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HomeMy WebLinkAbout01229 v GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT f 2014 Blake Avenue ( 7 { i Glenwood Springs, Colorado 81601 1 i Phone (303) 945-8241 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT O 1729 a building or use permit, Owner System Location OR96 266 County Reed. Rifle I nt 7 1st Filing Asgard Licensed Installer Village Plumbing & Heating • Conditional Construction approval is hereby granted for a 1.250 gallon XX Septic Tank or Aerated treatment unit. Absorption area (or dispersal area) computed as follows: Perc rate of one inch in t.0 minutes requires a minimum of 5Z3 sq. ft. of absorption area per bedroom. Therefore the no. of bedrooms 4 x z3 sq. ft. minimum requirement = a total of ( Zq 1 sq. ft. of absorption area. May we suggest I f� X 72. Y 3 Date a /„...• Z / i — Ins p e ctor Rrj) Gk , a -r +; -t 'Li " -1 „ FINAL APPROVAL OF 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. 0 Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground " C.2 I ' surface. � Proper materials and assembly. _ o Trade name of septic tank or aerated treatment unit. I IZ G� r^^ s K---- I \J Adequate absorption (or dispersal) area. / 8 x 76 i 3 / ©k Adequate compliance with permit requirements. d r — Adequate compliance with County and State regulations /requirements. Other r • Date • • • el Inspector J \ ..... !� e� / s • RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *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, 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 (6500.00 fine — 6 months in jail or both). Applicant: Green Copy Department: Pink Copy e5' ' r L R t14 E.? 1140 • o _7 i /ate /54----7 Ali��i'.I SS PHONE 7j APPLICANT T C_a _._ CnNak -_ ADDRESS - _ - _ - T -0 6-efr_a3S ---- -ITk4021,Cee6 PHONE (c .5 16 IP CONTRACTOR :Lop, ^5 ADDRESS PHONE 1S [ E2MIT FOR: ( 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 'n test holes. - LOCAT ION OF PROPOSED FACILITY:. County _ - n L itt Near. what.City or Town 1 � ' Lot Size _ y fo I egal Description s '_ r _ �� " ' � R - �_ __ WASTES TYPE: (? Dwelling ( ) Transient Use ( ) Commercial or- Lis titutional ( ) Non - domestic Wastes ( ) Other - Describe: '/ BUILDING OR SERVICE ` ?) V TYPE: S Number of Persons �7 it - Number of Bedrooms 'T- (;'Garbaye grinder (utomatic washer ( >) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ()1 well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: __ _ 141 _____________ _____ If supplied by community water, give name of supplier: _ GROUND CONDITIONS: Depth to bedrock: $� _ - -_ —_ Depth to first Ground Water Table: \ 14 0 1 - - - - - -- Percent ground slope: _ _ ' oz), - - - -- DISTANCE TO NEAREST COMMUNITY SEl _R SYSTEM: Was an effort made to connect to community system? No -- TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: . rig - Septic Tank ( ) Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use ( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use • ( ) Chemical Toilet ( ) Other - Describe: _ FINAL DI SPOSAL BY: ( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration • ( Underground Dispersal ( ) Sand Filter, ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: — d I,iIL f 0]SCH LD P_r CTLY INTO S OF i f S1Al[? � — 1 ,� SYSTEM IS I F SIFNLO FOR C„ I LO'IS PLR 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: i 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_completenes . 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 b 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 per as provided by law. Date e ,?1),_ Signed �!'1 _ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY • 1 .s' [[01 � 1)3 HLSIGN FLAIURLS: Include by measured distance location of wells, springs, potable water supply fir: s, cisterns, buildings, property lines, subsoil drains, lake, water course, stream, dry gulch and show location of proposed system by direction and distance from d,;e11ing or other fixed reference object, and additional suhrnissions in support of this ,appl ication such . as data, plans, specifications, statements and cor,rni Went s. Sibtrtss • 4 53 � 75 • 7_o • • • Date / _ - Tester j"� PERCOLATION TEST DATA Address n 8 / (0 CJ 246 Profile hole L:a4w4I • TEST HOLE *1 #2 #3 TIME (Min.) Level Drop Level Drop Level Drop 9 3/r� 8 5 0 10 8 5 /6 r( � 71, »" a % , h 15 8 ; -- ( 4 � I/ � z " i /f3 //b 20 p �Ln S" 3/n 4/ r s 76 /r 25 ; 4 3 H u 4 p _ / 4 ( if J /h 30 yt )ff %ri / �r �� 7 35 v Lv 40 45 50 55 60 Percolation Rate minutes per inch.