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Home My WebLink About02028 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 2 0 2 8 109 Bth Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 2453 -052- 00-004 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Robert M Johnson Present Address Box 5330, Snotsaassflllage 9234037 -- System Location Legal Description of Assessor's Parcel No. SYSTEM DESIGN kkk ". -() Septic Tank Capacity (gallon) Other / A _ Percolation Rate (minutes/inch) Number of Bedrooms (or other) 2 Required Absorption Area - See Attached Special Setback Requirements: Date /0 — Inspecto�f ia7 .t4 + 4.. FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer i iv E; (fir_ 'i *.1` Septic Tank Capacity / O ( ) �) Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface r • Absorption Area _ "``�� >` ! ' I '� Absorption Area Type and /or Manufacturer or Trade Name t . - t ! i -', ci ' l cm Adequate compliance with County and State regulations/requirements Other Date / G 2 . I 2. Inspector •-_'::4.: r"' V? l 17 _ -, , d.' n,. !! 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. Con- nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or 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 (8500.00 fine — 8 months In )ail or both). Applicant: Green Copy Department: Pink Copy Application 4 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: OWN%R ... it 41 ' t/ • -L p ADDRESS PHONE !,. J 0 y 7 CONTRACTOR_ «& AI. * psi au ADDRESS f/ f 7 � /nctt," t rte' PHONE gi{5 - S 7 4 h! 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 FACIL1T : C unty_ �r , Near what City of Town Lot Size Legal Description "� WASTES TYPE: ( k1 Dwelling ( ) Transient Use ( ) Connercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVItE TYPE: Number of bedrooms / A , A A, 4 .-? ) �''� Number of persons ( ) Garbage grinder ( Automatic asher (vl uishwasher 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: 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 community 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 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 TIIE STATE? SOIIlERtOLATION TEST RESULTS (To be completed by Registered Professional Engineer.) ` Minutes (5 p r nch in hole No. 1 Minutes per inch in hole No. 3 Minutes per inch in hole No. 2 Minutes per inch in hole Mo. 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 per ft.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 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 n_le9al action for per- jury as provided by law. Date / d /6 . l/Z Signed SI�dl�/ PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY • • • • n o A 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. 4 Page 4 SD2 INFILTRATOR CONT —_ Firer Dispersal . (0.5) A( 0PI1RC 131313 131313 beedroom Area T Trenccnc h Pieces Dcd Pieces Trench cb or Bed RATD ROOM ` FT* FT= 1 I' F" Pieces 19 1 491 160 240 13 200 15 2E313 17 2 275 549 183 275 15 ::30 10 330 20 3 824 275 412 22 494 26 494 30 4 1090 366 549 29 659 35 659 39 —_ 20 1 493 164 247 13 296 16 296 18 2 282 563 1013 202 15 33E1 10 33E1 20 , 3 045 202 423 23 507 27 507 30 4 1127 376 563 30 676 36 676 40 `_ 21 1 505 160 253 13 303 16 303 18 2 209 577 192 289 15 346 18 346 21 .3 066 2139 433 23 520 20 520 31 4 1155 305 577 31 693 37 693 41 . - -- 22 1 517 1.72 259 14 310 17 310 1.9 295 591 197 295 355 21 2 29� ir'1 177 y95 16 355 19 3 1306 295 443 24532 213 532 32 4 1182 394 591 32 709 30 709 42 23 1 529 176 264 14 317 17 317 19 2 :302 604 201 302 16 363 19 363 22 3 906 302 453 24 544 29 544 33 4 1209 403 604 32 725 39 725 43 . —_ 24 1 540 180 270 14 324 17 324 19 2 309 617 206 309 16 370 20 370 22 3 926 309 463 25 556 30 556 33 4 1235 412 617 33 741 40 741 44 - -- 25 1 551 184 276 15 331 10 331 20 2 315 630 210 315 17 370 20 378 23 3 945 :3 15 473 25 567 30 567 34 4 1260 420 630 34 756 40 756 45 — 26 1 562 107 281 15 337 19 337 20 2 322 642 214 321 17 385 21 385 23 3 964 321 402 26 5 5713 31 578 35 4 12135 428 6 2 34 771 41 771 46 27 1 573 191 206 15 344 18 344 21 2 327 655 210 327 17 393 21 393 24 3 902 327 491 26 509 31 5139 35 1309 436 655 35 706 42 786 47 20 1 5133 194 292 16 . 350 19 350 21 2 333 667 222 333 10 400 21 400 24 3 1000 333 500 27 600 32 600 36 4 1334 445 667 36 000 43 000 40 „ - -_ 29 1 594 190 297 16 356 19 356 21 2 339 679 226 339 1E1 407 22 407 24 3 1010 339 509 • 27 611 33 611 37 4 1357 1152 679 36 1314 43 814 49 —_ 30 604 201 302 — 16 362 19 362 22 345 690 230 345 19 414 "" 414 25 075 _ 34J ` 0 621 �i . 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