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Home My WebLink About02545 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2545 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (39) 945.8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY jet Owner'sName & Mabel Ann F azz resent Address 912 Ballard r-S�1t Phone 876-2982 System Location Jt /0 County Road 214, Silt Legal Description of Assessor's Parcel No SYSTEM DESIGN /000 6u Septic Tank Capacity (gallon) Other rr /r/ 2.2. M,N Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 6,4 w-isr P'4'cts4'- 886 m Roctc L EAc// Bap Required Absorption Areal Seb Attached Oft .6.3A. , w Nc,4ra,g AS is o . 6 emir* Special Setback Requirements: 4.2 S3 a W 5,0 t),,,,SdR = 1 8 VN Date Z -20 - 9L Inspector trade V 144e^ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer 4 414- 0 1 7 . 0 - 0 7 Septic Tank Capacity 14 5 6 Septic Tank Manufacturer or Trade Name C4/ Septic Tank Access within 8" of surface PF J` A Absorption Area Absorption Area Type and /or Manufacturer or Trade Name 5 32 p Mt f /L 7e/'rats 30 Fq Adequate compliance with County and State regulations /requirements ye- Other Date / �' y h Inspector idAr. 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 (5500.00 fine — 6 months in )ail or both). white APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER fN a rt ?o z. z ADDRESS qta fSo\\ . -&. S ; »v PRONE R71.o- a9R� CONTRACTOR G ADDRESS P.o, Bx 3loa Ca.S\ \r PHONE 98 _ PERMIT REQUEST FOR (/4 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 Gate t�G Near what City or Town St\\a-- Size of Lot In , 78 Arc, CSC. - Legal Description or Address �/V t e ) c- r WASTES TYPE: ( WELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: „S;,....\ Fa.r�7\y Zjwc�.� Number of Bedrooms 'Mc Number of Persons 1 ._., n ( ) Garbage Grinder ( ) Automatic Washer (V}- Dishwasher SOURCE AND TYPE OF WATER SUPPLY (DWELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: N / A If supplied by Community Water, give name of supplier GROUND CONDITIONS: Depth to bedrock: qe.e Depth to first Ground Water Table tAn\CA.ei w +\ Percent Ground Slope S — S �n DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: N /4 Was an effort made to connect to community system? ( ) YES (t4NO TYPE OF INDIVIDUAL, SEWAGE DISPOSAL SYSTEM PROPOSED: ( PraPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAL. DISPOSAL I3Y: (t- \BSORPTION TRENCH, BED OR PIT (: \ \rO cr') ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER- DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? (\1C'> 2 • . PE RCOLATION 'E T 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 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 fiuiher 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. 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 t1 Date (— 1 z PLEASE DRAW AN ACCURATE MAP '1'0 YOUR PROPERTY!! 3 r ', GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 5 4 5 109 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 budding or use permit. PROPERTY Freddie & Mabel Ann F azz� rosent Address 912 Mallard, Silt Phone Owner's Name_ — —__.__ System Location_ County Road 214, Silt Legal Description of Assessor's Parcel No. ,O __-- .- - -. - -- SYSTEM DESIGN /jea /r6ey _ion _ Septic Tank Capacity (gallon) _ __..__. _Other C \ 7gy' —a 7/r7 2 z Percolation Rate (minutes /inch) Number of Bedrooms (or oth_ _ 1 ��% 7 tea Required Absorption Area - See Attached 8 �� Roca GQ R � ° fY -'�- 9Q 263/ Special Setback Requirements: • ga.53.0 B eo 4 o%dn v / it,* 3 Date —____ __.___ — _ Inspector _ /r FINAL SYSTEM INSPECTION AND APPROVAL (as installed) (/ Call for Inspection (24 hours notice) Before Covering Installation T I �/1,,� System Installer_ -_____.___ ___.._-- -__._— _ —____— _. _ 7/1(4) / Septic Tank Capacity.` -- - - - - - -- Septic Tank Manufacturer or Trade Nanie _ Septic Tank Access within 8" of surface Absorption Area _ — — ' --- - - - - -- Absorption Area Type and /or Man`ulacturer 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 of flee shall automatically be a violation or a requirefnent 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 011ense ($500.00 fine -6 • months in jail or both). • White - APPLICANT Yellow - DEPARTMENT `io/e /vceivr9y 3 ° 30r-,,. nsT 7 8 S c,f) 9 ok4R o ),J z/ A 33 $fir `s /1 5% re 1 , ,)<._ 3 ON" = ?re' ,c! 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