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Home My WebLink About03209 o 1' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N_° 3 2 0 9 Assessor's Parcel No. ZJ�J J I �5i (!-e' 'i( 109 6th Street Suite 303 G lenwood Springs, Colorado 81601 `� /�� Phone (303) 945 -8212 GC This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY r �yy "� �1C" Owner's NameC .0 �.�' t Present Address y{ It J! ��,._ Phone 3 System Location ' c4>`1 B /of), l Pith I `-� /r Legal Description of Assessor's Parcel No. SYSTEM DESIGN U 0 Septic Tank Capacity (gallon) Other Percolation Rate (minutes /inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Date — Inspector FINAL. SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer - - -- — Septic Tank Capacity / S O 0 a L Septic Tank Manufacturer or Trade Name C f7 e C. L A N / 0 Septic Tank Access within 8" of surface — (0 / / r //� t ` t - (a r L c_ a c H r r C9) Absorption Area 3o v tan S ( A- § E rZot . s O F 3 to c-& Absorption Area Type and /or Manufacturer or Trade Name 1 (4 F ( LT It. k? on_$ Adequate compliance with County and State regulations/requirements Other Date— 1 2 _2 Q -99 Inspector A 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 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 —6 months in )all or both). White - APPLICANT Yellow - DEPARTMENT Au2-02 - 99 09:-.21A P.02 4' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION • OWNER peg LG tu8.t ADDRESS j In 7 (o \ b 0 KO ILO - PHONE 9 3 - `f S a� CONTRACTOR G t t L'& r C" a,.,r.s4,-r,.` A� ADDRESS 0 4 1? (2 PHONE 90 - Soo 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, tocation of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION QF PROPOSED FACILITY: Near what City of Town. CAR t / 0/4 (,3 Size of Lot .� Legal Description or Address 1 X16 (n n e_cl Asp -- WASTES TYPE: (4 DWELLING ( ) TRANSIENT USE N ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE e (tJ Cis 49 A' ' s - ! Number of Bedrooms 3 Number o Persons . ea (Garbage Grinder ( y)-Automatic Washer (Dishwasher SOIJRCE AND TYPE OF WATER SUPPLY. (t-ELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 3 '' t Was an effort made to connect to the Community System? L ' A site alas Is reouired to be submitted that indicates the foUgwina MINIMUM distances; Leach Field to Wef: 100 feet Sepik Tank to Well: 50 feet Leach Field to Irrigation Ditches, Stream or Water Course; 50 feet Septic System to Property Lines: 10 feet YOUR INDIV@UAL SEWAGE DISPOSAL SY PERMIT WILL NOT HE ISSUED WITHOUT A SITE PLAN. GROUND CONDITION. Depth to first Ground Water Table Not (=Du 4 9 Percent Ground Slope 1 to C)6c.4_ IF ( age O l 2 .'Aug -O2 -99 09:22A P.03 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED; (V( 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: ( Vf ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) 011-IER - DESCRIBE - • WILL EFFLUENT BE DISCHAROED DIRECTLY INTO WATERS OF THE STATE ?N a PERCOLATION TEST RESULTS; (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Teat) Minutes. 5 per inch in hole No. 1 Minutes 1 Z per inch in hole NO 3 Minutes__ per inch in hole No. 2 Minutes per inch in hole NO. Name, address and telephone ofRPE who made soft absorption tests. bAute ,4 • Pb o- e t I P, a, So c C31 c • - ‘14:23 9 1c , 1L3 `oNT Name, address and telephone of APE responsible for design of the system: 5 Applicant acknowledges that the eompieteness 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 Ainher 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 r Signed ' ��-w^" �i (04.4,--C-LA.. Date St 2 -1 e ty PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY I! J< t om X33 14-437 ( O'C -t14- g3L >d+- z as g F f� . r 4 WS w Sa ATtAc Y'.-- t .4Z 3 i O C y b5 N 3. .8 it en 0. .... A� c a i ti Z - y .fit" 1 Ili t 5 R a a _ d A M y 0 O 3 z 11 Z