HomeMy WebLinkAbout01652 a.
• w GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81801
Phone (303) 945 -8212
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REPAIR
____ n This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT f. ° 2 abuildi n9 or us permit.
Owner tthr]fl ;wviMs b Intro l ' A/ain 40 iZ r. /4 - //Agon .C // , U 4
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System LocatiorLLtf 5, Tick_ R Mk ('rnek fitrrlivisinn — 0051 nrrrwnx'.hen trail
Licensed Installer ___ `S' A. " tin 8 /A/ 4
Conditional Construction approval is hereby granted for a gallon ETin 5,,,,.;_j 7;,,,-. k ./„ ,. e w t, r Ir , .
- - -. Septic Tank or _ Aerated treatment unit. ti�g peril/111- /77101,>
Absorption area (or dispersal area computed as follows:
2 0 i Z 3 .fri
' e inn f ' e r tvt I 'I" I I C..l 0 'a
Perc rate of one inch in minutes requires a minimum of J sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms 2 x z 3 sq. ft. minimum requirement = a total of ft. of absorption area.
/ A • >t r /41 / /t1r //y itUn t. /.f , ' , 3. '7 , s.' -
May we suggest: V' 4-P � Yy -.-e I ,. Z e' r /e'ferw, c'( C4 1" f 'U
[ �/ �"�'. �1 e n- &A. r'h[vuf t,
Date —3 e B Inspector ' l l2� /!i .-7tA-4A _
FINAL APPROVAL OF SYSTEM: /
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No system shall be deemed to be in compliance with the Sewage Disksal Laws until the assembled system is ,, approved prior to cover-
ing any part .
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L E A / S Tr 4j Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
r' surface.
Proper materials and assembly.
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Trade name of septic tank or aerated treatment unit. r / /
/G /'/i Ir t a r.r / a G'.r , / i� % /C ( / '. r (/ /L.' /47 c elm /,/
iJ PC ' Adequate absorption (or dispersal) area. 5 / /
/� 1 42 l: / 2. X /¢dr/1 di j/( e /l :t PA•arTO
/V Adequate compliance with permit requirements.
0 i''' ' `— Adequate compliance with County and State regulations /requirements.
_ Other r�
Date _. i0A /U g _._ _ Inspector --� - r, �/ /
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RETAIN WITH RECEIPT RECORDS AT/CONSTRUCTION SITE (l
'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 I, Petty Offense
(5500.00 fine — 8 months In jail or both.).
Applicant: Green Copy Department: Pink Copy
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INDICATE BELOW THE LOCATION OF YOUR BUILDINGS, WATER SUPPLY AND DISTRI-
:U •N L `ES, R AMS, RRIG' IN DI CH • WI , • 1 :11', '
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(TO BE RETURNED TO HEALTH DEPT.)
- _ K£C €(V ED APP r
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t ; GARFIELD COUNTY BUILDING AN SANITATION DEPARTMENT 2 t -' ib8
2014 Blake Avenue "
Glenwood Springs, Colorado 81601
Phone (303) 945.8241 11`
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r .r' ti of r $ -
t .- -^? ' This does not constltute
INDIVIDUAL SEWAGE DlSPOSA PERMIT o� fly; -f ; 'K • , r r 4v{ a buildingbr'gse "p'e' i1
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F �w .$JL'°..�',
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OwneYtY x ' t Timber :R1 a `rf)RS • Y Ua �!K? L Qe M J r ? t r a ` }
. ,�•. .Ie � 4'r/s> a 4 k5 � w. ?S� r l ' Y t
x 1 se4 .r, y., nz" - y'"• - .,'r " 4, t`.�r':i'ii ,.xtle, i ;:F x ::
f. a i ! + A � 3f•. r £ > > .r i
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System L ocation dot 5 8, beVeloprtient; Jpw 5��(e •�` ij e '
' < ` 4 7';4.l 'A . +` 3 `E �'r °Y �� T. -fi�Y + $r't G lv.; t., fif. n't7t +'": ' �- it rt } r ` �rt�
Se J t ,-. f ' t ti< c +F3'r 1 �" •3 f '} ,•- s' a '( r ?'' } v •' A r > n sf n. k
Licen d- nstaller •<+ �•` ,4 p. f, ,i t* #`- t� -. t . .r i
7 `� Z � '( ••s :,' � f;' r s ',f�<r ri ��
t akr• t rrt Y`t `@7`C .r' y� ° a"x�w y }F i
t) s` ^ n Y] + - �` v.
cond +'G•'� •rf& ft' ,� fora t:7C 1., Y >t r,r O y� r SW �:c a Cr �Z d.r'r5 L {h'}�('
„ itrAona�yconstfuctionapprova�tsherebygranted �gal(on�'"'�\'r^3kt��4.
rs;'Tyr r
`"' '� ^F' f •, ter• M %
W�Itl
tl�Seeptic Tan orti ;' Aerated treatment unit 3 9 11 Y !
.. y M�.k ,.v'.� 4y't'ls�Y. °'Y. ,R <�. fi �
[Ye * '�'+>r .S.nm{> i.:. y . .,,r r�r CY j1Y. ? � r�r h•";
Absorption area (or dispersal area) computed as follows
Perc rate of one inch m?0`,s i
mjnp s requires a minimum of Z /0 sq f[ of absorption are per bedroom.
