HomeMy WebLinkAbout03033 t t
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N_ 3033 h t
i 109 0th Street Suite 303 A ssessor's Parcel No. ; If
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a Glenwood Springs, Colorado 01601
i " Phone (303) 945-8212 f
1 / This does not constitute ^ i
: a building or use permit. t P
f INDIVIDUAL SEWAGE DISPOSAL PERMIT ' ,( u 1
j• PROPERTY 1 ;
,, Owner's Namdf Mk ( t Address V ` `^� ` `t `F t U J' 1 esen� 7. l) N I `A ( Phone 03 • O ?
t LD ()� 3 � k ) (6 (� , m e {- L A , COWAN. 1 1' wn 4 . , CIS , O .
w ;; System Location , r
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` 1 , Legal Description of Assessor's Parcel No. � ' L IM. Q Q 1'■Ei ZSt� � i . I
f) ItooK— (t=gcH F (Cct9 - -- -7• 6 d'1 ist i i
` ° SYSTEM DESIGN 2) L CAC H C1.4AFAden 000 c 2 Cr N tr S —J-,.. 9o9 H
` } too o" ', Se ptic Tank Capacity (gallon) r Other - t Lii
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$ I J M,
Percolation Rate (minutes/inch) Number of Bedrooms other) 3 p
t [ 9 (,
i Required Absorption Area - See Attached t
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fe Special Setback Requirements: /
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� Date �� i �t. l I'e �/yO L � / (Y ` �7 �( I i r��r t , )N I i r al � 1"��"i
S b U (` j� I� � .2 I t/ i » �_ i
1 • FINAL SYSTEM INSPECTION A D APPROVAL (as installed) s
Call for Inspection (24 hours notice) Befpre J jion„ 0 f h( () Il I ' i t
t) � • / -
r system Installer / w�r� el ) l ' ; l , 1
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•a , Septic Tank Capacity ' O S
V 2 �� ,XXXIIIIII N. } I r , {� �1v2 /1 • .?
r Septic Tank Manufacturer or Trade Name ll n r (.9 ,tin--- ,
)' 1 ;� Septic Tank Access within B" of surface V S 2 1 8
Absorption Area l •
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; Absorption Area Type and /or Manufacturer or Trade Name ,3`t t IN -/ 2 A., r/4-7 • .7/��° - C: 7 1 ( ;t 1 j j I v) , 1
y .1 ( V / An
1 A dequate compliance with County and State regu s .. >' "� )� •
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° ➢ Other YIl 1 j J / { /. ' 1
pate / / ? b e,'t. I np4�E16! . 4 9 (
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i RETAIN WITH RECEIPT RE60160 AT CONSIRU / TION SITE
4 •CONDITIONS: C' k i,
, a 1. All install qLion must comply with all requiremerl,taojtheWlorado State Board of Health Individual Sewage Disposal Systems Chapter 4:
r 25, Articld 10 C.R.S. 1973, Revised 1984. ( { L 1 l 1
2. This permit Is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- if C.
r 4' ' 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. s.
I. 3. Any person who constructs, alters, or installs an individual sewage disposal system In a manner which involves a knowing and material II I
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 i
f x months In Jail or both). (; "
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r 6 _. _ White - APPLICANT Yellow - DEPARTMENT $ `
, INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
. •
OWNER , rr3,t Qnu( cbrent tc.4 y I '/ /o
ADDRESS 9?0. bcY $sP C !e Co• SC6 3 PHONE 963 - 0 7 65
CONTRACTOR owner — ace h,6wteS
ADDRESS 2`/ /-( (.4.m • ‘-4 50 Gnind jnctanCa 'MS PHONE /- -232- 7507
PERMIT REQUEST FOR (X) 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. ,t, 1 45.5
Near what City of Town Iv' hr w cln.6 Co. Size of I,ot /17 K 156.5
Legal Description or Address do-E3 /3 - /`f - /3 - /' o•1 6,o0 To4)rt S4./
WASTES TYPE: (N) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON- DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: 5;449 le 4/04.,/, ✓•e5(Vence
Number of Bedrooms . ? Number of Persons
( ) Garbage Grinder (K) Automatic Washer (x) Dishwasher
5OI JRCE AND TYPE OF WATER SUPPLY ()C) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: y
Was an effort made to connect to the Community System? , - dr5+c, u.. • e if Al £ fc
A site plan is required to be submitted that indicates the following MINIMUJM distances:
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 ISSIJED
WITHOUT A SITE PLAN.
