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Home My WebLink About02444 my r..,.. .. . � ,................_- ....4...�,.. +ev r+w.. ,, ....:.+....... -n v r ..- ... RR�� f GARFIELD COUNTY BUILDING AND SANITATIOt�I'OEPAI9TMENT Permli : N' { 2 4 4 4 I 109 treat' Suite 303 — `' K.. Assessors earcel No. Glenwood Springs, Colorado 81801 i Phone (303) 945 -8212 • \ `.,. \ + ,� I : This does not constitdte INDIVIDUAL SEWAGE DISPOSAL PERMIT . :' \- a building or use permit. PROPERTY .) ` ` ,� -- 4, _ i. CA O \ - .w. .. Owner's Name Dieter 8 Kath Cantru a resent Address 0745 ' Heather Lane, G.S phone_ 963 -9528 i t ,. 1, l; \ - 1 c System Location 0745 Heather LaxLLl &tr't�sUUleit y r " 6, Glenw is Springs e i Legal Description of Assessor's Parcel No. `. SYSTEM DESIGN 76'6 Septic Tank Capacity (gallon) `) ` Other, iM , t +i + f 41,4y,6Vt'colation Rate (minutes /inch) Number of Bedrooms (or other) 7 Poacii LeerU4 ePoL St&J9'd t Required Absorption Area - See Attached jt, t4 Tor / L7 /�r1 >a,�e J y fe_ , 4 F 414 +3 /c J /f-FusEes //f'Rs if Special Setback Requirements: I /� `✓ i Date to • l • Lf r � c" Inspector c - ca. Pa ' ,_j! mar.u.� .� .F t. F SYSTEM INSPECTION AND APPROVAL (as installed) l//! I Call for Inspection (24 hours notice) Before Covering Installation p S System Installer 6 EC $t Septic Tank Capacity /6O(( t Septic Tank Manufacturer or Trade Name i _ nn C A Septic Tank Access within 8" of surface It i t l Absorption Area LI r L ii� r t -f Absorption Area Type and /or Mandfacturer or Trade Name / / 7 /! , f= n. /iii 4 z / +( .1 if t Adequate compliance with County and State regulations/requirements (,-'/ -- , S j d Other ` t N M k Date )n 'I> ./ c/S Inspector t , j � hdi? v 7L).✓ _ 1 RETAIN WITH RECEIPT RECORDS AT COI STRUCTION SITE t *CONDITIONS: i r 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- t. f nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a y: . , requirement of the permit and cause for both legal action and revocation of the permit. I . 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material 7,:i i i variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 ); ,f months in jail or both). I x Applicant: Green Copy Department: Pink Copy 5 ii IND1VIDI JAI, SEWAGE. DISPOSAL, SYSTEM APPIJCATTON 4 so, OWNER c k c - cu.. k- r ADDRESS D 57 C. (A C4- C .I( G PHONE 963- rt'Sz$ CONTRACTOR Ow")b 2._ C onitRnt 1t.R , . C (\AsT ADDRESS 5;4,4 q, 3 v ho t — PHONE PERMIT REQUEST FOR QQ. 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 PROPOSE FACILI Y: COUNTY t ' 4 r �«\ A Near what City or Town G1c.n.Joo S A J Lot (o Legal Description Ckrisl l),cco c „ L WASTES TYPE: 44 Dwelling ( ) Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: CIA y Number of bedrooms: 2- Number of persons 2 ( ) Garbage Grinder (K Automatic Washer Dishwasher SOURCE AND TYPE OF WATER S1 JPPI,Y: () WELL () SPRING () STREAM OR CREEK Give depth of all wells within 180 feet of system: I If supplied by communtiy water, give name of supplier: C (n r t ytc ic 14 cw s Sub GROI JND CONDITIONS: Depth to bedrock: VAk✓inwnJ Depth to first Ground Water Table: 00 know 1 Percent Ground Slope: .' ° DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: UNv h o (-did Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 4Q, 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: IOQ 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? ND : PERCOLATION TEST R ESI II.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 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 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 tnie 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 la . 1( K E) Signed Date /Mr PLEASE DRAW AN ACCUR ATE M a '• • t t • , I t G oa ,y„ 41.e ravel +41 wItere \ +kr rave l road en.k aIt Ids MzO aset,+ A Al 1 tie ar +1.e k(li. l# i. aR' 40 Iti.e ltd rbrrleokryg }lse rand. c„bihlrsb ,46e t 4'•d ».o Ies frath Pip - 7 -- Ake a. rcgl^tr 04 tL e 4t 3 y ?, R KM i - d i) fin+ T in ne Rea butte A er -a+ / W F 014e $ 3vice Site a L0C✓V ;f 1046r Foy. et-it e `' F S'y ti t1 1. 0 4- 0 pr' „m s S to ss Tina a- I 2.) et_ _ aa6 a Qs - aon >. � 4" — S '' 2 46 : 5 /3,3 4 , ` 8 / s 4 61) = r 9- g, z l " /xi 9 mia 35z? epe K ' /Life"? a eta, ,7/4 - F/E rreit'rn2 r es rr 07144 a rD -d),r t) E--. 4 Pi's.