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HomeMy WebLinkAboutApplication- PermitGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY r 1p'1r� �� ' I_IQ' Owner's Name�`krw .Vs�� P n Address F.. Ia one 1plu.-4 1--'-3 System Location 31::::;i4 `l -Y` `0 T a- - 9..7 Legal Description of Assessor's Parcel No a I/(q -- 0 7 1— o O " a q I I Permit N2 3786 Assessor's Parcel No. This does not constitute a building or use permit. SYSTEM DESIGN (0©044 Septic Tank Capacity (gallon) Other 7 Jr Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: 'l Date —l— 03 Inspector f<C 33a.. Pi of Fac 4 -,we aY=i— FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Septic Tank Capacity Septic Tank Manufacturer or Trade Name (424- butaaLsraroteres;) Septic Tank Access within 8" of surface Absorption Area Absorption Area Type and/or Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements Other Date Inspector Li' tIt4k RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE syc/o& _ Cktz •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 jail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER Scbse c 1, l•C� l ti e rtsk ADDRESS 515' i=.. \er`--S . V1 I C_Whe PHONE e(40 - Col B' 14 I $% CONTRACTOR _ O(poed ADDRESS PHONE PERMIT REQUEST FOR ((NEW 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 test holes, soil profiles in test holes (See page 4). LOCATION OF PROPOSED FACILITY: t Near what City of Town 4 FL C Size of Lot 'I- ,4GPES Legal Description or Address « (P . (e 1P WASTES TYPE: (W6WET T ING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: TVA E D 4E5 i OEW Int& Number of Bedrooms (Garbage Grinder 3 (Automatic W Number of Persons 3 ( t-) 5 shwasher SOURCE AND TYPE OF WATER SUPPLY: (✓j WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: I11A DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 3 frZ m +U=S Was an effort made to connect to the Community System? tit 0 A site ratan is restored to be submitted that indicates the following MINIMUM distances: Leach Field to Well: 100 feet Septic Tanis to Well: 50 feet Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet Septic System to Property Lines: ( septic tank &leach f ield)10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (4 SEPTIC TANK a ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAL DISPOSAL BY: ( ) ABSORPTION TRENCH, BED OR PTT ( ) EVAPOTRANSPIRATION ( Vj UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? PERCOLATION TEST RESULTS: (To 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 and telephone of RPE who made soil absorption tests: Name, address and telephone of ItPE 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 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 lmowledge 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 in legal action for perjury as provided by law. Signed Date n3'6-2- PLEASE /d 6'Z PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 05/00/03 FRI 09:47 FAX 970 625 3264 A.C.C.C. 1A 002 MOW rias Faa afaa r1F1a1116 i Laaan fw.! Nelmn s W wswsea as r a lam. aalal SEEPAGE PIT DETAIL it PVC MIR PIPICOTrat --- PWIi1010 MR :M MIK WM& ar Old al 1r W! wet Onu ua a' POW nvW1 MAC to. la! aawwls r raW nate PR r naa man_ .• .YCIfa EN ..[ i�____ =ME R NIS 1!' PM VEIL >d nM aalr CO aoa aaa! \. a' MOM w! Orli in 2r 1103111 PIMPINI 10 e ma0el� r/ ir war arms Mr WM 1 1 \\\ \ `1 `,1`1 `:13 IIC,P 1` \401 —\` \ \ \I'- '1 \ , ` 1 Iaslaa'- a Tle ra IdIw, t ` ` . 1 >®11Oi M 10 ! IaCa01 1Q Yf4 lalf/Lt K1414HIG A ' • &24' 95 SD SYSTEM DESI aJ a } 2' } W J J_ G 4 CCm a W N 0 7 1 FROM :Mountain Cross Eng. Ipc. FAX W. :97094555% Apr. 25 2993 04:06PM P3 CONSTRUCTION SPECIFICATIONS 1. Topa, 'ltd be S ..4 0/11 sAe4 mS aides atlwnW speed Witt.. 01.11/1 oder. Saban dei .et M Sand w ro they Malleo of ae aa.rww. o2..eSR ASS aria em be . hated by a. a. the site dot b .add w that see wear der . a son alta ink ..yank Mt .oho.. 4. O.a.6seden Ad oafs to O.sW County O ldiadod Sob eitisal side Fusses 5. 1A. 0.wdCaadyW.F1aba..rr d Ospelment and 1MHSm Mar as.. r - ,. ..S -J of b mwaaOw se sae mole may k. Spooled Do sot MAdsl oar w .pawn aampb1rre a yell they dM hew brim Pe.laappr.td a. Sewer pNnp abs be sod a be s. A.aaMil.d alb veva 4 Yatee uaN, ayiaa ad 6 SS a bp of /Sits. Oaetle atop b. .ater0/nt and to ea. PIOM�p atop b SS pro. MPS 7. 