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/ ;GARFIELD CQUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 102
:.y .
109 8th Street Sulte 303 Asaedpor's Parcel No.
S' 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 $iMarcb r Ramxon Prese Box 301, Parachute Phone 285 -1141
System Location Tract 25, Morrisiana MHSa; Road 337, Parachute
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
/000 Septic Tank Capacity (gallon) 44JMS hi 4,/ Other
a
1" IIJ /A M "Percolation Rate (mi utes/inch) Number of Bedrooms (or other) 3
S9l'' etc.k. s 4 ens? Dent ADri sus% I tr 'n
Required Absorption Area - See Attached 711 k Z N r "- nee nors cry uM0r rite
7 , 7 k $/O - a, FFasC • S 44 oil rS
Special Setback Requirements:
Date /A 'S .... a 4i Inspector 4r_.c $ a..i re-
1- r ,� -) (4.),
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ',
Call for Inspection (24 hours notice) Before Covering Installation
_
System Instalier__D kA/ / / `/ F� O t
^ t,
S
Septic Tank Capacity ' �^ ^ - _(..D
Septic Tank Manufacturer or Trade Name C OP E c A iil9
�/ T r -
Septic Tank Access within 8" of surface / v 5 " r',c-
f�' [ ?fit
Absorption Area ` IP i
Absorption Area Type and /or Manufacturer or Trade Name I Al PV (. T tl s6 T G 1 i f
(� n to
Adequate compliance with County slid State regulations/requkiments V' /
r
i
Other - •, -.
Date / l__ ' L(_ Inspector •—•--..'...3.... :4
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All installation m istroomply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
25, Article 10 C.RS: Revised 1984.
2. This permit is valiq,ojtty for connection to structures which have fully complied with County zoning and building requirements. Con-r
nection to or use's/AO ny 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. variation constructs, Installs sewage disposal system material
on from the terms or specificationscontai contained
d In the of prmit commits 8 Class I, Petty Offense ($5000.00 fine va 8
months in )all or both).
White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
•
OWNER --- t tie L W Ua 1..1 .u• : • • 1 1
ADDRESS '«K ?C)1 ArY' 6u.a(1, CJD B I C PHONE LiII2.* -I-"r I I
CONTRACTOR 9)P0 F
ADDRESS Gr•_. CAS t hh PHONE
PERMIT REQUEST FOR (VNEW 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).
J.00ATION OF PROPOSED FACILITY
'7 .l'lu 7l L ot Io .34X 7��
Near what City of Town t Size of
Legal Description or Address Tac Rc-) (1 n ,nkC.• �nt'�
WASTES TYPE: (*DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: Nnm P
Number of Bedrooms � J Number of Persons 3
( v(Garbage Grinder ( ✓)"Automatic Washer ( shwasher
SOI TRCE AND TYPE OF WATER SUPPLY: (WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: I
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:,
Was an effort made to connect to the Community System?
A site plan is required to be submitted that indicates the following MINIMUM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System to Property Lines: 10 feet
YOUR INDIVIDUJAI, SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT RE ISSUED
WITHOUT A SITE PLAN.
GROI JND CONDITIONS
Depth to first Ground Water Table lArl &'t( •) YTh
Percent Ground Slope t t h V
2
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: Ccpt0& ety,C,tre.t
( 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:
( ) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE -in fl j cdo C
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?
PERCOLATION TEST RFSL JI.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 AA). l Q A__ , Date 101 I f7) S (Q
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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