The URL can be used to link to this page

Home My WebLink About02535 • GARFI )UNTY BUILDING AND SANITATION DEPARTMENT Permit 2535 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801"°" - Phone (303) 945 -8212 This does not constitute INbIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Donald C. Gaunt Present Address 0085 Panaramic Drive, Shtne- 876 -2795 System Location 0085 Panaramic Dttae, Silt Legal Description of Assessor's Parcel No. SYSTEM DESIGN fi4 - Ta Septic Tank Capacity (gallon) Other / • rN /146 MA P rcolation Rate (minutes /inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached • Special Setback Requirements: • Date / - �S - 'l s� Inspector .• S. : �! ' �-+ uJr FINAL SYSTEM INSPECTION AND APPROVAL (as installed) 1 Call for Inspection (24 hours notice) Before Covering Installation /I 1 t .,I System Installer_ f3� - 5� JS76wr i Septic Tank Capacity at /D Septic Tank Manufacturer or Trade Name • , Septic Tank Access within 8" of surface U Absorption Area 5- 17 ef Absorption Area Type and /or Manufacturer or Trade J 9i 7 • <n _7Fitra 3 3(., Adequate compliance with County and State regulations /requirements 9b5 Other Date /9. 4a-QA- Inspector 114t. - ' �/yrXayo al A. RETAIN &IT 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 structuv�d which have fully complied with County zoning and building requirements. Con- nection to or use with any dwelling or structures n to roved by the Building and Zoning off ice 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_A C�U� doff' , ADDRESS 4. ' ::/..'i/hM !: P • CONTRACTOR ' •i pc—� d ADDRESS PHONE ! P 7/7 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; COUN'T'Y Czeigr /�L 75 Near what City or Town 57 l Size of Lot Legal Description or Address WASTES TYPE: ( DWE►.I.IN(i ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms Number of Persons A /O Garbage Grinder (I- Automatic Washer Na Dishwasher SOURCE AND "TYPE OF WATER SUPPLY• ( ) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: i {' en L If supplied by Community Water, give name of supplier _.a e-+-t .ate 2,.tias GROUND CONDI'T'IONS; 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 ( ) NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( P'1'IC TANK ( ) AERATION PLANT ( ) VAULT • ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) Cl IEMICAL TOILET ( ) OTHER - DESCRIBE FINAL DISPOSAL BY: (41 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? / /a° renj " •y PERMEATION TEST RESULTS; (To be completed by Registered Professional Engineer) Minutes per inch in bole 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 'imposes of the evaluation of the application; and the issuance oldie 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. 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. Signed 69 Date /0 ^ 49 -95 PLEASE DRAW AN ACCURA'iE MAP TO YOUR 1 • EItTY!! Q i} N 3 I • , /� /�� \� / rl / 11 � � 1 e •_ �' ma Li J / � . � 40 Ny o , V t 7)AYbg , •CO. O A s 41 1 I tom 1 1 , . o^ o \ ,5 p g I 1 / * - %1 I:. ft* N , VP i , 2 I 1� ` 4; tt, ho ' X r I I ' �U Ie l FD �o > >� �� I v �I t1L� -III p --14 I Cam, 1 I '4111 � 1 0l t � o I � s 1 L WIC `v � � ^ t t � Y I tit IZ I 1 I I W k i 1r-93� $z"1. �J L._ ti _ J L } 9 J LI_ OZ•bc7 ll e l '/ 1'' 7 "V 6 , S S v i 4 2 ) ? -: �6 ,• z 5 6 6 3 n Q cJ - = _2, 9= .;26 t •