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Home My WebLink About01263 y . r y .l�nin'A�` - ]r V N,mv:r..y �.� m �.. . -... +.- .v rd"'XA Fn-. T'`*, f"F , f. YM •`µ.2x! r - m GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 1 2014 Blake Avenue Glenwood Springs, Colorado 81601 Phone (303) 945-8241 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT " 1263 a building or use permit. Owner Ronald Maynard yy System Location Parcel situated in the SE NE of SW Section 34 T ? County Road 331 (Dry Hollow) Licensed Installer Owner • Conditional Construction approval is hereby granted for a w•4feFiii gallon /e all ? XXX Septic Tank or Aerated treatment unit. Absorption area (or dispersal area) computed as follows: �r Perc rate of one inch in ,,[) minutes requires minimum of Z7 sq. ft. of absorption area per bedroom. Therefore the no. of bedrooms 4 x Z 2 sq. ft. minimum requirement = a total of/ 0/ 6 3 'iii.ft. of absorption area. May we suggest / ',X 76 / c 3 / Sez t ct Date — 9 � '' Inspector 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. Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. qq,,��,, Proper materials and assembly. ��,,,,,, Ns!_Pfrade name of septic tank or aerated treatment unit. O ` Adequate absorption (or dispersal) area. (74- Adequate compliance with permit requirements. Adequate compliance with County and State regulations /requirements. Other / Date tea / "/ tom Inspector C4��_" `-/J A 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 ($500.00 fine — 6 months in jail or both). Applicant: Green Copy Department: Plnk Copy INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION PAGE TWO 1 OWNER Ronrtid fl/aa,gno. —o/ ADDRESS l3n ((510 1'41- 9, -Q-, S16.5 PHONE 6.,5 APPLICANT -„-, e . ADDRESS S ja,, -,-e PHONE ,S a.m-, -c CONTRACTOR ,.nu,v4 72 f ADDRESS PHONE IS PERMIT 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 in test holes. LOCATION OF PROPOSED FACILITY: County il+PL;Pa Near what City or Town 51 /f Lot Size%. /3ac -, Legal l Description £ -cein4 /cad 51Mc.4er4 in. Tali�n p C[) 1"r_ 1 Merir1iah in an.6 rid Cv-n+ /4 -h I laln WASTES TYPE: / (.>C1 Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe: II�� \\ BUILDING OR SERVICE TYPE: / 'AiJen/-;,,,/ ((nape) Number of Persons ‘,0 Number of Bedrooms 4/ -- ( ) Garbage grinder (X) Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: A /onv loilhin {/v3)-ciis /onc,t, If supplied by community water, give name of supplier: GROUND CONDITIONS: Depth to bedrock: (j Depth to first Ground Water Table: /80 r � Percent ground slope: b DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: S S Was an effort made to connect to community system? 410 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: 'NAL DISPOSAL BY: (.\-) Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ) Above Ground Dispersal ( ) Wastewater Pond ) Other - Describe: INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION PAGE TWO OWNER Reno Jct flty ,7a.re/ ADDRESS - Bin MI g+ie. — Cis SVC,s - D — PHONE 6 - -- 306 . 0 APPLICANT _1, ADDRESS c ja.n-, -e, PHONE ,S -e_ CONTRACTOR ADDRESS PHONE IS PERMIT 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 in test holes. LOCATION OF PROPOSED FACILITY: County amp/ r/ Near. what City or Town Jill Lot SizeaS •/3 . Legal Description , i f .,. 5r 4, - vl�F zsin c$ &c.J 7atrm� G ' I'ri Mrridinra In Conrr-+rir( Ceti ( WASTES TYPE: / (.)-C1 Dwelling / ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe: (' BUILDING OR SERVICE TYPE: 5a /gi Number of Persons 6 Number of Bedrooms ./ ( ) Garbage grinder ()Q Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: n /one 1piihin fkaLL5kmc.e If supplied by community water, give name of supplier: GROUND CONDITIONS: Depth to bedrock: (lam _� Depth to first Ground Water Table: /80 &?> Percent ground slope: 0 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: S' -,rjeS _ Was an effort made to connect to community system? rf /p TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( K 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 i WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE ? ALL__ _____ _ 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 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 sane 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 ? - g 2 Signed /i,.4.4. A&(&.... 4 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY SL- NEk i "271-01 C �� PAGE FOUR J 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 corxnitments. S 1 k 4 A `∎ y i 0) N