The URL can be used to link to this page

Home My WebLink About02669 1 / . , GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 21.E 6 9 109 8th Street Suite 303 Assessor's Pareel No. Glenwood Springs, Colorado 81601 — — - - - -- -- Phone (303) 945 -8212 This does not constitute a building or use permit. INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Sim t Karen Trulove Present Address 0711 Owen Drive, Silt Phone 876 -5370 Owner's Name 0711 Owen Drive, Silt System Location - Legal Description of Assessor's Parcel No. SYSTEM DESIGN / COO Septic Tank Capacity (gallon) Other y! /IA1 3 / / Percolation Rate (minutes /inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date I - i� ! Inspector —a a - - FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer .00u . Septic Tank Capacity l m o° ,, ' Septic Tank Manufacturer or Trade Name 1n ,, ,,, (S Cj D Septic Tank Access within 8" of surface Ye= c Absorption Area T.571 Absorption Area Type and /or Manufacturer or Trade Name Y CS` 2 7 /v0,73 -2- / -5 Adequate compliance with County and State regulations /requirements l •As- Other - Date hi- 1 Inspector . ti a _si . ✓��... RETAIN WITH RECEIPT RECORDS AT CONSTRU TION 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 1964. 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 • - •x INDIVIDUAL SEWAGE DISPOSAL. SYSTEM APPLICATION OWNER h a- 'C s �cv sl.(NC. ADDRESS C» \\ o su O2 S V PHONE 67653717 CONTRACTOR ADDRESS PHONE PERMIT REQUEST FOR (y 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 G PC( \-r\ EU Near what City or Town S \`T, CO. Size of Lot LI0.6Z AC_ Legal Description or Address e7 OLa • c \LT CO 6 \4S — WASTES TYPE: ( ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms Number of Persons_ (Garbage Grinder (/Automatic Washer (vrDishwasher SOURCE AND TYPE OF WATER SUPPLY: (1...)--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: _ Depth to first Ground Water Table_ Percent Ground Slope_ DISTANCE '1'O NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? ( ) YES (ENO TYPE OF INDIVIDUAL. SEWAGE DISPOSAL SYSTEM PROPOSED: (EPTIC 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: (.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? NQ 2 a _ 1 . PERCOLATION TEST RESULTS• (To be completed by Registered Professional Engineer) Minutes per inch in hole No. I 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: Naive, 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 proposes of the evaluation ofthe application; and the issuance ofthe 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 con ect 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 fu 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 �J_� e Date A 2 / , L) )qc, PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! eWty `:V.. •'7 D l.? MtIoN ( ) O K . VA ‘7:-1 ----A rt Cpl _ - "I -70 • 3 Stk� 7 • or -s 1 7Cvei.c "-'& . m Jr' 3a -Paco° 31 An a✓ i_ 6 4 _i a ye/- era - (5a 7 s` y3 g 7 7 co 3 1 , , /4) ,/21)' ' a o Wl >� 7 p7 RbLk / //2�H t�� kl�A aG�� ID/GPer ss4,-ft t'o P. Fpv &eits 0?-2 Ofew r1/45