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Home My WebLink About02981 .. 9f t F GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2981 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 1 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY pp ��}(}� St 31. (� (Q (/� Q a Owner's Nameg(AR ° , 5 5 ( / is Present Address C V ` r� '.)10 R i Pe a Phone (/6 5— ,Asada V System Location ( L ` f) MFSels O* tMd `^' Id g, Pc co - Legal Description of Assessor's Parcel No. 4 / ad 7/ ( 1 SYSTEM DESIGN f - 7 & vF AA / / 4& /-, e /9:44W 080 /v Septic Tank Capacity (gallon) Other /n i 9 /0 Pbfcolation Rate (minutes /inch) Number of Bedrooms (or other) ' {/ Required Absorption Area - See Attached Special Setback Requirements: A # Date // ," �� 9 1nspector�� FINAL SYSTEM INSPECTION AND PPROVAL (as installed) ' Call for Inspection (24 hours notice) Before / Covering / Installation / System Installer ...--4 0 (A M ( Septic Tank Capacity . 0 0 0 A Septic Tank Manufacturer or Trade Name / ' C. j2 E C (- PI ILI 0 - • Septic Tank Access within 8" of surface ` r ( y� /7 Absorption Area - 2 t / S i r . ( 2 C- `i Absorption Area Type and /or Manufacturer or Trade Name I 14 F " ( 1 /k. d r Dn \C Adequate compliance with County and State regulations/requirements Other � Date 1 Z — 1 O _4! / / 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 Sys ems 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 - - -- of the permit and cause for both legal action and revocation of the permit. nonstructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material - a,rms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 DEPARTMENT / INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWIKER . 615.5 612_ /'O ADDRESS Rap cD/ U J2/ / PHONE /, *2 J-�c; l/ CONTRACTOR ‘S e if Co (� ) h /)I.LLf1 XtVG1 (i -Y)1 Sitar /7 r ADDRESS .S e-- PHONE PERMIT REQUEST FOR (W 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 FACIH •ITY.. Near what City of Town a I / Size of Lot / 0 ac rc S Legal Description or Address WASTES TYPE: (v(WELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: 4/ Number of Bedrooms Number of Persons (1.-Kdarbage Grinder ( ) Automatic Was (Dishwasher SOT JRCE ANT) TYPE, OF WATER SIMPLY ( WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: n0 YZ e Odn 1(b I E' Was an effort made to connect to the Community System? 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 (:ROI JND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (c EPTIC 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 (A)/UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? n 0 PERCOLATION TEST REST Ti .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 nthiilatory 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 1 _ - d _ .� Date 5 / y c7 Air PLEASE DRAW AID ACCURATE MAP TO XOUR PROPERTY!! X59 eft R &gag - sr /f tuAr 0_ r 33 Rc L, 3 • .. z G 1 n a 7 K y N 0 IT a. 'h f1 N CD O 0 N N C p(ul 7 N C10 m o- 0 I M N R S� a 1 1fl : s aT //JJ 'v i c (7 ) c S G/ O 'Cr cn eL Ct. in 4 ) ' i C fr 8 ' a Ca g o CD c R. a a. c H CA N FROM : Bar Reverse 1_ Lazy V Ranch Pt-LNE W. +876 2554 Apr. 06 1998 10 ;3341 P01 • ., Cr r. • • I 1/4 Corner Suitor •7/26 N; ,i 1 found 81» Stand West C Monument Set M . C 1/16 Corp Con ;action 10 " W �� 27. Found OW Standard . 5 C Monwnenl Set k 1993. 1 Caller 1/4 l o und 53 �j >4 � ,. _ Section 27. Found M Standard Mon. MIX ` �� 304'21'JO' 1 8( Set In 1093. • 4 '••' 4 I 1 —....... Ei 1 stet' , 1 • I 1 k I\ 8 70' Set /A Reber a \ 0.I4 wmu.. cop °-I ��•� \ 1' 4 ; , 1 51/10 enr. Sections 1 N r14 27 28. Set NS Reber SWI /10 Cor. Sm. I w Mwn. C. 27. Set 05 Reber I N88'49'82 "W W /2' Akan. Cap, - NAp$8'24'W 200.40' ` 1 � IJ�4 SJ" 888.87 1 8. 27. C -C 1 /10 Con. I. ,.�vi: 50 1 . 10'01/"F �7 --,� 27. Found UUA Slondo �i1 ff r e 1I Monument Set In 199 l ��hi`� Y ! 18.08' 8474'2p•1 PI = Lll 3 o cPsgs e r14 4 l ot g 1 1.13 acres q E lc 5 \ w w ( \ r3 pi •w. West 1 /18 Corner \ \ Lott � `" el 28 27 Section* 27/34. round '` a 0 20.00 acres 1 � 1 Standard Mon. W /Akin. • `tJ 1.10 t 1.013 Cap, P.L.S. /10673 ^ -- -.........,0 ! :0;: (ICre9 South 1/4 Cwmr (a /48438 Seclbn ?7, Found 1.11 C3 I1 Section Cor round o. a 6p' S1a1Jwd Mon. W /Mwn. 33 34 stun. Mon. W qo {� 70.6 1 .4_ Cop. piles, /10073 cap P.I..S. /i0732 - sA4'98 E _ SASV ' ,� I , p tt � ` ti ± Antler. 1 so ^M Nat 4 + I ' . � _ _ ,_ 1 1 »a;d,. _. Township 55, +r 1 . a .� 6 + ' ��' • I 1 Ra 92W, 6 PM l f 1.7 � ,337 § -+ r 0 T"i 30 */ yo p 19• ( i • — _ _. �ea'2s'4 -.. ' 1 + - .�.._ _ 111 'A CE 1 NWI /10 Cor. Sea ` 1 • ci }� 34. Set 95 Reba "`. _ " " �'- -� i .. 2' Mum. Cop. ` . W / i .. 7.r- •0-�.r— /)(1(1) } N I • I eats • f 10 0. k \ r5'6 { 1p \ 'I Orchard I �� 6 13 I 1 CO _' 1 SAA,2'69•Is I Ileoard. Set /6 Reber y, — N1/7'19'03 "W _ -•._. . ( f: .-- lb.--- .-..... --- Th3304" ..- —' "•^ / 33/34. Its T _ r bi 1117.70' 4 uwnsr t:ecuone � ' S 1 33 4 o f T' . -... NA78o' 0•w I j wm Mom y J/ j' — •- +-- .- �L.,,. an. J I J31 .04 ' N) N Cinder 1/4 Comer Secll. Position h fir otwmlnallad wide W/Plooth, Cop. --- -- " - -" J 1 34. Found Slut. P.L.S. •I Unman a and 3 Alum. Sot /6 Inks W/llreee Cop. .S. fly -- Ilsb ( � " ... She 1 of 1 f._xceptio T nook 391, Pogo 503 sansasnessansaassaseassaasse