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HomeMy WebLinkAbout02226 !!°we++a.dGe�eavr; W ,.'4».vdb^ - a .'CkS�:iF*�T'�'a"fls^�atna ^r4,:,; .. �`:, -� +- �,,xr...- -r �.- ., ,+:...: + GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N: 2 2 2 t 109 Bth Street Suite 303 A is 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 .Tawas A Minhal a hrdaarmmeresent Address Rat 1142, Carhandal a Phone_ 96901507 i System Location 0444 Crystal River Road, Rock Creak Subdivision, Lot 10 Legal Description of Assessor's Parcel No. , SYSTEM DESIGN i i Septic Tank Capacity (gallon) Other / Y / ' (a' / Percolation Rate (minutes/inch) Number of Bedrooms (or other) 4 Required Absorption Area - See Attached Special Setback Requirements: . Date Inspector T^ a+' -'' (7 .4" i s /L—M i P '� f 4.. 'JIG p. FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer -.\n y ).m V .ta , erv r'L- -''1/ Septic Tank Capacity 7,2 e 1 / I ! /, 13 r r ( J! 0- 1 r -1 1 , 7 Septic Tank Manufacturer or Trade Name ( rn " ' r J Septic Tank Access within 8" of surface /- ----- I 7 c' / (�' ' Absorption Area r Absorption Area Type and /or Manufacturer or Trade Name .+�� 4 J - A / " \.� Adequate compliance with County and State regulations/requirements L Other �'7 ( � /� Date 17- 10 - / y Inspector `'� --e-,4t4 L. RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: I 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. k 2. This permit Is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- t 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 frotathe terms og6pecifications contained application of permit commits a Clegsa, Petty Offense (3500.00 flne 9 „r i months In )alt or both). i 1 Applicant Green Copy Department: Pink Copy ��� 1 _^. i .-,.: d...,. J �.. uduo.: u_ a�a��Ltas..... k. v. _. °-`---_._,�.., �,u&.cc.u__.�.ia. _ -_r._ �: ._...._�:.�-'- -- =� W..�..� VY,r.n Application 1NDIVIDt JAI . SEWAGE DISPOSAI. SYSTEM APPLICATION Approval By County Official T OWNER PA 4 MICH CAR OANIoNE ADDRESS f3 o x / 3..5 2 - / GA R&M P t-C Co . ?423PHONE 9C7 - 1507 ONTRACTOR iA I H A t-L I D A `, ADDRESS PHONE ERMIT REQUEST FOR: 9 New Installation ( ) Alteration ( ) Repair .ttach separate sheets or report showing entire area with respect to surrounding areas, topography of area, abitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes CL, , page 4). P i ,OCATION Op PROPOSED FACIT.ITY Count y ()LA R � Tear what City or Town C/9 0 N A I- Lot Size 5 7+ Cie CS .egal Description L-o T /0 / /C0 C C C/ZECK S'c.433 b , V I S1 e VASTES TYPE : pQ Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe IUILDING OR SERVICE TYPE: 2 (CT / 0 CNT/ A L , Dumber of bedrooms "1 / Number of persons 2— '79 Garbage grinder ($) Automatic Washer (Jj Dishwasher ;DI JRCE AND TYPE. OF WATER SIMPLY; () well spring } () stream or creek - live depth of all wells within 180 feet of system: No NC f supplied by community water, give name of supplier: !2 C K CieCG/C /AM '1COW NE/(.3" ,4 ()C - IROt JND CONDITIONS: )epthtobedrock: NONC FOtt )epth to first Ground Water Table: VA R I he l,C . r FACT e r CHEW f}JJoc . flu c. 'TEST 'ercent ground slope: F L A T )ISTANCE TO NEAREST COMMUNITY SEWER SYSTEML. ? M 1 < vVas an effort made to connect to community system? N 0 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 74 Septic Tank ( ) Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use ( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use ( ) Chemical Toilet (") Other - Describe: (.V/ f'C 0 NJ /N M 0 CA NO FINAL DISPOSAL BY: ( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal QQ Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? N0 r )11. PRRCOL,ATION TEST REST IT .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. _ lame, address and telephone of RPE who made soil absorption tests: lame, 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 3 l - 7 ti Signed PI,E,ASE DRAW AN ACCTJRATE MAP TO YOIJR PROPERTY