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Home My WebLink About02583 • • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 25 8 3 109 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 Donald W. Larsen Present Address 0535 CR 260, Silt phone 876 -2882 System Location 0335 County Road 250, Silt Legal Description of Assessor's Parcel No.. } SYSTEM DESIGN rye L ree 7519 Ia /N /M�na f -, Septic Tank Capacity (gallon) Other y0 a„svrrs ' yL� Percolation Rate (minutes/inch) Number of Bedrooms (or other) 1 Required Absorption Area - See Attached 697 €ooc LUAU+ Far) aft ' /IIIF fl 'Nr/ re.oroA s il Ve Special Setback Requirements: 4 ,4 A/ Ci/o - O /f'` y -0 yar20 ,2 eo uc)se, Jv a /v/A/as, 3R044 r/ peon ass ,.o 49454*.V.M. Date *— // 91 Inspector TnK FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation system Installer G � t (/ Septic Tank Capacity � j n 0 Septic Tank Manufacturer or Trade Name Cep Septic Tank Access within 8" of surface Absorption Area ---y/ Absorption Area Type and /or Manufacturer or Trade Name L nz 5' -' / ' . / o (/6 7 , • Adequate compliance with County and State regulations/requirements. Other ( q Q �^ (,(//� Date 7 / p `/ i( Inspector `C , t'� Gay' {ei 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 specif ications 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 . c'cemon ADDRESSOS ?5 O,c t is Qg \nC\ r &nO $ tWS`(PHONE q tne Z\ CONTRAC'T'OR • ‘r .s k� ADDRESS O •9a rX \9,?), ;k , 00 \\CSC PHONE • • t 1•' PERMIT REQUEST FOR ( ) NEW INS'TALLA'TION (X) 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). LOCA'T'ION M PROPOSED EACILITY COUNTY QCICS' Near what City or Town d{ __._ __ Size of I.ot car\ c Scvrn Legal Description or Addresstr a YJ:JV - WASI'ESTYPE: (X) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: c - NwuberofBedrooms 16�re> Number of Persons_ - C\u3c.) ( ) Garbage Grinder ( ) Automatic Washer (X) Dishwasher SOURCE AND TYPE OF WATER SUPPLY; (X) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: If supplied by Con enmity Water, give name of supplier_ GROUND CONDITION• IVo-le. Cv,Sorv•'Q-K.-or. t,co.. S e : \ A % v 39 c )' & C\sQ q Depth to bedrock: rc e_ th4r (.00 Depth to first Ground Water Table me c-c n �U �ee C 1h�or� vb -tuc tv� \e� Percent Ground Slope. Y t• . •t. E• • , - 'e DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 5 (*'nveeS cm-t9 Was an ellort made to connect to community system? ( ) YES (X) NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (K) SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE__ FINAI. DISPOSAL BY: ( ) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL, ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND (K) OTHER- DESCRIBE__ CnS tiCCtttic SL.eE4_m — WII.1. FFFLUTN'I' BE DISCHARGED DIRECTLY INTO WATERS OE 'HIE STATE? V1 o _ 2 I'I RCOLATION TPS ' RESULTS: (To be completed by Registered Professional Engineer) Minutes per inch in bole No. I 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 kw 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. 11441A., Date �V " - 9 � Signed_ � ' — - PLEASE DRAW AN ACCURATE MAP 'f0 YOUR PROPERTY!! ,y 1,¢ «a �� r k c I IS r I, r/ _g7 (.2ei o .2 Co l. ou 3 b 0N /4/2.s04/ /SDS S} P Tom y -" -u /o so j // C!� g nee. 5 a,00, s S /S /8;L 1-‘2-;?1,w Moo Or EY e 30 8 X 697 JO lee4e lewd Bea 04 ad- /asrantenne ea. Bio D sse2. /Jousg