The URL can be used to link to this page

Home My WebLink About02656 o ` M GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2656 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 Mid Valley Baptist Churc 16472 Hwy 82 Carbondale 963 -2261 Owner's Name resent Addres Phone_ • System Location _ 16472 Highway 82, Carbondale Legal Description of Assessor's Parcel No. SYSTEM DESIGN .s.;s n.vn av °Y w 4 fa 4 e Septic Tank Capacity (gallon) dnA &t&E Other Septic Tnk r /•' R Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 /INCH 6 41 Lax Lencr7 Beu 3S x ZO Required Absorption Area - See Attached �� .i, q P gZJ UN /r5 7 .vrit ToQ dot. S'a - a /Pr �'3BS�0 Special Setback Requirements: Date 8 Inspector tae FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer_ k / E Xrn VA 77NA — _ -- Septic Tank Capacity /000 b'4Z nn-- Septic Tank Manufacturer or Trade Name De A E6f2 Septic Tank Access within 8" of surface yes Absorption Area 3 S X ?.0 7&C p .Cr � // ere Absorption Area Type and /or Manufacturer or Trade Name FCXC e_e / +gab Adequate compliance with County and State regulations /requirements 4,5 Other o � c ce $at e ter — Date 9 -`9 Inspector S/eh. 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 (8500.00 fine —6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER MID VA (.1.5i 13APTlsT CNvRcf! mauler() $oAAc4rcr, —,6y72 NwY tr7 PHONE 9G.3 aaGf y63 l71d' CONTRACTOR ,K I7 S ,S e4vr9 rm. ADDRESS PHONE PERMIT REQUEST FOR - 1'1 NEW INSTALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PROPOSED FACII•ITY; APP2cx• Near what City of Town CA3R I3o/IDAt t Size of Lot Y ACRE S Legal Description or Address #04/701. hl W Y ti WASTES TYPE: - Ni) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE — BUILDING OR SERVICE TYPE: ;F 5 MoDuL42. Number of Bedrooms 3 Number of Persons o2 /3 ((.) Garbage Grinder (Automatic Washer (t- ishwasher SMIRCH AND TYPE OF WATER SUPPLY: Zv) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: y� DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: �. Ames Biww - Ass We$T Was an effort made to connect to the Community System? JYD A site plan is required to be submitted that indicates �h5 "flown $'I II I UM distances: Leach Field to Well: 100 feet YY �. � a�`' Septic Tank to Well: 50 feet ./v Leach Field to Irrigation Ditches, Stream or Water CourseL 50 feet IVA Septic System to Property Lines: 10 feet •f - Is - YOUR INDIVIDUJAI, SEWAGE DISPOSAL SYSTEM PERMIT WILL, NOT BE ISSUED WITHOUT A SITE PLAN, GRO! JND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope /0 - . £ 7 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( , Q 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: N) 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? ND pFRCOT ,ATION TEST RESI11.TS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) 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 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 purposed 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 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. Signed �i4.14 -1 2i2 r g _ Date e9/21#‘ MID v/aceY 94fraf ci`/vtern PLEASE DRAW AN ACCURATE MAY TO YOUR PROPERTY!! 3 a I I y tin Z C7 C . e ~ • K z a CT o N N 3 11-1' ) PV O P r CL 0 O A 0 N w F o t E L _ O _ N z ill_ C • • 3 • . — N Rg °0 0 R0 o c \\ @ -n 3 c °o 2 y zo S w o �'' coo a w s .= w r te° c CD n 7 O r R c a C i r T ! / a (0 N - • a w „ i -r., 0 iti pi 1 1 % w O O 0 ti I r N R° + $. na. = I o . rn o cr ti y y y c y 9 \ Si r GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit z 656 109 8th Street Suite 303 Assessor's Parcel limo. Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute l II5DIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit PROPERTY Mid Valley Baptist Church 16472 Hwy 82, Carbondale Phone_ 963 -2261 Owner's Name rresent Address _ ---- 16472 Highway 82, Carbondale System Location____.._ -- -- -- - Legal Description of Assessor's Parcel No. -- _- - - SYSTEM DESIGN - 2krt2_ _- IC tank Capacity (gallon) jvai ea C Other _____ Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached Special Setback Requirements' Incpector _ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer - " - -- - - -- Septic Tank Capacity Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface ------------ - - - - -- -- Absorption Area - - -- -- — Absorption Area Type and /or Manufacturer or Trade Name Adequate compliance with County and State regulations /requirements Other Date 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 I, Petty Offense ($500.00 fine —6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT � s- , I S -3,� air a (8 8 - yl> s- s S7)7,4 - � t 3 1-7/ ✓O ` ' =7% / S% 2 9! IX ly e /7.7 /4o ; /7o 8, /Y cie X /184' ' 6t2 v� a/ ✓ , ,,f,em4 /WS = 3 R .0 N. y z • • „ .