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Home My WebLink About02426 `. y.....,...,.�; r NI a tA�11 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit IV _ 2 4 2 6 #j 109 8th Street Suite 303 Assessor's Parcel No Sh Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 • This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY 66 i Owner's Name Robert Burry present Address 9175 Highway 82 C'dale Phone_ 963 -2630 Y System Location 9175 Highway 82, Carbondale Legal Description of Assessor's Parcel No. SYSTEM DESIGN Septic Tank Capacity (gallon) Other . 1 Percolation Rate (minutes /inch) Number of Bedrooms (or other) 1 i t' Required Absorption Area - See Attached f'" U Special Setback Requirements: I Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) 11 Call for Inspection (24 hours notice) Before Covering Installation l 1 System Installer_ /1 Mai 44,14.4C7-1- t Septic Tank Capacity 2000 J " Septic Tank Manufacturer or Trade Name Al C:( R so - "v.Q. 2,- C.. Septic Tank Access within 6" of surface Qi' 5 , ` 1 ?610 K 1 Absorption Area 0 e is Absorption Area Type and /or Manufacturer or Trade Name /C K {` / F, ve A./ ` ;'c r `` ei / it, ii Adequate compliance with County and State regulations /requirements Q(S +l c Other +'i Date t/ ::;'.6 - 4 /6 Inspector _ 4041 4, dif ki. "% `i�yi.%a+r is,.e„■ RETAIN WITH RECEIPT RECORDS AT CONSTRUCT' o N SITE Ili *CONDITIONS: 1 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter r 1 25, Article 10 C.R.S. 1973, Revised 1984. YY 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- E nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a 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 w variation from the terms or specifications contained in the application of permit commits a Class 1, Petty Offense ($500.00 fine — 6 q months in jail or both). ` o- Applicant: Green Copy Department: Pink Copy ,,,'' FEB 06 '95 11:17 GARFIELD COUNTY P.1 Sy eovvrti f�UG, rs1 gets_ D, l INDIVIQIIAL$RWAGF. DISPOSAL SYSTEM APPLICATION OWNER . —. Nogg 9q5-36,06. ADDRESS .a 'i ' '.a. : 1 PHONE CONTRACTOR in 4 AI c...Al& r ' , ADDRESS PHONE PERMIT REQUEST FOR NEW INSTALLATION () ALTERATION () REPAIR Attach separate sheets or repot 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 pa 4). CATION DE PROPOSEn FAcwrry: COUNTY r A,epiEl. o Near what City or Town Col sv,ri ty4 G i Lot Legal Description SEE '1:SR9- ") t t e WATTRS TYPF,: 6welling () Transient Use () Commercial or Industrial () Non-domestic Wastes () Other - Describe BUILDING OR SERVICE TYPE: l A+'.ti'+ 1 Number of bedrooms: / Number of persons ( ) Garbage Grinder ( ) Automatic her ( ) Dishwasher souRatAND TYPE ()R WATER SUPPLY: LL () SPRING () STREAM OR CREEK Give depth of all wells within 180 feet of system: -4:1 LcS' If supplied by community water, give name of supplier: Ay A- fiRO1IND CONDITIONS Depth to bedrocdc• 2 P5 F Depth to first Ground Water Tab Percent Ground Slope: Z DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: > MILE 5 Was an effort made to connect to community system? IV 0 f TYPE 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 Toile. ( ) Other - Describe: FINAL DISPOSAL BY: ( ) Absorption Trench, Bed or Pit () Evapotranspiration () Underground Dispersal )4 Sand Filter () Above Ground Dispersal () Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 4/0 •FER 06 '95 11:17 GARFIELD COUNTY P.2 PERCOLATION TEST RRSI II .TS: (To be completed by Registered Professional Engineer) Minutes por 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: SVEE 'tom titiConJ 1 OA Name, address and telephone of RPE responsible for design of the system: % eC " jsn 1 '1/4. Applicant acknowledges that ihecompleteness ofthe 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 2S, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements make, information and reports submitted herewith and requited 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 an designed to bat relied on by the local department of health in evluating the same fat purposes of issuing the permit applied for herein. 1 further understand that any falsification or misrepresentation may result in t i 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 //2/fir pLEASP DRAW AN A ( T1RATE MAP To rAUR PROPERTY