HomeMy WebLinkAbout02370 'R•_R �...: -.�, F; rvTRim...ir/a+�4"AF'�F'�,P'�"RRwSW,. m�V....- .-.r.. .,. - rv.c" -.
N. 1
♦
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit I V . 2 3 7 0 ?
109 8th Street Suite 303 Assessor's Parcel No.
5
Glenwood Springs, Colorado 81801
Phone (303) 945 -8212
i
e 1+,
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Clifford & Debra Brainard SO Sage Dr., El Jebel 963 -3137 fi
Owner's Name Present Address Phone_
System Location oS I6 East Vista Drive, Antlers Orchard, Tract 32, Silt ''-
S . 9 i"I t, 5 r f'3 c / / • .,,Z: / ; , i ,,
Legal Description of Assessor's Parcel No.
1.
Olt Hsi% i
SYSTEM DESIGN 1, ° 9
C /
4- fr0,{ r; , 1 Septic Tank Capacity (gallon) ( Other '' ` , Vi ' ,
". ' a t ' � '
A
+.+ t i, L+ v .' r ' /1 ercolation Rate (minutes /inch) Number of Bedrooms (or other) 5 (1? ( c t
/Y7 7 ` 4 /luck- b 2 eA.' c h Ccei —/7'4 Ye'Y; "
Required Absorption Area - See Attached f r
gga i N t rO A t ai, n /s 7 ) ' d f
Special Setback Requirements: e,,,,) /_) 1 51115 E r? - , '-e ft - r — v.,../_ �- J
Date it ^ /// - / y Inspector 4 \ ! 1 4 c...::4$ i r n 4 -/
I.
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ;
Call for Inspection (24 hours notice) Before Covering Installation
/� '
System Installer (, l,(.u-M.v.J F, g .
' (9
Septic Tank Capacity / 9 '/1 r M
,1
Septic Tank Manufacturer or Trade Name 1^� �-i 1.- "y.
- s A
a rrtt
Septic Tank Access within 8" of surface L- ': (
Absorption Area i / U / ;j - ' 'I /R4c ,// ' c r-{ f
1 / / 1
i L
Absorption Area Type and /or Manufacturer or Trade Name ! H (Jr 'R 4- -' / r ,- 1
Adequate < li ce County aqd State erati 4 qui ,, I jt i -4 l'l qtr t
q � comp lance F, - YC�a { y ' cif . / �g f C! y - f y °
Other ) /7 / () ik
Date / L — ' 7-- ! 1/ Inspector ) 9 i ( 1 ) tom.7 niti,o ) 1
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. i
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- .1
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a t 1
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
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).
Applicant: Green Copy Department: Pink Copy
'.
•
Application
INDIVIDI JAI , SEWAGE DISPOSAL. SYSTEM APPLICATION Approval By
County Official
OWNER , . •rrti a. at 'n.a
ADDRESS So 811 - (-,F T r F t — 3 e. bel PHONE 51,o .3 r
DNTRACTOR /4Gh / rI&dt ry l 7 i urn tii
' ADDRESS s L o a N . R 141 S f Ca c bon r•I a_Of PHONEY - - SS
3RMIT REQUEST FOR: Of New Installation ( ) Alteration ( ) Repair
ttach separate sheets or report showing entire area with respect to surrounding areas, topography of area,
tbitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes
:ee page 4). /�
OCATIOWOF PROPOSED FACILITY : County T�RR ri
'ear what City or Town c '1 j# • Lot Size _ 6Mei? r
egal Description Ac.T 36( .Tn .Sex' to . ,3, Tawnh6k 4, sod /
Rfriwit.. '7 wFs7 — rat 7Xe dia- P As ,o " . � ' pin»e,ts frcha,cr�
` Dev ` l ` Transient Use � '�tS Cn-.c�eJej Co •
TASTES TYPE : Dwelling ( )
( ) Commercial or Institutional ( ) Non - domestic Wastes
(:) Other - Describe
•UILDING OR SERVICE TYPE: No t) s F. he d
lumber of bedrooms S Number of persons H
) Garbage grinder t Automatic Washer C) Dishwasher
OI JRCE AND TYPE OF WATER SI JPPJ.Y: t) well () spring () stream or creek
;ive depth of all wells within 180 feet of system: �4PpRoxnfaJ .(b' C 4. 1 t
f supplied by community water, give name of supplier:
iROUINI) CONDITIONS:
)epth to bedrock: l to Kr)nton
)epth to first Ground Water Table:
'ercent ground slope:
)ISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: on nnnn
Vas an effort made to connect to community system? IJ o
'YPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(),¢ Septic Tank ( ) Aeration Plant ( ) Vault
( ) • Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
( ) Chemical Toilet ( ) Other - Describe:
?INAL DISPOSAL BY:
O Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal O Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) • Other - Describe:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?
it!
PERCOLATION TEST Ri?Sl1I.TS: (To be completed by Registered Professional Engineer)
Minutes per inch in hole No. 1 Minutes per inch in Bole No. 3
Minutes per inch in hole No. 2 Minutes per inch in '-tole No.
um, address and telephone of RPE who made soil absorption tests;
tme, address and telephone of RPI3 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 { . /' .. J. - Signed /y/177
pi .P.ASR DRAW AN ACCURATE MAP TO YOUR PROPERTY
•
•
• i
i
in ,OT PI AN AND DESIGN FP,ATtHRES
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.
c CQ 11--
1 ,14 1
4
� S 9
o r��w art
__/
i
0- c erny
7 - V
uwSE <- 8 .7
e -
N N Paail
t
il „
�h . ` 5
a� �o � �q-Si.MEtG
I1'
I I
0.
v
\ r u t
C
4 t `
5 ;Lit
Fi•! It ttaRtricer �3.5`'
1
1-4 ,t
16
1---t
3 b��2
eilTH (------ . ‘11 : 643
I t V
2 I 0
a 6 51 ii
s 7,.sgA- 30
iD I y ,,
7•2&' 4,1) g Z S
® 8'
a 1" v -
// Ny, 3a, - / , on, ,2
re-A pi A, A /yn .