,' • Q i 6 L/ Absorption Area Type and /or Manufacturer or Trade Name -- L d .77,14.4.- 6 /V [ - 1 Adequate compliance with County and State regulations /requirements Other 9 q Date °',5 / Inspector .� C/. ALL ..�L4' 4 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 Individualsewage 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). Applicant: Green Copy Department: Pink Copy i GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N. 2 2 1 7 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945-8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT I a building or use permit. PROPERTY / Owner's Name lion 7, outhan Present Address 440 -T.. 7t4 St, Rifle 625– ) 7 Phone '��' System Location 0530 County Uoud 326, S i l t • Legal Description of Assessor's Parcel No. SYSTEM DESIGN Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) 9 t,'r� �> f, ¶ - U y ,. �. ; q Required Absorption Area - See Attached Special Setback Requirements: Date Inspector FINAL SYSTEM INSPECTION AN • APPROVAL (as installed) Call for Inspection (24 hours notice) efore Covering Installa •.n System Installer Septic Tank Capacity Septic Tank Manufacturer or Trade Nam: Septic Tank Access within 8" of su :ce Absorption Area Absorption Area Type an • • r Manufacturer or Trade Name Adequate compliance with County and State regulations/requireme s Of �. r_ Other . at aaL /, 4 _•I.4111. • i.= / / ���• Date 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 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 (5500.00 fine — 6 months In )all or both). Applicant: Green Copy Department: Pink Copy m'.,.+a..oew.+ sawn +nlwe"'"ur^ Lwow ++wt.^�„+�:'�:....�.-- .. —�-.. . --a... q It GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit .. ± .... 2 109 8th Street Suite 303 AssessN Glenwood Springs, Colorado 81801 Phone (309) 945-8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT % a building or use permit. PROPERTY 1 ! � / J Owner's Name Don Louthan Present Addrestl j i \ 440 -E.. 7th--St- ,- -Rifle Phone_ 42625-74 System Location 0330 County Road 326, Silt Legal Description of Assessor's Parcel No. SYSTEM DESIGN • / ( 0 ) Septic Tank Capacity (gallon) Other Li' A / ^" 1: • Percolation Rate (minutes /inch) Number of Bedroom other) 3 • ✓` Required Absorption Area - See Agmehed � ' 03749 en, .:..9 / �� (S) * - I Special Setback Requirements: (�'� Pate ///- y- 9 y Inspector �f°77 \ )..44„.1.(7,44.4„.. FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation y I System Installer y # Septic Tank Capacity - Septic Tank Manufacturer or Trade Name - Septic Tank Access within 8" of surface Absorption Area ./ Absorption Area Type and /or Manufacturer or Tra. - Name _ Adequate compliance with County and Sta - regulations/requirements • Other , _S.. ji : .. .. ...�. . __- • • 1 S, •J 0 ... Date 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 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 1 variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 months in )ail or both). Applicant: Green Copy Department: Pink Copy fEB 2 2 1994 i Application J1 ��I�TJ � ��NFYWAGE DISPOSAI. SYSTEM APPI.ICATION Approval By County Official OWNER D n n oa7"f/A n/ f D, ADDRESS PHONE 1>C ISo' :ONTRACTOR S N w I -e ADDRESS PHONE 'ERMIT REQUEST FOR: (0 New Installation ( ) Alteration ( ) Repair kttach separate sheets or report showing entire area with respect to surrounding areas, topography of area, iabitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes ;See page 4). LOCATION OF PROPOSED FACILITY : County - GOY r/ ) Near what City or Town S' i / T Lot Size S ' , ? ? 7 .q cPs. Legal Description S F -4- - S E + S t (.7 0- - ry ,Q, N i b- -Al,; it s ,-T, 0'1 ? q TS6 50" Iit„c.. `! )— WASTES TYPE : ($ Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Ai n, t r, Number of bedrooms 3 Number of' persons (be) Garbage grinder (}Z) Automatic Washer (A Dishwasher SOI IRCE AND TYPE OF WATER SI JPPI.Y; (4 well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: 3 9' o If supplied by community water, give name of supplier: GROI IND CONDITIONS; Depth to bedrock: u n /f tne n Depth to first Ground Water Table: 6. o F Percent ground slope: 3 3 , DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_ 5 n, • i Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (>9 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: (xc) 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 THE STATE? ''1 P OIL PERCOLATION TEST REST JJ.TS: (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. _ dame, address and telephone of RPE who made soil absorption tests; dame, 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 permit 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 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 understand 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 perjury as provided by law. Date a/ a. a-/ 9, Signed J7 0 p1.EASF, DRAW AN ACCT IRATE MAP TO YOT IR PROPERTY 3,1G ■ r 1 cv 0 0 T a 7.n- 5 7 rYT �] s ;IT , .. pl.OT PI .AN AND DESIGN FEAT! JRES 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 commitments. r C H i.- T -11 2 > H0 t - y -,2. ' z I / 1 -4--,- r N 4 5 e 40 / " fr 7 oni n V o il A -)-•- 4 T ortcia 2 /•. 3 = 3,33 N� r \ I , ^ i 4 D ° / a- • Caen) oten,awtt4 © S - 3c C R 3X 4 9:4(3 /0, 73 4° 1 .„ ?" ela, a yet 8 u cc x 6 74. frit ,Z),,p5Chdmveter 32p L cs