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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit i `.. Z 4 7 8
109 8th Street Suite 303 Assessor's Parcel 3.,
Glenwood Springs, Colorado 81801
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. Phone (303) 945 -8212 f t
This does not constitute c
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
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PROPERTY n
Owner's Name L.B. Montover Present Address 1914 CR 311, New Castle Phone_ NU- 876 -2633 f
System Location ___B
0 0 County Road 313, New Castle
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Legal Descr of Assessor's Parcel No.
SYSTEM DESIGN
,!'' Gad;
P J U Septic Tank Capacity (gallon) Other e
4 2 i s
µ/ Percolation Rate (minutes /inch) ,,.,,pNuumb Bedrooms (orr other) $� a
Required Absorption Area - See Attached Y� r"' •oh ea, �Vr _ 0 ,, "
Special Setback Requirements: '
Date 4 --A Per Inspecto '/L.< <' I , - /c' / . - ` J t
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FINAL SYSTEM INSPECTION AND APPROVAL (as installed) $(
Call for Inspection (24 hours notice) Before Covering Installation Li
System Installer_ r (d) /( /P F
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Septic Tank Capacity I � � 0 1 f � qyy
Septic Tank Manufacturer or Trade Name ( /E7 /V I t ,
Septic Tank Access within 8" of surface p•-•-•-- ) ,
Absorption Area Ze 4/4_8 / - Z a, - / 4 7 �, !CieC - ' - y lief ✓e& !Y
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Absorption Area Type and /or Manufacturer or Trade Name 4/ /" / 4.. / : e t / 7t. iK.
Adequate compliance with County and State regulations /requirements YA 5 . A
Other 4110V d
Date -- " - /C!/ Inspector /t!GPi (-- .44, ✓ /i. __-__ r
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RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE ti
*CONDITIONS: !;
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter M 4
25, Article 10 C.R.S. 1973, Revised 1984. w
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con - ,
nett ion to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a r
requirement of the permit and cause for both legal action and revocation of the permit. li
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 I, Petty Offense ($500.00 fine -6 ( V
months in jail or both). 'f i
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Applicant: Green Copy Department: Pink Copy '
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INI)IVII)UAI. SI:WA(;liI)ISPO )SAL- SYSTFMAI'.I'_LICATIQN P 1
OWNl It �, . /`�o,dTve_R --- - - - - --
ADDREss ___ 3//
L�J� / - - -- -- PIIONI ?_ P76 -633
CONTR. A CIO R. _- Dwiuc
ADDRESS - — -- - --
PER MIT 14 IiQI 11iS'I' FOR --- ___- - -__ -- __.- _----- - - - -- PI IONE
(✓j NEW INS'1'AI.I.ATION ( ) ALTERATION ( ) REPAIR
A llach separate sheets or report showing entire area with respect In surrounding areas, topography of area,
habitable building, location of potable wailer wells, soil percolation lest holes, soil profiles in test holes
(Sec page 'I).
LOCAT ION nl? I'Rnl'(?SIiD 1 TACIl.I'1'Y: COIJN'I'1' _ -G 4g - b
Neal what 444 nr . _
Lcgal Dc in Lot - —
WASTES TYPE: (1 1 hvOling ( ) Transient Use
( ) ('nnunc or Industrial
( ) Non dmneslic Wastes
( ) Ol leer - Describe
- --
BUILDING OR SERVICE TYPE:
inihcr' or bedrooms: Number of persons_ — — —
( ) Gat huge Grinder - _ - - --
( ) Automatic Washer ( ) Dishwasher
SDI JIR(Ii ANI) 1 YPI: OLWA'I'PR SUPPLY: ( ) WELL
Give depth or all wells within IN Feet orsystem:
4-4 ( STREAM OR CREEK
Ifsupplied hycmumnatiy water, give name nf supplier: —
fi,R0IINI) CONDITIONS: — —
Depth In bedrock:
Depth In first Ground Water Table: - .
Percent Ground Slope:
DISTANCE'10 NEAREST ( 'OMMIJNI'I'1' SEWER SYSTEM:
Was an effort Horde to c onnect to community u --
TYPIiOJ INDIVIDIJA1.Sf WAGE DISPOSAI�SYS'I'13fv1 PROPOSE!):
( Septic Tank ( ) Aeration Pinut
( ) Vault Priv O Vault
( ) Cnrnposting'I'oilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration Toilet
( ) Chemical Toilet ( ) Other - Describe: ( Recycling, other use
E l NAI. I)ISPOSA I. IIY:
( ) Absorption Trench, lied or Pit
(✓) underground Dispersal () Evapotranspiration
irolion
( Above Ground Dispersal ( ) Sand biller
( Olhrr - Describe:
( Wastewater Pond
WI1.1. Isl'1 IIE DISCI IARGI ?D D1104 -11.Y INTO WATERS OF TI Its STATE?
N. 11 I1. I{COI. A ON T EST itES1'L 1 S: (fo be completed by ltegistered Professional Engineer)
NI Mutes - - - -_- per inch in hole No.
Minutes Minules per inch in Hole No. 3
Per inch in hole No. 2
Minules per inch in Hole No.
Naive, address and telephone of I21'1'. who made soil absorption Icsls:
Na me, address and Iclephone of It PI? responsible for design of (he system:
Applicant acknowledges Ilia( Ihecompleteness of' heappliclion isconditional upon such further mandatory
and additional tests and repo Isasmayberequiredby( Irelocalhealthdepartmenttobemadeandfurnished
by the applicant or by the meal health department lint purposes oldie. evaluation of (he application; and the
issuance oldie Permit is suhjcci In such terms and conditions as deemed necessary to inusrecompliance with
rides and regulations minified under Article 10, 'rifle 25, C.R.S. 1973, as amendecl. The undersigned hereby
certifies Ilia( all slit leincnls make, infornnIlion and reports subminled herewith and required to be submitted
by I lie applicant are or will be rePresenled to he (rue and correct to fire best of my knowledge and beliefand
arc designed to bre. relied on by (lie local dcpartnicnl of hurllh in evlualing (he same fro purposes of issuing
he perniil applied for herein. 1 Mather understand That any falsification or misrepresentation may result in
1Iic denial of the althea ion or revocation of any permit grained based upon said application and in legal
all ion lint Perjury as Provided by law.
Signccl
PLEASE 1)Itnw AN ACCURATE ,.. -� --
I RA T li MAI I f �_YnI11 {.I'12QPfil2TY.
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