Therefore the no of bedrooms 2 - �x 2 ,/ 0 sq ft :'minimum requuement= a total of ft of absorphorc� er a "� �
` 1� /' � ��x �� d•.l. ° a d•
Maywesuggest ,•/ /'rte )2Cjyb c/e e,p l y ._ l �.
Date /l> / �!� d; z � . t t � .r' +, +ins pector [��Ii r r d/ � dS�L/ / /I 1
£ .c L J '°- "'. <� t �b.,e•. + ? Fi' S 4,"
FINAL APPflQV`A O
•. SYSTEM � T + '� -�`� °''a ;�` ri �F....•n -,,.�� �. � ,��
"� .3 f ..x{rfi`r`3 %: ks, Teets � ' k'+'•. ,y . Y `pI r Y` �•t�'f v s]-"•i �:+ r pP ? #4
Y °h ° J • `s i.�L+ tt e' +f� 32. ra.n r : . x x Y u 'k r
Y { No fystem shall fie tYeemed fo ber �e w u 1 ' ti .s e F.
e,a p i rNCe� t}�3fi wage Aisposai aws pnUlt eassein e. s
n anypart � .,& s� s � X -.e+ ,. <y +�- ., k��` � .c•� i+ - w < $! � efn,Frapproved pr or' ;ti t;tw¢
ng
3 - n v j r t' - xi : r i ',ya �.. . uu_ y /ne ' w .,M�a ;
�ir (t) /�--'-'� pE�3irt'TF�F�?{��1 � � -' �r?�i»�°"rF a t r�. . L •,'� t i.:, �
? � lan�AV�1 i n 1t2 ro und surface or aerated access p .l ` " abo e � r a i W.?'
r Septic lanka for inspecuo andz�eanmg withm�l2 o�- groorts above groan. Y
F 4.: ... �rface 'tr ii a- +isv�t"[ h \Y$ "} n P •:3 .r i r r 3 >> - .s� + - r a
a' a: ' :'9f t Y �. w, S 'x g� r "tti '� ..
titatenalsagr}-arse `a : F� Ott rxseY.� , .� •t� • ,•�' -t v�u
v.s ,
nluly i ;ry + f L u s , I L
> s ! 4._.d ; Proper
at F"•,I "^I}"2& _ 0 V W4 ( � F 'tt�(4 T� W� :!�N .
-77 Tradena raLa men u pi� S� ��, f ,r +lS''r i
f�zf < i, z i..s�i��. r �swa �,�•�
f�
Adequate absorption .r dispersal) area ; y r (. i t -rr
f u t te
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Adequate compliarice with permit requirements � " ham , ' �Y.
1-� +1 •t,� f i r t4 ♦ r 4 } K •4 `�!` r '..
/r. S 7nt r. S h6 1 K r �-n (
Adequate compliance with County and Slate regulations /requirements �� r
Other < .r�
Date �1PF `' Inpe V » .
e sctor � (t Y't -
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' RETAIN WITH RECEIPT RECORDS AT CONSTR TION SITE
Lw lt , > >, i , J ,f -" r ° "t'•n` rlf ('�� t
CONDITIONS f
3 1 : All installation _must comply wixfy�l1,•regmrements of the County Individual' Sewage Disposal Regulations, adopted pursuant to au
thority granted 'n66444 CR$$ 1963 amended 66- 3�14;;CRS "1963: `> h t • �j f .,C i ,{
`l. This permit is valid only for connectlon�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'recuirement of the permit and cause for both legal action and revocation of the permit2 ,, :ZE +
3. Section 111, 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 1
Petty Offe?Fse (5500 00 fine 6 months m jail or both). i. _ - r
` t" t > � i 'r a r ' ��- x F- t +»
:Appilcent: Green Copy Department Pink Copy • . a ,.+ ,—
.n •.n.. .. wwv. rn �� . �� v " � N�` MrH` r�` iv nM�• r/` •.•vWV�w�r/.,w. +w ---- -- - -� `
(TO BE RETURNED TO HEALTH DEPT.)
,' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval
OWNER. Work/ 5-2c._ County Official:
ADDRESS 6. S. PHONE ire / ?^ e
CONTRACTOR d - t'/,,,,, b ,, t � no ! ` Q
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ADDRESS
�i�� PHONE
PERMIT REQUEST FOR: ( ) New Installation ( vg (✓) 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 rc�f e/c/
Near what City of Town / (GS � f� ( v Lot Size
Legal Description G O f S SZA-- ,41 A /A— c*. ,%'eve40h, 2
WASTES TYPE: ( V) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: 71 - 4,07 r
Number of bedrooms it— Number of persons
( ' Garbage grinder ((/} Automatic washer (P- Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: /1/o4 e-
lf supplied by community water, give name or supplier: 7,;(../in c.c//ebreCcf/ /o4.m', fs•,
GROUND CONDITIONS:
Depth to bedrock: a O
Depth to first Ground Water Table: L1/4i
Percent ground slope: _ ti/ a4
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Z v v i ,' /e s
Was an effort made to connect to community system? Ofio
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(v) 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:
(✓j 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 ? /1/0
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• S0I1'PER'COLATION 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:
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 Signed
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
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