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HomeMy WebLinkAbout01367 V . I . , GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT I l i 2014 Blake Avenue Glenwood Springs, Colorado 81601 r Phone (303) 945.8P41 INDIVIDUAL SEWAGE DISPOSAL PERMIT +n 136 This does not constitute a building or use permit. Owner__,_________ • System Location _ Count Road 100 SE NE Licensed installer Df Section 25 T75 R88W * Conditional Construction a i c • 75 0 hereby granted for a PProval is h '-- -- - -- gallon —2C2_ Septic Tank or Aerated treatment unit. Absorption area (or dispersal area) computed as follows: Perc rate of one inch in U - -- minutes requires a minimum of Zee- Therefore the no, of bedrooms , 3 sq. ft. of absorption area per bedroom. x —'� sq. ft. minimum requirement - - May we suggest ,S�_ -Zr_- a total of Jq {t. of absorption area. Date Inspector FINAL APPROVAL OF SYSTEM: _ r r No system compliance with the Sewage Disposal P Y m shall be deemed to be in a osal 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. �j Proper materials and assssembly /� _____ Trade nEm eo f © pti ' n ` Qj uni _ ( ��� , • ( _04^ 7l'° or aerated treatment unit. - he- 2 �te�„ -•-- Adequate absorption (or dispersal) area. ' / -' — Adequate compliance with permit requirements. Adequate compliance with County and State regulations /requirements. • -__---L,.., \ -' Other Date < / Q Inspect• j . L RETAIN WITH RECEIPT RECORD ONST Air 'CONDITIONS: 1. All installation must comply with all requirements of the County Individual Sewage Dis posal 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 9 i i tio Connection is valid use with any dwelling or stru not a pproved by the Building and Zoning office shall automat tion of a requirement of the permit and cause for both legal action and revocation of the C permit. zoning and building requirements. be a viola- 3. Section III, 3.24 requires any person who constructs, alters, or installs an individual sewage disposal s volves a knowing and material variation from the terms or specifications contained in the application of Petty Offense ($500.00 fine - 6 months in jail or both). system in a manner which in- permit commits a Class 1, Applicant; Green Copy Department: Pink Copy ' Hpp iication INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by OWNER i` -l�k Morel I' County Official: RDcz -v n �_ /� I S t rn kT C �O -e ADDRESSid6 S'2 Laar' .sI C(etliuooJ PHONE9ff 8783 p CONTRACTOR g ,} G- wi c-to tdsr+w -c14 ADDRESS PHONE ° PERMIT REQUEST FOR: ()C) New Installation ( ) Alteration ( ) Repair Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes. (See page 4.) LOCATION OF PROPOSED FACILITY: County C a rfre /j Near what City of Town r/,r6P/ndrt(r Lot Size /3.55 gcre Legal Description A carve. rrc In>r.d ,.>h.r \- ; n rS 4 SE ky \II= WASTES TYPE: (u ) Dwe ling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: rip 6r /e gewie Number of bedrooms4j 3 1441/4 Number of persons f ( ) Garbage grinder (y) Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ( ) well ( ) spring ( ) stream or creek e/ Give depth of all wells within 180 feet of system: 4 / WP f/ 7` 0s If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: 2647 I Depth to first Ground Water Table: 3,S-0 Percent ground slope: ,S % DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 3 tats /PS Was an effort made to connect to community system? ho 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: (X) Absorption Trench, Bed or Pit ( ) Evapotranspiration =. ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? Pk 6 Page 2 SQL PERCOLATIO TE4T RESULTS: (To be completed by Registered Professional Engineer.) 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 same for purposes of issuing the permit applied for herein. I further under- stand 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- jury as provided by law. Date — (f 7 Signed t�z < / `AC Y. PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY £:aF o t 1 — - -f4.c o iJ „ s ic • •. fo AriucWGy flirty ref+ Page 3 • MIS • • • 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 / r 66' \ o i.� 50 /ao EciO' p ro ft' (:'uc.� On • Page 4