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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit ni . 2 4 9 9 i ,.;
109 8th Street Suite 303 Assessor's Parcel No. t I
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
This does not constitute • ,,,
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. t
PROPERTY f
Robert 3, Memel 2503 Cigar Ct., C.6. 928.8759
Owner's Name Present Address ma Phone_ S. ,
System Location 0235 Odin Drive. Silt
i,
Legal Description of Assessor's Parcel No. $ i
541 41 / K'a"d.A f /rl cit l r:%.'u /I C0 >o 4 / 9,441510. p9,441510. ei.4rtc ?4 (,f• -, SYSTEM DESIGN NA %4 1 ` A ' 4t � A1 hr`s r ' l .4 rr t
,s 6 »), ff ✓S5K5 R a. „ 4 -, 'e I ,
ket,m 1 Septic Tank Capacity (gallon) Other )
/ " it 9.,,, i Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 i
Required Absorption Area - See Attached gym,
Special Setback Requirements: •
Date J2 • S •`yr Inspector hit. W..�- > »a" . _ - y ;.�4,,. f
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ( ) i. c
Call for Inspection (24 hours notice) Before Covering Installation t 1
`
System Installer_ x 1
x
Septic Tank Capacity /SS 0 fr'.
(
r
Septic Tank Manufacturer or Trade Name !'•94 4 j
i i i
Septic Tank Access within 8" of surface t/ 5
i
Absorption Area // /
� y
Absorption Area Type and /or Manufacturer or Trade Name 4 67`• 1 ,ter: i / /7A1rn E.' f i( l N
Adequate compliance with County and State regulations /requirements Y C S f
a
Other lj
/� J )' i
Date J - /j( . `/.i Inspector Pict 0 . �: °ve,,,. J /4 d..a , Al.�. - F ' .
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE k
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•CONDITIONS: #
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter 6 1
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 I, Petty Offense ($500.00 fine —6 ( )
months in jail or both). e"
Applicant: Green Copy Department: Pink Copy
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IND_IYIDUALSE >'AGF 1)ISPDSAI, S_Y_ST_EIYLA.PPLICATTON
OWNER 2 oR c n 7 T , ui, A /LrI
ADDRESS 2 50 - s c# 544 Cctitr z D P11ONE(7 92 -6-759
CONTRACTOR L, b, ern Ar-
_
ADDRESS A/ezweA -ate; Got PHONE (970) ?elf - 2 7/7
PER REQUEST FOR (X) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area,
habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes
(See page 4).
LOCATION__OF PROPOSED_TACILITY: COUNTY c 7>
Near what City or Town S,LT Lot CO (0111 511.7 t1 S,A
I .egal Description A- /11 9 b D,V,E,e&
WASTIiSTY1'G: (x) Dwelling ( ) Transient Use
( ) Commercial or Industrial ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: s/A./6 r r=� Ens - Re s,nF w,ria 5 a woAKS. c/
Number of bedrooms: 3 Number of persons r
( X) Garbage Grinder (x ) Automatic Washer (x) Dishwasher
SOUItCI:_AND TYP_ROLtVATER_SUPP_LY: (X) WELL () SPRING () STREAM OR CREEK
Give depth or all wells within 180 feet of system: No For- -r
If supplied by communtiy water, give name of supplier: A/h
GROUNI1QONDITIONS:
Depth to bedrock: nen r TeA A/ i/o peer ' sec wet a Pe-F,+. 5 r �+ r t
Depth to first Ground Water Table: _ (. / Fee - WArC/- Ma D , ter JV[Y
I ?9c n r - .rfp P cn,.nrr.
Percent Ground Slope: F,✓ Fa Tirr w,�tcN ALSO SSt
I 2a T -'tt£ am vs nPY r •
DISTANCE TO NEAR EST COMM UNIFY SEWER SYSTEM: IVA 62vcnt. A n.e,$)
Was an effort made to connect to com niunily system? A ( nvn.n.a m.n_a)
TYPE OF INI)IVIDUAI. SEWAGE DISPOSAI. SYS'T'EM PROPOSED:
(y) 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, Red or Pit ( ) Evapotranspiration
(X) Underground Dispersal ( ) Sand Filler
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCI IARGED DIItNCI'LY INTO WATERS OF THE STATE? A/o
4 .
PLOT PLAI±AN fin ESIGNTEATLJI? liS
'Include by measured distance location of wells, springs, potable water supply lines, 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.
Sea ski et_ o Y trr, / k PC/1W- S
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