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Home My WebLink About02976 .– IVe..$ 4 ;,x. : ;`"TFWF :'F'r , 1 A. ` mow +.:: 6 y) 7?. 'x r'' x v f .., �.' "?T , 7 Q F r j (' • 2916 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit . y s 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 d..,� This does not constitute , INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY -t O Owner's Name. JO ar s � Jcnr r r - 21 P 110 ‘,It' Present Address 214 L OJl) ( SC. E. cce , CC C '] Phone 33 - s a-i$ System Location () 7 )S C ea et( Yti IC-r S PS . _ T- . 1e ( . Legal Description of Assessor's Parcel No. Rock L04-0,ti 8— — S3 r SYSTEM DESIGN e#a heR5 / 4' fl' TR, #fc?Jt /tie D <- e� Septic Tank Capacity (gallon) Other / g mg z,,, Percolation Rate (minutes /inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date / ac s /o" 7 n Inspector k FINAL SYSTEM INSPECTION AND APPROVAL (as installed) t s± Call for Inspection (24 hours notice) Before bovering Installation S Installer (9L >L! Septic Tank Capacity 1000 Septic Tank Manufacturer or Trade Name A V/ A AA Septic Tank Access within 8" of surface Absorption Area 0 7 - Absorption Area Type and /or Manufacturer or Trade Name c1 / /:9 J N F /4- 7P Q H4/ba Q'5.• Adequate compliance with County and State regulations /requirements liss Other Date II ~It 5t Inspector kiwi' .0 RETAIN WITH RECEIPT RECORDS AT CONSTR CTION 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 )ail or both). White - APPLICANT Yellow - DEPARTMENT • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER._.__. q e, Jev,.u. -i c/ n, 4C, • ADDRESS T? Ced. r At, Lr PHONE 3 ac.C2 7e CONTRACTOR ;To ADDRESS Co Bp,. 3s 63 f.: rr, X /4 / PHONE sea. R. 7 d' PERMIT REQUEST FOR po 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). LQCATION OF PROPOSED FACILITY ��//� " Near what City of Town i Size of Lot 'T f r ^ Legal Description or Address en !no • I_ n Rn.t / y 2.1 e1Z WASTES TYPE: DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms iZ Number of Persons 2_ • ( ) Garbage Grinder kf Automatic Washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: WELL • ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: -5 • Was an effort made to connect to the Community System? /29I A site plan 6 required to be submitted that indicates the following MlNIl1'ITJN(distencest 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 AISPOSAI SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PI AN, 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 ( ) NT 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? AD PERCOLATION TEST RESI0.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 / i Date PLEASE D' I ACCURATE MAP TO YOUR PROPERTY!! • 3 4 19 ‘',Av �^ OLC core 1 » ,� J N ......_ Not \` \ coed / , f t , hams � A --, -, C 9 --, , -. -�},o s L * ') a, �,4 J 3 i C Pct i gr y 6 kJ Rot �, Cor ole p �' P c, r-°ct1 CP NAV