HomeMy WebLinkAbout04476GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 7
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
10,
Assessor's Parcel No.
This does not constitute
a building or use permit.
Owner's Name 1 Present Address Phone
3 3 q (2. 3 (2 3 CA Ue CD Rt)° .
System Location
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
!t �- j
f c:�&' < C� tv, Li; t Extewei C3 ✓` , ,
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
! 3 f---/ �- 7 c: t
Required Absorption Area - See Attached�' t,.> (_
5.6 2rN Cr
Special Setback Requirements: 60 G�¢ .>
1,
Date s 4 Inspector jftrlWi 1- -1`
•
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer i AA/ t JL
i'000
Septic Tank Capacity
Septic Tank Manufacturer or Trade Name
f7 . --f:::;> f.
Septic Tank Access within 8" of surface
i•
� k
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
lT..'l, itl,A.G,',.ir.
Adequate compliance with County and State regulations/requirements
Other �y
79 Date �cJ :� inspector �.. �: .f 4` \ ��
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 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 1, Petty Offense ($500.00 fine --•- 6
months in jail or both).
While - APPLICANT Yellow - DEPARTMENT
GARFIELD COUNTY SEPTIC PERMIT APPLICATION
108 8'h Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-82121 Fax: 970-384-3470 / Inspection Line: 970-384-5003
www. gaeld-courtty.cotn
1
j � �6I g1 °cc> `
Parcel No: (this information is available t the asseszorrs office 9 5-9134) 0f\ f 164+sig
Total fees: d a
IP 173
Building Permit #:
((c
Job Address: (if n address has not been assi fned, please provide Cr, Hwy or Street Name & City) or and legal description
%VCS $ -... r •• A ' .- +-•'. • CIZ ..
1
Issue Date:
7(??/
Lot Size: 12 .7o ' Lot No; Block No: Subd./ Exemption:
APPROVAL
DATE
Owner: (property owner)
f /CH*ZP roti.- /5pN
Mailing Address
33cq ere, 3L3
AI C457:46 ep gJ p7
Ph:
8 7 6-2,2 6
Alt Ph:
G-3/9--,s—XVV
Contractor
Mailing Address >
Ph:
Alt Ph:
Engineer:
Mailing Address
Ph:
Alt Ph:
PERMIT REQUEST FOR: New Installation ( ) Alteration ( ) Repair
8
WASTE TYPE: welling ( )Transient Use ( )Commercial or industrial ( )Non- Domestic wastes
( )Other — Describe
9
BUILDING OR SERVICE TYPE: r ' , 4,--
iNumber
Numberof bedrooms
Garbage Grinder ( )Yes 1jNo
_(
10
SOURCE & TYPE OF WATER SUPPLY: 'WELL ( )SPRING ( )STREAM OR CREEK / )CISTERN
If supplied by COMMUNITY WATER, give name of supplier;
11
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System?
► _ // ✓
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
12
GROUND CONDITIONS:
Depth to 15t Ground Water Table UNI< . Percent Ground Slope
13
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:
Septic Tank ( )Aeration Plant ( )Vault ( )Vault Privy ( )Composting Toilet
)Recycling, Potable Use ( }Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet
( }Other- Describe
14
FINAL DISPOSAL BY:
( )Absorption trench, Bed or Pit ( )Underground
( )Wastewater pond 'Other-
Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( Sand filter
Describe e seu.,, 7...6/2.. 3 e9) D - E1 5 > '/'Y1
15
Will effluent be discharged directly into waters of the state? ( )YES pt.00
16
PERCOLATION TEST RESULT: (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
re) I LE
No.3
Na._ � � '
Minutes per inch in hole No.2 Minutes per inch in hole
Name, address & telephone of RPE who made soil
Name, address & telephone of RPE responsible
absorption test:
for design of the system:
17
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 1-'..I action for perjury as .rovided by law. ..
r; NER 1 N'TU• ✓ DATE
STAFF USE ONLY
Permit Fee: 0 D
73 ,
Perk Fee:
1 a 6 .
Total fees: d a
IP 173
Building Permit #:
((c
Septic Permit #:
4(1
1
Issue Date:
7(??/
Building & Planning Dept:
APPROVAL
DATE
The
Equalizer® 36
Chamber
INFILTRATOR
SYSTEMS !NG
Environmental Onsite Wastewater Solutions'
aVoi
The Equalizer 36 Chamber meets special sizing requirements when a
narrow trench is specified. The chamber fits in a 24" wide trench and is
available with 10", 9" and 6" invert end plates to provide a variety ofdesign
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enhances evapotransporation and delivers optimum infiltrative performance.
With 12" of compacted cover, it supports 16,000 lbs/axle, equivalent to an H-
10
-10 AASHTO rating.
