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Home My WebLink About01700 li • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 Sth Street Suite 903 Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT W ' 1700 This does not constitute -j, a building or use permit. Owner— C_ «enwr o ,h> x T MAIN �dANCE SHOP mss one A ir{ F{ I • System Location CaRe 154 Glen s°Od •8 Licensed Installer ,1t___Ii C, Iyre+A.,.a.a.. Conditional Construction approval is hereby granted for a _.SO__ gallon Septic Tank or Aerated treatment unit, r;J� ,�/ / > if Absorption area (or dispersal areal computed as follows: W r•K e s ,.,_, c.• n L. Perc rate of one inch in ____S____ GI, v ,� minutes requires a minimum of pti • r per ed `' ' y' sq, ft, of absorption area per bedr000m. Therefore the no. of bedrooms x sq. ft. minimum requirement = a total of May we suggest: I _sq ft. of absorption area. /p' / 0 ' X. C o r(eef3 f { J c n e per ura(P l• I ' � � t '' L' ✓i Date_ - .Inspector ... '' i i, It 1 (-7.1 / FINAL APPROVAL OF SYSTEM: ? /�r S / _, (-tie ) 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. li � _ Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. • (�_ Proper materials and assembly. Trade name of septic tank or aerated treatment unit. ,/ / 0 • Adequate absorption (or dispersal) area. r i re -- Adequate compliance with permit requirements. `.,— / r-- ,.<.---_ Adequate compliance with County and State regulations /requirements. "`" ._ Other Date -.. ` 6 y % (�` h Inspector A.� �L !l ,+, g.r,..� RETAIN WITH RECEIPT RECORDS A,TCONSTRUCTION SITE ONDITIONSn: // / 1. All lns tallauon must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter 2. Thls permit Article 1973, Revised it Isvalid only or con ectionto 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 — 6 months In jail or both.). Applicant: Green Copy Department: Pink Copy BUILDING AND SANITATION DE ,� GARFIELD COUNTY B DEPARTMENT 109 8th Street Suite 303 --.� Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT N '. ` 1700 This does not p a !wilding or r use se permit. constitute e MAID TFNANCE SHOP ranyyre Owner .- tilai et_za .& :rankle', P4el System Location C.R. 154 Glenwood Springs Licensed Installer & G Ilr1•inG Conditional Construction approval is hereby granted for a 7' —b gallon ___„ Septic Tank or _ _Aerated treatment unit. Q �F7 E %,S /'/0 / Absorption area (or dispersal area) computed as follows: l �P r ^K v :."..).,../ `'^ '� `- . Cie v 4 C). -, 7,,; I.. y :. Perc rate of one inch in S _ 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 we suggest: x / U i / c P e 1.) ( f. e r 1:..) , r~ f �{ f ^ 7) j, } 1 t. I i Date t /,t-j y' Inspector . '-/ Al/ � ' I I FINAL APPROVAL OF SYSTEM: rrr��PC S/ >titir�Y 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. i H .. Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground k surface. g nd I (0 1< Proper materials and assembly. 1 1k Trade name of septic tank or aerated treatment unit. % '�� / /� ; 1U6� / G l GI u_ - ,�/4 Adequate absorption (or dispersal) area. • Pt -- Adequate compliance with permit requirements. —(; 5,.,. _ Adequate compliance with County and State regulations /requirements. — _ Oth � j • Date / 6� /G / - -- Inspector j /ix/ / vi�'='lr' _ _ J '/ RETAIN WITH RECEIPT RECORDS A CONSTRUCTION SITE / /'' ONDITIONS: 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 ($500.00 fine — 8 months In Jail or both.). Applicant: Green Copy Deportment: Pink Copy Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by ,,,, `�� County Official: OWNER .. /ia /ds, .To�� r;Le C('-,p ji 14e' Ail .ri •A ifilJ� / • ADDRESS PHONE 90 1 . CONTRACTOR , G 6 ADDRESS T, ADDRESS , _ ,.. (' /o PHONE fScc- K.Fa PERMIT REQUEST FOR: (r- 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 Near what City of Town .�rrr„ood sr_Jn c (3 /e Lot Size /.,rte 3 Legal Description „5 -,,. .A J /1 4 WASTES TYPE: ( ) Dwelling ( ) Transient Use ( ') Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: /,e () sf1 Al„,;„ / ,- ,„„aircr w /zofl Number of bedrooms A/„ if Number of persons (.O Garbage grinder (,(4.) Automatic washer (14) Dishwasher 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: GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: ° Percent ground slope: .2 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: w a a .6; /,- Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (4 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? 4/6 Page 2 • • .'SOIL 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 per inch in hole No. Nance, 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 suchtermsfandeconditionsnasf application; ; and issuance nsurecompliance permit is 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 fr � /pd Signed a/ . de PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY / npincere 40,;t4 /dam Ce4J( • Page 3 hppliccaon INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval 41JNER County Official: ,:. e_ /ADDRESS / %i 44 PHONE 13 , 9 CONTRACTOR )'E 4 - t . /,,;, ADDRESS G C PHONE 57,4,5 -4' 7? PERMIT REQUEST FOR: ( ) 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 , i Near what City of Town / 1 Lot Size /,.3,3 /5 ,, r s Legal Description 1.7!/4. f 41 WASTES TYPE: ( ) Dwelling ( ) Transient Use ( v , &ommercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: 4,f1 5/ a Number of bedrooms ,(/q Number of persons 7_ ( ) 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: A4nr If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: 2 Depth to first Ground Water Table ,.. L.. 30 Percent ground slope: / / DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: - %y Was an effort made to connect to community system? ; TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (j- 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: fly c,-e // WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE ? Page 2 SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) f • 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 permft S 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 Page 3