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Home My WebLink About02538 . ., 44 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 253 8 109 8th Street Suite 303 , Assessor's Parcel ,No. Glenwood Springs, Colorado 81601 Phone X303) 945 -8212 ti � ,..,: V 'phis does not constitute , INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Dana Yerian Present Address P.O. Box 582 • Glenwood phone_ 945 -2469 k \ System Location 4. 3-4 County Road 214, a gilt \ Legal Description of Asstsspj's Parcel No. SYSTEM DESIGN \\ is s" Septic Tank Capacity (gallon) Other ~I Percolation Rate (minutes /inch) Number of Bedrooms (or other) /3 ref ROCK fGfr7GN boot- (NO lMRfrott- 4 Rr/� . E k) Required Absorption Area - See Attached Sa %.. j 1 1Jf/t7/7f7DR..5 — 44L art o -Di fr - osors .,[y AL of Special Setback Requirements: Date /A- ai - 93 Inspector Kan. FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer 0Lu&6 Septic Tank Capacity aca Septic Tank Manufacturer or Trade Name efyi- T •I1. Septic Tank Access within 8" of surface Y & - r' A Absorption Area • '3 .ete Absorption Area Type and /or Manufacturer or Trade Name 7 Adequate compliance with County and State regulations/requirements 9= Other Date / – 47 %. Inspector �ij.4 ts "i ce ` 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 —8 months in )ail or both). White - APPLICANT Yellow - DEPARTMENT rTr s INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER v. " 14C ADDRESS ?3S — Sy Zl _ "51121 ilatONE ergr - S 7 3r CONTRACTOR _ 111 .us L�a'41 _ S • b`-C.- ADDRESS 0 STdZ C'NA.°S PHONE 9/(-x'7 -4401 PERMIT REQUEST FOR . NEW INS'T'ALLATION ( ) 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 boles, soil profiles in test holes (See page 4). LOCATION OF PROPOSED FACILITY: COUNTY Near what City or Town_ 'S I L — T - Size of Lot 1 30 -v Legal Description or Address '4f• 7 • r - a WAS'T'ES TYPE: 24 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER ��- DESCRIBE n BUILDING OR SERVICE TYPE: 1tf'S Number of Bedrooms 5 Number of Persons tO Garbage Grinder (>4 Automatic Washer (4 Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (›q WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: 1 0 ( :f If supplied by Community Water, give name of supplies' -id 1 : r �S - L GROUND CONDITIONS Depth to bedrock: Depth to fast Ground Water "fable Percent Ground Slope DISTANCE 7'O NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? ( ) YES ( ) NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 94 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, I3ED OR P1T ( ) EVAPOTRANSPIRATION (2C) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER- DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 6 2 yi '1 ' S RCN,ATION TEST RESIJI:I'S• (To be completed by Registered Professional Engineer) Minutes per inch in bole No. I Minutes per inch in bole 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 niy 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 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 / .a Date 1t IC cc PLEASE DRAW AN 'IJRATE MAP 'l'O YOUR PROPER'T'Y!! I ll 3 ■ e' Th- CIS /: /S g 8 7 8 r g3 6 7 ' . 3 r 7, G og. a 30 a ` S'�� - ,7 el() et SO ! at iu - se- . ___)