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HomeMy WebLinkAbout02389 aarrr - : rR ' ra ^ fist:'A:: . t.'r ;+tF N VIe ' ra r Wiry . ,, . 4 r, ,Y ,. �. ... .. .. - �jj • il t . f GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N: 238 9 i 109 8th Street Suite 303 Assessor's Parcel No. P Glenwood Springs, Colorado 81601 tt, Phone (303) 945 -8212 4 This does not constitute i i INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. 5 PROPERTY r ' owner's Name Kichard Schwabe Present Address 0511 331 Rd. Silt Phone_ 876 -2745 R N System Location SSA b ZS 0 , 3 ' 2- C R 3 _3 I i f Legal Description of Assessor's Parcel No. Sec. 10 T. 6. S., R. 92W. V SYSTEM DESIGN t, 0 ,n lam' Septic Tank Capacity (gallon) Other k J 'i " 11/ n„ ;. Percolation Rate (minutes /inch) Number of Bedrooms (or other) ? t, It 7 Required Absorption Area - See Attached / (J 7 I � r ? ofx? Fi b Special Setback Requirements: y (' 1, a Ji - Alt) - `) .r. a i ''i r >' - ' f r " Date 3 - / - 9 , Inspector r A'>. C ` 2 ° ^' FINAL SYSTEM INSPECTION AND APPROVAL (as installed) I Call for Inspection (24 hours notice) Beige Covering Installation System Installer 0i )NF Septic Tank Capacity //) /5A py y Septic Tank Manufacturer or Trade Name w 5 ae ,T t t , Septic Tank Access within 8" of surface L' 65' Absorption Area W.VT a - 2 Absorption Area Type and /or Manufacturer or Trade Name -w T � • d /p - Li rrt ass yC 1 Adequate compliance with County and State regulations/requirements i0 F 4 P `Other Date 4 - C`- 95 Inspector f ` -4i( L-0 "tiUi i RETAIN WITH RECEIPT RECORDS AT CONSTRUCT! N SITE . 1 *CONDITIONS: , 5 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter i C 25, Article 10 C.R.S. 1973, Revised 1984, 4 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 e y 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 materiel variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 - a months in jail or both). Y Applicant: Green Copy Department: Pink Copy � ,, INDIIVIDTJAT. SEWAGE DISPOSAL. SYSTEM APPT.ICATION OWNER t iciintJ \ CiF/ w "meo c— ADDRESS 0D1/ ,e) 33 PHONE X gtT CONTRACTOR ©Lu 4' J - ADDRESS .S ' 79-r) L= 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 FA IT,ITY: COUNTY 6 to - Near what City or Town S'/ C--t Lot * t Legal Description c fC -. /0 77 C . .S . / R, 9 z to WASTES TYPE.: nicwelling ( ) Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: 1914 Can 7 ,x cr f' Number of bedrooms: 3 Number of persons 3 ( ) Garbage Grinder ( ) Automatic W er ( ) Dishwasher $OI JRCE AND TYPE OF WATER ST JPPI.Y: WELL O SPRING () STREAM OR CREEK Give depth of all wells within 180 feet of system: ‘d If supplied by communtiy water, give name of supplier: TROT JND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: 335 ' T • p Percent Ground Slope: / DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: / /h / Was an effort made to connect to community system? TYPE OF,WIDIVIDUAL 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: FINAL DISPOSAL BY: (4 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? PD � • pERCOT .ATION TEST REST TT. 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 appliction 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 inusre compliance with rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements make, 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 bre relied on by the local department of health in evluating the same fro 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. Signed Date pT ,E,ASE, DRAW AN ACCI IRATE MAP TO YO1TR PROPERTY { X 51(A 3: v keriaz Flo ( 2a24 X k Z 33 (pi 1- r N - 0 o 0 � -1 -"I r 1 ! so ' Tiftf i ( i4 0- u - si C o y.i fi p) 1 i 12 2O � , — 3 3s� /3.33 , 5' g � H- I 7 far / << ; ) 9