HomeMy WebLinkAbout01978 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT . 4� 1978 a building or use permit.
Owner 11krk & Melissa rnl;lieL _
System Location _ 1216 No Name LAne, Glenwood Springs,
Licensed Installer
Conditional Construction approval is hereby granted for a /j '0 gallon
Septic Tank or _ Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in 4 %� _ 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 4 // sq. ft. of absorption area.
May we suggest: _ • .�
Date !. � �__ . Inspector . .11 .1 . . <,,
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.
Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
0:4 Proper materials and assembly.
( 'I Trade name of septic tank or aerated treatment unit c 2 /A' % 4 -/ 1.1(- / / / 0G C-1 0 ;.f I ,
Adequate absorption (or dispersal) area 1 5)7 C ,+ 7 (/; /,I / • / � "17.1" f; a'
cy;. /
C.) /^;� Adequate compliance with permit requirements.
i`■ . _ Adequate compliance with County and State regulations /requirements.
- -'_ _ Other
Date - _ Inspe ctor 1+' `1 1
//
RETAIN WITH RECEIPT RECORyt..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
($500.00 fine — 8 months In jail or both.).
Applicant: Green Copy Department: Pink Copy
. Application
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
v
County Official: -f
OWNER //Mkd,t: 10 Name Me /issc 17 5/�'rl rS/� `verve/
ADDRESS Ja7(,' Ain Name- Ian( PHONE9gS77y2 0 QPd i 0 P � ,v/la
CONTRACTOR (octArr for` it
ADDRESS <5a n. v PHONE
PERMIT REQUEST FOR: (c) New Installation ( ) Alteration ( Repair
Attach separate sheets or report showing entire area with respect' to surrounding areas,
topography of area, habitable building, location of potable water wells, soil percolation
test holes, soil profiles in test holes. (See page 4.)
/
LOCATION OF PROPOSED FACILITY: County ('4,. c /ot T �r Near what City of Town (!> / ✓a, 41000 n( .c ,nQ y Lot Size nC' AChcs
Legal DescriptionSO Aatnrr e.( Al,(14 5wgi 5er.02 - co 6., le 8'4Gi r-lip$i
WASTES TYPE: ( 7C) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: ,sialo«- r la I —
Number of bedrooms c2. Number of persons c2 - 3
(?s) Garbage grinder (-S) Automatic washer (X) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ('r ) stream or creek
Give depth of all wells within 180 feet of system: 1/0lrr., _—
If supplied by community water, give name or supplier: No/YQ,mt(rr /A9arrr ,4ss'r.
GROUND CONDITIONS:
Depth to bedrock: -- — Depth to first Ground Water Table:
Percent ground slope: 2 3
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: r2 _ N' t Le s
Was an effort made to connect to community system? - Alrxtzsi ss, bl u
TYPE 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:_
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? _- wict...Jio-F,
1V
X- r "../..
rtRCOLATION 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 of the evaluation of the application; and the issuance of the permit 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 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 Si rAtt i
gne��i �/
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
A il
„
c,t
r �
r4• ; Colalk
Most
1.226 N N am&
e Duet * c 0 es
o 20 � a.sd t n s
C2ipg rowtot
_ . 0
Improvement Location Certificate
SCALE I' -150'
BOOK 361
PAGE 41„ SURVEY BASED ON HIGHWAY R.O.W.
MARKERS. PROPERTY CORNERS ALONG
WESTERLY LINE OF EXCEPTION LANDS
I•" "'� N� 8.4 '0 - AND HIGHWAY MAPS. NORTHERLY LINE
164.9 • OF PROPERTY HAS BEEN ROTATED TO
MATCH TITLE BEARING BASE ALONG
OLD HIGHWAY 6 G 24.
imia •
� �. � 164
. y90. .. di BOOK 363 ❑ \\ PAGE 370 VEL DRIVE WAY
SHED \ \`` ..,
I ,
,^ ''"jiOBILE HO, N . HO
JA
rn � S . 2
1` :IC \ 1 ^! \\ COVERED
' .� i
0, . PORCH
l
W / ` on •
O O C \ ' ' 12.1 " " 1276 NO NAME LANE
j
l- \\ O o IOLD HYWAY 6 6 24)
M
0 0 0 FRAME HOME
0
0 0 " n try 1�
0
b D ECK • �` c SEPTIC
0 O 2 Y " TANK
0 17,9' 12.0 0
Z v) 1 • • 1 Ll � ,
4
SHED r 1 iv e
r 1 X � `
J
NGUD - lal 0
ii
BLO • •
SCAL- I' -50'
164.93'
588' 18'00 "E
P •' 1 ' • ' •N
C 6 1:). • e„
SEE P • GE TWO
IMPROVE•= • !' • ATE
I HEREBY CERTIFY THAT THIS IMPR•VEMENT LOCATION CERTIFICATE WAS PRE-
PARED FOR MARK W. & MELISSA T. ENGLISH , THAT IT IS NOT A LAND SURVEY
PLAT OR IMPROVEMENT SURVEY PLAT, AND THAT IT IS NOT TO BE RELIED UPON
FOR THE ESTABLISHMENT OF FENCE, BUILDING, OR OTHER FUTURE IMPROVEMENT
LINES.
1 FURTHER CERTIFY THAT THE IMPROVEMENTS ON THE ABOVE DESCRIBED PARCEL
ON THIS DATE, 06/22/91 , EXCEPT UTILITY CONNECTIONS,
ARE ENTIRELY WITHIN THE BOUNDARIES OF THE PARCEL, EXCEPT AS SHOWN,
THAT THERE ARE NO ENCROACHMENTS UPON THE DESCRIBED PREMISES BY IM-
PROVEMENTS ON ANY ADJOINING PREMISES, EXCEPT AS INDICATED, AND THAT
THERE IS NO APPARENT EVIDENCE OR SIGN OF ANY EASEMENT CROSSING OR
BURDENING ANY PART OF SAID PARCEL, EXCEPT AS NOTED. \a��aauIIIIIIIgp7i /
\J\ � S �GS B F9� S �
IT IS HEREBY STATED THAT THE STRUC- a 1P' P 7 ,.....e://
Tr IRF G LOCATED ON THE ABOVE DESCRIBED 3 — _ •