HomeMy WebLinkAbout01626 ,.• GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT . "A— 1 626 a building or use permit.
Carl Wittier
Owner
System Location _ 1028 St. Hwy 325, Rifle
Licensed Installer CM
* Conditional Construction approval is hereby granted for a /0!', 0 gallon
—._Y Septic Tank or _ Aerated treatment unit.
Absorption area for dispersal area) computed as follows:
Perc rate of one inch in _Ai.__ minutes requires a minimum of 3, �j / -y
sq. ft. of absorption ' area
/ LJ'Lsper bedroom.
Therefore the no. of bedrooms _..�_ es
x 3 V Z1. � ft. minimum requirement = a total of q. ft. of absorption area.
May we suggest: s43 a t r ec`uc Q , 2-0A 14'),- 4 o 9cef -4 ay c yr • is der = f a rcO•, /'7
/2 , 7Q ' X 3 deep or /8
e t K CZ _ !/(/ 'PC 3 `deep O
Date__ ____ / - . Inspector,/ ,�`_ � /*
FINAL APPFVAL OF SYSTEM: G "'+
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.
o v Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
1j./29______
surface.
Proper materials and assembly.
Q G e Trad apeic tank or aerated treatment unit.
2 .1 dequate on lor dispel sal
A.----)__ Adequate compliance with permit requirements.
v _ Adequate cornpliance with County and State regulations /requirements.
Other
— e� / I
Date .2 ' / `__ _.. —_ ___._.. _— _.__ -- Inspector _..qL�/c s4 _— ______.
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
`CONDITIONS:
1. All Installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems
Chapter 25, Article 10 C.R.S. 1973, Revised 1984.
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 violation of a requirement of the permit and cause for both legal action and revocation of the permit.
3. Any person who constructs, alters, or Installs an Individual sewage disposal system In a manner which involves a knowing
and material variation from the terms or specifications contained In the application of permit commits a Class t, Petty Offense
($500.00 tine — 6 months In Jail or both.).
Applicant: Green Copy Department: Pink Copy
Application
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
y
- County Official:
'OWNER Ca rI (j1111,I, P,c
ADDRESS 019,5— 42g7 R g i ck PHONE (02,5—fib
CONTRACTOR £k ,q ee.
ADORESS/-o Syfrz1 /az,sittfwyea5 PHONE
PERMIT REQUEST FOR: ( New Installation _F�
Attach separate sheets or report showing entire area 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 r , e �d
Near what City of Town l' -Y Lot Size
Legal Description
WASTES TYPE: ( ✓) Dwelling
( ) Transient Use
( ) Commercial or Institutional ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE:
N tuber of bedrooms -3 Number of persons Li
arbage grinder ()() Automatic washer ( )C) Dishwasher
SOURCE ND 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:
GROUND CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table:
Percent ground slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
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, 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?
Page 2 .
4O�L VERCOLATION TEST 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:
fu Applicant acknowledges s completeness the application
dadditionaltestsandreportsas
ayberequired
bythelocal
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
and conditions deemed
adopted underArticle10, Titlle25, C.R.S. S as amended. The undersigned hereby certifies that all statements made, information and reports submitted herewith and required to be
submitted
and will be
on by of s health in evaluating the same for purposes of issuing the permit applied for herein. 1 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 (//- Signed _ • ..�iL L=
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
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