The URL can be used to link to this page

Home My WebLink About02227 - -, remr -5 r r< - vie - P-t r',*+r.ro-.. +ewe'WplrrOrtn tten mr+n• ^r..,q..^+r- .. _.^,.p .p:...-v.,...-.. .-_-e- �.. . a . j , . `d 1 ii GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N.. 2 2 2 7 1 I 109 8th Street Suite 303 Assessor's Parcel No, r Glenwood Springs, Colorado 81601 1 Phone (303) 945-8212 ) This does not constitute 1 INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. ' PROPERTY ( Owner's Name Joe & Lori $ stria Present Address 0085 CR 105, Crdale Phone_ 963 -2982 System Location County Road 335, Parcel 11D, R & D Minor Subdivision, Silt ` Legal Description of Assessor's Parcel No. e SYSTEM DESIGN i j i / 5 Septic Tank Capacity (gallon) Other i fr - ) 1 Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 P ' h. 4:7 13- i.e. -t.- / ,..r .r / 7 - t Required Absorption Area - See Attached - , -{.. -F- r ' ., 2,� '7 ./ Tv . N il, is, 1 l/ Y•r t n} . r `/ Special Setback Requirements: if 3 7 I,'" / C.4,-1 ' .r <t.17r. -' ,rte ? /, / '.+ ,�+- e 1 Date L/ _. e _. '1/ Inspector -- '-.'%^...+-.i , • i. „, . -•.4i FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installatiop - System Installer aqtart r ' Septic Tank Capacity SDI /0. .0 • k t Septic Tank Manufacturer or Trade Name - e t /Mitt " 7 F,rat&2 - <,A119G 3 Septic Tank Access within 8” of surface S1E-3 v y n Absorption Area :a a�ke A /l if "- Ltd f . ��/ ' X Absorption Area Type and /or Manufacturer or Trade Name 7(,- a �� 7 O� / u " � p 1 Adequate complla 'nce with County and State regulations /requirements Qe c 6 Other Date) .1'3 - 7y . Inspector SCm....LLLL e- -.CC- RETAIN WITH RECEIPT RECORDS AT SITE I 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 structureswhich 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 9 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 )all or both). Applicant: Green Copy Department: Pink Copy • Application JNDIVIDIJAL SEWAGE DISPOSAL, SYSTEM APPLICATION Approval By t I County Official OWNER JQC qi Le [14P Pen 0 ADDRESS Qj5 (n /, nh Pei log PHONE94L2 &2 9) • CONTRACTOR Ow ea l ADDRESS PHONE PERMIT REQUEST FOR: 00 New 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 PROPOSE. ACIT.ITY : County {r3aecp.1 Near what City or Town 55 Lot Size 6 J t) 4C Q v s Legal Description WASTES TYPE : 06 Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms .3 Number of persons cQ ( ) Garbage grinder 0() Automatic Washer () Dishwasher SMIRCH AND TYPE OF WATER SIMPLY; O well () spring () stream or creek Give depth of all wells within 180 feet of system: If supplied by community water, give name of supplier: CiROI IND CONDITIONS; Depth to bedrock: Depth to first Ground Water Table: Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: $,l 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: IA 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? NU • SOIL PERCOLATION TEST RESTJT,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. — Name, 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 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 rayocation of any permit granted based upon said application and in legal action for perjury as provided by law. Date Q j - 14 - 1 Signed A A 514 PLEASE DRAW AN ACCTJRATR MAP TO YOIJR PROPERTY • ' • m,1 e rum\\ kizAt, 0 «Ji.v i . r /7/0- si /9f:C T , Tt'r'r t r) / is , c: S TU D /Si /I e C - v t :: ■ PA ate-1 A , .. /V H --e s/tti' fferfR / - 7" at si. 7,431, z _e ma 9's7 j cde i - 4," at 7' __ / N A, z s. TO Y —; „ -‘e^2 i o 3 'It‘ /�At / ;j q j7 y /0 y. die 2 .94. ?.17 y -ter /o 4, _n a i , � 2 sr � a .z ” z , - 3dn = IeLvo" - /s �,.r / S- m''`om,