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Home My WebLink About01182 r Orr • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 2014 Blake Avenue Glenwood Springs, Colorado 81601 Phone (303) 945 -8241 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT 4f 1182 a building or use permit. Owner Eugene Leven System Location 1176 Cnsinty Rnarl 111, Carhnnflalsa Licensed Installer Conditional Construction approval is hereby granted for a 7M) gallon XX Septic Tank or Aerated treatment unit. Absorption area (or dispersal area) computed as follows: Perc rate of one inch in I 1 minutes requires a minimum of asq. ft. of absorption area per bedroom. w r1 Therefore the no. of bedrooms 2 x 2 sq. ft. minimum requirement = a total of C2._sq. ft. of absorption area. y 31 May we suggest Z. X '-� o • / f/t 10 l 7', / /` Date 1 / . L Z - Inspector 1 1 4 ulZC r ) A —71 FINAL APPROVA SYSTEM: • 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. 11 \ Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. Proper materials and assembly. !< Trade'"n3 "m'e di s p i�tar(9 ae atecatmint u it f 4 / /( q p /Z )( 4 0 r 44c / q /�e cif Adequate absorption (or dispersal) area. 0 4-C Adequate compliance with permit requirements. �^ 0 /.c Adequate compliance with County and State regulations /requirements. Other Date 7/7/15 Inspector 114, ,• X � 11 1A RETAIN WITH RECEIPT RECORDS CISTRUOTI�UN E i1/4 / l k cJ `CONDITIONS: 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, 124 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 I, Petty Offense (5500.00 fine — 6 months in jail or both). Applicant: Green Copy Department: Pink Copy - ----- --- r.u.an ua.aaaa naafi naSaeaaa aaflan 1 INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION PAGE TWO OWNER C e , 7 ADDRESS 5 ` ' R „ ,.,,i -. • 1 12 PHONE 9d4:0 - S 1 c1 p, APPLICANT t ADDRESS PHONE CONTRACTOR C ADDRESS PHONE IS PERMIT FOR: (X) 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 lit . 1— Near ' what ,City or Town _ ...> •) . Lot Size y_$ lira• Legal Description Bohan;,,,; 1'1A,..•,,,r `l C Sn.rxt, WASTES TYPE: (X) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - ( Describe: BUILDING OR SERVICE TYPE: \ �,.s•9,��o,.n� Number of Persons a, Number of Bedrooms A . ( ) Garbage grinder ( ) Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (X) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: If supplied by community water, give name of supplier: GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? TYPE OF INDIVIDUAL 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: (,)() Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: PAGE THREE 0 • WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 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: Aop1icant acknowledges that the_completeness 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 3/ 97.82-- Signed „ sta ► d PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY r • ■ PAGE FOUR 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. I O 1 m I i 1 , \ ■ \\ ■ V 1 • n E ter• i o- i .Date (�1 IY Tester j� Q,1G� - PERCOLATION TEST DATA C Address j 515 fa) (v 3 Profile hole ,, TEST HOLE ill ll2 N3 TIME (Min.) Level Drop Level Drop Level Drop 0 6, 4" &V ' 7/ rl 034" 5 S�r 7 /11 Q 4j � /. 11 h I 10 I i / 4 Q X 1 7 v r1 4 � ' I I 15 y 4 3 / X II ?7 ?if/ 20 9 � l� `I U 1 Ir 3/ 11 7 E 941( " � b Y> C _ jB 25 z 36 % l /r% " z- 8 �z 30 (i / ��o CD /4 /PJ' I y Z 11 35 40 45 50 55 60 Percolation Rate / I minutes per inch.