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Home My WebLink About02880 ''4,419L •+- ryyr ni tizan/.n - wwi r ^ nime vs+n � , K . W - 4 .ca , ,4-77 ;07- a . .. T -, p . ",,,, � �7 / /Tf7 5 �• .. - I. �``1 ,'� .. t / i / MA /t- G- xi" yen ...+ : ^, i l , _� ` GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 8 8 a v , • 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 Frederick E Schultz Jtp yesent Address 0900 Cedar Breaks Rd, Rif4,8 379 -7546 System Location 0900 Cedar Breaks Road, Grass Mesa Ranch, Lot 5, R1.cle i Legal Description of Assessor's Parcel No. Roc Pt— C is4 C /4 • C'36 • --4 b'36 al SYSTEM DESIGN OF PtCCEI 7_, LE^cry — cm AMdcd ' �E`tl —4. So t , ,• I.1 &Fr 1r t, r 4t tot /40 ,ar 412 2Co t r tttl 8Fr I( I tr Septic Tank Capacity (gallon) Other -' 3 J V E l ' M Ra1 — 8 Percolation Rate (minutes/inch) Number of Bedrooms (or other) B. 4 1 - Required Absorption Area - Sge_Attached V Special Setback Requirements: ' 1 • f " , " 1 .... _,, • Date sPector Er"' — Tit/ SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before - g Inst: : 'or r P ' System I alte Septic Tank Cap aid fir Septic Tank Manufacturer rade Name • Ilar Septic Tank Access within 8" of surfa _ger Absorption Area _.,_ J. Absorption Area Typ: - • or Manufacturer or Trade Name J L r , 1 • fir o ► - .. • ate compliance with County and State regulations /requirements - Other , / (,N' , { / Date Inspector 1r I L ., . RETAIN WITH RECEIPT -• •'DS AT C•N- TRUCTION 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 sad material variation frorjthe terms or specifications contained In the application of permit commits a Class I, Petty Offense ($5000 fine — 8 months In jail or both). . . .' White - APPLICANT Yellow - DEPARTMENT , • INDTVIDIJAL SEWAGE DISPOSAL SYSTEM APPLICATION l �T OWNER t*�. T t . k � G u, Z J 2 ADDRESS 0o cZ otkle_ IER.ett-kS RI PHONE 3 7 9 li & CONTRACTOR 3 c , ADDRESS PHONE PERMIT REQUEST FOR (4) 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: Near what City of Town R t ; `e Size of Lot 'I 0 4 c 2e 5 Legal Description or Address /V W I A( /v c( b c cf a'- WASTES TYPE: ()9 DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms Number of Persons _ 7 ( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (x) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: IA AJ K AJO WN Was an effort made to connect to the Community System? /U 0 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 INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 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 FINAL DISPOSAL BY: ( ) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION O UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? Al U PERCOLATION TEST REST ILTS: (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 ... I Date 7 9 I . PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 /} 7 » &2 EA CZ / I � > 3 / / ° \ \\ \ 3 — / ` \, _ r �, \ \ \\ » d;% {§ 7 — u ro c0 - - -- �\ \ cip I .. _ __� /2j \ J\ ,. - 2 %o J ® f)2 } 0 \ / \ \\ \ r\: ^ �: ` I \ / \ \ \� ... /` } — r //- — - m 0.) - 5 ® C. CZ \ Z \ $ • 0 0 CC b t {) / , / ƒƒ ! VS \% ) .% g [ a. \ 2 z ( • . . � . . .. 1111: Garfield County BUILDING & PLANNING DEPARTMENT Date ,5-11---co �— / To:Fre Deri t *a H rio 8765t Dear Permit Holder, Please refer to our previous letter, dated , advising you tjyur Building or Individual Sewage Disposal System permit, number n .2. 0 &f was due to expire, per section 106.4.4 & 5 of Uniform Building Code, and that you had been given an additional thirty days to call for the required inspection or to request other action from the building department. The above permit has expired and been closed. The work authorized by the permit has not received final inspection, is not approved and may not be legally used or occupied. Yours truly, a/a Compliance Officer 109 8th Street, Suite 303, Glenwood Springs, Colorado 81601 (970) 945 -8212 (970) 285 -7972 Fax: (970) 384 -3470