The Equalizer 36 Chamber
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delivered in one pickup truck
load and hand -carried into position
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Approved in
The
Equalizer 36
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13.5,1
1" Overlap at Latching Mechanism
The Equalizer 36 Chamber
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100"
Effective Length
nvert End Plate'
Specifications
Size (W x L x H) 22" x. lO0" x 13.5" Weight
Storage. Capacity 70 gal/9.3 tt3
33 Ibs
Louvered Sidewali Height 10
NFILTRATOR SYSTEMS. IND, STANDARD LIMITED WARRANTY
NFILTRATOR SYSTEMS, 1100., ('Infiltrator") STANDARD LIMITED WARFANTY FOR SEPTIC PRODUCTS
a) The structural integ8ty of each chamber and end pi8ie manufactured by ln1i€Irator (OolleclIvely referred to as "Units"), when Instated and operated in a
eachfield of an onsite septic system in accordance with lnfittrators installation instructions. i5 warranted to the original purchaser ("Holder") against detect
ave materials and workmanship for one (1) year from the date upon which a septic permit is issued for the septic system containing the Units; provided
however, that if a septic permit Is not required for the seplk system by applicable law. Me one )1) year warranty period will begin upon Me dale that
nslallalion Of the aeplic system. Commences. In order 10 exercise warranty rights. Holder must notify infiltrator in wilting at its corporate headquarters In
O5d Saybrook. Connecticut. within fifteen 515) days of the alleged defect. Infiltrator sold supply replacement Units for those units determined by In(ltr810r to
8 defective and covered by this Limited Warranty. 1091118ters liabiay spociflcsly excludes the Cost Of removal and/or insta€Iation of the units.
fib) THE 1.M5TE6 WARRANTY AND REMEDIES 1N SU5PARAGRAPH (a) ARE EXCLUSIVE, THERE ARE NO OTHER WARRANTIES WITH RESPECT TO
HE UN5T8, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
c) The Limited Warranty does n01 extend l0 incidental, consequential, specie] or indirect damages. Infiltrator shall not be liable for penalties or liquidated
images, including loss of production and profits. labor and materials. overhead costs or other losses or expenses incurred by the Holler or any third
party Specifically excluded from Limited Warranty coverage is damage t0 the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or
neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the i8 1a11aton instructions: failure to main.
Mtn Ina minimum ground covers set forth in the installation instructions; the placement OI improper materials into t184 system conta5lkng the Units; failure
of the Units or the septic system due to improper siting, Improper sizing. excessive water Usage. improper grease disposal or Improper operation 0r any
other event not caused by lnfillrat01. This Limited Warranty shall be void if the Folder fails to comply with all of the terms set forth in this Limited warranty.
5000e , In no event 5hail Infiltrator be responsible for any loss or damage to the Holder. the Units, or any Ih€rd party resulting from 1nsi3Nation or shipment,
Or from any product liability 018158 of Holder or any third party. For this Limited Warranty to apply, the Units must be installed In accordance 0458 all site
condition required by state and Meal codes, all other appticatt4e laws and infiltrators installation instructions,
id) No representative of Infiltrator has the authority t0 Change this Limited Warranty In any manner whatsoever. or to extend this Limited Warranty.
No warranty applies to any party other than the original H01der,
The above represents the standard Limited Warranty offered by infiltrator. A limited number of slates and counties have different warranty requirements.
Any purchaser of Units should contact 10131135dr's corporate headquarters in Old Saybrook, Connecticut, prior to 08811 01.1Ch808, 10 obtain a Copy of the
eppticab18 warranty and should carefully read that warranty prior to the pssrCrfaso of Units.
Infiltrator Systema does not recommend rn510111ng On5150 Systems Under pavement.
Chambers; must be lnstal*ed aceor5ing t0 manufacturer's instructions. Failure to install according to manufacturer's instructions with void warranty
Infiltrator Systems recommends the use of septic tank filters and laundry Stem with all onsite septic systems
System saying is determined by government regulations.
INFILTRATOR
SYSTEMS I N C
Environmental Onsite Wastewater Solutions'
6 Business Park Road PO. Box 768
Ofd Saybrook, CT 06475
800-221-4436 860-577-7000
FAX 860-577-7001
www.infiltratorsystems.com
1-800-221-4436
For technical assistance, installation instructions or customer service, call Infiltrator Systems at 1-800-221-4436.
U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401.459; 5,511,903; 5,716,163; 5,588,778; 5,839,844
Canadian Patents: 1,329,959; 2,004,564 Other patents pending.
Infiltrator, Equalizer and Sidewinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France.
Infiltrator Systems Inc. is e registered trademark In Mexico.
Contour, MicroLeaching, PotyTuff, SnapLock, CharnberSpacer, PosiLocic, and QuickPfay are trademarks of infiltrator Systems Inc. t5)) 2001 €nfiltrator Systems Inc. Printed in U.S.A
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