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HomeMy WebLinkAbout02100 l ! 1 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit ni .. 2 1 0 u y ' r 109 8th Street Sulte 303 Assessor's Parcel No. tEi Glenwood Springs, Colorado 81801 .1 , Phone (303) 945.8212 t This does not constitute ' INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. t PROPERTY i ttt ) Bob lCslley 916 1.`;11COlfa Glenwood Spgt 945 -9291 11 Owner's Name Present Address one_ System Location County Road 113, Glenwood Springs Description of Assessor's Parcel No. SYSTEM DESIGN /��� Septic Tank Capacity (gallon) Other r Percolation Rate (minutes/inch) Nurnyar of Bedrooms (or other) 1 �• ; l ` ' M Required Absorption Area • See Attached f _ ,' Special Setback Requirements: ) . '" . a f Date yl /9 Inspector �1° [p 6(fif '.F"" f ..... / / i'r t t FINAL SYSTEM INSPECTION AND APPROVAL (as installed) S Call for Inspection (24 hours notice) Before Covering Installation System Installer f jc, Septic Tank Capacity j 0 n O GA 1-... M n 1 pc. 2 11 10 4 t 1. Septic Tank Manufacturer or p Trade Name 11 . Of. TO rJ / C. $• Septic Tank Access within 8" of surface 4'f S P II w Absorption Area ' "a, Absorption Area Type and /or Manufact or Trade Name I/ a / O - b errp o eC." - 'I1 S 1 Adequate compliance with County and State regulations/requirements " r Other "M6 ,J"cpne . r...Sym.ys n7 NJ s &d CaC •coC �aarr6RE Z.1r6PfEG'i a.r / . c MP• elc alre ass@ ? /G9vlas ' egpys 6.+' qct ties, 4 Date / -a - 9r Inspector ter Q- • ' • RETAIN WITH RECEIPT RECORDS AT CONS RUCTION SITE r' I *CONDITIONS: f os 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 connectlon 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 offloe 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 ($500.00 — 8 4 months In )all or both). A, a Applicant: Green Copy Department: Pink Copy t , ` Application ItNIDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by ' -- — — — — County Official: OWNER :am ro p �(/� IDDRESS__9r4 L�NCOt N Sas't�wmc0 5+tss e_o PHONE q4S - 17A 9 (' • t 7 :ONi ItAC1 OR . ©wsl ER — -- - -- '1lJ DRESS - -- -- -- -- -- — - -- P11011 ' ERMIT REQUEST FOR: (,/)'New installation ( ) Alteration ( ) Repair \ttach separate sheets or report showing entire area with respect to surrounding areas, '.opography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes. (See page 4.) .00ATION OF PROPOSED FACILITY: County atMWM4b dear what Ci ty of 1 ow ti_ttiwpo p SPR \Nts LU Lot Size tt s Ae- ' egal Description_ es se,Qglfz nc eL AG 23 q;3 knot" tg ANn L,f-Attn -_ PARyc or I csys Co, tat SEatovt lo, 7S R. Hawn vP �4,e___o R S L aaty_.__ov tHF C<. Rt. C:.ttTAtNttrrr 1- 3.5 Ate.. ITAS1ES TYPE: (,/f Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe_ _- nUILDING OR SERVICE TYPE:_ re ___12xr- ngt_ — — - — Dumber of bedrooms Number of persons / ( ) Garbage grinder ( ) Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY_: (.71 well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: Nov - If supplied by community water, give name or supplier: N,A, GROUND CONDITIONS: Depth to bedrock:_VAR\A@sx - w' +U 30' OMo.vaa. - Tr Depth to first Ground Water Table: l6v' — - Percent ground slope:_ V)AwtAtK.E - 306 +n 30% DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: x -J tA,,_e Was an effort made to connect to community system' O TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (t/7Septic Tank ( ) Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use ( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use ( ) Chemical Toilet ( ) Other - Describe:_ L 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' tin ,UILtERCOLATION 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 Mo._ lame, address and telephone of RPE who made soil absorption tests: y I lame, address and telephone of RPE responsible for design of the system: \pplicant 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 lepartment 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,i3'subject to ;uch terms and conditions as deemed necessary to insure compliance with rules and regulations idopted 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 If 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. 1 further under- stand that any falsification or misrepresentation may result in the denial of the application -n• revocation of any permit granted based upon said application and.in legal action for per- jury as provided by law. Date Signed PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY w. 3 - cwrlowda�Q. Cxicwvoed Co�t1` G (COw.