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HomeMy WebLinkAbout02661 ' A 571u Vc1IVL-- `7t ic'/ /vba.0 i�iblh Ii , iL" tcL( .vS GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2661 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945.821? This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name John & Janice Sherman Present Address 2422 Palmer, Glenwood Spa phone_ 945 - 0808 System Location 0265 County Road 119, Eagles Nest Subdivision, Parcel A, Glenwood Springs Legal Description of Assessor's Parcel No. Y1 oCK -L GAcM1 – FILL° Y a'G{ G.DUP. 0 G3 SYSTEM DESIGN 3 N L Er-AcH 1 - °t�dA/ GEC G ya 6 1 ( ! N T iL Cft,cHCS Grr A. 0A mi 1 00 0 Septic Tank Capacity (gallon) Other 02 N( 04 41 M.414 rob FP Log fr M /N '� Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached .. Special Setback Requirements: Date 2 ` / G : 1)7 Inspector A 1 A 0 • FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer © LC- r – ; C 2 Septic Tank Capacity ( S 0 1 Septic Tank Manufacturer or Trade Name C O PC C- / Ft ' Septic Tank Access within 8" of surface ' / ES Absorption Area tC (! 2 Absorption Area Type and /or Manufacturer or Trade Name I N F 1 t- 7 A- A r o n-s V equate compliance with County and State regulations/requirements U GS Other Date e- 2.S - 97 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 • INDIVIDUAL. SEWAGE DISPOSAL. SYSTEM APPLICATION OWNER Idg1u 400 1Njjt SHee4 r ADDRESS o2 2 t�, ietne 6 9 t PHONE . ate CONTRACTOR 6/feel/eta Op* 57724.077o ADDRESS otvzz. f/�j n1E AC PRONE 9f 't Ore? 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). LOCATIONOF PROPOSED FACILITY _ COUNTY 9i4eFia d ` / o e rt Near what City or'I'own ievevooQ sf7 /,v ,a. Size of Lot 3 f' Aries Legal Description or Address O a OS" Co ti b t ,Pd 1/ 9 ,, 7 evsood 51o,n ys Co , // WAS'T'ES TYPE:) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms a • 3 Number of Persons .2 QO Garbage Grinder (Xi Automatic Washer ( Dishwasher SOURCE AND TYPE OF WATER SUPPLY' (X) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: No WELLS - own is Rigour 224 i)Ze p, If supplied by Community Water, give name of supplier IY714. GROUND CONDITIONS: Depth to bedrock _ Depth to first Ground Water Table Percent Ground Slope 7 - 8 !° DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /V, A Was an eilort made to connect to community system? ( ) YES OO 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 BY: p‹) 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 ' PGICC ° (NATION TEST RESlll_i_S; (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 bole No. Name, address and telephone ofRPE who made soil absorption tests: Name, address and telephone ofRPE 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. 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. Signed Date a, GP l 99 PLEASE, DRAW AN ACCURATE P TO YOU PROPERTY!! v I/S n/ a 0 X -/ H R H N N � y°/z hpLa 3 „FROM : EVERGREEN CONSTRUCTION PHONE NO. : 3039450808 Feb. 06 1996 02:54PM P2 MRp of EAjL,$ rsEsr 'foRs g StiERMRN aun RS Sc 2 er r MPS S 83 ° CS 1 0$ n 1..S. 91 4 1235.6 659 w, \ t � 1 h 6 \ sapni. • WWI nerd � @ �( n x /k a M ts et) • UATM -- W ELL - PARCEL. 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