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HomeMy WebLinkAbout01910 4" , r p rP: ( a a1 ,,,i4) n �C4 6 r ) .14:),..1K ;' z i ^ r n GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 4 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT ! \y' 1910 a building or use permit. Owner Bill and Debbie Sanderson System Location 0109 Oakland Knoll G.S. Licensed Installer ___ StAalaOre Inc. Con dit ional Construction approval is hereby granted for a . /.2 4 o gallon 1 / i 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 S x — .. sq. ft. minimum requirement = a total of 9f/ ? sq. ft. of absorption area. 12 ,/ 7,1 'Y ' 3 ' a-✓ / SS X\f May we suggest: 1/ 7/ ;-.r. ' t� rep) S1 • ' /4 7 c'Y. r ('p- � r... , Date 7 Inspector 2 4 ' r» 1 ( edv.e 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. / 0 Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. Proper materials and assembly, ),' el Trade name of septic tank or aerated treatment unit. �'Ii7 f, ✓,A?O r' 2 ROWS rlj tS t' / cf / 2 (, r� <c t . ' : 11 .1 '' Adequate absorption (or dispersal) a ea. ) L` �• Adequate compliance with permit requirements. Adequate compliance with County and State regulations /requirements. !– Other Date 4 - J lr' 9/ - _ Inspector 2,„(ti....Cwt.& 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 ($500.00 fine — 6 months in fall or both.). Applicant: Green Copy Department: Pink Copy • 1 Application e 3/ ` , INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by �( II II f 9unty Official: OaNER`flL.LL DoJo ll aau t "75-- ADDRESS s ir? - 1}14)LI . CaI��S PHONE QL 5t LL� — CONTRACTOR_ , L S tnpr e . 2 rw .. _ 0 / u( � I/2 „ . 2 ADDRESS_ Piio r �' PERMIT REQUEST FOR 0 New Installation ( ) Altera 7 2 Attach separate sheets or report showing entire area with r 2 n 14 , ( lel► ' topography of ar habit building, location of potab C B - l -- l 'pj €3 test hole$,'soil profiles in test holes. n (See page 4.) 7 1 P (y LOCATION ()F PROPOSED FACILITY: County (4∎G rf le l,cJ, ' l' ' / �, q U �Q Near what :City of Town • . se , • v/,�tI 2 v legal Description Co+ ? . 4. ii, (14. ,a nip PYj V al` l �� / ! (©alc.t / so _ ( 11 r`b ! WASTES TYPE: (xf Dwel l ing ( �` i ✓t 'lI c' / Y d J ( ) Commercial or Institutional ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms -` Li _ ,.., , tuber of persons ( ) Garbage grinder ( )4 Autom• is washer (X; lit washer 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: I`Y�oLt[ 4riu s GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent nrnund clnnn• • DISTAP ^ / � nr /� 4a_ Was at K ( 1 / v system? TYPE ( PROPOSED: /--/NAL leration Plant ( ) Vault "'composting Toilet ( ) Recycling, potable use Incineration Toilet ( ) Recycling, other use ce vti e Cni e "VW U S t )ther - Describe: FINAL Fil' ( %\ t / l ° 7 1 1 A ( ) Evapotranspiration kJ0 IV' 9 � — 1; 1 . ( ) Sand Filter �` I ( ) Wastewater Pond . WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? , 1 Dann 9 . Application • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by ONINER_ eitand i - Cpunty Official: "4-0 sop ADDRESS ! [ 41.4)14 ' 7 , QIL\S PHONE qq5: (4q CONTRACTOR__ZaftlatCtre, ADDRESS_ PHONE PERMIT REQUEST FOR: (icl' 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 percolatic test holes, soil profiles in test holes. (See page 4.) LOCATION OF PROPOSED FACILITY: County __ LTLr g,,_r __ Near what City of Town_ �I r Lot Size Legal Description de ,,„ • • • • _. (©alC / hw,0 WASTES TYPE: 2(1 ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms - t _ _ , tuber of persons Li ( ) Garbage grinder ( )Q Automatic washer ( 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: fY�oa[9[1t��S GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to comnunity system? 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 loilet ( ) 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 TiIE STATE? • • SO1L)PERCOLATIOtt_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 pf 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 uhder 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 niy 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. 1 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 4h �Q Signed . ,yam, dew th- PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY • • Page 3