HomeMy WebLinkAboutOriginal OWTS PermitGARFIELD COUNTY AUILDING AND SANITATION DEPARTMENT fl , ,.
2014 Blake Avenue
Glenwood Springs, Colorado 81601
Phone (303) 945-8241
INDIVIDUAL SEWAGE DISPOSAL PERMIT r This does notconstitt1366abuildingorusepear
Owner L nda Twamle
System Location 3548 Co nt Road 226 Rifle
Licensed Installer Owner
r Conditional Construction approval is hereby granted for a _ 1 . (100
X gallon
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in -_minutes requires a minimum of
sq. ft. of absorption area per bedroom.Therefore the no. of bedrooms 3
x -ate sq. ft. minimum requirement = a total of 5216 2 sq, ft. of absorption area.e va we suggest car '.X -S "i ' _' . - '2• =z° 65e2? u.>/ T- . e.Yo oie. 0 loS X -er rSe - c >/ sfl s r
Date 8 y G el / 77 a4DlAT - erno.rs c'= .gG PeD
Inspector
FINAL APPROVAL OF SYSTEM:
No system shall be deemed to,be in compliance with the Sewage Disposal Laws until the assembledinganypart.
ed system is approved prior to cover-
a Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above groundG
surface.
Proper materials and assembly.
IC '` ilOade name of septic tank or aerated treatment unit.
Adequate absorption (or dispersal) area. S rXloS V
Adequate compliance with permit requirements.
Adequate compliance with County and State regulations /requirements.
Other
Inspector Z
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITECONDITIONS:
1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations, adopted pursuant to au-thority granted in 66-44-4, CRS 1963, amended 66 -3 -14, CRS 1963.
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 viola-tion of a requirement of the permit and cause for both legal action and revocation of the permit.3. Section III, 3.24 requires any person who constructs, alters, or installs an individual sewage disposal system in a manner which in-volves 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).
Apprloant: Green Copy Department: Pink COPY
Application
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
ter County Official:
OWNER
ADDRESS 0s i l PHONE 2fr...20,/t-rs
CONTRACTOR d
ADDRESS t a F -
PHONE
PERMIT REQUEST FOR: N•w 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: County
Near what City of Town Lot Size
Legal Description
WASTES TYPE:11 . Dwelling Transient Use
Commercial or Institutional Non - domestic Wastes
Other - Describe
BUILDING OR SERVICE TYPE:
Number of bedrooms 3 Number of persons
Garbage grinder T'Autoriatic washer Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: well f spring stream or creek (E= tom`)
Give depth of all wells within 180 feet of system:41//'
If supplied by community water, give name or supplier:VA
GROUND CONDITIONS:
Depth to bedrock:l.4221 -(4Tr
Depth to first Ground Water Table:Aci
Percent ground slope:li S'7ei'9
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:4 77242.6.
Was an effort made to connect to community system?7
TYPE OF INDI IDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:Septic Tank Aeration Plant Vault
Vault Privy Composting Toilet Recycling, potable use
Pit Privy Incineration Toilet Recycling, other use
Chemical Toilet Other - Describe:
FINAL DISPOSAL BY:
41 Trench, Bed or Pit Evapotranspiration
Underground Dispersal Sand Filter
Above Ground Dispersal Wastewater Pond
Other - Describe:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE ?_ rid
Page 2
S RCOLATION 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 OCY Signed r7Klyidef./
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
lue a
utJ2 1
AO trasfre Vern 5;
hoair
Page 3
etv l Q S