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Home My WebLink About02854 • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2854 109 8th Street Suite 303 Assessor's Parcel No. 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 Briscoe, David P. Present Address 30 Prince Dr. , Carbondale phone 963 -8280 System Location 30 Prince Drive, Carbondale Legal Description of Assessor's Parcel No. St SYSTEM DESIGN Septic Tank Capacity (gallon) Ot Percolation Rate (minutes /inc ) 'Nu • .r • • r - .rooms (or other) 3 Required Absorption Area - See Attached 4% Special Setback Requirements: / 0 I Date ector / / i FINAL SYSTEM INSPECTION AND APPROVA as installed) V Call for Inspection (24 hours notice) Before C. Bring Installation System Installer Septic Tank Capacity 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 Other Date 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 Mar. -28 -97 11:47A Stella Archuleta 970- 945 -7785 P.02 INDIVIDI JAL SEWAGE DISPOSAL SYSTEM A OWNER .. Tb.Att � galC('a Tank I^ 61 -0C' ADDRESS a1) Fr -Annr4 PHONE Ib 3 �g�� CONTRACTOR __ ADDRESS / / PHONE f. l0.cemc n( - Lew- ii PERMIT REQUEST FOR ( )) NEW INSTALLATION1 ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, '• cation of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PP,OPOSSED FACILITY Near what City of 12�rs own CAncra L Size of Lot 02 P Alc►e'e-S Legal Description cr Address WASTES TYPE: (X) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON- DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedroo,ns Number of Persons (K) Garbage Grin ier N Automatic Washer 0 Dishwasher SOI MCP AND In PE OF WATER Sl JPPLY: ( ) WELL ( ) SPRING i ( ) STREAM OR CREEK If supplied by Ct •nmunity Water, give name of supplier:ri +n1 s Rots, S .Pri 1 111 \ DISTANCE TO .'iEAREST COMMUNITY SEWER SYSTEM: mmunity System? MLC 9 % J// I that indicates the following MINIM1rM stances; i 100 feet �� f la" f�v c 50 feet (/ am or Water Course: 50 feet 10 feet • OSAL SYSTEM PERMIT WILL NOT BE ISSUED Mar. -28 -97 11:47A Stella Archuleta 970- 945 -7785 P.02 ■ INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER . TbAJ,IV) ►J f 7 , _ alste �1 T L- & i/ h e ADDRESS 20 Pr -n WlnApe PHONE 1 9 9 CONTRACTOR __ ADDRESS PHONE telacemeul or ,.„, LeoA6i. 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, '•cation of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PF',OPOSSFD FACILITY: Y: Near what City of l own 0A1Qb-K'ncta Size of i.ot 0 2 2 4c)e'. S Legal Description cr Address WASTES TYPE: X) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedroa ns .3 Number of Persons ()() Garbage Grin ier 0) Automatic Washer (N Dishwasher SOI IRSF, AND T` PE OF WATFR SI TPpLY ( ) WELL ( ) SPRING II n ( ) STREAM OR CREEK If supplied by Ct , munity Water, give name of supplier:M Rots S le.►�rl t WSI�V� DISTANCE TO :NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to the Community System? A)44 A site plan is required to be submitted that indicates the followin. i INIMTTM 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 INDIVU' UAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOIIT A 5 TE PLAN. CIRO' ND CON';)LTIONS: Depth to first Gr. and Water Table Percent Ground Slope 2 Mar -28 -97 11:48A Stella Archuleta 970- 945 -7785 P.03 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( ) SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINPOSAL BY: ( /) ABSORPTION TRENCH, BED OR NT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? PFRCOJ .ATION TEST REST TT.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 Imo) Cr /L v`?�(.M Date Wigrk 7 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 , t i - - ------------------..--_ _ _ - J i I i r . '7u '-I , M - V , k�uvmwwo -� / \ T tA T / 5 f - 1 z )10 I p I o � o Q U 1 0! orb . s \ ( t. � 'row.l. - Ng ID - gQ )s co 3D ?r1 nc-c pr. p C&rl nc\tile, CAD O l br 3 0)0) 9t 3 - S►99 (u (io) 7DN -)030 (Lo) wkA6yv. nn-41- etIsO.cis -fir c " P,C. rc. - R5 -i —) ) - ffJ SlA cam_ (kAd y) LAT& 0-kr \ A .