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Home My WebLink About01193 . r• tARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT • 2014 Blake Avenue Glenwood Springs, Colorado 81601 Phone (303) 945-8241 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT ;tt 1193 a building or use permit. Owner Mike W. Hughes System Location 9225 331 Road Silt • Licensed Installer SAme 0 Conditional Construction approval is hereby granted for a anon • / XXV 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 tWr) x sq. ft. minimum requirement = a total of sq. ft. of absorption area. May we suggest • Date Inspector • FINAL APPROVAL OF SYSTEM: No system shall be dttemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to cover- ing any part. Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. Proper materials and assembly. Trade name of septic tank or aerated treatment unit. Adequate absorption (or dispersal) area. Adequate compliance with permit requirements. Adequate compliance with County and State regulations /requirements. Other Date Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE "CONDITIONS: 1. Atl 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 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 I, Petty Offense (5500.00 fine — 6 months in jail or both). Applicant: Green Copy Department: Pink Copy INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION PAGE TWO OWNER if; d ADDRESS PHONE C7 APPLICANT // esar ADDRESS .. a PHONE CONTRACTOR ADDRESS PHONE IS PERMIT FOR: drew 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 inn test hole �J LOCATION OF PROPOSED FACILITY: County (' Near.. what. City or Town Lot Size Legal Description [f I ; / �F 1 ' ' - . tv ' 1 0 1 , . " • j Cz ' i ( ZePti 1 4 WASTES TYPE: welling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe: BUILDING OR SERVICE TYPE: Number of Persons Number of Bedrooms rra�tt ( ) Garbage grinder CV was er ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: 4 j-) 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: �O 6 ? Percent ground slope:n DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: ie 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, Wor Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: PAGE THREE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? SYSTEM IS DESIGNED FOR —2 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 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 nay 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 7 So— Signed „ se Ale PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY aka- 11�. 3/44 It PAGE FOUR r . 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. • a 1 d l/. F. G. & S. SEPTIC SERVICE FRED QIOMI BOX 844. SILT, CO 81658 . Customer's Phone ` / / C Order No. No. ; Dat 19 Name /nom e i / 1 O Address 99P,1" (. ea/ ? ,/ • ® CASH C.O.D. CHARGE ON ACCT. MDSE. RETD. PAID OUT OuEnIlty - DESC /0 q _1 44, ► It( nA 2144 7 6 - to 4 3 Ael (v0-0-414 ' a _ TOTA, , , .� • ALL claims and retur L. c `l r .. 4411 ,� bil Recd rx, .` . // ..f 20003 r, ^(t .1: . /_ f PRINTED IN USA. • F. G. & S. SEPTIC SERVICE FRED GIOMI BOX 844 • SILT, CO 81652 Customer's Phone JO /? �� Order No. No Dat / 19 ( 3 : — .1 Name / '�� Address N ec R3/ r /SOLD SY CASH C 0 0 CHARGE ON ACCT. MDSE. RETD. PAID OUT Quantity DESCRIPTION PRICE AMOUNT p wfr'c - -.) //n 00 ......- AIL var . - .... TAX �` TOTAL ,, D O V ALL claims and recur . t j bill. p Tr� ; S.. . 20003 •r (llj PRINTED IN USA