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Home My WebLink About02504 ° . - t': - » drasre riornitr2",1 0 "gi A:.'k:;i '"N1: i.,'7/WI`f. t _ ' I � . , ' , , ' . I I ... y 1.: 1U 1 A GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2504 109 Sth Street Suite ;03 — ng Messaged' Perco! No. Glenwood Springs, okloradp'0?891 Phone (303) 94-8212 .^.<,. _ Z. i t This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a a building or use permit. s c PROPERTY (L -- ', - �'` . r� Owner's Name Dennis Delsas Present Addrea's "'0277 Glet Eagle CitCi R1: 984 -0341 System Location_ 0085 Seneca, Mineota Estates, Silt Legal Description of Assessor's Parcel No. 13o941 Roc Rocx 4 teAtsf kW, aaq 4am8r 6w. ea 11 S0 SYSTEM DESIGN 9 a /NF /!- r Zt>d2 , re) *4 9'44 9'44 4,6 D, FFasSac 3'0 E nc Septic Tank Capacity (gallon) Other / w /AI 562y2,,U Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached Special Setback Requirements: • Date /6' )q'9s Inspector / p4.-vg.91 I FINAL SYSTEM INSPECTION 'AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer /V/ /C Art , ' Septic Tank Cepacity /a...5 - - , t Septic Tank Manufacturer or Trade Name ` tl Septic Tank Access within 8" of surface 5 , Absorption Area 991 ,s ,2 o / ' P /.t//✓L°? 43, 3e- i7>14 .vi . .', 5 Absorption Area Type and /or Manufacturer or Trade Name l'Aoi r . Adequate compliance th County and State regulations/requirements� Other n/l a - r Date / % 3 t /f`' r Inspector `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 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 coQstructs, alters. ortns,talls an Individual sewage disposal system In a manner which involves a knowing and material variation from the terms or specification's contained In the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 months in (all or both). White - APPLICANT Yellow ‘• , DEPARTMENT- INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER Azisc 4 .5 ADDRESSA A 1 77 6 /etv ;/� C rr,/-e PHONE 9(71/-0 3 f/ CONTRACTOR C d m e ADDRESS PRONE PERMIT REQUEST FOR (>0 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 h (See page 4). LOCATION OF PROPOSED FACILITY: COUNTY G-cc r /i iiI Near what City or "Town 57/ Size of Lot /6 &.c - LLega Description or Address • s 1 6' , • eat._ An WASTES TYPE: OO DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Moo'u /a - r Number of Bedrooms 3 Number of Persons 3 (k) Garbage Grinder ( ) Automatic Washer (k) Dishwasher SOURCE AND TYPE OE WATER SUPPLY (1/4) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: If supplied by Community Water, give name of supplier M //v P a /a ES tout,. $ GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table Percent Ground Slope -P/a.1 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /(O Was an effort made to connect to community system? ( ) YES (.S NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (,) 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, BED OR PIT ( ) EVAPOTRANSPIRATION (y) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? Al 0 2 WI a ELATION 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 trade 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 department of health in evaluating the same for purposes of issuing the permit applied for herein. 1 fiuther 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. Date % //. S PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! I \ / W oThi to 3 new .77 2 SS- 9r ?S` Soma 6 ft 3 !1 a g g g �8 + 2 =5 = mss /, /N 3- OO2 //t) (p}0 4 c s w Cm 5 Ilk re tot- - -- — MImETA - De. ....- -_ -.