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Home My WebLink About02962 + ,, ",•^i' +vre_... Tn,p Aya+a'..... -,.7a. "...,.' "' r;,x... • s.v ., v ' r—. :'- -•�. -C.` + #�e i +) • - • . \ ARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 9 V ' 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 1400 ' ` CO v Owner's Name � Ck� q (P�rassent Address �� +�� ' Co P o^e Q�3� — I y u-7 System Location I 4 33 t t ✓" • I> d� Ie w �► Spit; 1• to , `- Legal Description of Assessor's Parcel No. 1 - r ttOCK te rrELP 67 SYSTEM DESIGN f l C kr A s t4 4C'c at0 al ( Cc es -� r 906k t. t. Tncrrcr(rs I J Septic Tank Capacity (gallon) Other ^ S 3, fr -7 I"` Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date {_ 2 Z 9 Inspector n` a- t-f O FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation p System Installer 3 0 I-I / / 4 1 . b/& 10 / '1-/ Septic Tank Capacity 1 ;L S U E X 15 et Septic Tank Manufacturer or Trade Name S Septic Tank Access within 8" of surface 7 \/ c " t- Absorption Area G G r F T 2 g` Q 2 Pi (CC Absorption Area Type and /or Manufacturer or Trade Name IN F I L T (l... / /N T Vn S Adequate compliance with County and State regulations/requirements Other `` p L !7 c f Date ^ b�� n Inspector A Yom- / � V 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 ($500.00 fine —6 months in Jail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE D1,$POSAL SYSTEM APPLICATION ewe I I OWNER r li i k r ADDRESS 1- E3 1- E3 3 44-9 Itog ZJ PHONE / q �0 3 - J,16$' • CONTRACTOR EUEI2r2EEEA) (14. 5772uc77d</ _ JMu 7 S4 ADDRESS 62 6 5 (olti 7 i2d 119 _ PHONE 9 Y3 o �� g g 6.E4v W6 OA 5 nit Cd� f /6 S 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 profiles in test holes (See page 4). LOCATION OF PROPOSED FACILITY' Near what City of Town f ,AR6 ati 7)RLE (� Size of Lot io , ¢rflS Legal Description or Address /2 5/,33 Y'4 X/lon Z WASTES TYPE: ,) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: y V 5fi6N'T� .4L Number of Bedrooms >. — 3 Number of Persons ( ) Garbage Grinder C) Automatic Washer pc) Dishwasher SOIJRCE AND TYPE OF WATER SIJPPLY ( ) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Conununity Water, give name of supplier: 1t/ E L L DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Lit) hrtiot•it/ Was an effort made to connect to the Community System? /Vi7 As • 11 S'• 1 1/ \ 1/ 14 • i Leach Field to Well: 100 feet d C. C. Septic Tank to Well: 50 feet a 1< Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet PO su Septic System to Property Lines: 10 feet 6k YOUR INDIVIDUAL, SEWAGE DISPOSAL SYSTEM PERMIT WILI. NOT BE ISSUED WITHOUT A SITE PLAN GROI JNI) CONDITIONS: Depth to first Ground Water Table (lit /kroaw Percent Ground Slope • -3 2 • TYPE OF R I1' UAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( ) EPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAUL ' RIVY ( ) 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 WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? PERCOLATION TEST RRST II.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. • ' 'V�t z� 7 77F Signed ry Date ) PLEASE a" • W AN ACCURATE MAP TO YOUR PROPERTY!! 3 C /4 1 to a? er CD cn d 1 \%, 0 0 co S cit 7d o E. a a O ii, M ( • Z wb 1 a n g - H y (y g 0,,: - CD o� z r ,b o'er e cu -1 - a 4 r � � o c _ L-¶ eo g . o• ■ 0 w ; c--------i 4, / d N 7 N Co • a. iw d z th AA k v CD V a a N y N