HomeMy WebLinkAbout02809 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2809
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81801
Phone (303) 945 -8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name RArnent nerdy Present Address P Boy O g 1035. Rifle phone _ 625 -9751
System Location 4L C>-A New Caat1° ^ ]�
Legal Description of Assessor's Parcel N r o j . UCK- LEA cis! - pi E t-D —> QS6- �t"i
SYSTEM DESIGN L EACH - cPAMCSCn5 - 84: '3 /
s --
1( ' "-a
l 2 .S° Septic Tank Capacity (gallon) Other 7'ti CNct.(
/r m
- /Q Percolation Rate (minutes/inch) Number of Bedrooms (or other) 4
b YL .
Required Absorption Area - See Attached
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V fT, 1lu ta t Al
Special Setback Requirements: /� �c" (y Olt h10vt a Fr. A PA✓tT
-
Date 7' I S a/ 7 Inspector A R K v 4
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer O W /ti EZ
Septic Tank Capacity /r7c n
Septic Tank Manufacturer or Trade Name 6 bpi-4r, i
Septic Tank Access within 8" of surface
Absorption Area 7il:eE-A-b.
Absorption Area Type and /or Manufacturer or Trade Name 9 Slv In / PNo /c --r.z' S 01.5 1 TS
Adequate compliance with County and State regulations/requirements Y
Other
Date 9- 0 9=1'7 Inspector _ • — sins ✓L
RETAIN WITH RECEIPT RECORDS AT CONST 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 off ice 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 ($500.00 fine — 8
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
+
� •� INDIVIDIJAI. SF.VdAGF, DISPOSAL SYSTEM APPLICATION
•
OWNER L ArNeSi hrd j , r
ADDRESS PO )f1X /03 S RA 0/65 PHONE q 62S 9 7-SI
CONTRACTOR
ADDRESS PHONE
PERMIT REQUEST FOR (>9 NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area,
habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
J .00ATION OF PROPOSED FACILITY:
Near what City of Town S I t t I C 0 Size of Lot W 0 a c
S 24 1?- SI R q2 ( A) New ('nnt1r, )
Legal Description or Address SE y,, /Jai •,
WASTES TYPE (5<) DWELLING ( ) TRANSIENT USE 8/ 1
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE. Man °Ca dvr'4 i - nP` °Cone.;
Number of Bedrooms 7 Number of Persons
(X) Garbage Grinder ('X) Automatic Washer (x) Dishwasher
SOIJRCE AND TYPE OF WATER SIJPPLY: (X) t#I/C ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: A /
Was an effort made to connect to the Community System? A) in
• • • ltn i r t Jr.! i • t ht '. ti • I • fl 11 in IS INI J si In • •
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED
WITHOUT A SITE PLAN.
GROUND CONDITIONS:
Depth to first Ground Water Table
Percent Ground Slope 0 - 170
2
•• - f`
• •
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
($ 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 THE STATE? NO
pE,RCOI.AT1ON TEST RFSIJI,TS (To be completed by Registered Professional Engineer, if the Engineer does
the Percolation Test)
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 purposed 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
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
understand 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 perjury as provided by law.
Signed f ,.,... / f 7 %n Date jon_.0 6 i s
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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N "PRASE '111E LORD" / 5
CoPELAnD COnnnu
, 28803 U.S. Hwy. 6 & 24 RIM, CO 01050
(303)625.1112
10' -4"
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5'-8 ". 20" dia. f 20u dia.
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Model D.Z. 1250 gallon septic tank. Compressive strength 4000 P.S.I..
The bottom and side walls are reinforced with 6 -6 10 -10 wire mesh plus 4 -3/8
rebar in the bottom. Top reinforced with 6 -6 6 -6 wire mesh and 6 -3/8 rebar.
Digging Specs: 6' -8" wide X 11' -4" long. From the outside bottom to center
of the inlet is 4' -31/2". From the outside bottom to center of
outlet hole 4' -1/2".
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