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Home My WebLink About02584 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2584 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 This does not constitute ' INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. 1 PROPERTY William N. Johnson 1698 CR 103, Carbondale 963 -3998 Owner's Name Present Address Phone_ - / 70'O County Road 103, Carbondale System Location Legal Description of Assessor's Parcel No. SYSTEM DESIGN 0100 Septic Tank Capacity (gallon) Other y /N YY/ /NPercolation Rate (minutes /inch) Number of Bedrooms (or other) 3 IQ DGK t Lena S ea /W1TN aAeDAdt ts#w ' -No fameenee $ 20( Required Absorption Area - See Attached 2 4 F/ r. WFetr4sS / 6, e A 3vop 6 A 4 • Special Setback Requirements: 8/ 6 i .)! rrrsmla -s / Date J}' /1.44. Inspector Alien rt... R./ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Cell for Inspection (24 hours notice) Before Covering Installation `. System Installer fWy Septic Tank Capacity .42`s - D Septic Tank Manufacturer or Trade Name (',f�Oe[ANy? Septic Tank Access within 8" of surface `*'- Absorption Area. Absorption Area Type and /or Manufacturer or Trade Name /A'F /tTR/I J79 Adequate compliance with County and State regulations/requirements "" /0, /S /Ans 4 e/J S49e Or thirty Other & a'*Q Date 12 Y7 71 Inspector .T/ 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 — 8 months in (ail or both). White - APPLICANT Yellow - DEPARTMENT IR" INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER WII I IAM N. JOHNSON ADDRESS 1698 Cty. Rd..103, Carbondale. CO 81623 PHONE 963 -3998 CONTRACTOR Ron Martin & Son's Construction ADDRESS 1584 Cty. Rd. 10.., Carbondale, CO 81693 PHONE 963 -2264 PERMIT REQUEST FOR (X ) NEW INSTALL ( ) REPAIR Attach separate sheets or report showing entire area 1 ' of area, habitable building, location of potable water wells, sc )les (See page 4). LOCATION OF PROPOSED FACILITY: Near what City or Town Carbondale Legal ;j: :ii:-' legal Description or Address 1698 Cty. Rd. 10 WASTES TYPE: (X) DWELLING r( f Ci o 4' n S'E ( ) COMMERCIA' fIC WASTES ( ) OTHER- DES ,%% � r // BUILDING OR SERVICE TYPE: Residence �, /� 0 Numb r of Bedrooms_ 3 3 ,j1/JI arbage Grinder ( X) Automatic Washer 9O uisuw0,...,. S RCE AND TYPE OF WATER SUPPLY (X) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: If supplied by Community Water, give name of supplier GROUND CONDITIONS: Depth to bedrock: 20 - 40' 9,14.4„, Depth to first Ground Water Table 70' Percent Ground Slope 5 -10% DISTANCE TO NEAREST COMMUNITY SEW} - TYPE E OF INDIVIDUAL made to connect to S ;% community e �� y �— NO TYPE OP INDIVIDUAL L SEWAGE DISPOSAL ' b`�G ( X) SEP'T'IC TANK ( ) AERA" ( ) VAULT PRIVY ( ) COMP / , POTABLE USE ( ) PIT PRIVY ( ) INCIN , OTHER LUST. ( ) CHEMICAL BY: TOILET ( ) OTI1E / � g FINAL DISPOSAL BY: ( X) ABSORPTION TRENCH, BED OR 1SPIRATTON ( ) UNDERGROUND DISPERSAL ( ) SANE ruu 12,1t ( ) ABOVE GROUND DISPERSAL ( ) WASTEWA'T'ER POND ( ) OTHER- DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF TIIE STATE? No 2 W INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER WII I TAM N. JOHNSON ADDRESS 1698 Cty. Rd..103, Carbondale, CO 81623 PHONE 963 -3998 CONTRACTOR Ron Martin & Son's Construction ADDRESS 1584 Cty. Rd. 103, Carbondale. C0 21623 PHONE 963 -2264 PERMIT REQUEST FOR (X) 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 Garfield Near what City or Town Carbondale Size of Lot 116 Acres Legal Description or Address 1698 Cty. Rd. 103. Carbondale. CO (See AttachmentL WASTES TYPE: ( x) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Residence Numb r of Bedrooms_ 3 Number of Persons_ 3 ,I101 arbage Grinder ( X) Automatic Washer l O Dishwasher S RCE AND TYPE OF WATER SUPPLY: (X) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: If supplied by Community Water, give name of supplier GROUND CONDITIONS: Depth to bedrock: 20 - 40' Depth to first Ground Water Table, 70' Percent Ground Slope 6-10% DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 5 miles Was an effort made to connect to community system? ( ) YES ( x) NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( X) 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 I3Y: (X) ABSORPTION TRENCH, 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? No 2 tR OLATi N TEST RESIJLTS• (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. Nance, 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. 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. / 3 22 9G Signed A / .t I/i D ate / / / PLEASE DRAW AN ACCURA FE MAP TO YOUR PROPERTY!! o‹____, -- H ---- 0 E:x, S 7 ,,,,m f'tu v5 /C98 co /2 t9/0 \___ C l/_ 3 r e /a 'ct M a u �, n G F -.v ex.' C/ �r r-o.( ' I ' J To f � -s!-� !- GARFIELD COUNTY BUILDING DEPARTMENT NOTICE You are being assessed $ 44 - for reinspection of ,/ oit .Seo27e I have upon this day A4e/L /S 96 at J - attempted to do requested inspection and have found: El Work or portion of work for which inspection was called was not completed. n Corrections requested on previous inspection were not completed. In You have failed to provide access to building or jobsite. You have deviated from plans which requires approval of the Building Official. nee /vi //7ia yro25 ( ) At r / -57'y "l,. / i, , e ,Cee: "ni /» a,,- r ;r2 n1,ve jAi/!e / /r•"-` / , 7 A2,v R. /nf /VA'OT �n ; 1- . rte Inspector St 'te For reinspection you must complete the following: i9 /G P /J y N� / ?.a 4 ,' /45r Mfle Permit r�ber �� ,4 ,_c ...62475:2%, Job Address i Owner's Name / , Contractor / I request reinspection to be made on (type) A.M. at P.M. (date) (time) Signed: Bring this copy, with the reinspection fee, to the office of: ti GARFIELD COUNTY BUILDING OFFICIAL 2014 Blake Avenue Glenwood Springs, Colorado Phone: 945 -8241 YOU ARE HEREBY NOTIFIED THAT NO FURTHER INSPECTIONS WILL BE MADE UNTIL THE REINSPECTION FEE IS PAID.