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Home My WebLink About02540 j ✓ � No c tiP S ;�y O wi . 2 ,r e Iw cos e read v( flVl siuow A.A. .�.a / -3- • GARFIELD COUNTY.BUILDING AND SANITATION DEPARTMENT Permit 2540 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Tnm Si l velmnn Present Address 055A art 1491., C s Phone 945 -8721 System Location 0554 County Road 149A. Chelyn Acres, Glenwood Sprit+ ny • Legal Description of Assessor's Parcel No. SYSTEM DESIGN row 7564 480 aO% a > *770 /O00 Septic Tank Capacity (gallon) Other A4 Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 /" /4. or anti 707 lb ceac <e temo 13e0 Required Absorption Area - See Attached 7 O a p 4 SpetWI Setback Requirements: 04. .9 /NfitZR47ca42 UN /rs - ,SyS'tp Date `5Tha 96 Inspector SA FINAL SYSTEM INSPECTION -AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Del a" se. Ivy Septic Tank Capacit Septic Tank Manufacturer or Trade Name O_PLi 44- Septic Tank Access within 8" of surface Tf S i/-- Absorption Area Ca Ca-Cr ,�Y.v Absorption Area Type and /or Manufacturer or Trade Name .7 4 / . i ( c Adequate compliance with County and State regulations/requirements VE 4 Other Date .S- (' 44. Inspector Alan RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: 1. All 1 stallation 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 zoging 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 tertns or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 months in )ail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL. SEWAGE DISPOSAL SYSTEM APPL ATION • OM OWNER /0 vy■ I tiOrif1a✓\ ADDRESS ., Q 1 4r4 - PHONE q4,c CONTRACTOR 9 Q c i ADDRESS (9 )L :4,, t .i PHONE ' _ - / 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: COUNTY Near what City or 'I'owu ` [.tkplio,,, 1 Size of Lot Legal Description or Address Se y,,,f( G.S eiv0 r C WASTES TYPE: ( DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: // Number of Bedrooms_ 3 b /4 [5r t"k Number of Persons_ (>4 Garbage Grinder (A Automatic Washer S 4 Dishwasher SOURCE AND TYPE OF WATER SUPPLY ( WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: 41, w 14 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: i n//4 wf- kv4,1A0,{ Was an effort made to connect to community system? ( ) YES ( ) 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 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? /1 /0 2 • PI?RCOI:A'I'ION TFS "I' RESI11 TS: (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 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 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 L • �� Date 42 /� t / V PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! • pc,t 6 � ` ,` 3 1 A rt: Y t / r19 /?k / C ,or)rY;la" 1 - � /1 c`. e c' C r u i- , -j'I,C , ,'r/t .' R)e .7..1 . U 1 -3 - 5'4 /•s- C-. GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 254 0 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 946.8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Tom Silverman Present Address 0554 CR.14`1A,_G..R — Phone 945 - 8721 System Location 0554 County Road 149A, Chelyn Acres, Glenwood Springs Legal Description of Assessor's Parcel No. _ SYSTEM DESIGN /CVO Septic Tank Capacity (gallon) Other Percolation Rate (minutes /inch) Number of Bedrooms (or other) —.__— Required Absorption Area - See Attached Special Setback Requirements: Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer —. - -.— - -- -- — 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 - - -- - Date Inspector 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 Of ($500.00 tine —6 months in )all or both). White - APPLICANT Yellow - DEPARTMENT TIME 3 e r S 3 3� f/J /N Tear 0 7 `/VS' (3 " / 4/ Y L sa Sale /c %n 6% 1.1 , 9/ lea �r� F D,& ,ay f /y /y, 3d = aro = /y = /6 r>o� 3 = /q,7 x ' 31- y,v ^7 �J 4-G 7 7' ADO dot � m/1, Rat / 4%4 &1 2 o/e i9• bvf .i'r