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HomeMy WebLinkAbout03168 IT i.: i 1 • y ; i y GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N e 31 rr - - - -. .. ,. 109 8th Street Suite 303 Assessor's Parcel No. i Glenwood Springs, Colorado 81801 g ) 1 ` Phone (303) 945 -8212 7 ' 3 This does not constitute' ' ' t r" INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. ) 1 ( PROPERTY /,� Jn1 J Par ( t I t Owner's Name 1W)(Ker n A yY� JM► / Present Address 6,Go /�� j s nl a Pline 9 a. ( A System Location -�� / /�t.S7Lt V 1�1 ! ' ^ SQ / kt Rr J Rt 4 r T WO ��J C� 9 �J ' A Legal Description of 'vessor's Parcel No. M1OCK- L.eACH- Ff eL0 -- a 'GGS7 \,gi SYSTEM DESIGN t) L C pc 1.4 C M A M O CA- 0 C- O rL ' b a k Z a' V ti t , f f t1 , [ 's1 — r ti cot Nn -s :40 1. -) ( r...-- E cr I. 1 U U v Septic Tank Capacity (gallon) Other 4 3 4 t i I 1 -1.\-- Percolation Rate (minutes/inch) Number of Bedrooms (or other) {( 111 t Required Absorption Area - See Attached .. t Special Setback Requirements: r ,. L t r 1 Q q �t 'r ` Date 7 - - - / 1 _ Inspector /j n Pf V I 1 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) , i i Call Inspection (24 hours notice) BefoCe C Installation i 1 ` ' d (O M i • ! System Installer / k Septic Tank Cale 1 Pi ?' '`' . 4 { k x 1 • } yt V I ' ` Septic Tank Manufacturer or Tred� l Na1Ne i� 3 i? b �,Qn r 1I', l C ✓ 1 ` Septic Tank Access within 8" of surface v'sr (// /` ,i 1, r i a Absorption Area 0 L 144A– / 0 l41 .f ' } i _ /�' / /per // • 1 Absorption Area Type and /or Manufacturer or Trade Name 9 v i 1 � / s 41 . Adequate compliance with County and State regulations/requirements eli ? A; 41. Other I L' 4,, I. i 'Date L"� 1 ' � Inspector $ 4 I, R TAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE J *CONDITIONS: • s 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter .t :`. • t 25, Article 10 C.R.S. 1973, Revised 1984. -.. ' ' i t 2. This permit Is valid only for connection to structures which have fully complied with County and building requirements. $ Con- ` t nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a t f 1 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 '., ? t variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 1 " months In Jail or both). �y; ,,,, J /yY i ii White - APPLICANT Yellow - DEPARTMENT - INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER . . kt3.4 a ") ..__._/ C � 4 ) 0 / t) 4 ADDRESS ht . ei c s PH ONE 6 - y�o E CONTRACTOR BELL- aberJriry ADDRESS P. .Boc ZZq 4euS Cnrce, CO PHONE 9&V" PERMIT REQUEST FOR ($) NEW INSI ALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing °ntire area with respect to surrounding areas, topography of area, habitable building, location of potable wa er wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PROPOSED FACILLD Near what City of Town t E (-,G _ Size of Lot 40 Ace s Legal Description or Address 1-9 / Im GlMSS n?Er'r4- • ' l ZS n/vf rn s AC.54 TP-RJ U WASTES TYPE: (>4 DWEI LING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: teat E Number of Bedrooms 3 Number of Persons ( ) Garbage Grinder (> Autnnmatic Washer (j9 Dishwasher SOURCE AND TYPE OF WATER SUPPLY __( )c) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: ± /b AIL Was an effort made to connect to the Community System? A/6 A site plan is required 10 be submitted tilt • ; • • • • . ' 1. • • . • t • 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. GROl1ND CONDITIONS; Depth to first Ground Water Table Percent Ground Slope_ 2 __ /_ L • • TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ___ ($) SEPTIC TANK ( ) AIiRATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) II ICINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) 0 1'11ER - DESCRIBE FINAL DISPOSAL BY: Q4 ABSORPTION TRENCH, BED OR Pl f ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT 13E DISCHARGED DIRE(' I'LY INTO WATERS OF TILE STATE? 44) PERCOLATION TEST RESIJI.1'S: (1'o be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes per inch in hole No. I 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 ofRPE 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 or my knowledge and belief and are designed to be relied on by the local department of health in evaluating the sane for purposes of' issuing the permit applied for herein. 1 further understand that any falsification or misrepresen'ation 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. j or Signed ally .• Date s/L �9 PLEASE DRAW AN ACCURATE MAP 10 YOUR PROPERTY!! 3 LOT 16 GRASS MESA 1255 MUSTANG MESA TRAIL l 2640 Efl lJ ',TANG MESA TRAY - �/-250 d - 00" /// — 660—. - --- _______ — OC T MPROVEMENT LOCATION (SEE DETAIL) DEL COMM HOMES PROPOSED iPROVEMENT LOCATION P.O. 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