HomeMy WebLinkAbout01843 2 3R
r + GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT ` T S
109 8th Street Suite 303 fGx ��z�
Glenwood Springs, Colorado 81801
Phone (303) 945 -8212
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4
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT { 't T" 1843 a building or use permit.
REP/C(32 4ARLY
Owner wit K U 1): Crai4tiCr) _ p �
System Location 6':;16 idsv 82 CTrzr rx'i `p . _ - �1 F{e /P - Pc k'E57E/Q /1/ /
Licensed Installer — L :__:01POr1 - (2 _ SI i v
co//4i/6, T /o4 /C
Conditional Construction approval is hereby granted for lOQ d gallon r s OS PEn r°/ l T /32-
—y _ _ Septic Tank or _ Aerated treatment unit.
Absorption area (or dispersal area) 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 1U2 x sq. ft. minimum require ent = a total of sq. ft. of absorption area.
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May we suggest: 5 e e a //ez-c- 4 e 4 pAir�tn e fe 4 _ 1 i-
Date. -0 / ! t _ Inspector .e 44 L,.�!/
f
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.
J..
�K /S r n Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
.�
surface.
Proper materials and assembly. ��//
X 1' 5 "/" Trade name of septic tank or aerated treatment unit. s2 Kd S 71 /Z 9 /000 Con cke 10/171 -
" b ee // CAS Fern /t7„5' ii7 thee_
e7•
ry e r - a Q'Adequate absorption (or dispersal) areaj/t
0 . —_ Adequate compliance with permit requirements.
(9/(C.- - Adequate compliance with County and State regulations /requirements.
_ Other
Other � Inspector
// s
Date /0 3� p O _. „ - - - -- ,J''' �� ( - -� - --
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RETAIN WITH RECEIPT RECORD' F O NS T RUCTION SITE Ocu
`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
($500.00 fine — 8 months in jail or both.).
Applicant: Green Copy Department: Pink Copy
et Application
` 1, INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
County Offio.fa1: -
O,WNER CO n4MoJ) /TYC jr /OT7 (�c��}t�K /C � e 0,A / � e �y�+
fl1RESS 67/ (0 ilk 8 z ���,w�1 y s Co PHONE f iii _
!ONTRACTOR v ecivv o✓a /Q ∎-t- \I\Q K
DDRESS C 24; AL. PHONE r
ERMIT REQUEST FOR: ( ) New Installation ( ) Alteration (✓) Repair
ttach separate sheets or report showing entire area with respect to surrounding areas,
opography of area, habitable building, location of potable water wells, soil percolation
est holes, soil profiles in test holes. (See pa a 4.)
OCATION OF PROPOSED FACILITY: County r �a f p'er't/-
ear what City of Town (7'. "ate / c Lot Size 2, 2- f ac ,
egal Description / t
NOTE 7ic's Is /A 4 eV 7 ,S34/ 4ses /ode Cm Al le mu
ASTES TYPE: ( ) Dwelling ( ) Transient Use i gi
( ✓) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe
UILDING OR SERVICE TYPE: s ,F '/'C A 4LAA
umber of bedrooms /C/ Number of persons 7CJ
) Garbage grinder ( ) Automatic washer ( ) Dishwasher
OURCE AND TYPE OF WATER SUPPLY: (t/) well ( ) spring ( ) stream or creek
ive depth of all wells within 180 feet of system: /3 c)
f supplied by community water, give name or supplier: /V ,4
ROUND CONDITIONS:
epth to bedrock: - - /- c/0
epth to first Ground Water Table: f /3 0 ei
ercent ground slope: /----/ a1
ISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: S ry
'as an effort made to connect to community system? N
'YPE 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:
'INAL DISPOSAL BY:
V ) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
ILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE ?___S0
PALL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.)
•
Minutes per inch in hole No. 1 Minutes per inch in hole No. 3
• 1 Minutes
per inch in hole No. 2 Minutes per inch in hole No.
lame, address and telephone of RPE who made soil absorption tests:
lame, address and telephone of RPE responsible for design of the system:
1pplicant acknowledges that the completeness of the application is conditional . upon such
- urther mandatory and additional tests and reports as may be required by the local health
lepartment 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 perniEtis'subject to
;uch terms and conditions as deemed necessary to insure compliance with rules and regulations
.dopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies
:hat all statements made, information and reports submitted herewith and required to be
.ubmitted by the applicant are or will be represented to be true and correct to the best
)f 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-
;tand that any falsification or misrepresentation may result in the denial of the application
o revocation of any permit granted based upon said application and in legal action for per -
iury as provided by law.
)ate Signed
'LEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
•
1/ 1 ,
PLOT PLAN AND DESIGN FEATURES:
Include by measured distance location of wells, springs, potable water supply
lines, cisterns, buildings, property lines, subsoil drains, lake, water course,
stream, dry gulch and show location of proposed system by direction and distance
from dwelling or other fixed reference object, and additional submissions in
support of this application such as data, plans, specifications, statements and
commitments.
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