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Home My WebLink About02280 b. GARFIELD COUNTY BUILDIN AND SANITATION DEPARTMENT Permit Pi— 2 2 8 0 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 ° r f. f This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. I PROPERTY 7 : Thomas & Marilyn Hays P.O. Box 717, Carbondale 963 -2592 Owner's Name Present Address Phone_ 4 r ' '. System Location 0593 Wooden Deer Road, Lot 10, Carbondale 1111 ' Legal Description of Assessor's Parcel No. . 1 SYSTEM DESIGN / ," /! 7 V / « / 1 Septic Tank Capacity / 1 n / "iri7 P ly (rlon) ,,,I. 07) <,r' ' - _ ' ( cr'A' b / H „ f � r r � . -' ,.c /n"` Percolation Rate (minutes /inch) Ntimbe"'ot Bedroome -(or other) f r h i 7 / N T 0 Ca " (1 r yr / r- � re, ..4t. 'r 0, f" . /,/ 4 / O J n 4 .- I Required Absorption Area - See Attaohed 2' ?..i l-1 ' J• n, 1' 71i. r./-!) ,✓ [7v' ,J / f, t_v -t_P- , E r : C Special Setback Requirements: n Date l — e c/- </ " Inspector � 1 JIwI CA'lL f � fi b FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for, Inspebtion (24 hours notice) Before Covering Installation C ( r 0 System Installer • _ _ , r / a _ - 1 1 T 7 r 9'.. - Septic Tank Capacity / 0 9 S d / P n 4. - , A Septic Tank Manufacturer or Trade Name ,7i. v 1 - ' /✓ c ` 2 .< Y..1 ,) t Septic Tank Access within 8" of surfaced 5 l t Absorption Area 'hi ;h y U ) Absorption Area Type and /or Manufacturer or Trade Name e s A 7 /'" ,,r7/727.-6,66-AL... K: }l p • Adequate compliance with Cpu6ty and St ate regulationslregUirements 'y 's a 1 i , Other Date / / - ii - CAI- Inspector _lc.. rr- -+ 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 d 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- !• nett ion to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a F 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 —6 months in jail or both). pr Applicant: Green Copy Department: Pink Copy {;, y, Application jNl)IVIDT IAI. SEWAGE DISPOSAL, SYSTEM APPT.ICATION Approval By County Official OWNER - Thorvas O. 41 mAan-i A- NAys ADDRESS P.o sad( - 1 n GA2csontOFN E , (O 816 3 PHONE963 is G CONTRACTOR SA''' e ADDRESS PHONE PERMIT REQUEST FOR: (9 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). J.00ATION OF PROPOSE") FACILITY : County CP.stet Ln Near what City or Town 6 Lot Size 3.7 t ACtZES Legal Description Lt.Z' tD kloofln..) Dees - S acnvtslot.) WASTES TYPE • (9 Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: 51N'te 9Aa'\t.1 ikwosce Number of bedrooms 4 Number of persons 5 (x) Garbage grinder (4 Automatic Washer (9 Dishwasher ,SOT JRCF. AND TYPE OF WATER SI JPPT,Y: (k) well O spring () stream or creek Give depth of all wells within 180 feet of system: 14 /A L. . ' e . v `r1 61sTe"' If supplied by community water, give name of supplier: k DEree SC&bW tS10tJ GROI INJ) CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: klocoet.3 feet. ¶, tav — ros e e SE c e jet Was an effort made to connect to community system? of WT TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (x) 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: (9 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? 110 • SOIL PERCOLATION TEST RESI JI.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 S 12 9 Signe. wa PLEASE DRAW AN ACCI IRATE MAP TO YOUR PROPERTY Lo7 \ 10 • ■ W00004 Da it\ °Mg 103 12or o }1w1 i 1 5 � � U 6 6 ' .23/4 �� i,� 2 r 3 0 8 aar.�av ROAD Awes el San top OS M fMwPap 7W u a w • 1 1 ' I 1 LOT 1 a. IOW AW or "" Pate/- LOT 3 LOT 4 LI Oa LYE ae. v: .M. w.f- - 1 N 14 I il e I f�«1�Y1�-- SS y LOT r awe r. /- � �� (— �`� ei► v. ,. �' ," " �L � z = • �_�s. • , LOT 5 i z 1 SAN 41‘ Y. {fit 1 ,1 ` s 1 i ! tt l 8� r ri r y + �i \ 1 er sitr� % z . z .._^ .` "3 ` -- \ 1 • LOT 8 LOT 7 '�� " i LOT 9 ua r. / - � . t. s7 a.H- i �` • 4.$111 u.../- i Cis \� ( ' 00, 1 ' LOT 6 M �v • SIN ta '~ LOT 10 88Y • ua 1 1a. /- t71IAa / n Q , • ` T \ � ` I o a e % �. r VS LOT 11 N ...i • 3 ' i' k i • LOT 18 / A _ " M Own *WW 7 R W rase ^ t " "" per, 'Set • >( LOT 14 = . s. -.... r 1 ca ar Mat _ -' o e z . a - ^. .\ Cbcfrn in truwus XY/A(f 5ERR GORDON MEYER /Na � � e;� - r "'"" „ PATE Wooden Deer Subdivis :TS?r: "' MOWN .cxR aac aotlo o (�w) .se -sns