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Home My WebLink About01181 /774- - --7 / ° - / , � � i i � - G tRFIELD COUNTY BUILDING AND SANITATION DEPARTMENT l � � � j � � �- 2014 Blake Avenue /, c (� ! Glenwood Springs, Colorado 81601 r L, �' � �� Phone (303) 945-8241 PERC RATE KNOWN - PERMIT FEE ONLY This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT ,in 1 181 a building or use permit. Owner William & Josephine Lopez Sr. System Location 21/2 miles south of S i l t Licensed Installer Conditional Construction approval is hereby granted for a 1 .000 gallon XX Septic Tank or Aerated treatment unit. Absorption area (or dispersal ?_ l area) computed as follows: �t L (p al Perc rate of one inch in �j O minutes requ res minimum of 7 sq. ft. of absorr are per bedroom. Therefore the no. of bedrooms __ x • ft. minimum requirement = a total of (.S2r�z_sq- ft. of absorption area. May we suggest 0 /8 P A-- 7� X 3 ? C Date 7/7/(12 Inspector .40 ' . 1 N, /o �� // FINAL APPROVAL OF SYSTEM: / "v / e /1/4A / # a f _. , " , No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to cover- ing anny� part. Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. 0 < Pro er mater Is and a embly. / i an /00 0gq,/ B Tra name of septic tank or aerate trea unit. (� Ar Adequate absorption (or dispersal) area. Adequate compliance with permit requirements. • 17K Adequate compliance with County and State regulations /requirements. Other Date / 7 �� Inspector , i - 'L-d !/ :--T-rf Now •% RETAIN WITH RECEIPT RECORD • ON% RUCTIO ITE S � "CONDITIONS: ' 1. All installation must comply with all requirements of the County Individual SevVage 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 111, 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). Applicant: Green Copy Department: Pink Copy • INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION PAGE TWO OWNER ( /1.Y4M G/, v 4/pc/a lii-pc,. p Lop t_ z St-• N• ADDRESS l a 7 Ao M e 14/7: sizit PHONE e37G -x29 S" APPLICANT ADDRESS PHONE CQNTRACTOR . `i .Q -in r ADDRESS PHONE IS PERMIT FOR: (sC) New Installation ( ) Alteration ( ) Repair Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable buildings, location of potable water wells, soil percolation test holes, soil profiles in test holes. LOCATION OF PROPOSED FACILITY: County (;2,71.4;;44 Adrrd. to 0292 .roumtvRtq 3/l Near .. what City or Town a % raa/ S<. '4 A65 Lot Size ,2 37 1 Legal Description WASTES TYPE: V) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe: BUILDING OR SERVICE TYPE: J,,,,,4,,,,4 Number of Persons /L Number of Bedrooms ' ( ) Garbage grinder (>C) Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ()() well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: 0 ) Et, If supplied by community water, give name of supplier: GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: a ;` 91 - Percent ground slope: 2 O l-g_, 9s /0 F� DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 2 • s 47/L6d Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (x) 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: (>1 Absorption Trench, Bed or Pit ( ) Evapotranspiration 491rUnderground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: 111111L . PAGE THREE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 44-0 _ SYSTEM IS DESIGNED FOR GALLONS PER DAY If the system is to be designed by a Registered Professional Engineer (RPE), state rate of absorption in test holes shown on the location map, in minutes per inch of drop in water level after holes have been soaked for 24 hours: SOIL PERCOLATION TEST RESULTS: 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 ack__nowledges, 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 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. Date S - - /0 — 2 Signed e4 /��.�cuti ri 4• I S % o,C fir PLEASE DRAW AN ACCURATE MAP TO YOUR PROP RTY ELI eS «�. ` ` . O III , 0 -1 s e I 3 ' I;d 7- y k Icy O• o » 4c - °PPS T� \ L_ 5q PAGE FOUR ca PLOT PLAN AND DESIGN FEATURES: 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. Nor tit Pro I'. L,:1.., .X v w 2 w w cr, . f 3 L ead. t �s� ac' ir, e g 7'• , L v Se?. C f <zv M 54/00X d 4- \y LP . 1 y_t oS6 _p — — — � I �, _ — r.,v -hfy I < S tA•449 G4 ^e \ 09 j a a� l 3!l t,,µ.es APPPK, Raft % NSW t P rap. L,1., P ea Me •