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Home My WebLink About02292 fi f i • 4 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit I 2 2 9 Z t 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 tr Phone (303) 945-8212 k This does not constitute 4 INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Cheryl Fischer } Owner's Name Barbara Chesney Present Address 511 CR 216 Rifle Phone_ 625'.9531 4 t System Location Highway 6 6 24 Parachute Legal Description of Assessor's Parcel No. SYSTEM DESIGN • 1 :11 ) Septic Tank Capacity (gallon) Other '4 ' s Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 / r : i / 0 4'1 F` ' r ? 4.) ''r p ( / r -'k 1 , / ' / • , Required Absorption Area - See Atteohed ' C 7 _ / , , 4 Special Setback Requirements: �, // � a -F �xr ,.. C+' ' �.r i , I / ' d - � ,.- 1 ' 7 .1. 4 t i Date /�" / . '" r� // Inspector - ) r ; 1. , f .,.. � . . < i /) n A' ) FINAL SYSTEM INSPECTION AND APPROVAL (as installed) k Call for Inspection (24 hours notice) Before Covering Installation t System Installer_ ! ' 14' •/ r ". i , Septic Tank Capacity / 2 ` t r Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface 1 1 1 Absorption Area / '' i` Absorption Area Type and /or Manufacturer or Trade Name J I i'< - . d / , Adequate compliance with County and State regulations /requirements Y/ Other 1.. / ' j i Date J C) 4 Inspector .. • rte ^.q (/ /' yi( a'::.. RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE ii •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. L ii 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 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). !1 1 Applicant: Green Copy Department: Pink Copy ? r• Application JNDIVIDT TAT. SEWAGE DISPOSAT. SYSTEM APPT.ICATION Approval By County Official OWNER i ' r.: : ,L. At r %1i .i 4 .4 - L/ ,,� ADDRESS A / .' Co PHONE <._+ • 1 /5 - 0. CONTRACTOR S4t41, ADDRESS PHONE PERMIT REQUEST FOR: 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 PROPOSED CIT .TTY : County (O-a-•^ 6 (£(60 J � Near what City or Town a it -VF Lot Size Legal Description Sj a `41-5 WASTES TYPE • 04, Dwelling () Transient Use () ommercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms 3 Number of persons 1 ( ) Garbage grinder ( ) Automatic Washer pe) Dishwasher SOTJRCE AND TYPE OF WATER STJPPT.Y; ,Q well () spring () stream or creek Give depth of all wells within 180 feet of system: fir If supplied by community water, give name of supplier: /444 C:ROI JND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SY ) 4 Was an effort made to connect to community system? IV 0 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: V( 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: ( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration (k Underground Dispersal 4€01-41 rile ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 10 D i • SOIT, PRRCOT.ATION TEST RESEJTTS. (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. p Date (t k / - 9i Signed ( � g pr RASE DRAW AN ACCTJRATE MAP TO YOTJR PROPER . '1 4 , GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit ti= 3 5 6 0 r ' ♦ ) ( . 109 8th Street Suite z 303 Glenwood nwood Springs, Colorado 81801 Assessor's Parcel No. �� Phone (303) 945 -8212 This does not constitute • INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY 1' M 7ktti I) Phonetl7C'- �8 -LJ Owner's Nem�� U!• SL A V 71F) IZ�jAI� Present Address � (1 �� fn System LocationSN (n 0 tk-4 1,71-2.( 1 0AI ponut: en Legal Description of Assessor's Parcel No. SYSTEM DESIGN la $0 Septic Tank Capacity (gallon) Other 3 Percolation Rate (minutes /inch) Number of Bedrooms (or other) 4 �� f3E'o CI ST.A (rkt(- s)F-l. Lt4 c 1F t Required Absorption Area - See Attached 'air O C E„}GH C Vhz� - vJI 6E1:5 f " B C? b El CJyC 4� O'K S 3(g VC, 690 cE.A -C H cfi} lid TQn)C. ill S 37 Special Setback Requirements: cm, / Date 9- - O f Inspector I i - - - - - FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation �7 ` System Installer 6- ,4-f•N Ak< xr ,4-J 14-77e Septic Tank Capacity 17 So tX i C y/c Septic Tank Manufacturer or Trade Name C-,/,Ft e..• 4'7J 't> Septic Tank Access within 8" of surface Y& 5 -- {�. •., . r! `� Absorption Area ri .- - . . Absorption Area Type and /or Manufacturer or Trade Name Adequate compliance with County and State regulations /requirements / �./ I S i Other t ? ' t- / l Date ! U 2 - O I Inspector L ` _if ,e "r��iJ ' 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 off Ice shall automatically be a violation or a requirement of the permit and cause for both legal action and revocation of the permit. 3. variation fr from constructs, or installs an Individual contained in the application cat disposal n of permit is a Class I, Petty Offense ($500.001ine -8 months in jail or both). While - APPLICANT Yellow - DEPARTMENT