HomeMy WebLinkAbout02630 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit z 6 3 O
109 6th 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 oh Bo
,yd Present Address P Jl, Rnx 607 , N.C. Phone 984 -3678
0 1,5- A
System Location • • t • = • - "
Legal Description of Assessor's Parcel No.
996 bkbak. 1EnnM8 APP aa% r 4 b4 bhs cflc 9 .74,7
SYSTEM DESIGN n tn, 6a L4 r / r
/17 / 0 1:7:44rielearrzims Ea tit /tit
/7 V6 Septic Tank Capacity (gallon) Other
k /.rl /t. N) Rate (minutes /inch) Number of Bedrooms (or other) 3
Required Absorption Area - See Attached
Special Setback Requirements:
Date 7- 7 -9G Inspector 14.-g, 'M e-
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer D 0 / A I L/
Septic Tank Capacity 12 5 U
Septic Tank Manufacturer or Trade Name NO 2a) c 5 1. o L AI
Septic Tank Access within 8" of surface Y 4 S
Absorption Area 1 2 '"D
Absorption Area Type and /or Manufacturer or Trade Name 4 fix/ v � ' ` C
Adequate compliance with County and State regulations /requirements \/ ` J
Other ,l ! / ma y , / ' . �7
Date / tl 9' I ` 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 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 1, Petty Offense ($500.00 fine —6
months In jail or both).
White - APPLICANT Yellow - DEPARTMENT
a
IN DIYI I?UALSf:WAG liD_ISPOSALASYSTf.MAP1'I.ICATION
OWNER Trio// / • � yea
ADDRESS 4b&nn) 136N A -4,4 PHONE ?84— ,'67/3
CONTRACTOR
ADDRESS PHONE
PERMIT REQUEST FOR (1) 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_Ol? PROPOSI'D_I?ACILI71Y: COUNTY (7AK-f-re /D
Near what City or Town Alta, (iAf r /rc Lot 3
I.egal Desc / ription i 6 I ,, , _ • • _ .
WAS'11 S1YP_13: (X) Dwelling ( ) Transient Use
( ) Commercial or Industrial ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: L jGat,41 Wn
Number of bedrooms: 3 Number of persons 3
(s) Garbage Grinder ( ) Automatic Washer IC) Dishwasher
SOURCE .ANIIIIYP_Ii.OILWATER_SUP_PLY: (k)`W ( ) SPRING ( ) STREAM OR CREEK
Give depth of all wells within 1 KO feet of system: / T K_XX AA? A /y, t Est. keit la,' 4
If supplied by community water, give name of supplier:
GROUNDSONDU'JONS:
Depth to bedrock:___
Depth to first Ground Water Table:
Percent Grc iind Slope:
DISTANCE TO NEAREST COMMUNI'T'Y SEWER SYSTEM:
Was an effort made to connect to community system?
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(4 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 RY:
(x) Absorption Trench, lied or Pit
( Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCI IAItGED DIRECTLY INTO WATERS OF THE STATE; ?1t /O WA/
P_lACC LATIONZI'EST_RES!!L1'S: (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 R PE who made soil absorption tests:
Name, address and telephone of RPE responsible for design of the system:
Applicant acknowledges that the completeness of the appliction is conditional upon such further mandatory
and additional tests and reports as may he 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 inusrecotnpliance with
rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby
certifies That all statements make, 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 bre relied on by the local department of health in evluating the same fro 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.
Signed Date 4 - /6 - - 6
PLEASE LRAW_ AN _ACCLRATE_MADD_YQUICP_ROPERTY_
Q. /s - 9y. SD en/ 4.)
s
6t 7" S% 3 = /S'
r
7" 4 I ----- C - 0 75 4 0 s _ = / /4
S
- ASK
O 3
1 44- `
i,. i r ...:fi{fe- 1r+ax:Fv'..e ate:_ -
i
V
- ..
0
v
.
1 N 0013'16" E k S 00'13'6 " W
140.94' L _ ` _
A 1 Iz
I n m*
-i A
O
Ro f
n
Ill 4; gJ
P •
e
r jco
I' z
V
Cn
W
O
z
m
_ 2
it
c cn '
J /
c O
R o.
> /�
t. /
•
ul
WI
y
n
C
- i /
c
0 1
-1 I /
•
(7 111/114
i . , ,, a a iv a i t a IT H r
w, i