The URL can be used to link to this page

Home My WebLink About02580 ■ t. • i GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2580 .( 109, 8th Street Suite 303 Assessor's Parcel No. GIpnwood Springs, Colorado 81a01 ca .\\ Phone (303) 945-8212 •• This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT ._) \ _ a buttding dr use\permit. \ PROPERTY -LA �( cS \ Daniel Gardner resent Ad 303 Road, Par\ghute \ph \' 2 85 -7604 Owner's Name • �.. $� `� ` System Locatio \ V 0134 Cot t? Road -303, S Parachult 0 Legal Description of Assessor's Parcel No. QI \ \ SYSTEM DESIGN /600 Septic Tank Capacity (gallon) Other 3 TrE. Wii4 /s era eMPO /r /A) IS bil r olation Rate (minutes/inch) Number of Bedrooms (or other) g �.y a ef fn \ i ulred PbaorptigNArea 9�e d °' \ ` / GS' o 5 1S +EA IniF /LTT14 Special Setback Requirements: 4 41 L . �� 1 Dates lS 9 /yv Inspector Qqs FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer.D G y✓pe f,2 Septic Tank Capacity / Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface W. Absorption Area 4/4 k Absorption Area Type and /or Manufacturer or Trade Name Aire S t 4.147 -erahf Adequate compliance with County and State regulations /requirements r4''5 Other Date R ' Q' Inspector Alai 'leL RETAIN WITH RECEIPT RECORDS AT C NSTRUCTION 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 )ail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION - OWNER DOW ?e (t1 AA0 ADDRESS 6 - r• r i� _P Ll PI -IONE : - • n r CONTRACTOR l7�'' t r Eq to 'f 'I" ADDRESS 0 ... ' / v i P 1 •NE i I 54 _A• PERMI'I' REQUEST FOR (y�iEW 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 pr i t test holes (See page 4). LQCATION OF PROPOSED FACILITY; COUNTY l ✓`Re Id Near what City or Town---. — Baitenint., `��P.SG - -- Size of Lot _,9-0 O..lrPS Legal Description or Address WASTES TYPE:: (✓rDWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms_ 3 Number of Persons_ a.- ( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY ( N LL ( ) SPRING ( ) STREAM OR CREEK (live depth of all wells within 180 feet of system: 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 (WNO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (✓V 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, BED OR PIT ( ) EVAPOTRANSPIRATION (V) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 2 PERCOLATION TEST 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 fiurther 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 Corr ct to the b- ; of my knowledge and belief and are designed to be relied on by the local d��artment ofbealtl '1 , . %satin. he sane for purposes of issuing the permit applied for herein. I further understand that any f. ifi . or 15 epresentation may result it the denial of the application or revocation of any permit granted ba d u s d )p cntiou and in legal action for perjury as provided by law. Signed i Date 5 2 ( —94 PI SE DRAW_AN ' CCURATE MAP TO YOUR PROPERTY!! 3 b CGA fl4J 2 //.'a c _ 0 ,x //As - 6 3 , , ,,,, 9 --ci e-- 9,` 7 -/6, 1(2. If /s I /6 /6 8 7 X H / ° // u /S / 3,9 d 26' i z--- /7/ a in 026i, a AprAtr 4. X36 h /7 0 11 `f ,S.1g A e r n f- /4 7,i9 Tr5r5 0 I S Q 4