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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 71.7
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81801
Phone (303) 945 -8212
This does not constitute
INDIVIDUAL. SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
owner's Name Gregory Cotner /Diana J e&A nt Address 295 Black Hawk Tr. , Parachp a 285 -1117
System Location g 7 A County Road 306, Parachute
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
/0120 Sep ICTank Capacity (gallon) Other
i Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3
2 HS Rpeg L(.eej' egret w sbi Pori aa . c�,tsf .
Required Absorption Area - See Atte - che s d 1 X As.i. r e-4 n01-4 n t n.) irs
Special Setback Requirements: a 4 ".d6 asd. u17,cr
Date a -14 Inspector Aland 6 s Z'4 J
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
"System Installer ( 00211- l)
E
Septic Tank Capacity )100
tteptic Tank Manufacturer or Trade Name e.O n Lend . V
Septic Tank Access within 8" of surface tfih tit
Absorption Area � \ q
Absorption Area Type and /or Manufacturer or Trade Name 4109 A 7 /v F,L Tieg70
��
Adequate compliance with County and State regulations /requirements Y 6
Other 41/32.--Li ,s,
Date ) /�' 97 X Inspector / `d-'
RETAIN WITH RECEIPT RECCCORDS`A C NSTR CTION 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 — 8
months In Jail or both).
White - APPLICANT Yellow - DEPARTMENT
•- • °• .
•
Application
INDTVIDTJAT. SEWAGE. DTSPOSAT. SYSTEM APPTJCATION Approval By
n County Official
OWNER e F.4nn.( COnJER / 1.7 /anIrnwsu _
ADDRESS 29.5 5/-4cic M4 &k T/LAV I. /ARAGIVTF. , <,e> PHONE 285 -1117
CONTRACTOR BEid, Coo •TU
ADDRESS P • o. io< 229 NF0 Cern(r, Co PHONE ?eV - 3soo
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).
LOCATION OF PROPOSED FACIT ,TTY : County 4n,e Fred
Near what City or Town 'PA ea r of c Lot Size 3 5.11c€1 A cats s
Legal Description Lot \ fz'/waLb Fx F.ntiktm•,1
WASTES TYPE • 60 Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: 2p41.10 t ,T I Ad.
Number of bedrooms 3 Number of persons Z
( Garbage grinder ( ) Automatic Washer ( ) Dishwasher
,4.,. JRCF AND TYPE OF WATER ST JPPT.Y: (X) well () spring () stream or creek
Give depth of all wells within 180 feet of system: Nor Akr‘IA- Viz
If supplied by community water, give name of supplier:
C'ROT TNT) CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table:
Percent ground slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM
Was an effort made to connect to community system? No
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
04 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:
_L EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?
;OIL PERCOT ATION TEST REST JI.TS: 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. _
4ame, address and telephone of RPE who made soil absorption tests:
4ame, 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 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. 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.
Jate //- 7 - Signed /1�� �� �• (tea ^�
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