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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit IVe 2 4 3 7
109 8th Street Suite 303 ' Assessor's Parcel No. 1‘.1
Glenwood Glenwood Springs, Colorado 81801 I F Phone (303) 945-8212 4'
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This does not constitute •
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. ++
PROPERTY
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Owner's Name Robert Stowe Present Address f1w9 6 b 24. O.S. Phone_
945 -8426 r .
System Location Highway 6 6 24 Riverview Subdivision, Lot 3, Glenwood Springs f
Legal Description of Assessor's Parcel No. I
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SYSTEM DESIGN r n �. r r"
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Septic Tank Capacity (gallon) Other ;
/,,t, r ' r Percolation Rate (minutes /inch) Number of Bedrooms (or other) . ? � g { R
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Required Absorption Area - See Attached r 6
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Special Setback Requirements: I' (,. / C � j, ( [ f ,,. ;, - Q it
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Date 01 . " 1i //( ` / / /. _ Inspector ` _. - Y:: }'s'� � , t,: �tir7 Cn ^..
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FINAL SYSTEM INSPECTION AND APPROVAL (as installed) e
Call for Inspection (24 hours notice) Before Covering Installation I
System InstallerLc l / 'a c -'
Septic Tank Capacity rn 0
Septic Tank Manufacturer or Trade Name ) '1 d 'i
Septic Tank Access within 8" of surface /...----- t i,
Absorption Area t•:• . • la • ...� ./ s.. .,, . . r t ri f
Absorption Area Type and /or Manufacturer or Trade Name e — I - 5i r, I `t` r A r0 1^ ( '
Adequate compliance with County and State regulations /requirements R )
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Other L :,
Date 4 ✓ 73 Inspector .c4 2 1 t tl co- ' "'
t RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE ` .
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•CONDITIONS:
1. All installation must comply with all requirements of fhb Colorado State Board of Health Individual Sewage Disposal Systems Chapter
26' 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-
nectiontoorusewithanydwellingorstructuresnotapprovedbytheBuildingandZoningofficeshallautomaticallybeaviolationora r,
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 specltications contained In the application of permit commits a Class I, Petty Offense ($500.00 fine — 8
months in jail or both).
Applicant: Green Copy Department: Pink Copy .
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IND_IYIDUAI.SEWAGE _LISP_OSAL.SYSIENLAPPI,TCATION
OWNER ) _ _ �
ADDRESS - . . 00 _) ('HONE _ I S'
CONTRACTOR Cal .,
ADDRESS PI - TONE
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).
LOCATION _OF_PROPfSEI? CILITY: COUNTY G ,.
Near what City or Town (i k)/)0Z 7c4 P'Lot .3 `B j'<-
1.cgal Description _ j ti f p. 1f t (U7 .r ( 43 nl ✓t S /o
WASTES -I%PE: ( Dwelling ( ) Transient Use
( ) Commercial or Industrial ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE:
Number of bedrooms: � j Number of persons
( ) Garbage Grinder (4 Automatic Washer e ) Dishwasher
SOURCEAND T\fl()I_WATEI?`SUP_P_LY: ( pH () SPRING () STREAM OR CREEK
Give depth of all wells within I80 feet of system: 1'
If supplied by community water, give name of suppl er: Er cif 2
GROUND CONDITIONS:
Depth to bedrock: f
Depth to first Ground WaterTahle: '
Percent Ground Slope: /'2' t pJ
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to comm system? PO
TYPE OF INDIVIDUAL. SEWAGE DISPOSAL SYSTEM PROPOSED:
()0 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 iL ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe: 1�
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE ? /Av1
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• L'I:RCOLATIOWT :STILESULTS: (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 telep lone of RPE who mad soil absorption tests: r-n :Pair
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-, ,?)C2 -G• 14-1
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C -t-t-i p_eI r" 1 610 -(c z—
Name, address and telephone of RPE responsible for design of the system: C y/1 - 7444 - ./
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 evinating 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.
Signed � UQ „..) not t y 4 Date ) 4_-2-p 3
PLEAS 1i.P_RAYLAI*ACCLRATE MAP TO YOLRIRORERTY
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