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Home My WebLink About01860 u PC GARFIELD COUNTY BUILDING AND TM , - ° ;, , • rt, -`� SANITATION DEPARTMENT 109 8th Street Suite 303 Gle twobd Springs, Colorado 8'1801 Phone (303) 945 -8212 f a This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT N 1880 a building or use permit. Owner David A. Powell '� System Location NE1 /4 SW1/4 Sec 24 175 R88W Licensed Installer Conditional Construction approval is hereby granted for a /000 allon ,Ic. 1 9 T$ � i n c h c/ r et t )ei -c, — .— .1..e:Septic Tank or _ Aerated treatment unit. bavis( F. t..,tt(. Absorption area (or dispersal area) computed as follows: 7 C� C3 Perc rate of one inch in � 2 L sq. ft. of absorption area per bedroom. Therefore the no. of bedrooms 3 x _anesgq. ft.. minimum requirement = a total of sS4 sa ft. of absorption area. May we suggest: /P 10 47 k C1VG1^. O{- 2.�-x 3 � � K RVP{-. j • ff Date_ SP �� . Inspector .sr 14 44 .. • 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. A 1 .). Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. Proper materials and assembly. � T rade name of septic tank or aerated treatment unit. C • D! / M+, ,Z.. S ^ (j r �� h k , '�,ste1I• 1 4 i /2e /y z4' SW Adequate absorption (or dispersal) area. �' O r n S-0 • L _ Adequate compliance with permit requirements. Adequate cornpliance with County and State regulations /requirements. Other / Date — "1 I - . Inspector ��_, 1 ] 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 I, Petty Offense ($500.00 fine — 6 months in fall or both.). Applicant: Green Copy Department: Pink Copy Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: OWNER 17 AJ1 10 A. 'Pow SE L L /�QRESS qboec t ($(o CA& F3A5�1 D�4 � , PHONE go -I( o°( 4\ 1).1 , RACTDR 5ps4 € .ADDRESS PHONE 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 G74.ptete --t) Near what City of Town cA4 (' 4I A.t. t Lot Size c ,14 QC, Legal Description NE Yy. 5W Y4 Sav4 T g S R Bfkw WASTES TYPE: ( /1 ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: R£SIDEsNc.e Number of bedrooms 4 ' Number of persons A- ( vl grinder ( ✓fAutomatic washer ( ✓YDishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ✓s well ( ) spring ( ) stream or creek lie depth of all wells within 180 feet of system:,�� kNCyc,sw, Illtupplied by community water, give name or supplier: GROUND CONDITIONS: JJ Depth to bedrock: (/ P6 "Jet/ _ Depth to first Ground Water Table: (44 Kd/ Percent ground slope: 2. j a DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: OitIveVi c0,1 Was an effort made to connect to community system? sit, TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( 4 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: 410. EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? N • • 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 connitments. A -1.4- • • • Page 4 SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) Minutes 2a per inch in hole No. 1 Minutes d per inch in hole No. 3 Minutes /9 per inch in hole No. 2 Minutes •e, address d telephone of RPE who made soil absorption tests: per inch in hole No. <-4 G+ » IG L; ZS$ / Name, address and telephone of RPE responsible for design of the syst m : 4,0 p A , 4:1) ‘44th raa, GGPc LAetatin ,4-4.4 / Go g!f'L/ 2 5 tic. 1 f Applicant acknowledges s and additional completeness tionaltes t s tsandreports ay beequired 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 permftis 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 7 t ! qv .�� l�I Signed 410ASE DRAW AND ACCURATE MAP TO YOUR PROPERTY • Page 3 • N WEST 1/4 COP. 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