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Home My WebLink About02253 a a. r GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit n- 2 2 5 3 (i 109 8th Street Suite 303 Assessor's Parcel No. 4 Glenwood Springs, Colorado 81801 Phone (303) 945-8212 This does not constitute 1 1 INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. r PROPERTY r Robert M. Dobbs 165 Navajo, New Castle 9RA - 2W k Owner's Name Present Address Phone_ System Location 0165 Navajo, New Castle. Legal Description of Assessor's Parcel No. 4 SYSTEM DESIGN 1 Septic Tank Capacity (gallon) (' Other "? r L ) J t Bedrooms (or other 4 i (r `� O O.,..' �/ 7 r 1 ' Percolation Rate (minutes /inin c Number of Be t i' i n 1 �10 f .x ,` f ' }., / S. rw. `( ..1 i :. - Ji f , Required Absorption Area - See A$teohed r , ij / - Special Setback Requirements: ti, 'r .. L" �' - / - ! _. --r �� Date /. / .. J, rap en d ' "... t FINAL SYSTEM INSPECTION AND APPROV, Sre r / ' C ,rz o t!�J Tf!'� 1 Call for Inspection (24 hours notice) Before ( / �OOVT r � (� rf,S - .94 Gi1�J System Installer / btt�ttS V `Q) fi Septic Tank Capacity /j ( 0 tJ / / rw efts Septic Tank Manufacturer or Trade Name I ( pi/pp/770 Septic Tank Access within 8" ourtece•k gat L y C'��^i SVa Absorption Area / /'` n pp ,fd �°,C 4 /' /7 Wits Rd Absorption Area Type and /or Manufacture' 1 i l Adequate compliance with County and State regulations /requirements "" " . Other t Sri ^ 9 `J / Inspector CX f ( t (I .P/1 C& Date 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 4 . 1 25, Article 10 C.R.S. 1973, Revised 1984. 2. This permit is valid only for connection to structures which havefully complied with County zoning and building requirements. Con- , j nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a r 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), Petty Offense (5500.00 fine —S & months in jail or both). ', i . (. Applicant: Green Copy Department: Pink Copy tit a. . I GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N.- 2 2 5 3 ( 109 8th Street Suite 303 Assessor's Parcel No. Jr Glenwood Springs, Colorado 81601 4. Phone (303) 945 -8212 This does not constitute �'. INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. k PROPERTY Robert M. Dobbs 165 Navajo, New Castle 984 -•24AR ) Owner's Name Present Address Phone_ System location 0165 Navajo, New Castle a Legal Description of Assessor's Parcel No. �1 SYSTEM DESIGN f' til / � Septic Tank Capacity (gallon) ��,,// Other l . q !- I 1 olation Rate (minutes /inch) Number of Bedrooms (or other) 1 f /f. ti Perc I / , � f --ti l � � r o cam& 't .f C.cre +L r. s / Cr 1 . .' _f i{ ,. !i , Required Absorption Area - See Attached r ( Special Setback Requirements: w , P , �' t * '" t. r" C r 7 k y / t Date /_ _. ._ l �.F Inspector i i... ( ' .d. I .4' ,., ��II 4 FINAL. SYSTEM INSPECTION AND APPROVAL (as installed) Cali for Inspection (24 hours notice) Before Covering Installation l System Installer �" ,A- e Septic Tank Capacity / (t 0 0 , i ' Septic Tank Manufacturer or Trade Name ` .f!ge' - ,- 1 Septic Tank Access within 8" of surface {--- `` f �" b; Absorption Area Absorption Area Type and/or Manufacturer or Trade Name tT " "!) '"� -.1 r r I h Adequate compliance with County and State regulations /requirements f-" t . r Other '. Date . , / () - 91/ Inspector �.. {.tt-. -t-4 _ -' RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE f; *CONDITIONS: i 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter 4 25, Article 10 C.R.S. 1973, Revised 1984. c 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 ($500.00 fine —8 ) `` months in jail or both). 1. Applicant: Green Copy Department: Pink Copy Application JNDIVIDTJAL SEWAGE DISPOSAT. SYSTEM APPI.ICATION Approval By County Official OWNER He et- rn t3evehLyr p066S ADDRESS /L C Na VA J Alta) Cr O • PHONE' . ' CONTRACTOR ADDRESS PHONE PERMIT REQUEST FOR: () New Installation pQ 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). r J.00ATION OF PROPOSED FACILITY : County G *F /,' 1 Near what City or Town Re w Cs cat C - Lot Size 6' Y 1(0 Legal Description 1 n7 8' f{Loc,G( ELI? CI-ec /( Ott., L-n p /H<.v'T WASTES TYPE • Kt Dwelling () Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: /10 a S' e Number of bedrooms 3 Number of persons 2 Garbage grinder Qs) Automatic Washer QQ Dishwasher ,COI IRCF. AND TYPE OF WATER ST JPPT X; () well () spring ( stream or creek Give depth of all wells within 180 feet of system: /U ON e If supplied by community water, give name of supplier: New Ck s L`L. / o uv ,v (ROT JND CONDITIONS; Depth to bedrock: D ee f Depth to fast Ground Water Table: D eep Percent ground slope: 3% DISTANCE TO NEAREST COMMUNITY SEWER SYSTEML. 1 Von T L c S Was an effort made to connect to community system? N 0 t TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 14 Septic Tank ( ) Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use ( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use ( ) Chemical Toilet ( ) Other - Describe: F, INAL DISPOSAL BY: * `6' 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 ? /V 0 • • SOIL. PERCOLATION TEST RF.SII1,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 revocation of any permit granted based upon said application and in legal action for perjury as provided by law. Date Signed PLEASE DRAW AN ACCT IRATE MAP TO YOi JR PROPERTY v I v I h I � a I C� I 1 Zp'r ,p, PLOT PT ,AN AND DESIGN PRATT JRF,S 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. • -4 _ I DV To w 4Te. Lime_ •41 ore /3104 0 L i( 0 b T is 6 Q1 s p r 9't/ 10" /Off 7 8" q :2( 9y /° 41 7 qtly -9 ,11 7 g 4 c. S i 3 4 6.33 4 1 A .2 2 ""` y• .2 11 n. : .+ !R MUFF • r !14 a \ Oil Sr N� Y ' `° 4 r e. A LLm • t 1 4 ' Va,‘ • - 0.1 • ' " A �r r aleri, „ ' -4 . ^ - t • ,,tr. "rtice5.• . ‘ • rio V, ' r. Iii‘cir o \ • . . • pie 1 � _ �' • 3 ±• • It r V. '� X \ 1 '� w ift ' ' ti .J