HomeMy WebLinkAboutApplication6eRrrekt a P" I ED
GARFIELD COUNTY SEPTIC PERMIT APPLICATION
108 8'h Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-82121 Fax: 970-384-34701 Inspection Line: 970-384-5003
u �a rfieid-county-row '
FEB 1 5 2011
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I Parcel No:t6 intormaIon ilableatth assessors office 970-945-9134} BUILDING & PLANNING
041,T1-)- 0-3L1-00- T
2
Job Address: (if an address has poi been assigned, plea provideCr, Hwy or Street Name & City) or and legal description
111-a, c 'please
P�
Q ., Cts 6 16 SO
3 Lot Size: Lot No: t Block No: Sud.! Exem tion:
1 Q CC 7 � k111 ()C\_&(fI >i 105
4 0�!er {p own Mailing Address Ph: Alt Ph
elf
� \ i\ %AA' t11%\ *-A\ time) ci9 &I 3dto V: SiP,fu tl110.6c)-5- 3W 3ot-q03- quo®
5 Contra or�� Mailing Address,
Ac- Ph: Alt Ph:
6 Engineer. Mailing Address Ph: Alt Ph:
7 PERMIT REQUEST FOR: ► 4 New Installation �w ( ) Alteration ( ) Repair
8 WASTE TYPE: i elfing ( )Transient Use
( )Commercial or industrial ONon- Domestic wastes
( )Other – Describe
9 BUILDING OR SERVICE TYPE: -
Number of bedrooms Garbage Grinder Q()Yes ( )No
10 SOURCE & TYPE OF WATER SUPPLY: ( )WELL ( )SPRING ( )STREAM OR CREEK CISTERN
If supplied by COMMUNITY WATER, give name of supplier
1I DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: lU Li -
Was an effort made to connect to the Community System?
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
12 GROUND CONDITIONS:
Depth to 14 Ground Water Table Percent Ground Slope 1 0/
13 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:
rSeptic Tank ( )Aeration Plant ( )Vault ( )Vault Privy ( )Composting Toilet
( )Recycling, Potable Use ( }Recycling, other use ( )Pit Privy ( }Incineration Toilet ( )Chemical Toilet
( )Other- Describe
14 FINAL DISPOSAL BY:
Absorption trench, Bed or Pit ( }Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration p OSand filter
( )Wastewater pond ( )Outer- Describe ,
15 Will effluent be discharged directly Into waters of the state? ( )YES KNO
16 PERCOLATION TEST RESULT: (Io 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 & telephone of RPE who made soil absorption test
Name, address & telephone of RPE responsible for design of the system:
17 Applicant acknowledges that the completeness of the application is conditional upon such further mandatory and additional test 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 misrepresents, io e r ult in e denial of the application or revocation of any permit granted based upon said application
and legal action for perjury as provided by law. ; j
OWNERS SIGNATURE _a~11 , `'-`
t r-., r- .. — DATE
C14- BO'5
STAFF USE ONLY
Permit Fee:
Septic Permit #:
Perk Fee:
Total fees:
73
Building & Pla ning Dept:
Building Permit !i:
61gE-S-Jo -159 6
Issue Date:
»,-t5-doll
APPROVAL
DAT
1
C14- BO'5
STAFF USE ONLY
Permit Fee:
Septic Permit #:
Perk Fee:
Total fees:
73
Building & Pla ning Dept:
Building Permit !i:
61gE-S-Jo -159 6
Issue Date:
»,-t5-doll
APPROVAL
DAT
401 : SEPTEC
The Next Generation
Key Features
• Low -profile high-performance design
• Convenient and watertight threaded access riser system (sold separately)
• Includes connection gaskets (pipe grommets)
• No water required during backfill process
• Fifty-year manufacturers warranty
• Heaviest poly tank on the market
Watertight and corrosion
resistant onsite
wastewater tanks
Sli tabk° for septic
or pump tank
applications
Designed 10 perform
under tough conditions
Meets or exceeds standard
tank requirements
Fast/ handling and 1771 Mr -port
inletloutlet pipe configurations
Sturdy, lockable, threaded rover
and riser system
CERTIFIED
FRALO is the proud owner and operator of the world s largest
blow -mold machine. Our patented multi -layer co -extrusion process
(COEX-4), utilizes high molecular weight HOPE to produce the
"Next Generation" of onsite wastewater tanks.
