HomeMy WebLinkAbout02503 ,;-'*!S^.girn' *. !'"F3r . *r' r27,',,
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2503
109 8th Street Suite 303 Asse$sor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 9454212 "'.',(\ j
- U "� � I l'his does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Thomas R. a s 1 2Q.�1�, Battlement''.Pkwy„\,P chuee 285 -1434
Owner's Name Cray z'> 'present Address' - Phone '
County Ro$ 309, Par4chute
System Location ,
Legal Description of Assessor's Parcel No.
livs69 . & ? 9C �4
SYSTEM DESIGN ,S 0 'j J /ur/ rgn ra 2 g l ace
.5[f2 Ito- /3/FF &JZ' 41,4ifv l
oop Septic Tank Capacity (gallon) Other
ercolation Rate (minutes/inch) Number of Bedrooms (or other) 3
Required Absorption Area - See Attached
Special Setback Requirements:
Date / h – /e?'" 9S Inspector 1,2,4-uL
FINAL SYSTEM INSPECTION AND APPROVAL (as Installed)
Call for Inspection (24 hours notice) Befo4ring Installation
System Installer !f
Septic Tank Capacity 1420 ////
Septic Tank Manufacturer or Trade Name ate/ YXSt- •
Septic Tank Access within 8" of surface vs
11
Absorption Area 3 4
✓ I4
/ .¢sorption Area Type and /or Manufacturer or Trade Name 84-2 c
Adequate compliance with County and State regulations/requirements T
Other
Date 11 - Inspector 4a.2,
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
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-
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automaticamy 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 (5500.00 fine — 8
months in Jail or both).
White - APPLICANT Yellow - DEPARTMENT
l
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER no 44c ,
ADDRESS /' r.. ra P ONE - : —
CONTRACTOR
ADDRESS 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).
LOCATION OF PROPOSED FACILITY: COUNTY______ .r7e
Near what City or Town !/Z'P Size of Lot .3 4" 7 4
Legal Description or Address
WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:
Number of Bedrooms Number of Persons
( ) Garbage Grinder (Pr Automatic Washer (()'Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (nj) WELL ( ) SPRING ( ) STREAM OR CREEK
Give depth of all wells within 180 feet of system:
If supplied by Community Water, give name of supplier
GROUND CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table
Percent (hound Slope_
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to community system? ( ) YES ( ) NO
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
X 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:
a >4 ABSORPTION TRENCII, 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? No
2
PERCOLATION TEST RESULTS: (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 of the application 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 insure compliance with rules and regulations
adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements
made, 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 be relied on by the
local de of health in evaluating the same for 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 attn.., , a-.--- Date °Zvyy r
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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