+y ■) • iieuset L'Svst 'at*. *Ca Mike, "guar t t Pane 3_ r • PLOT PLAN AND DESIGN FEATURES: Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, Eater 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 SITE AND CABIN PLAN Roe.eRr b. KILL Y 13K1L.yetwc. Set I6(INiMWt 5 Wit 7004.1 6 obi e rsaldhea * 45' COKNRt. 11 TY R u Wd SR. GdP3..r. X 4 (s •,....14.$) ( , &vrS PL AN WITH pRopbSEh CAt3(N Loc ct\on - Seevl:t ks'$c v.\\\ I.e.. St? strew.. *Le. .Neu t.,-.4_ L. V0 w;11 be. 100 t rew. 41.e.- tut l Aesees0o'3 Oir/.o.1 Mo. ?_393%0 300 z-°11 wr.el, 014r10 lees +e l ;v. 4"Lah Parts oS c ol s 13 ah0. 141- i Cc-,11 Soc.+'\ew, to T. 7 S, 3 R. Bt to. e4 41.4. S +IA I RM., 1 ,1;r.9 b.ort\etrt ok• +L. toUv4.Nl 4 ¥b c( tD % +..%h: 3. S' . tb C4 b M.a'64. V or Ien V . 4 • •- • r .. <5 .«O r'r. Y • , ._ _ .. - x " \ I .,., .; •� tie . io •\ % s o r e r ). i 1 . ,1 i , r .. : .• . i,e., . i G I , it y ( . .` t1 fi. 11, r,._r 6 o Ni to F • r h....q, t 1 F II � ti �, 9 L 9 i, 0 f py u / .` .. y 00 ! ' I1 r IT t i � • o h 1 1 O 0 9 (0 y , w IS . pY \' y. ( r 0 0 O • . 1 I . .I I � �! .. a\ o ,;>.0 , e / , \ .. : :)::. lik. ( . : zi � ? � i t I �A�1 Ij 0 9 p. li\I 1 W V m w W n • 11 I bO O S 00 0000 p F NOUr 67 ' 1 1 U 31 1 t k 2 is yr ...? S I + ' ' [ . 1 i . 0� t, is j0 L%" 6 *1 1( Cr cc4 • 5.03 f f7 7 3 3:33 v I. 3 . * . RMI-G RMI-0 RMI-W RMI-PIPlastech 17038 Si Feuer"' RCM 5590JdM1 Sims ( 3101rqusInal Perk Road John Fsloh Ire. Park, P 0.55050 i Gardena. Celedwe 90248 Denver, 03102410 80239 Deerlieb. Wisconun 53531 Pia ninety. Pennsylvania 18974 P ( F1 1 0) 327 567 PM FAx.a' 13031 3-93th F jr' Phone A x (608) 7648416 FM FAX Phone ( 411 -08 2 0 AN p01 ) p031 )37 1 3310 K A. 1081 e 1 (2 RMH RMI -C RMI -F RMI- TdPlastech • no Honk IIMAVenue 1320 Ard3ra Avenue 230 Barlow Municipal Argon Heeway 435 at FM 1306 • • oaawe, Mahu63605 IMaa, MICAS 60143 ROT'ONICS MANUFACTURING INC. Barlow, Florida 33830 GainoIIM. Taus 76210 PIIO M Inc 45,9271 PMa (7 pp) 7139510 phone (6 534,1768 phone 131716688596 FAX, (?'!1 1513089 FAX. (708)773-4274 FAX. (813)533. 629 FAX (917) 665.9831 LIMITED TANK WARRANTY Rotonles Manufacturing Inc. warrants that all tanks 'manufactured by RMI to bo free of delectsearniak 4W ,a. workmanship for a period of five years from date of manufacture. WIththe exceptionof D.O.T. tanks which have a special warranty, this warranty is sublectto, but not limited to, the following: P• 1. Produce are used In accordance with the chemical resistance table furnished by the resin. manufacturer. Some tanks require manufacturer approved skid restraints. It is purchasers responsibility to check requirement& 2. Warranty does not cover misuse, lire;eccident, negligence, transit damage, unauthorized alterations tithe pro-, duct. Or abnormal use. 3. Llabkitycthe Manufacturer under Oils warranty and under any other warranty, expressed or Implied, statutory or otherwise, Is limited to repair, or at Manufacturers option, replacement of defective product which Is shown to havebean defective when shipped, and onlythen Mahe Manufacturer is notified in writing of the defects within the warranty period and Items In question are promptly delivered to its point of manufacture. Transportation charges to be prepaid. Manufacturers liability as stated herein cannot be altered or enlarged except in writing signed by an officer of the Manufacturer. . .-4> 'Warranty does not cover loss of product through leakage or damages for injury to persons or property caused by leakage or any consequmalal or Ilquaated damages. 6. D.O.T. tank warranty Is for one year from date of manufacture. Tanks and fittings have not been cleaned or pretested for leaks. Flush out with water and clean before using. Rinse well and check oornpaabillty before tilling with a different solution. • Do not drop Unload by lifting or rolling down ramp. Do not weld or use cutting torch close to tank. Do not put next to exhaust Excessive heat will destroy the physical properties. Horizontal and Cone Bottom tanks must be supported by RMI approved cradles. Vertical, flat-bottom tanks must be installed on stationary, flat, level, solid surface. Sand or fine soil is satisfactory. Excessiveweightof strainers, heavyshut-off valves or heavy hose must have secondary support and must not be carded • by the bullets. i Check with chemical companies or resin manufacturers on use of agricultural or Industrial chemicals If not on chemical resistance chart Inspect for any shipping or handling damage to tank or fittings upon receipt of tank. ��� 31 y / z • � 11 /'( ; k L rG G • A03 9.1 0v