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Home My WebLink About02330 ".^ .^ f i"frw .,yry w.crfr'. i '' a _.1"T rin'T'' , — rvmn. ;i,v "'VI."' ., ... ..,- . ,.. • 1 1' i III -e V - n • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit IV' 23 3 0, 109 8th Street Suite 303 Assessor's Parcel No. 6 4 Glenwood Springs, Colorado 81801 , .. y Phone (303) 945 -8212 y r; g This does not constitute # G' INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. i $ PROPERTY 1 1 Cary 6 Sherri Thurstin P.O. Box 76, New Castle, CO 984 -2474 Owner's Name Present Address - Phone_ y County Road 250, Lampiris Exemption, Silt ° System Location Legal Description of Assessor's Parcel No. y SYSTEM DESIGN 1` 6 4 "� 0 /1t) ` ! Septic Tank Capacity (gallon) Other r.: " t -�- Percolation Rate (minutes /inch) Number of Bed.00ms (or other) 3 'yY f $ x Required Absorption Area - See Attacttad 1 . j ! ( ! l; .9r i i r -1 6 P i Special Setback Requirements: 1 it? / r;,. _1 1 I - . - ' ik Date e i l - 4 - 7., . Inspector ) 2' }1.2 i • (4.r r <• %Y & FINAL SYSTEM INSPECTION AND APPROVAL (as installed) f Call for Inspection (24 hours notice) Before Covering Installation System Installer. Septic Tank Capacity /006 j l c Septic Tank Manufacturer or Trade Name CQ / 7.c& v Septic Tank Access within 8" of surface �C S t e Absorption Area sn7 0 i Absorption Area Type and /or Manufacturer or Trade Name 91 L /ii f /t-71 4 Xt' S 1 Adequate compliance with County and State regulations /requirements , � )ES t Other 1 1 i Date 9 - 1 t 91.- Inspector i v. Qy, /�/i o.rr .�. 7 RETAIN WITH RECEIPT RECORDS AT CCONSYRUCTION SITE •CONDITIONS: i i 1. All installation must comply with all requirements of tha Colorado State Board of Health Individual Sewage Disposal Systems Chapter 'A p rt 25, Article 10 C.R.S. 1973, Revised 1984. f 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- f 3 nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a cc:-0 f requirement of the permit and cause for both legal action and revocation of the permit. f { 3. Any person who constructs, alters, or Installs an individual sewage disposal system in a manner which involves a knowing and material i 4 variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 k months in )ail or both). 1 ' Applicant: Green Copy Department: Pink Copy ) e . Application INDIVII)T JAI, SEWAGE DISPOSAL. SYSTEM APPI .ICATION Approval By County Official OWNER Gnu-1.1 - n-r, 4 c.� c.4 -i i 1(') Thule - 4 - n ADDRESS 20, 1!.a W 7l o , k ".� 1JC0e CO PHONE - :ONTRACTOR FCIG Cin A9 - C A Ccn ttrt- - -C±f'm ADDRESS � • <=.2.2:3 C i co PHONE D` - 'ERMIT REQUEST FOR: New Installation ( ) Alteration ( ) Repair &ttach separate sheets or report showing entire area with respect to surrounding areas, topography of area, iabitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PROPOSED FAC:JJ,ITY : County ra--P Li Near what City or Town ci t 1 t Lot Size )0 Pa � Legal Description '+ 1 - 'c C - 1 (CZGhe1 WASTES TYPE : \j) Dwelling () Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes () Other - Describe BUILDING OR SERVICE TYPE: IP Pi m 1,4 GIe rC —t; Number of bedrooms 5 Number of persons ( ) Garbage grinder V) Automatic Washer 4 Dishwasher SOT JRCE AND TYPE OF WATER Si JPPJ,Y: "4 well () spring () stream or creek Give depth of all wells within 180 feet of system: h (A If supplied by community water, give name of supplier: n 10- ( INJ) 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? 00 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: " 1 (J) 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 AV) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? rig EXHIBIT A • A TRACT OF LAND SITUATE IN LOT 4, SECTION 30, TOWNSHIP 5 SOUTH, RANGE 91 WEST OF THE 6TH PRINCIPAL MERIDIAN BEING PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT A POINT WHENCE THE WEST 1/4 CORNER OF SAID SECTION 30 BEARS N 00 DEGREES 22'26" W 1893.96 FEET; THENCE N 90 DEGREES 00'00" E 746.77 FEET; THENCE S 04 DEGREES 47'43" E 719.78 FEET; THENCE N 89 DEGREES 59'12" W 452.26 FEET; THENCE N 00 DEGREES 22'26" W 373.38 FEET; THENCE N 89 DEGREES 59'12 W 350.00 FEET; THENCE N 00 DEGREES 22.26" W 343.71 FEET ALONG THE WEST LINE OF SAID SECTION 30 TO THE POINT OF BEGINNING. COUNTY OF GARFIELD STATE OF COLORADO ALSO KNOWN AS LOT 3 LAMPIRIS EXEMPTION ACCORDING TO THE PLAT THEREOF RECORDED JUNE 21, 1994 AS RECEPTION NO. 464833. ___ Lgt( D ip- i on f lJ c >IL_ PERCOT.ATION TF.ST RESI1TTS: (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. _ ame, address and telephone of RPE who made soil absorption tests; ame, 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 pe • a ed . ed upon said application and in legal action for perjury as provided by law. /��/ // � Date / _ 7 / g ./ 4j PLEASE DRAW AN JR ATF. MAP TO YOT JR ' R� Goitof 4-- . 1 t4 \-J Pck • MOT PLAN Akin DESICGN FRATI JRFS 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. -nom- p--ceed (cca Orm (� � of i4aci- sd , 9.7514 AG-ce 9SS iac«+, 250 mot ecpl -+G -I-an L. - c o 2o' -PrCrin cy2J -013 j barn Iccc-h-Gcid ctC4-cckLj wee -I-. 1 O Oft. w E S