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Home My WebLink About02333 1 - rr„ V M GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 2 3 3 3 { 109 flth Street Suite 303 Assessor's Parcel No. i Glenwood Springs, Colorado 81601 Phone (303) 945-8212 L This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. I PROPERTY t. g t Leonard & Mindy Langston 323 Park Ln, Basalt 927 -9424 Owner's Name resent Address Phone_ , 6500 Highway 82, Glenwood Springs I System Location i t Legal Description of Assessor's Parcel No. SYSTEM DESIGN P • n a Septic Tank Capacity (gallon) Other ti / n (n /0 ''"Percolation Rate (minutes/inch) \ . ^ Number of Bedrooms (or other) 3 Required Absorption Area -See Aitaoped u l r , y I I / c / n ' x / 1 ¥ J i ;.., t ;- �; F i) Date Special Setback Requirements: Inspector F f t 1 L4.*.� C.n^. ri \ Q_ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation r System Installer -BOt. eF $/' 1 Septic Tank Capacity - 5 6 (� 4 /� D o /'� i E I. Septic Tank Manufacturer or Trade Name 4/ -9 >�4.- C - 44‘ti -C.-4 P - - , 4 - ! r i Septic Tank Access within 8" of surface L• , e r I / ■ Absorption Area - A ' —...i 444 9r 1 Absorption Area Type and /or Manufacturer or Trade Name 1 -�'- i 7/ 0 a jr Adequate compliance with County and State regulations /requirements L- .--- - 1 Other `J � ._ 4 Date 7''7' 7 '7 Inspector &L �. 1 �' RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: i i 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 office shall automatically be a violation or a It 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 ($500.00 fine — 6 months in )ail or both). i 4 Applicant: Green Copy Department: Pink Copy Application INT JAI. SEWAGE DTSPOSAI. SYSTEM APPT.ICATION Approval By County Official OWNER I fir.1 217 1 awl( j of 6 0 0 ADDRESS32.3 pa "' u-. Z1 1 l ,C (l 810-0 I PHONE'Z1-'474 / S° 'ONTRACTOR tatseE ADDRESS PHONE ERMIT REQUEST FOR: (0<lew Installation ( ) Alteration ( ) Repair .ltach separate sheets or report showing entire area with respect to surrounding areas, topography of area, abitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes ee page 4). .00ATION OF PROPOSED FACILITY : County a £L.O tear what City or Town tL...hi./CDO 0 gt -aC•' Lot Size 2 .egal Description tit-- 1 / T g / a SG1 VJ VASTES TYPE • ((Dwelling () Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes (:) Other - Describe tUILDING OR SERVICE TYPE: lumber of bedrooms 3 pumber of persons 3 ) Garbage grinder 46 Automatic Washer (f Dishwasher ;OT IRO? AND TYPE OF WATER ST IPPT,Y; (well () spring () stream or creek dive depth of all wells within 180 feet of system: 'O er) CT I supplied by community water, give name of supplier: - AN- 1R01 IND CONDITIONS; )epth to bedrock: )epth to first Ground Water Table: t R 5 CI" 'ercent ground slope: )ISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: rt 0 4 t Vas an effort made to connect to community system? t.-LB I'YPEQF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (Vf 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 ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond (Vc Other - Describe: DILL -( ► WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? NI-0 . PERCOT.ATION TEST RESi11TS: (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 alsification or mi representation may result in the denial of the application or revocation of any permit g, nted based upon aid application and in legal action for perjury as provided by law. 1 o 1 Signed Date 8 0 T ' g b c PI .EASE DRAW AN ACCT IRATE MAP TO YOI JR PROPERTY \ \ Dc 6,50° tAwi 82 82 FQp i-4 tN`C g 23 3 3 cranr 6sod Hai s z y'j.st, = f/ 11 2 /0 41-1.4;%t ,�� S z /,z0