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HomeMy WebLinkAbout02735 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 21 " 109 9th Street Suite 303 `` Assessor's Parcel' No. Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 Thls does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Kenneth Jaynes Present Address 0341 Ponderosa. Glenwood phone 945 -4752 System Location 0341 Ponderosa. Glenwood Springs Legal Description of Assessor's Parcel No. SYSTEM DESIGN /bc+O Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Att ched SEPTIC TANK REPLACEMENT ONL Special Setback Requirements: • Date 4' Q<-17 Inspector / 7/ 0" 171 -417 Q FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer_ Septic Tank Capacity. n©C'b 2ti P <.4c.- T// /UK - 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 Otter Date 2' z4'— 92 Inspector 44 RETAIN WITH RECEIPT RECORDS AT CON$TRJCTION 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 ($500.00 fine — 8 months In Jail or both). White - APPLICANT Yellow - DEPARTMENT • INDIVIDUAL. SEWAGE DISPOSAL SYSTEM_APINACATiQN OWNER--_ /-F�-� e y � �I iJ ADDRESS O 3�nnd?Pros 1 G c„-i S ` PHONE 9 yr — 9 S R CONTRACTOR 'Dr 0 \ l e .0 mac✓ (• - -- - - ADDRESS v _ PIJQNLfi2 7 - 3_`/ % - _ - - - - -- PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION (/) REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profilesA�'n test holes (See page 4). LL�CATION OF P$OI?OSED FACIJ-ITV' COUNTY 60 !_7te Near what City or Town G(ei -46100 S Se 9 1 c_ g -_- 1.egalDescriptionorAddress O3Y(tonder - g < WASTES TYPE: (K) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE - -. -_ —.- _._ —_ -- BUILDING OR SERVICE TYPE: _-- ...._. Number of Bedrooms 3 • Number of Persons t _ Garbage Grinder ( Automatic Washer CDtt sOl1RCE AND TYPE OF WATER SUP1_'J.Y; S WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: Ifsupplied by Community Water, give name of supplier — . - (-7Lc/ GROUND CONIDITIONS;. Depth to bedrock: - --- Depth to first Ground Water Table .___. —_ - - -- t'ercent Ground Slope .___ _ -- ---. DISTANCE "f0 NEAREST COMMUNITY SEWER SYSTEM:____ —_. Was an effon made to connect to community system? ( ) YES ( ) NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL. SYSTEM PROPOSED: (a) SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET (' ) RECYCLING. OTHER USE ( ) CHEMICAL TOILET ( ) OTIiF.R - DESCRIBE . . —__ INAI. DISPOSAL. BY: p4 ABSORPTION TRENCI I, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE NILI. EFFLUENT BE DISCFIARGED DIRECTLY INTO WATERS OF TI IE STATE? A/o 2 ('P*V(y »TION TEST RI ?Sll1.TS; (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: 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 purposes of t h e evaluation ofthe application; and the issuance of the permit is subject to such teens 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 fiuther understand that any lulsification 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. °c 7 -/-_ 2 Signed P/✓Y i - ��_. _. Date_ / _ _ ______ II.FASE DRA . s i 1 ::V1r u AP T.1 YOUR P...&OPFRTY!! — ___ -- — _ • 0 0 3 ........... . • GARFIELD COUNTY BUILDING DEPARTMENT NOTICE You are being assessed $ 442 — for reinspection of Re,/ ctri, usfw 7 - 4 4 ,Q,8A I have upon this day 2 - 7 7 at / / f attempted to do requested inspection and have found: Work or portion of work for which inspection was called was not ready. ❑ Corrections requested on previous inspection were not completed. ❑ Permit card and approved plans not readily available on job site. ❑ You have deviated from plans which requires approval of the Building Official. 0 I ns for Permit NumbetZj2PS Job Address% ?/// -P0> 1hFax54 Owner's Name f-YPNeiprQ ..r77p ) T3 Contractor _ . , - , - QA • '-t REINSPECTION FEE MUST BE PAID AT BUILDING DEPARTMENT BEFORE INSPECTION WILL BE RE- SCHEDULED. Bring this copy, with the reinspection fee, to the office of: gaft/ie( Bount Buddin and tannin 234tt. 109 8TH STREET, SUITE 303 GLENWOOD SPRINGS, CO 81601 9454212 YOU ARE HEREBY NOTIFIED THAT NO FURTHER INSPECTIONS WILL BE MADE UNTIL THE REINSPECTION FEE IS PAID.