1he spas bank dab be pensee eaneena. et Mel an a bed of rant add S. tis mam/o.b.er. manimendatlene • Ta N ae a tort a not be of leant the 4. 7te aped tank kit ossa be et Mat 3 blas Nabs than Ihe oast. ha SA tee or attend abate the arbeee of the lipid toMSSO t1 knot 0 he bobs 0 the tank top ad mart Send it Set /4 Inches Wow be Med. 10. A bier le r.std on Ittethe e fled .Nat be r .t bunk obeembe field ea St so point between the Spa Shot I n Other abbe ban or SS sad salved lana as/aa. r tla yud4 Is .sada as Mel. I the andrdde et the tank ape Tse mat octad at Wort 14 &alae below be anN.t. 11. leas et... Mas tb «pit twit octad to the ..�.hi.das of the .w tank hip et ba at lea 10 12. s/at sea ymat b e last 30 lataa end Incites. whichever le Is..e1sae tank SA r a0 13. A repel tank gaud hes two or man co pat ants (r mks. thin one tank b1 Sea to procklo the sly ooprolly). To Bra 01/11aMant mat east a int a sr eland 14. Th. baler of Sid tors the ant a•mpatrinOa to ink ...end ran swAe aeeflbas.t must b made et a sped depth rat Mat ludi.. baler !b OudotM..not a t t. led e NU* sa 15. At Mak one sea no leap than 20 &.Iles tens must be prodded M each osapatrant of . lank 10. The .peas sew .t a apes teas, &.peas pat. re saaplae n. pert Mao be mil d ad west be no mea IS Mese MS the Shoed pads. R mit be nab s/ m tasks Sant le dspadelke Mens molds er sewer 17. wa«y oaoseolbe Awa e. rrs by ..e taaosa rest read Mors O...pole. tank et 1st the (5) fat from the Mt a1d Slot alas. it M aaatwalr Mea sad set be sasstruead of SHAM. sM:,� N. . n th teas pipe and SM. • Sia7 ATLI Sand.* iestoreteddistrbutat Md with • ininbus Was wrouledb mak MS a sell �imAto A 140.044 272Ik or carreer4 it1Mwit mot lase atrial. MTN p4Yai 11262 spec lsalWr r .ldsala t 76, ape n-jaYd pips, ad ant is pips ma net be weed b Meta 10. M ooatpsSmSSW. Mak odeMea. asd a n t be asesid. sperebed and maYda"Nd a a St the rrirdiniat rotational, of the sad cam* SSW, Ihteliteal. Mina • alkor redo In leas a tbe deb of Ihe ISM Prit 20. M r «mpersste net sea buolsd an as al Sana kM./d mat Maat a puma nt plate or rad ad AS. far pepel sapesslan. to es. idea. acne of mersulacturar. ski or add da ad koalas... OWpn sadly of the 1st Ml^a. 21. Seel shag be sash nese sack W t. 2 -IP b els. 22. Tads, treatowd aq poky mnabelkd mast be essess/a se ma! bee *IS yy the Maw Gay OS* DIN t of be Cfeepartnent of Palle dabao ealth awl Eiraminent. Underaba asrlstn raasar,l0.. b.p&ksad any sops. • Nr bet with sate prior to MSS b 23 1b soma oar try part of be MS mat b .a talo d b Say r S est 01 Sur the stein is Mases as dryad and that .5 est oaatl.ae to «rOasrw d be eel or b aa e be.Yao biding Situp b w of s. amps* Sr samben a dsp.s Mm.lpw paltry as Sirs tdi.pe. WM ssael 00114aasad ams and Sr sadly sena may net bo plead a r also a MS distal tleed. 24. Mahle. fwpbp, sap, or l *sSe I�a J irsoss roe be 4 ped Sep neeaaa.aay Wan. �e the all is sat same or Ma ttMenl 0 e inseue aster. 26. The alb tit salt en alb Oan b or* sanspd and canotru Medals the Sion r0oled. b a gds 5* of aap.oted. C.ndedle n Sid peva. J iso alts. M mat spection a.▪ ''tr bleb 1110 oPerated enti Man y `t b. le as. FROM :Mountain Cross Eng. Inc. FAX NO. :9709455558 May. 14 2803 11:22AM P1 Mountain Cross Engineering, Inc. Civil and Environmental Consulting and Design 826 Y Grand Avenue, Glenwood Springs, CO 81601 Ph: 970.945.5544, Fx:970.945,555S FAX TRANSMISSION MEMO DATE: 05/14/03 NUMBER OF PAGES (INCLUDING THLS COVER SHEET) 1 TO: Tim Holliday. Garfield County Building Inspector. #384.3470 FROM: Chris Bale. PE RE: ISDS Inspection of Willey Residence. 304I4 Highway 6 & 24, Rifle CO The purpose of this mcmo is to confirm that on Friday May 5, 2003 Mountain Cross Engineering, Inc inspected the ISDS for the Willey residence. In the professional opinion of Chris Hale, as a professional engineer licensed in the State of Colorado. #35964, and a representative of Mountain Cross Engineering, Inc, k was installed per the plans prepared by Mountain Cross Engineering. Inc for the project. Feel free to call if you have any questions or comments. C: Bernie Wiley, #625.3264