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Home My WebLink About02433 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit L. • 2 4 3 109 8th Street Suite 303 A is Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute INDIVIDUAL, SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Ve].1a Toor Present Address 1 .. 1.(»: ' "li..lf , Jd J l . e Phone ' System Location Cottnt:y f:oati 701, Parachute Legal Description of Assessor's Parcel No. SYSTEM DESIGN Septic Tank Capacity (gallon) Other Area Attached (minutes/inch) (or other) Required _ + ( ) Number of Bedrooms 1,1 a J ! I �.� i l ,, t t' Special Setback Requirements: < ��_ r') �a �!� „ '' IC ,.. J i ; , , .r , .. Date i / , Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer —U 'M e 4 a'rJ Septic Tank Capacity ) /DDU Septic Tank Manufacturer or Trade Name _ts jLiIA.d Septic Tank Access within 8” of surface 4SR.5 Absorption Area 4 64 Absorption Area Type and /or Manufacturer or Trade Name (94 4 NC ilZ'd5 l 4- Adequate compliance with County and State regulations/requirements 96-0 Other Date 6 icy Inspector 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. 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 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 1, Petty Offense ($500.00 fine -`� months in Jall or both). /) Applicant: Green Copy Department: Pink Copy -4 1- - 'It • INDIYJfUAL SEWAGB DISPOSAL. SYSTEM APPLICATION Aso OWNER v r Li // //11)()A ADDRESS/0 A3au ln'i'/ 4'/ /7/ cc- r''l6 PHONE / 6 -9`/1 CONTRACTOR ,f/k'W%,ie ADDRESS PHONE /- 30.7 -6 2 r- 9V y PERMIT REQUEST FOR 04 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). LOCATJON_OILPJ3OPOSEI? EACILIT_Y: COUNTY /4 /S(r/ (- Near what City or Town PAK4CHU T/L Lot /F. fSCtC m aJ I.egal Description 3 5 7 5 , 22s/ &J WASTESTYPE: cy4 Dwelling ( ) Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: mo,'cc t,# Al erne Number of bedrooms: 3 Number of persons 2 ( ) Garbage Grinder (I Automatic Washer ( ) Dishwasher SOURCILAND TYPE OF ATEI?_-SUPELY.: (?Q WELL () SPRING () STREAM OR CREEK Give depth of all wells within IRO feet of system: /1/e /vi rf /i t Tr h�� 1 f supplied by communtiy water, give name of supplier: /v/.4 GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent Ground Slope: 2 To 31/4 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 1/ nni't Was an effort made to connect to community system? /VD TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 00 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: 09, Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCIIARGED DIRECTLY INTO WATERS OF THE STATE? NO r- ., i PERCQLAT14N_T_ESTItLSULTS: (co be completed by Registered Professional Engineer) c 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 he 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. 1 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. / / Is A-' Date Signed _ P_i.EASI3DRAW ANA IIRATE1vIAP_Tn'101;R PRni'ERTY :T • ea LG/Sou✓ —T-.9 /c /T To /l ✓ <iC to NY[!av G�Zd PA[�ACNUrg ,. < ..r-/•0 Ta ,ell 1J-0,v merr "ea N s ix / 7 L rFr(sewn° l✓--f—i folLO re YC 1 ?e1 5' f 1 ir pAVC Aj ON 3 09 ,Po/ PAV.0 i .41111111 Tot' e /" X / [ - rtv , ✓ H,tL S. /1 "tom- 7 70 �p /� ( 4._ fon CA/ 30/ gal a tee Cs' cHO/Ye r 04n sit 4,47:1- cfl g en re TO TL ref' fl F //LL, N /L4 Ve bTJ,C 1 'rrN,[Cfl AC yea rot a wi/c SLE .�� A Tw jrpy 404 on R[G7/Y A�'O Tiro • inert Alive uA /" cgmert.P o N' G,err Nowt 0 OR i v 6 WA)' „ 'Y PRl v7WAy ... c • PLOT PI ANiND DESIGN PEATI 1615 Include by measured distance location of wells, springs, potable water supply Iines,•cisterns, buildings, property lines, subsoil drains, lake, watercourse, 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. 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