HomeMy WebLinkAbout03208 e' e
4 i I GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 2 _ 32 0 R i
q ti 109 8th Street Suite 303 Asses$r's Parcel No. !
I /( I G , • 1 1 . 1 ■ 1 0 4) Glenwood Springs, Colorado 81601
l�J t Phone (303) 945 -8212 `�
' s / .i This not constitute '
t y INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
)
' PROPERTY
1 Owner's Nam `b �✓ ( R ����//��Present Addressft(tCIL_ 100 C d `{ JC \Phone CAP
J' 1 15 7 -r)
System Location I L 1 I w C . 1
f Legal Description of Assessor's Parcel No. '
1 7
SYSTEM DE- '
L 7
1
el 4 / -e Tank Capacity (gallon) Other ?
i
/1 w,,
? E ercolation Rate (minutes /inch) Number of Bedrooms (or other)
,
Required Absorption Area - See Attached
i • r, .,
y Special ■ Setback Requirements: - ! ti
1.
p
d Date — Inspecto It
t
FINAL SYSTEM INSPECTION AND APPROVAL (as inst led)
Call for Inspection (24 hours notice) Before Covering Ins allation
f ,.
System Installer 6 (A /igl 1
I 'I
• Septic Tank Capacity / 0 a 0 1� 4 ;,
" ' ' Septic Tank Manufacturer or Trade Nagle ; 0 ` ( . N r
H
Septic Tank Access within 8" of surface n 0 4 ' ' 13 V 7 t Cr A C < l - ,L 1
C f0 I
4 n Absorption Area _ _ �'e a , v '
v:
Absorption Area Type and /or Manufacturer or Trade Name Lam a
f Adequate com with County and State regulations/requireme s
/ i
il
tv •
/
Other ii
-y„."-- 4, I IL .. �r/ y ! . 411 ' . �>/1_� '4
r C Date �. _ l' Inspector � �ri��� / /�aL� '�l� _..
` RETAIN WITH RECEIPT RECORDS AT CO'STRUCTION SITE i.
*CONDITIONS: ); 4
1 i F
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.
" ii 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 violationpr a i 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 aknowing and material +'
r � variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500_.001loe — 8
i months in jail or both). n
t - White - APPLICANT Yellow - DEPARTMENT
so-
' Aug -02 -951 O9t21A F.O2
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER .,_..pia LC �f33�
ADDRESS I 6 i L. 1 b t C-e) O PHONE 9 (o 3— S 0,s
CONTRACTOR r (,j4 .s&- cis.cf w;
ADDRESS. 0 t+g8 (qes t_w�P _._ ___. PHONE 94) 3 - fS41_ ..._
PERMIT REQUEST FOR ( NF_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 teat hoies, soil profiles in test holes (See page 4).
t,QCATION OF PROPQSI?D FACILITY
Near what City of Town C, 4L?Ec – f Q ,4- (_ Size of Lot
Legal Description or Address 1 &1 ( n g - e• �_ ---
WASTES TYPE: ( F DWELLING ( ) TRANSIENT USE
("Q COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC. WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE °Me eS(Ltak.5 k AA & N e3 - *I 2
Number of Bedrooms Number of Persons SEE 41t4C
(. Garbage Grinder (0-Automatic Washer (-1
SOURCE AND TYPE OF WATER SUPPLY (t.i'ELL ( ) SPRING ( ) SCREAM OR CREEK
If supplied by Community Water, give name of supplier.
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 3 M„ Le __
Was an effort made to connect to the Community System? Klb
A site plan Is required to be submitted that indicates the followina MINIMUM distances;
Leach Field to Well: 100 feet
Septic Tank to Wen: 50 feet —
Leach Field to 'irrigation Ditches, Stream or Water Course; 50 feet y
Septic System to Property Lines: 10 feet "-
YOUR INDIVIDUAL SEWAGE DISPOSA4, SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
SITE PLAN.
JND CONDITIONS;,
Depth to first Ground Water Table 'LID t't>u ^
Percent Ground Slope
2
s
P403
AUV-02 -99 00122A ,
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
(
( ) IyAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) NT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE
FINAL DISPOSAL BY:
( yj ABSORPTION TRENCH, BED OR NT ( ) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE •
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATEN
PERCOLATION TEST RF,S1fI.TR; (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test)
Minutes '1. _per inch in hole No. 1 Minutes 1 2 per inch in hole NO. 3
Nfu sites.._ t per inch in hole No. 2 Minutes, per inch in hole NO.
Name, address and telephone of RPE who made soil absorption tests:, J isc oto Q Poo 1 l , R 6 e $ (3/
c.4424tAiOhcti C i t St. 3 _ _ 7 . _ 'no eiL3 `1? to c i _ --
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 applican
or by the focal 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 titre 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 Arnhcr 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.
Signet' VY - 44.4 c C�Lo c Date SI ¶
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTYI!
)C
06 �ONJ /ate / it-
r)3kJ7 V
,
Sy td+-
ti
IMMEr
a
z4
1 el
01 8
� p
a
S Mtav- - ►*co ®9M . �
i C
4 3
G
. lig.
a z -64 Lg d M
D p ffi u z
4
i
i
v o
tY w 6
o g
I
Z 4
1.