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HomeMy WebLinkAboutApplicationd-'ly 1'0 Garfield County Community Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.Rarfield-countv.com TYPE OF CONSTRUCTION 0 New Installation WASTE TYPE ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION 0 Alteration Of Repair 13' Dwelling 0 Transient Use 0 Comm./Industrial i 0 Non -Domestic 0 Other Describe INVOLVED PARTIES Property Owner: '` 1-.1 cri : � Phone: (3i L , }.1 t; - I 6 q Mailing Address: I (a 1 0 \t` pr-- c .,, ¥ S o.p ion Contractor: ___L_isSzc gaQ LLC_ Phone: 01 ) O1 -i Mailing Address: P C '1 Engineer: -- Phone: ( Mailing Address: PROJECT NAME AND LOCATION Job Address: 41r41 C ci c,11 Q -c Spc`\ a, LC I Lot ;. ' Blacks'/ Assessor's Parcel Number: 33q•Sub. 114 Building or Service Type: Ref,„ k l � 6 c4 #Bedrooms: Ca Garbage Grinde K ,c Distance to Nearest Community Sewer System: 1Vcc CKLc�, w4 12 Was an effort made to connect to the Community Sewer System: Type of OWTS Septic Tank 0 Aeration Plant 0 Vault 0 Vault Privy 0 Composting Toilet O Recycling, Potable Use 0 Recycling 0 Pit Privy 0 tndneration Toilet O Chemical Toilet 0 Other Ground Conditions Depth to e Ground water table Percent Ground Slope Final Disposal by Water Source & Type Effluent O Absorption trench, Bed or Pit 4 Underground Dispersal 0 Above Ground Dispersal O Evapotranspiration 0 Wastewater Pond 0 Sand Filter O Other 11 Well 0 Spring 0 Stream or Creek 0 Cistern O Community Water System Name Will Effluent be discharged directly into waters of the State? 0 Yes J No CERTIFICATION 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 misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application and legal action for perjury as provided by law. I hereby acknowledge that I have read and understand the Notice and Certification above as well as have provided the required information i is c ect, nd accurate to the b t of my knowledge. /tCc),/tiboliJ tae Property Owner Print and Sign OFFICIAL USE ONLY ( Special Conditions: ek/Z-?(-4C-i4Cf ,— /fir- ellLI/ Permit Fee: Petit Fee: j total Fees: Fees Paid: Building Permit Septic Permit: i Issue te: 1 Balance Due: l�( BLDG DIV: ii .! 1�p �'4„. ......2.2_--2,o6- z2 L.O/ APP 'OVAL DATE c) Er' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81801 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT i• ° 1939 Owner Art Angelo System Location 0477 C.R. 167 Glenwood Sprints This does not constitute a building or use permit. Licensed Installer Leo Jammaron Construction Conditional Construction approval is hereby granted for a .f C' rn ') gallon F Septic Tank or — "----- Aerated treatment unit. Absorption area for dispersal area) computed as follows: Perc rate of one inch in / r minutes requires a minimum of sq ft of absorption area per bedroom. Therefore the no. of bedrooms 3 x - sq ft minimum requirement = a total ofsq ft of absorption area. May we suggest: K� J!::, r �.. �.�<',-1.(,-,2'' /r'` '` , r !�/7 ,.`,.t c r r Date r Inspector < f f -°=7-t1 (""',.,„2,/,.., i' ,k, FINAL APPROVAL OF SYSTEM: No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to cover• ing any part. Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. Proper materials and assembly. Trade name of septic tank or aerated treatment unit. Adequate absorption for dispersal) area. Adequate compliance with permit requirements. Adequate compliance with County and State regulations/requirements. Other r Date / Inspector _44_ RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: 1. All installation must comply with all requi rements 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. Connection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation of 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 jail or both.). Applicant: Green Copy Department: Pink Copy Ott uaw .l4`ff CS" 1 lel a*4 .GARFIELD COUNTY BUILDING AND S N ATION DEPAR - , :109 • ;:8th ' Glenwood Springs .Colorado 81601 -' (303) 9454212 INDIVIDUAL SEWAGE DISPOSALPERMIT .Nr Owner Art Aruej o This does not constitute a building or use permit System Location 0427 C.R. 167 Glenwood Spring Licensed Installer Leo Jammaron Construction * Conditional Construction approval is hereby granted fora 1) d 0 0 gallon )/"Septic Tank or Aerated treatment unit. Absorption area (or dispersal area) computed as follows: Perc rate of one inch in / 5 minutes requires a minimum of """" sq ft of absorption area per bedroom. Therefore the no. of bedrooms x sq ft minimum requirement = a total of sq. ft. of absorption area. kiX' X 3' 8.erciq !- e o c h t3 e d oma q 3-.."0.%, £ t � , err- # 3 May we suggest: ,TM/t.f�te,. A AIp.ce.c�e4 Date /0 —1°' 9/ Inspector FINAL APPROVAL OF SYSTEM:" J Yom_ f. No system shall be deemed to be in compliance with the Sewage Disposal Laws until the 'assembled system is approved prior to cover- ing any part. 60 0 Septic Tank access for inspection and cleaning within 12- of ground surface or aerated access ports above ground surface. ✓ Proper materials and assembly. �.. .. �. Trade name of septic tank or aerated treatment unit. 2y r)' i- X ? i Adequate absorption (or dispersal) area. �r Adequate compliance with permit requirements. 1�.. Adequate compliance with County and State regulations/requirements. Other Date // `7/ 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 Systems Chapter 25, Article 10 C.R.S. 1973, Revised 1984. e • 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Connection to or use with any dwelling pr structures not approved by the Building and Zoning office shall automatically be a violation of a requirement of the WO 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 Jail or both.). Applicant: Groin Copy D.partm.nt: Pink Copy INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER .#1;r- -! 1 e) D ANUS'S 00:7 Go pa /47 PHONE '9'5--o 7r CONTRACTOR -roil owl ll�a-IL / /-d.o SA -M keAdeN) 9i45--5ib ADDRESS gip -it PHONE 87646 67 PERMIT REQUEST FOR: (14 New Installation ( ) Alteration ( Attach separate sheets or report showing entire area with respect topography of area, habitable building, location of potable water test holes, soil profiles in test holes. (See page 4.) LOCATION OF PROPOSED FACILITY: County i Acr ici Near what City of Town q7674, wow c( 5),G/d1Gj Lot Size % 7 ,4ctd.5. Legal Description Application Approval by County Official: feeo''� fe rL ) Repair to surrounding areas, wells, soil percolation WASTES TYPE: ( V) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non-domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms — (S'zeI A,e. 3 EL4Oree4umber of persons { ✓)Garbage grinder (✓) Automatic washer ( L Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: u N k u o - u If supplied by community water, give name or supplier: GROUND CONDITIONS: / Depth to bedrock: -- Depth to first Ground Water Table: UO iCuoav r) Percent ground slope: 0— / DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: £ /w/ Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( '1 -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: ( 4 Absorption Trench, Bed or Pit ( ) Underground Dispersal ( ) Above Ground Dispersal ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ( ) Evapotranspiration ( ) Sand Filter ( ) Wastewater Pond PLOT PLAN AND DESIGN FEATURES: Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, water course, stream, dry gulch and show location of proposed system by direction and distance from dwelling or other fixed reference object, and additional submissions in support of this application such as data, plans, specifications, statements and commitments. Page 4 SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) 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 Mo. 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 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 purposes of the evaluation of the application; and the issuance of the pernui'tis'subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements 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. 1 further under- stand 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 per- jury as provided by law. Date PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY ( Signed L°MC 1—lirid 6L/