HomeMy WebLinkAboutSeptic InfoI
.. --· r _,.. ..,..,..,~ie;z:i-ill: 1111e~•t;;;::t;;;::;;$Pfllilsl&=::;;;:.i..-: r;;a,m•c;•~•r;a~Rliit)ll::l'E•s•••••=-·-----w---.--··--· ·-·
._ ..... ~ I
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
1Gt Ith llrHI 8uHe 303
Glenwood lprtng., Colorado 11901
INDIVIDUAL &!WAGE DJBPOIAL PERMIT
PROPERTY
Phone (303) IU-m2
Tallaba•••t FL.
Permit N~ 2 t 3 7
Aaaeuor .. Parcel No.
TIVI doM not c:on.lilute
1 bultdlnv or UN plmllt.
Owner'• Nime lob 6 ludie CArter Pl9Mnt Addr•• _3_3_7 ... t_z_.__...1._•_k_•_•ho..__r_•_...Dr_. __ Phone 904-385--41'8
t
Bratem Loclllan __________ ~15::;..4;;.;;6;...eo..:;.;:..:ma=tJt...,;;;lo:;;;a4;;;....:::1::.:37:...!!1~0l::::•="°::.::o4:.:.....8=iP~r:.:1=Dle.:•:._ ____
1
'
lAgll DMCflplion al A111110r'1 P1n:tl No·----------------------------' '
8Y8TEM DESIGN ~
/J () 0 0 S.pUc Tank Cesllclt)' (g .. ~) 0th« j
, ' i -:= /.0 IH 1::1 /' _ ~ p e f
/ ',c.~ ' () ~ Ptniolalla!) Ral• (mlnutnllnchJ Number of Bedroome (or olhlrJ 3 VII
1 i
I (J /If 'A. R~·n T ~A{ e~ I g 'x .f 1,'x J ,
Requnct Ablotptlon Arll. 811 6laMMcf '{,)..] a.. f n.,f ,...:~t..J<n-e.rv 3 J f2" (' r ~ '
Sptei.!Sttb.JokR1qull9mtnl1: /,,,,)3 I(' ~/"f.~J,:.y-t:J-r" 31 p-i.t.~·'--t1
Date 7-J£• 91 lnapeotar ~t cc·~~
FINAL 8Y8TEM INIPl!CTION AND APPROVAL (u Installed)
Call Jor Inspection (24 hours notice) Before Covering ln1tallatlon
Sp11m tnttlfler·.-:7-q~~~lJf;;. SSE?#~~L_J./114~&,co.Q.-.Q.£~.,4'~ j~::4f212.A~4-------------
S.pllo Tank c.P9Cl1r-... 9+-..... o ........ o~a...._ _____________________ _
BtpClc Tank Manuf1cturer arTradt N1m1 _ .... C"'""'lc~·"t1as..f.a __ om...,, ... J.'"4,_.-----------------
s1pllc Ttnk Acaett within I" of 1urfece -""'i---------------------------
Abtarptlon ArM :i n~ "6 &.-'3 fl&Y& 'D 7
Ab1arptlon Ar .. T~ Ind/or M11nUftclur1r ot Trade Name r ooCM-""19~
Adtquat• oampll1nc1 with County 1nd St.t• 19gul1Uone/,.qulrwm1ntt,_--.::~-----------------
Other-------------------------------------
01t1 9-''I lntpector ~ 0'11 ~
RETAIN WlTH RECEIPT RECORDS AT CONSTRUCTION SITE
•CONDITIONS:
1. All lnttallatlan mutt comply with 111 rtQUltemtnt• of tM Coloredo Slat• Boud of H11lth Individual Btwage Dlepoul 8yst11111 Chapter
26, Article 10 C.fU. 11173, twvf19d 11114.
2. Th fa permll h nlld only fat oanntcllon lo 1tNctur11 which hlft fully comp I led with County zoning and bulldlng requll9mtn1t. Con-
nect on to a11111W11,, anr dw.lllng or 11ruc1ur11not1pprav1d bytht Building and Zon ng olfJce th&ll autam1tleellyb1avlal&tlonor1
lll<lUlttment 011111 patmlt and cat1n for bath 1-0al action and r1V001tlon of th• Ptf'mlt.
3. AnrPMOn who oon11tuct1, 1 ll1rs, or lnt l 1llt 111lndfvldu1111111ao1 d l1po11I1ptem In• mann11wt1lcb lnvalvel a knowing •nd mattrtll
v1 111t lon lram t h• term• or 1peelflca1tons eon1al ned In th • appl !caU on of permit commit• 1 Ota .. I, PtflY Ofl•nat (1500.00 f 1n1-e
month• tn Jiii ar 11ott1).
Applloant : g,.,n Capr Dtp11lm1nl: Pi nk Copy ---------------·
I
I
f
l
J
..