FRALO looks forward to serving all
your SEPTECH' tank needs!
4. ,r qtr V ` .. _ _ Plas t/cb
'a -Mil Free .86r 9437256 ~- - 37.,-37.,-. 'In'rro ative Plastic TTclail g]7 i
1
r
Mod.' I
3000.
MODEL
DESIGN CAPACITY
US G:llk>ns (Liters)
TOTAL CAPACITY
US Gallons (1_1:01.4
HEIGHT
WIDTH
LENGTH
WEIGHT
Pounds
LIST
PRICE ,
J 1 ..A1 O. 1,.,,, ,1 i ,.),
ST-300-1Pf .100 (1136)
in.' (11 16)
100 (1116)
'.i4":
.i4"
,
50"
50"
.20
14(1
$0,'000
161(1
134'
4L.`
MODEL
RATED CAPACITY
U. Gallon.-, (Lrlerc:)
TOTAL CAPACITY
US Gallon:; (Liters)
HEIGHT
WIDTH
LENGTH
WEIGHT
Pound:,
ST -500
4110 (1515)
500 (1893)
51"
62"
110"
225
ST -750
750 (21340)
1007 (3812)
51"
62"
101"
1611
ST 0900
1100 (3405)
1147 (4340)
51"
62"
118"
450
ST -1000E
1000 (.1409)
1147 (4340)
Sr
62"
118"
4 $)
ST -1060
1060 (4012)
1311 (4962)
51"
62"
133"
52(1
ST -1250
1250 (4730)
1464 (5541)
51"
62"
148"
5611
ST -1500
1500 (5678)
1768 (6692)
51"
62"
177"
641)
Notes
M.Hha•. 00(x1 !10x0.4,11
rrr lnl'Mrl, e:hh, l
WARNING
Access at or above grade level must be secured
against unauthorized access
• Not rated for vehicular traffic loading
WARRANTY i 1 -(ALO Plasterr'h M(11 warranties the I-RAI.0 SGPTECI 1 lank lor a period of fitly years fano date of
purr.h.. ,r, ,ul, un•,.I uny nlanular.lurrny defec.l5 [mewling Iho took has been used rail tcn:skiled in aa:u rdru rrr' wrltr
111.1101110, 1144e•r wrllr:n IIlstruu1,111 . rI1ALO will. at ds option 1ep.ur or replace any lank 11 deems In be de'Iertuve .urd
1117\10 .. e.bllg,rleunu, unrk:r II,, wan -only are strictly 1rnired to the repair andlor resplacernent r l the deiler.leve 1.u.k I ('(Al Cl
.r �.unu, , urr Ii.IbiLly 111 14111-, nl imp OIM:r installation or misuse. f-RALO rs not lespon:.rhlo lor any re'sulltr>.I cand1ng1'I.1
kali tIII . rt e Ir,rrrlrr, fhr. w:11r,inly .rptekt's only to th[r original tank rnslallalron
/ With an emphasis on products for the waste-
water and environmental Industries, FRALO
Plastech is your innovative partner in business
Our products aro engineered for performance
over the long term We welcomo your comments
and look forward lo meeting your future engi.
nue:rrKi pl:r-:ks_ prrxkrcl needs
DISTRIBUTED BY:
SA
CERTIFIED
FRALO Plastech Manufacturing, LLC • CaII Top Free. 866.943.7256
1
www. fralo.net
sst.v7.1204