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Home My WebLink About02534 7 ; . stapflefflitt ,MP S' Wili:°.SM, irAn:.sr;p .. .,t �.. y ... 7 ., 4Ali 4 . • { GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2534 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL. PERMIT 8 building or use permit. PROPERTY Owner's Name PRrau Ron Present Address Phone —$84 2638 System Location 04(17 961 Rned R41 t Legal Description of Assessor's Parcel No. 9 , 4,424 ijoeo< t e cm dotal- /f•P copal O.y4f era ra e.. SYSTEM DESIGN 3 a ds; Y yr r��RKrO✓s A�/ p /, � r 7 ° 49.40tiend gas .07 M.00 Septic Tank Capacity (gallon) Other /* /43 AI,L.* /N'ercolation Rate (minutes /inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached Special Setback Requirements: Date / �3'9.f Inspector 4 a / FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer ,rf7 .d/1CP Septic Tank Capacity /01'i7.44L� Septic Tank Manufacturer or Trade Name -4 Septic Tank Access within 8" of surface _ _e_ 5 pr Absorption Area S070 2 iw7'02S 7 /NF'L ,9 — rAeNcw 9..5 -3 RCS c Absorption Area Type and /or Manufacturer or Trade Name ./__!YF/G 77,/9 7 Adequate compliance with County and State regulations /requirements..( / e 5 Other /her/AL- q e tear- /Lr/1nrns- ,a -k 772 Date 3 "/` /l Inspector TTe 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 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 • r • e� INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER ?Ofn Qe rcw,. ADDRESS nt -10 a,( Rd S; N- 1 5 PHONE CONTRACTOR ADDRESS PI -LONE 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 (--1. RA is i CZ� Near what City or Town 5 t I T Size of Lot a avr P Legal Description or Address 0 u0 - 7 alv I - ka.. i_tit 'J WASTES TYPE: (1g DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms 3 Number of Persons ( Pic Garbage Grinder (A Automatic Washer (;4 Dishwasher SOURCE AND TYPE OF WATER SUPPLY• ( WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: (AA .l_/ /-159' If supplied by Community Water, give name of supplier 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 (x O NO "TYPE OF INDIVIDUAL SEWAGE DISPOSAI. SYSTEM PROPOSED: (✓) SEP'T'IC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAI. DISPOSAI. BY: (k) ABSORPTION TRENCH, 1311) OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) O'T'HER- DESCRIBE WILL EFFLUENT BE DISCHARGED DIREC'T'LY INTO WATERS OF THE STATE? NU 2 N '!?ERCOI.ATION TEST RESULTS: (To be completed by Registered Professional Engineer) Minutes per inch in hole No. I Minutes per inch in hole No. 3 Minutes per inch in hole No. 2 Minutes per inch in hole No. Name, address and telephone ofltPE who made soil absorption tests: Name, address and telephone ofRPE 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 fiu'nished 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 dwarunent of health in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any fdsification 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. Si ned_ Date — V 5 PLEASE DItAW AN ACCURATE MAP TO YOUR PROPERTY!! 1 2s r.� b t'( ._ S IU1 1 RD 233 ' C\ MquA1 s i t•sJ( lAS - 7l' /f- ik). o _/ _ X1 . 13 - GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 109 0t1 Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 01001 Phone (303) 945 -0212 !his does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY � 1 ��11 /� / Owner's Name /"L��! r � . / Roe-, Present Address [03 C 0.2J/4- hhnne 9 ag -4) 7 Syslem Location /4 < 0Y6 / _. -GC. S /G r e aQ � R 9cP6 tr 9 Se 4 RocA te.vcir /?sp 96D �D' fg,e, �/.4n / 8 S ,I7 Legal Description 01 Assessor's Parcel No. .5-el rJ a. ntiew -r/em R 077 �� -_ I 56 t1 81 Pl"v5 f2 46A4 SYSTEM DESIGN _ /b00 Septic lank Capacity (gallon) Other r a - p'I[{ -?7lLY Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Requirements' Requiremmd Date Jo�' /J_`1" ,SS_`_... _ ____. Inspector / �'1 %� FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Coveting Installation Systole Installer__. Septic Tank Capacity _. _. Septic lank Manufacturer or trade Name - Septic lank Access within 0" of surface Absorption Area Absorption Area Type and /or Manufacturer or trade Name Adequate compliance with County and Slate regulations /requirements Other ___ _ _ _. .. Date. ._ __ _ __. _. Inspector _ RETAIN WITII RECEIPT RECONDS AT CONSIRUCTION SITE "CONDITIONS: 1 All installation must comply with all requirements of the Colorado Stale Board of 1 Ieallh Individual Sewage Disposal Systems Chapter 25, Article 10 C.R.S. 1973, Revised 1904. 2. This permit is valid only ler connection to structures which have fully complied wilh County zoning and building requirements. Con- nection to or use with any dwelling or structur not approved by We Building and Zoning ollice shall automatically be a violation or a requirement of the permit and cause for both legal nation and revocation of the permit. 3. Any person who constructs, alters, or installs an individualsewage disposal system in n manner which involves a knowing and material variati0o Iroltl the lermsor speoilicalions contained in the npplicntion of permit commits a Class 1, Petty Offense ($500.001inn - - months In jail or both). While • APPLICANT Vullo:^ - DCPAIT I MEN N • ,•. I ��„ s , 8 S g g - a 9 d9= 3>9 cg-./0 6 £ .30 g 4 1 0 : /o = / mA ry l /A ) S 6- \b re-