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Home My WebLink About02830) •. ,. J ,,_ ---... ·· ... r/ .,. ------GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT\ ·_d • ... · T~--.,\~ INDIVIDUAL SEWACE DISPOSAL PERMJT 109 8th Street gull~ 303 Glanwo«iil Springe, Colorado 81601 Phone (303) 945·8212 PROPERTY / Permit 2830 Aeeeeaor'e Parcel No. This does not constitUte a building or use permit. Owner's Name_L_i_s_e_&_P_a_u_l_S_a_n_s_om ___ Present Address _1_6_1_3_C_a_t_t_l_e_C_r_e_e_k_R_d:::_• _c_• d~'tne __ 9_4_5-_6_7_3_4 __ 1613 Cattle Creek Road, Carbondale System Location ___________________ _:_ _______________________ _ Legal Description Of Assessor's Parcel No.----------------------------------- SYSTEM DESIGN C~OSTING TOILET SEE ATTACHED INFORllATION r , ·.._ ______ Septic Tank Capacity (gallon) _,_ ____ Percolation Rate (minutes/inch) R_~_qulred Absorption Area -See Attached Special Setback Requirements: ------•Other 3 Number of Bedrooms (or other) ____ _ ' ' . - Date_~~----------Inspector ___________________________ _ ,...,,/ FINAL SYSTEM INSPECTl§N AND APPROVAL (as installed) ~ -' .~ ~Jllll!!!:!-M>tieeH"1ll."l 2?ering Installation . ' System nstaller·--'~------+~+.r-t<-----------------------'-"-''-----/. / (:: t-/ 1 111//·I) Septl Tank Capacity_·~· ~2~..,...----+--------------------------'------ Septic Manufactu: ~de ·• ;t ) .. i 2' Septic Tank Access wl hin 8" of surface -------------------------------- Absorption Area --f-------------------------------------- Absorption Area Type nd/or Manufacturer or Trade Name-------------------------- Adequate compliance Ith County and State regulations/requirements ___________ ~---------- 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. 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 lnfitalls an Individual sewage disposal system In a manner which Involves a knowing and material variation from the terms or apeclflcatiohs contained In the application of permtt commits a Class I, Petty Offense ($500.00 fine -6 months In jail or both). · · · Wh~. APPLICANT Yellow. DEPARTMENT •• INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION ADDRESS --"\ \.,,.,_,_\?:>"'---"'-"'"'--l..""""----'0._,_c-'=-e.e"'-\_.!=--"\<.o""""'cl-""d""--_,,,C.,,a.ilir bo,,J., \<-PHONE '] 4 S -<c, 7 3 <-/ CONTRACTOR __ ....;;;..1~c........----------------------~ ADDRESS ________________ _ PERMIT REQUEST FOR ( ) NEW INST ALLA TI ON ~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 Near what City of Town _ __:C:.:a..;:.'<:..:be.:o'-'-,_-0,.,,.,."'""'"'"g------------"'S'"iz""e-"o:...f,..L""ot.__-'5'"'-.::.."'-:..:C.:..:>r..:::e:..:s,___ __ Legal Description or Address--------------------------- WASTES TYPE {/:) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WAS TES ( ) OTHER-DESCRIBE ________________ _ BUILDING OR SERVICE TYPE __ __l\-*::lQ~:>f....----------------- Number of Bedrooms _ _.3"'--------------Number of Persons _ _>o!_ ____ _ ( ) Garbage Grinder ( ) Automatic Washer • ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY ~WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: ________________ _ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: ___________ _ Was an effort made to connect to the Community System? __ ...ui:"-------------- A site plan js required to be submitted that indicates the following MINIMUM distances: Leach Field to Well: 100 feet Septic Tank to Well: 50 feet Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet Septic System to Property Lines: 10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GRQUND CONDITIONS: Depth to first Ground Water Table. ________________________ _ Percent Ground Slope. ____________________________ _ 2 '. .. TYPE OF INDIVIDUAL SEW AGE DISPOSAL SYSTEM PROPOSED ( ) SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ~ COMPOSTING TOILET ( ) RECYCLING, POT ABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER -DESCRIBE FINAL DISPOSAL BY: ( ) ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRA TION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POJ\1D ( ) 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 ofRPE who