GROI ND CONDITIONS;
Depth to first Ground Water Table 8ft 6 " p ro-F AA k — Key ; re, u v4e( to w 1 r^
Percent Ground Slope — n cs Iowa. -A AL # /n its
2
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? rt.l)
pERCOI.ATION TEST REMITS: (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 A.a _ c - «•b• Date //V/
PLEASE DRAW AN ACCURATE •.• TO YOUR PROPERTY!!
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4.
PERCOLATION TESTS
The successful operation of your septic system depends on the rate the soil in which your leach field will be installed
will accept water. THIS IS CRITICAL. The rate of absorption is called the percolation rate and it determines the size
of the leach field needed for a particular flow of sewage and in some cases even determines the feasibility of the
installation of a septic tank and leach field system In some cases, the profile hole may be waived but only by specific
approval of the Environmental Health Department. PERCOLATION TEST MUST BE DONE AT THE GROUND
DEPTH WHERE ABSORPTION WILL TAKE PLACE. STANDARD SEEPAGE BEDS (LEACH FIELDS) ARE
IL it DID Ii.I;`J! 24. • p • i P4' • . • • _ : i. D • Y. T •EEP A T
20 FEET APART. IN A TRIANGLE SHAPE. THE PERCOLATION TEST IS DONE IN THE BOTTOM ONE (1)
FOOT OF THE HOLE:
1'4.41 ILLG BACK HOF, Hni,F,
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A post hole digger, auger or back hoe can be used to dig the percolation test holes. If a back hoe is used, dig the back
hoe hole three (3) deep, with a bite for steps, and put a test hole one (1) foot deep and 8 to 12 inches in diameter
in the bottom. Installation of absorption areas (i.e. drywells) deeper than three (3) feet require the permission of the
Environmental Health Department.
Saturation with water will affect the percolation rate, and since the system will be expected to operate when the soil is
saturated with water, THE HOLES MUST BE FILLED WITH WATER AT LEAST EIGHT (8) HOURS BEFORE
THE TEST AND ALLOWED TO STAND. More water will be needed to perform the percolation test, so AT LEAST
FIVE (5) GALLONS OF WATER PER HOLE SHOULD BE ON HAND WHEN THE TEST IS PERFORMED.
• AN EIGHT (8) FOOT PROFILE HOLE IN THE LEACH FIELD AREA IS REOU1RED IN THE STATE OF
COLORADO TO DETERMINE THE PROXIMITY OF GROUND WATER AND BEDROCK. (One soil profile hole
shall be drilled or dug to provide observation of the soil profile of the area of the soil absorption system. The hole shall
be prepared at least eight (8) feet deep. The hole may be terminated when groundwater or bedrock is encountered.
The hole shall be prepared in such a way as to provide identification of the soil profile four (4) feet below the bottom
of the soil absorption system).
(FOR APPLICANT'S INFORMATION)
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ACCORDING ! RTYEY BCE F RE THAN WI YEARS TIE DATEE OF TIE CERTIIF� C ICA ' TI M
' SHORN HEREON. TH
Lot 12
• O S 89 °22'00 "E 156.5
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20 Lot 18 N
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A Lot B --_,
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N 89 °22'00 "W 156.50'
County Road 106
0 INDICATES SET REBAR & CAP L.S. 14111
LEGAL DESCRIPTION
LOTS 13. 14. 15. 16 AND B. BLOCK 4. TOWNSITE OF COOPERTON.
GARFIELD COUNTY. COLORADO.
NOTE: THE REAL PROPERTY DESCRIBED HEREON DOES NOT LIE WITHIN THE LIMITS OF A 100 YEAR
FLOOD HAZARD BOUNDARY. ,
IMPROVEMENT SURVEY CERTIFICATE
I HEREBY CERTIFY THAT ON MAY 1I. 1998 A SURVEY WAS PERFORMED BY ME ON THE PARCEL OF LAND
DESCRIBED EREON. ALL EASEMENTS. ENCROACHMENTS AND RIGHTS -OF -WAY IN EVIDENCE OR KNOWN TO
ME ARE -AWN. THIS SURVE4
/ IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
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BY: 2! '
SY �' Y L IN t V+ P I, • '�
v., 14111 °
Y - -. Q a" ` a IMPROVEMENT SURVEY
o ll e ii i 'LAl pps` �, w � Lots 13. 14. 15. 16 B. Block 4
`. Townsite of Cooperton, Colorado
8 BY L /NESINSPACE
0 15 30 SYDNEY LINCICOME ( L.S. /4 / I I 1
SCALE 1 " . S 0 ' BOX 0 CARBONDALE C_140, 303-96-3852
DATE.• 09/03/98 I SCALE 1 30'
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