HomeMy WebLinkAbout01456 l; m
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
2014 Blake Avenu-
Glenwood Springs, • • o
Phone (30 5.8
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I t ' d This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT ;,? / 4145 t' a building or use permit.
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Owner Dere Flora and J.`• : � . y . - - ` t ( j � ) 1 v Y
14350 Hie. 6 and \arachute Colo..
System Location
Licensed Installer Berry Darrah
Conditional Construction approval is hereby granted for a gallon
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal areal 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 x sq. ft. minimum requirement = a total of sq. ft. of absorption area.
May wd suggest
Date 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 r aerated access ports above ground
surface. �i
Proper materials and assembly. � s OG�
Trade name of septic tank or aerated treatment unit. / 257 S A � [
Adequate absorption (or dispersal) area. 7C/ yl ' C
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T Adequate compliance with permit requirements. ` / // OS //'�
Adequate compliance with County and State regulations /requirements. ell i017 e ex 7 31 - {OS, {� 4
` vuryps� 6 1 4/�
Other 3he/86
Date Inspector ���///
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 (S500.00 fine — 6 months in jail or both).
Applicant: Green Copy D.partmant Pink Copy
aaa seaman -l_�
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a� INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
County Official:
OWNER_._Fjoy ere. .. £' J4 A' p,
ADDRESS 14- Sc) ,.% ? '/ /. ArJLUte)(e1. PHONE &SS -7hi9Z
CONTRACTOR_ J/ i 71, �„ ' �
ADDRESS _ /� i �i�f , i Qi>/i i PHONE4,26 /ZR?
PERMIT REQUEST FOR: New Installation (>Q Alteration (X) 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 :ARF/E1. -D
Near what City of Town ////// 1 .317 Lot Size
Legal Description T to 5,4 , , 95 jl /�gf Skin fi %A 4
WASTES TYPE: ( ) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Noi- t
( Other - Describe T PL. . - - ; 0, 4.
BUILDING OR SERVICE TYPE: Dn> 'J ' Wzfr'wa{724' 1-
Number of bedrooms Number of persons
( ) Garbage grinder ( ) Automatic washer ( ) Dishwasher See RtAc4e&ca' '(i 'bnS
SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system:
If supplied by community water, give name or supplier: Al A
GROUND CONDITIONS:
Depth to bedrock: (yeeLtar tA 8 ft%
Depth to first Ground Water Table: V )p Mljp maw) 2,Q ft.
Percent ground slope: s, • 40 • 0.5 °.:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 5
Was an effort made to connect to community system? C , / r;, • -P„ 0, ,,,/ , -" e
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:
( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
Vv Other - Describe: , , at` 2,n. X Ali. d• -- e- < / /. .,ags eh(I tiS •
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE ? A/C)
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sciit PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.)
Minutes per inch in hole No. 1 Minutes
Minutes per inch in hole No. 3
per inch in hole No. 2 ,,Minutes.0 /5 per inch in hole No. /
Nance, address and telephone of RPE who made soil absorption tests: /Sryna
Name, address and telephone f RPE responsible for design of the system: ggthf d aphithr
S4 - 309 A14, Bin tekh 4, 49/b35 tt #625-Ze191 4,-)
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
statements made,
represented true w and correct
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 g.. ,' f.7�.S Signed 2 t y a l
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
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See Aka phn 1 //11 /9c5,
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