INOIVJOUflL StWAGE DlSPOSAL SYSTEH APPLICATION
·• 0WHER~Ft>:;£tr E \ < 6 1\ll>CA f . C.Al2.TG1.>
J\111• l ica l 1 on
Approval by
County Official:
l\DDllESS33:7Cj E , 4 A •ca!'=;> hog.u l>e Ji,u 19Hlni~~fipNE9 ll4-3 S :)-4f$
CDNTRACTOR_~"ab?te. TIC'. Col)17toere( -HACJ.i?!f 1? ll?J!~Y
11.DDRESS \silJ C.C-.anv "i2b .24o f.)jjtt.) <!.f!4;n-1..e PHONE qs4-z \Si
PERMIT REQUE~T FOR : (V"f New Installation ( ) Alteration ( ) Repair
Attach separate sheets or report &ho\'tlng entire area with respect to surrounding areas.
topography of area, habitable building, location of potable water wells. soil percolation
test holes, soil profiles tn test holes. (See 1>age 4.)
LOGATJON OF PROPOSED FJ\ClllTY: County Gst):l~LJ)
Near what City of Town CLErJlWoo'i> 1[i211JD.'S CrL .•
j
Lot Size 3S-t Ac ..
legal Descr1pUon Scg AU·AC-HlLa>-Atr
WASTES TYPE: ( ~ ) Dwel 1 ing
( ) Councrc1a1 or Institutional
(
(
) Transient Use
) Hon-domestic Wastes
( ) Other -Describe _________________ _
BU llOIHG OR SERVICE TYPE :_'S.;;..;..::H~J4iw:.hic:..=E---t;E...:~.:..::._;;.:i_..IL=.1kc..V...__ _____________ _
tlumber of bedroOIMs 3 Number of persons._..;;;z.;;;;;...... ____ _
( .\') Garbage grinder ( X) Autoinat tc washe r ( X) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY : ( X) well ( ) spring ( )·stream or creek
Give depth of all wells within 180 feet of system: _____________ _
If supplied by con1tllnily water. give name or supplier: ____________ _
GROUND C~ND I TIOHS:
Depth to bedrock: · tlo"r )tlet<A.111r&e.i:-?>
Depth to ftrst Ground Waler Table:_· _1L ____ "---------------
Percent ground slopc: __ ...i:L:..;~:::..~;:;....e._L=-------------------
DISTAHCE TO NEAREST COfoHJNITY SCHER SYSTEM:_;..,tJ2~f\=---------------
Was an effort 111ade to connect to co11111unity systetn?----"\l_c_· ------------
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEH PROPOSED:
()( ) Septic Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy { ) Composting Toilet
( ) Pit Privy ( ) lnc1nerat1on Toilet
( ) Recycling, potable use
( ) Recycling, other use
( ) Chemical Totlct ( ) Other -Describe: __________ _
FINAL OISPOSl\L BY:
( "I ) J\bsorp ti on Trench, Bed or r I t.
( ) Undarground Dispersal
( ) Above Ground Dispersal
( ) Olher -Describe :
( ) Evapot.ransptration
( ) Snnd Filter
( ) Hilstewater Pond
WILL EffLUEHT DE OJSCHARGED DIRECTLY INTO HATCRS OF TllE STATE?_ ..... P .... n _______ _
...
"
\
l
...... ·
I • '
SOIL PERCOLJ\TION TEST nESULTS: (To Ile completed by Registered 11rofess1ona1 Engtneer.)
141nulcs 1>cr inch 1n hole No. 1 Hfoutes per inch in hole No. 3
Minutes per inch in ho 1 e No. 2 H1 nu tes per 1 nch 1 n hole Ho._
Home, address and telephone of RPE who 111ade soil absorption tests: __________ _
Naa1e, address and telephone of RPE responsible for design of the syste111: ________ _
/\pp11canl 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
deparlJl1cnt to be 1.ade and furnished by the applicant or by the local healtti departnent for
purposes of the evaluation of the a;>plication; ond the issuance of the parnif.tj.s ·subject to
such tenns and conditions as deented necessary to tnsure compliance with rules and regulations
adopted under Article 10, Title 25, C.R.S. 1973, as a11ended. The undersigned hereby certtf1es
that all staten1cnts made, information and reports subln1lted herewith and required to be
submftted by ll1e 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 sa111e for purposes of issuing the pennit applied for herein. I further under-
stand th11t any falsification or misrepresentation may result 1n 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 ___ CD_-_a-:!._~_q_43.:......._ _____ Signed ~b luJ-l. · Q~
PLEASE DRAW AND ~CCURATE M/\P TD YOUR PROPERTY
b-HtJu.!ooP -bVRC~'S\ 1:_-·.!_1 D=----------~r------------~ ... -
rage 3