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HomeMy WebLinkAboutApplication- Permit• 3 41 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT N9 1593 Owner Bill & Marilee Jo meon System Location 1698 Co. Rd. 103, Carbondale This does not constitute a building or use permit. Licensed Installer WiLlti�r Kixtdal1 Conditional Construction approval is hereby granted for a ____LofIT Septic Tank or Aerated treatment unit. gallon Absorption area (or dispersal area) computed as follows: Perc rate of one inch in sa�tP _ minutes requires a minimum of 2 2• ksq ft of absorption area per bedroom. Therefore the no. of bedrooms 3 x7 2-,• sq. ft. minimum requirement = a total of ..'ft of absorption area. May we suggest: /4 X S 7 X -3 dee ©1"' /8 Jx- 3 8 'Ix. 3 /d e Date ., `� I nspec a �1�t #/// f C4411� ANAL APPROVAL OF OSTEM: 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. :e Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. Proper materials and assembly. r4" Trade name of septic tank or aerated treatment unit. e /cteld /e'UO' yr.( J. (c,? (�,• ]� Adequate absorption (or dispersal) area, /2. X . r lJ I3'7'-4 /Ite Adequate compliance with permit requirements. ,•'rte• Adequate compliance with County and State regulations/requirements. Other ' /rDate ��/ 7 Inspector L�9 rr-t✓ 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. 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 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT PROCEDURE REQUIRED FOR COMPLIANCE WITH THE GARFIELD COUNTY SEWAGE DISPOSAL REGULATIONS: Step I: Application A. Obtain a standard "Individual Sewage Disposal System application" from the Building and Sanitation Department, 109 8th Street, Suite 303 Glenwood Springs, Colorado 81601, 303-945-8212 or 625-5571. B. Return completed application, map to property, and diagram of site to the Building and Sanitation Department (Pages 2, 3, &4), C. Obtain a receipt for the applicable fee. Make check or Money Order payable to ''Garfield County Treasurer ". FEES ARE NOT REFUNDABLE. Step II: Percolation Tests - SEE DETAILED INSTRUCTIONS ON PAGE 6 *A. Prepare three percolation holes 4 feet deep, 8 to 12 inches in diameter, and 20 feet apart in the area of the proposed leach field. B. Fill percolation holes with water once for the required 8 hour soaking period. C. Request percolation test by Sanitarian. (To avoid construction delay, we suggest arrangements for percolation test be made at least 24 hours prior to the end of the soaking period.) Please have at least 10 gallons of water available at the site for the percolation test. D. Upon completion, you Individual Sewage Disposal Permit will be issued provided no prohibitive problems are encountered. *If a drywel] (seepage pit) is proposed, consult with the Environmental Health De artment for percolation test procedures. !IIMPORTANT!! Please be advised that if the Sanitarian's initial field visit to your property reveals any unusual difficulties such as high water table, excessive percolation rates, bedrock, etc., the services of a Colorado Registered Professional Engineer and/or Board of Health . approval will be required prior to the issuance of your Individual Sewage Disposal System permit. Step III: Final Inspection A. When all components are in place, connected and ready to cover, request final inspection by the Sanitarian. B. DO NOT backfill any part of the system prior to inspection. C.. Upon final approval, carefully cover entire system. Please feel free to contact the Building and Sanitation Department if questions regarding your s&ware treatment system arise. (FOR APPLICANTS INFORMATION) INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER $,II z Marks Jck‘nsor) ADDRESS eo. E6cx -Mao Asprn CO P I fp12. PHONE 'Wp _ 23C05 CONTRACTOR 1 1Gi a IJ 1 ADDRESS lie> 1a. B1If Greel g'4., CJbi2Ad.2 PHONE 1601). 3$19 PERMIT REQUEST FOR: (X) New Installation ( ) Alteration ( ) Repair 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 C -f .G(e} Near what City of Town m ,e h LQ Lot Size I/5 acres Legal Description 1LOa V-411, * (o3 see (tjAJ eip.cr.iJ an v�2xT Dict cu J Application Approval by County Official: to surrounding areas, wells, soil percolation WASTES TYPE: " ( )( ) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non-domestic Wastes ( ) Other Describe BUILDING OR SERVICE TYPE: Number of bedrooms 3 Number of persons . ()C) Garbage grinder ()() Automatic washer (4) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ()4 ) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent ground slope: rf-plc. V/0 DISTANCE TO NEAREST COMM AITY SEWER SYSTEM: cute- Was ui Was an effort made to connect to community system? h o. TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (X) Septic Tank ( ) Vault Privy ( ) Pit Privy ( ) Chemical Toilet FINAL DISPOSAL BY: (x) Absorption Trench, Bed or Pit ( ) Underground Dispersal ( ) Above Ground Dispersal ( ) Other Describe: ) Aeration Plant ) Composting Toilet ) Incineration Toilet ) Other - Describe: ( ) Vault ( ) Recycling, potable use ( ) Recycling, other use ( ) Evapotranspiration ( ) Sand Filter ( ) Wastewater Pond WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 110 Page 2 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 No. 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 permit is 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. I 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 A, --G1 i •a - a? PLEASE DRAW ND ACCURATE MAP TO YOUR PROPERTY Fay A NG 1/4 4W'/4 N'Iz se% et/Nei N'/z N'1z s'k s04 ,F SeCKCA 2,4i T 1 sc&-+-t, Signed P. 41\02. rugs L 445. co 4 -et emt Lai- 3 wed a fan uu2gi-er iy 416. co' Loo 4 5GTIOA V1 Som jZ . 1251 1.4%+: Frei E5 N'/t. se /4 S 1 `/q d 3 e/ can 24, -1-7 -7 SO.444, jZ. ee,Lt�s� Page 3 PLOT PLAN AND DESIGN FEATURES: -(y 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