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HomeMy WebLinkAbout01682 t QARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT • 1111111Fr---% 109 8th Street Suite 303 Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT N 1682 Thledongorusepermit. a building or use permit. Owner Michael ShDte System Location Lot 26 Kings Row t zkzlivirsion Licensed Installer _()Wrier /• Conditional Construction approval is hereby granted for a 00 gallon `/ -71 L'" Septic Tank or _ Aerated treatment unit. / `/ b a r( E4L t / Li Absorption area (or dispersal area) computed as follows: - sc 1 1 Perc rate of one inch in minutes requires a minimum of e] - sq. ft. of absorption area per bedroom. Therefore the no. of bedrooms Z x sq. ft. minimum requirement = a total of sq. ft. of absorption area. we suggest: - • May 99es1: r �> 4 A N / I i._ Date. (� �j (/ Vi I Inspector ' %,/ �J ) 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. Proper materials and assembly. LJ Trade name of septic tank or aerated treatment unit. (r��>r -7,1.{ ,r e /00 0 /; � r I ( r f r . J Adequate absorption (or dispersal) area. i r )f r Adequate compliance with permit requirements. ��' r'1 4 ' c^-•� rJ co�.r/ j 4!/ Adequate cornpliance with County and State regulations /requirements. Other //4, 1 n 1 Date /4/ (—L-L,9 Inspector /-1/. RETAIN WITH RECEIPT RECORDS AtCONSTRUCTION SITE T 'CONDITIONS: 1. All Installation mustcomplywith 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 ($500.00 fine — 8 months In )all or both.). Applicant: Green Copy Department: Pink Copy nypilLOLAUfl INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by OWNER M&' ore / 94e County Official: ADDRESS 11,0,c4. Fib esing, G..- L.Y,,Joie PHONE ?AS - &6& CONTRACTOR SptN.,, e ADDRESS PHONE PERMIT REQUEST FOR: (1/f 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 Gctr 1 /L Near what City of Town C ✓{anr..dm/{ Lot Size 3, OCO A-c. Legal Description La4 7L )C 4,a RQw s' s a .tiSroa WASTES TYPE: ( I/r Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: /ee cirl Number of bedrooms 3 Number of persons ( VJ Garbage grinder (✓) Automatic washer (✓) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: // ys7 LL If supplied by community water, give name or supplier: i�gfj ow ( M,vjdrnYy . Plv GROUND CONDITIONS: J Depth to bedrock: C/r1 known Depth to first Ground Water Table: On k✓1"w"? Percent ground slope: (j `2 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: S Was an effort made to connect to community system? / A/ c2 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? /.A7 Page 2 • • SOIL PERCOLATION 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 permtt 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 S ^ y B r r Signed / —.sit PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY Page 3 . ,, ,... 4 /Th vi il) 2 — N 7 S°4 3 ' w . tailj 5A G -7- 1.1 - n 5 30 * 00 A 1 11 en 1 4 I III. N 2 , - • %-. etz, 0 CV -- `---- °‘ kil \ C \ cS\ 5g,------ --..... , • / , . 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