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Home My WebLink About01975 TrarrwrrigalTh R 41 GARFIELD COUNTY BUILDING AND SANITATION DEPARTM r..- 109 8th ;Street Suite 303 Glenwood S¢ringe, Colorado 81601 Phone (309) 945 -8212 This does not constitute il INDIVIDUAL SEWAGE DISPOSAL PERMIT N° . 1975 a building or use penmtt, Owner Ronald & Robin Prit:alan System Location 1 5R2 CA 7 3% B fie Licensed Installer __ Owner Conditional Con approval is hereby gr anted for a J� my CI gallon ' J`r Ze U/ � � c- ` a, e ` 6tmn c7e` 6,0 ` r (' Septic Tank or Aerated treatment unit. y- Absorption area (or dispersal area) computed as follows: ' ere rate of one inch in •1 � minutes requires a minimum of ;/ ..�. sq. ft, of absorption area per bedroom. q „I ' t ' " a . M� Therefore th o. of bedrooms _ x sq. ft minimum requirement = a total of kb ` ' sq ft of absorption area J/r 70' A / .' x ' !i' o r . ` f t h - , a-e c -> . '24 e n" ,2 t Ye'', , ii .f. r ( — 4) (1 I May we aug at: ”. ` A' M , r'' ( r .,,,,, r t o .Y 'o 7 �,r. K. .,^r /;'�; ^� fi � T .r i.: Date 4� " - '7 2 Inspector :.-+ ,r . ` / \ ... � .. ?. 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• ;I,p. li ing any part. K2 r > 0 . Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground (// surface. Proper materials and assembly. m ( f I i .(roNetni -A Trade name of septic tank or aerated treatment unit. ' ', '� IVY t , I r Adequate ty ro"' r a . 32 Z" ,, Z, absorption (or (dispel sal) area. \ Adequate compliance with permit requirements. ` i i - 1 /Adequate compliance with County and State fegulations /requiremd ts. Other CO " / � . )- Date 7 I nspector 1 \ !O " E= ' 2`Q 1 RETAIN WITH RECEIPT RECORDS AT CONSTRUOTION SITE ,„: ' 'CONDITIONS: 1. All Installation mustcomplywith all requirements of the Colorado State Board of HealthindIvIduat towage Disposal Systems Chapter 25, Article 10 C.R.S. 1973, Revised 1954. ,, 2. This permit Is valid only for connection to struoturos whioh have fully complied with •Oogaty and bulldi g ?requirements. Connection to or use with any dwelling iDr struoturea not approved by the Building and Zoning offloe sh�ll automatically be a violation of a requirement of the permit and cause for both legal action pan evocation of the permit. 3. Any person who constructs, alters, or Installs an Individual sewage disposal system in a m Mier Which Involves a knowing and material variation from the terms or specifications contained In the application of permit dpmmfsa Class 1, Petty Offense ($500.00 fine — 6 months In )ail or both.). \ i Applicant: Green Copy Department: Pink Copy ! ` ` \ \ 1' . t Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by I County Official: /RESSTOR 6, 3O i • (rte Ad PHONE i < )FV ( 11 ADDRESS PHONE C PERMIT REQUEST FOR: (K) 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.) 6 LOCATION OF PROPOSED FACILITY: County i10e Jic ld Near what City of Town fit( Lot Size 6,3 % cl c , Legal Description Ravi r, P Sec 2 - 4,; 1 Cr c. 3 - -C C ie 9'3 W. WASTES TYPE: ( I.) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: re S L'c(t n r. e Number of bedrooms 3 Number of persons ( ) Garbage grinder (X) Automatic washer (X) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (X ) well ( ) spring ( ) stream or creek f Give depth of all wells within 180 feet of system: %lo . rj/ �4(1 If supplied by community water, give name or supplier: N4 GROUND CONDITIONS: Depth to bedrock: 11 ✓i k now r — Depth to first Ground Water Table: O kn v yip, Percent ground slope: %-//C) 7o DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: y .,..:, Was an effort made to connect to community system? Al 0 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( n 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: (K) 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? A/ . 1 RCOLATION 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._ ame, 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 pernift.is'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 sane 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 f9---". C� PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY 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. Page 4 v h e \ % 1 k o o 0( t NI o \., 1 \I - ,; ) \ 0 _ I -t \ t•' \j‘l(N -,. o vJ tic\ It N IV t ' V 1\ • • • t,. • t 1 1 N t .•kf.>t <q .l 1 x. 4 4 M '\`5` ' -t. . 't+l, i , t no t t 1 ` 1e i 1' I ' Y ke. r iY • t F 1 t. ...._..... _.._...... .._ 1 _ _ ... .. _. ' 1 Jesse L. Gordley Cj r•rt Stale 011 Inspector : t � , Li 1 •1 • Colorado Department of Labor & Employment 1 1 Division of Labor ! • p 011 Inspection Section 1 • Telephone: 1001 East 82nd Avenue, Bld0.1 • Bus.: (303)288.5843 1 Denver, CO 80218 Home: (303) 241-7814 I k •