made soil absorption tests: _______________ _ N~e, address and telephone ofRPE 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 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 in legal action for perjury as provided by law. Signedd j~ Date. ___ j,_;;1._3"--l-j_q--'-7 ___ _ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 t ' I " 9. the unit shall include fly-tight construction and exterior ventilation as required by the plumbing code. (4) When the available effective volume is filled to seventy-five percent (75%) of capacity, residue from the unit shall be properly disposed of by acceptable solid waste practices. (5) If a system will be installed where low temperature may be a factor, design shall compensate for the effects of the low temperature. {6) Composting toilets shall bear the seal of approval of the National Sanitation Foundation or an equivalent testing program. Composting toilets shall Ee- • operated according to manufacturer's specifications. Systems for which data on design, maintenance, based upon use in limited or undetermined: operation and Colorado, are a. Systems which recycle treated wastewater for non-potable purposes such as flushing water closets or urinals: (1) That portion of the wastewater recycled for nonpotable purposes such as flushing water closets or urinals must meet the treatment requirements of Article IX of these guidelines for effluent in which the possibility exists for occasional direct human contact. (2) No cross-connection to a pipe, fixture, or supply containing potable water shall be permitted. b. Systems which recycle treated wastewater for potable purposes: (1) No system shall be permitted which will recycle wastewater for potable purposes except a system which shall consistently 47 • • 1a .............................................................. ...... J_, WORLDWIDE SERVICE COMMITMENT ~.£ PRODUCT AND CUSTOMER SUPPORT , ~· ·~No matter where you live, Sancor* is only a phone call way. 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Or, because Envirolet* has been installed and operated for more than 15 years by thousands of satisfied customers, including Fortune 500 companies and governments? Or, the fact that our Systems meet or exceed worldwide test and performance standards for composting toilets? We think the real reason is because Envirolet* offers the finest combination of product quality, performance, features and customer support available. STANDARDS & REGULATIONS Envirolet" meets or complies with standards or regulations, and Envirolet' is either certified, accepted or recognized by government and regulatory bodies. Canadian Standards Association (CSA) is a professional body, internationally recognized for testing of products, including accreditation by the Standards Council of Canada (SCC) and the U.S. Occupational Safety and Health Administration (OSHA), as a Nationally Recognized Testing Laboratory (NRTL). ~. Performance Test. Certified by CSA to meet 1i!· Electrical Safety, Canada. Certifie.d to meet CSA ~ National Sanitation Foundation (NSF), liW Standards for electrical safety requirements. " 5 ' 41 Standard 41 (USA). Tested according to manufacturer's rated performance specifications. Test: 6 persons (18 uses) per day continuous use. Commitment To Quality Certificate, Industry, Trade and Technology ~. Electrical Safety, USA. Certified by CSA to meet liW Underwriters Laboratories Inc. (UL) Standards for NATL electrical safety requirements. Ministry of the Environment (MOE), Ontario United States Coast Guard Certified for use on non-inspected marine vessels Designate North Arrow Your Neighbor's Name & Address I to l) Your Plot -Shape to Fit (No Scale) Ca.t+I~ Ca.r bo'"'J ~ l ~ Cre.ek Kco.d Co 81(0 z.3 Locate well, all streams, irrigation ditchs, and any water courses. Draw in your house, septic tank & system, detached garages, and driveway. If a change oflocation is necessary, you must submit a corrected drawing, before a Certificate of Occupation will be issued. County Road (Note the Road Number and Name) eorie ~-\wpwin(,Olwpdc>c'<\plot \oc Your Neighbor's Name & Address