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Home My WebLink About02513 rr ,, 44 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2513 r 109 8th Street Suite 303 Assessor's rcel No. Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Thane & Betsy Lincicome P Box 115, Edwards 926 -1953 Owner's Name Pre Add ress Phone System Location 0098 Glenwood Avenue, Shtank, Carbondale Legal Description of Assessor's Parcel No. t g 1 4.--eAmar fl (/ R,xz) SYSTEM DESIGN 3q4 S N/r. 39L ?, J /Frets fos 04 -d l )n74 Septic Tank Capacity (gallon) Other J /7f //1j Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 // Required Absorption Area - See Attached Special Setback Requirements: Date 1/ " 5 '9S Inspector erl/ tree'n4ren, A� FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer i : bw/ILg Septic Tank Capacity /h„50 Septic Tank Manufacturer or Trade Name et - Septic Tank Access within 8" of surface 7l Absorption Area .3 7L3 tr Absorption Area Type and /or Manufacturer or Trade Name .5 Ws SG -Tait T/' -"P Adequate compliance with County and State regulations/requirements Other 1 st 0191p719L °F 4 x 09.4 unifier= r074 c'o7 Ti, Fit 04/rdzs Date J/- /5 9s Inspector ' .G01-d2s RETAIN WITH RECEIPT RECORDS AT CONS RUCTION SITE +CONbITIONS: 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 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). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER /hair p ///tI �4 hAricome ADDRESS Pe rdx /15 re/t/4/f, (CP 2 PHONE 990 9,76 /9.53 CONTRACTOR Larry-. ADDRESS, 9 PHONE PERMIT 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 FACILITY COUNTY ra^ield Near what City or Town car/Aw l Ja le. Size of L t _ Legal Description or Address /J 09g 6 /e.t//a- + -,- a' £ ^lino! �� /a / a�� c . WASTES TYPE: ()() DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms 3 Number of Persons 2 ( ) Garbage Grinder (x) Automatic Washer (X) Dishwasher SOURCE AND TYPE OF WATER SUPPI Y• ( ) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: / / If supplied by Community Water, give name of supplier (1 , o/ ( %on 4,4 //a Jq /nJ i/n/e/ GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table Percent Ground Slope, DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? ( ) YES (K) 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: ( ) ABSORPTION TRENCH, 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? /✓o 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 ofRPE who made soil absorption tests: Name, address and telephone of RPE responsible for design of the system: Ajiplicant 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 niles 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. I 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. • �`�— Date 7 0/5//9 03- 6 J Cf� Signed / PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 U 6" - 3 k of y- a7 4_4- „l ./- moo = � 41 :t 7 zt / f' = 3 z ,-2 / 1,1 ::--a // 1 if / u 1/ Ill L v • 6_, ,y1, K6 �' /64'zzrf - 1 2, ez D - C N.6 y 3. H- 4t3'etdea J ef 3'7 ( ix, irk_ 277-4 re) R5 a a ,r uii q 4 (. _-- 1 v Cit 0 � y'i�1 / vU l - C a l l y c. l n i- r vE7 w U It t o [s v i9�`� GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 513 109 81h Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 th is does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permitl PROPERTY Thane & Betsy l.incicome P.O. Box 115 Edwards 926 -1 • Owner's Name — _____ _____ Present Address _ —_. ___..______..- ..__._ _- ____.___ Phone_ . ......__ —.__. System Location_ 0098 Glenwood Avenue, Satank, Carbondale Legal Description of Assessor's Parcel No. _ 4.* Rtn.-K R Lei-Pew 2 art (tJO a,/%Wiv t .724 - 751) SYSTEM DESIGN 37L � .t 1`/oY/ q?R tr-4 � 7b � �o ‘')/ Fr- vslhbx an a'4 _x,2,$iO.___ Septic Tank Capacity (gallon) Other • rte_ II OW Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 _ - ...... Required Absorption Area - See Attached Special Setback Requirements: • Dale _/ (' 3 - ' F �_ __._._.._._. _______ Inspector _ 14z7 'y ��n_C -/ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) "''''�� ,��, d Call for Inspection (24 hours notice) Before Covering Installation System I n s t a l l e r Septic Tank Capacity_ Septic Tank Manufacturer or Trade Name _ Septic Tank Access within 8" of surface Absorption Area _ ___ Absorption Area Type and /or Manufacturer or Trade Name Adequate compliance with County and State regulations /requirements Other Dale_— — _- _— ___ —__— _ Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: 1. All installation must comply with all requirements of the Colorado State Board el 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 - neelion 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 arid revocation of the pormit. 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves n knowing and materiel variation from the terms or specifications contained In the application of permit commits a Class 1, Potty Olfensn ($500.00 fine -- 6 months in jail or both). While - APPLICANT Yellow - DEPAftIMENT