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Home My WebLink AboutSP-2625 f± . r t GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 b 15 109 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 Scott Manup Present Address P.O. Bnx 98987, El ,TPhel Phone 969 - 8799 System Location 98/ • • • • • • • • • • Legal Desctjption of Assessor's Parcel No. • SYSTEM DESIGN /7 /AI � A2-5 Septic Tank Capacity (gallon) n/n('4.tbt6c7•4e.Other /-r Percolation Rate (minutes/inch) Number of Bedrooms (or other) 4 " /N /SN9 /NU?tS = ?X 40 Rock Lam/ &p • • Required Absorption Area - See Attached Or 3/ vw 6, /44 /.o ' tin) = Special Setback Requirements: ale ole UA/TS ' ' / N A rte e v t / / r * W O Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer 44ach' Septic Tank Capacity / 2 Septic Tank Manufacturer or Trade Name A-)04 1..4.4c eo Septic Tank Access within 8" of surface 96-0 O Absorption Area. 9 ' Absorption Area Type and /or Manufacturer or Trade Name 9 7G s27 UAf /766 S Adequate compliance with County and State regulations/requirements Other Date 9 -S-'QG Inspector I$ /►•+ RETAIN WITH RECEIPT RECORDS AT CORSTRUCTION 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 jail or both). it White - APPLICANT Yellow - DEPARTMENT ti • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER � ADDRESS Po GO oag3 ; / Y ` /6 CO PHONE 963 - (5 3 CONTRACTOR ,• ADDRESS PHONE PERMIT REQUEST FOR 34 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 I ofiles in test holes (See page 4). LOCATION OF PROPO ED FACILITY: COUNTY i Near what City or Town �'�� .r /i� `` Size of Lot itoe Legal Description or Address ,ri✓1 a. s �• .4,7,,h WAS'T'ES "TYPE: DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL. OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: flew- 53 ,4*)nt.e_ P2- at4e-1'1CR Number of Bedrooms L i t Number of Persons 3 ( ) Garbage Grinder 34 Automatic Washer Dishwasher SOURCE AND TYPE OF WATER SUPPLY. 4 WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: t elYl p lyvl If supplied by Community Water, give name of supplier U !� GROUND CONDITIONS Depth to bedrock: a 9 / Depth to first Ground Water Table o� 1/0-6() Percent Ground Slope 6 8 !h DIS'T'ANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? ( ) YES (>1 NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( Ni 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: pa ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL. ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL. ( ) WASTEWATER POND ( ) OTHER—DESCRIBE WILL EFFLUENT BE DISCI IARGED DIRECTLY INTO WATERS OF THE STATE? jilifr 2 " Mg4 .v iRCQI„ )110N TEST RESULTS: (To be completed by Registered Professional Engineer) mines per inch in hole No. 1 Minutes per inch in hole No. 3 Minutes per inch 11111°1e 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 firrnished 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. 1 / Signed ‘/V `_ L �/ ►� / 4,�� Date �/ PLEASE DRAW AN ACCURATE MAP '1'0 YOUR PROPERTY!! E fi 'PI 3 • w J /filF 57ne two 3 d 3 36 ,ea = is4� 3" 3 8 ' 1 /y /a i ii 17kgo- g/b ,st /6r/6= y7; 3= /s is. 67 I 30 = 2 V - /s . 7 _ /S Af i?s -v 64t - Tiswx y eemoarS is 976 / $g 77zenm5 B & 3/ / S64. ,6ec(