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Home My WebLink About02964 44 . . '777.7 M GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2964 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 Tf) if V ` ` _ 1 & OC ul -4-(1744k s /L, BIZ Phone (o a — es 9 et' t IN Present Address System Location C f2 01"b ow.-k - mss orc-kc va. 71n4 ► lc \ 3L Legal Description of Assessor's Parcel o.0 K ` ( r f EL D 1 1 27 AorY0 13s7R SYSTEM DESIGN LE AC if C la Oen- TYt L°FrtuES 36 P(Ects ,� 6, It 6 c D it Septic Tank Capacity (gallon) Other 3 still k IA I — 17' Percolation Rate (minutes /inch) Number of Bedrooms (or other) i f Required Absorption Area - See Attached Special Setback Requirements: Date G- (` 4 o Inspector A 2 .. N FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System InstallerPLbN SP Septic Tank Capacity /COO Septic Tank Manufacturer or Trade Name Qppawd Septic Tank Access within 8" of surface 4S Absorption Area 67� Absorption Area Type and /or Manufacturer or Trade Name. 34. eili »;bEp s Adequate compliance with County and State regulations/requirements 7 rS Other D ate '7 • /- 9 )3 Inspector 'r - _ • e . " - � l RETAIN WITH RECEIPT RECORDS AT CONS ' UCTION 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 requiremerft 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 DISPOSAL SYSTEM APPLICATION OWNER - 11 1 :1 1 -r25 ✓A- 7744/J ADDRESS (PC'S w Z 4 re- , /FA 6— PHONE 6>Z S- 415 ‘94. CONTRACTOR 5A-m 6 A S Ago"-, g ADDRESS PHONE PERMIT REQUEST FOR (y) 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 FACII HTY: Near what City of Town E / F L c Size of Lot R . 5 ACRES Legal Description or Address ten 5y, 1'L Ai- N O.1 , p.N Vas haNARb 3Z Co eta z ;3 WASTES TYPE: (DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: / °C. OA A Number of Bedrooms 3 Number of Persons Z pc) Garbage Grinder (Yr Automatic Washer (>4 Dishwasher $OI JRCE AND TYPE OF WATER SIMPLY: ( *WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: g 0/Pk/ r w ^J Was an effort made to connect to the Community System? N A site plan is required to be submitted that indicates the following MINIMLJM 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 Wilt NOT BE ISSUED WITHOIJT A SITE PLAN, GRO! JND 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: V)- 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? PRRCOT.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 `f / G Alyfr by `" _ _ Date ' 7 / 9 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 • a O - PC +�/ es a _ * 1 M -k 0 ill 4 1,2 4.4 Z. N N L j S4\ A V 1 i I c I 0 r 4 tti L D 45 1 $ (r` CI .114.. 4 \I‘ t cal 1 \ \ ■‘) al t % I CI ) - w .' ,�� . i a •-..„. a t Illfre... c _ . .... Tc s, ? moo, a Hafer' Z CI 0r1girIY1 ❑ Update • • • Site and Set Up Information Nome -g4-4# t 4r °' -4 "TiEVA, t✓4n! Home Phone 970 •has- gee/ Cortina caress •Lsc` ✓ w z Fors Sf Applicant's work v47dr aeaws 97014 Current mailing address .Q. r a' en, 8/ 4 5 - 0 Co -ap's work r New address A'cw.urr .gyp ,3'3 "(jeerer 6r2 . New phone New maWag Foundation Information (check one) 0 Lenlhwise roamers 0 No foundation or Other fills. 2af.OisrEN7 f ,cl ea O Concrete pads 0 Perimeter Required height from ground or top of concrete owner to perimeter floor jokt Is a perimeter wall to be erected before home b set? ■ Yes . O No if yes, what klad? Pod 44 Pau u »*'Ttn a Slow load required by the city or county: 4'G .CRf nit Is there an area on site to park home until setup? 0 Yes ® No If yes, note area on plot plat Map to site 1 oPECr�rs n no • W 8 h • 4.:"„"t b 24 4o lb/ I have Inspected wens: to site 0 Vet 0 No Sitret.4m Run. November 24, 1991