HomeMy WebLinkAbout02482 1
m - • H
4 t. t.
141 . 7 f
GARFIELD COUNTY BUILDING AIQpp^^ 1 -
D SANITATION DEPARTMENT Permit �- 2'� 8 'i
109 8th Street Suite 303 Assessor's Parcel No.
t
Glenwood Springs, Colorado 81601
it
Phone (303) 945-8212
# 4,.w This does not constitute i,r
INDIVIDUAL SEWAGE DISPOSAL PERMIT `' - a building or use permit. 'i.
PROPERTY
John Martin -''- - 1002 Bennett, Glenwood 945 -7056
Owner's Name Present Address Phone_ '{
3495 County Road_14, Silt
System Location _ f
Legal Description of Assessor's Parcel No. - t o
& Qe I. (4604 a 46
SYSTEM DESIGN -( /✓ F rc WeN7"CNC $ t 7g .-;:/ YC.
7 ci
42 1V Septic Tank Capacity (gall fr ✓ �r� J Other A Re ..a
3 t v ' '
1- _9n *241 )Percolation Rate (minutes/inch) Number of Bedrooms (or other) ,'4
J.
Required Absorption Area - See Attached
W
Special Setback Requirements: Se
Datefi " aiZ 'r-rS Inspector -4 /s'77.tyrl•..
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) f
Call for Inspection (24 hours notice) Before Covering Installation
T tp"
System Installer_ r7O/ /N "'frerN`' 5
. tr.,
Septic Tank Capacity JZSO �
Septic Tank Manufacturer or Trade Name _ .FLAI)1O Li 4 /tAe re ii
Septic Tank Access within 8" of surface y.6
1
Absorption Area O` ftQ'ti5 /5 74.,42045 36 %Yf/M - 4 YC, i'd95. ,e°rU ir'Cr7C',',, T:>
id
Absorption Area Type and /or Manufacturer or Trade Name I/✓F /L ?X,9r c <
Y
Adequate compliance with County and State regulations /requirements Ye e
II
Other ''OR ... 4,,, f
7
Date s 9S Inspector r)/tE 1/4.TAr,x243c :y,/
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
•CONDITIONS: R''..
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter g r
25, Article 10 C.R.S. 1973, Revised 1984. I' y ..
mr
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con -,i ;g
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a Violation or ` i t
requirement of the permit and cause for both legal action and revocation of the permit. J r
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 A
months in jail or.both).
Applicant: Green Copy Department: Pink Copy
------- - - - - -- i_� 4
INDIYIDUALSEWAGILI2 _ISPOSALSYSTI:M AP_P_LICATION
OWNER Z CLN 1Y)ru
ADDRESS to gat* pa v PI IONE _ C )4< t 7n5(,,
CONTRACTOR 0.
ADDRESS ,C,, PHONE
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).
LOCA17ON_OII PROPOSED FACII { ITY: COUNTY •
Near what City or Town �/ LC Lol
Legal Description 3 CL- (ZA • Z I°(- c�L * -
WASTESTY.1E: X Dwelling ( ) Transient Use
( ) Commercial or Industrial ( ) Non - domestic Wastes
( ) Other - Describe
IIUILDING OR SERVICE TYPE:
Number of bedrooms: Number of persons .
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
SOURCILAN1? TYPE DILWATEll_SUPP_LY_: () WELL () SPRING () STREAM OR CREEK
Give depth of all wells within 180 feet of system: '
If supplied by communliy water, give name of supplier: RE 2 1\ owa —
GRQUNI) CQNDITIONS:
Depth to bedrock:
Depth to first Ground Water Table:
Percent GrOlind Slope:
DISTANCE TO N EAR EST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to community system?
TYPE 01? INDIVIDIJAI. SEWAGE DISPOSAL SYSTEM PROPOSED:
pQ Septic "Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
O Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
( ) Chemical Toilet ( ) Other - Describe:
FINAL DISPOSAL BY:
Absorption Trench, lied or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OFT'III STATE? WO
•
•
PERCOLATION LESTRPSULTS: (To be completed by Registered Professional Engineer)
Minutes per inch in hole No. I Minutes
Minutes per inch in Hole No. 3
per inch in hole No. 2 Minutes
per inch in Hole No. —
Name, address and telephone of RPIi who made soil absorption tests:
Name, address and telephone of It PE 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 he 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 Ib, 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 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 app ' •ation r revocation of any permit granted based upon said application and in legal
on for perju a provid• • by law. /
Signed p
Date 0S -Z3 -95
PLEASlid2R • ' ' MAPT2You1 '_RQPl lCLY
•
•
C O
—111 -- O r + + +N t • 1
' IlL ca
® p
il ---• _ .
I .
I
): e e ® +
G + P 3 .
1 iii o+
r II Vi l S 2110
es vi ono
/ A r
1 a) Main
ij
4 1 + E- HC(E -F)
e. ...... .� ..... .......
cm
E- H(9 -F) �,
a ro"
W sik
N :.
A > ±0: j i 1
N \ @ 0 ; fe rn
' 181- 072- .0 -195 // —
r %
P N
..
n
x
0 0 0 0
p P P
S r91eY / bz S Ct/t 00S" cle
- _3 el -crap .4-e ` 6e)
Tx
IPSD !mule