HomeMy WebLinkAbout03097 ,k.wdsp. . . - C a l f `� �'
1 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N °_ 3 0 9 7 a "f
109 8th Street Suite 303 Assessor's Parcel No. f
y Glenwood Springs, Colorado 81601
4 Phone (303) 945 -8212 't r
This does not constitute I `e
i r INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
1s PROPERTY �� / 53" q Q C y� 1t ' / I C �t� �/6�7 ,I `
1 Owner's Name. ' 9 `r p�f 5( 1 `- - Olf 4 ^ g Address a f 'I Arm, E' Phone AT 5
• System Location 4 3 39 l F a I! toe (-0 Cc( ST re Co 6 J 6 V 7
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r Legal Description of Assessor's Parcel No. t. ,
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) .1 SYSTEM DESIGN 1
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Septic Tank Capacity (gallon) Other
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) , Percolation Rate (minutes/inch) Number of Bedrooms (or other) , ,,
is
I k Required Absorption Area - See Attached
I? ,c.a. ^ s I
I' Special Setback Requirements: ' c
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/ / Q �x Dcs e.�o 4
Date o s < / �I/ /g/ Inspector
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■ ; FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
' • ' Cali for Inspection (24 hours notice) Before Covering Installation ),
S ys tem Installer
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Septic Tank Capacity l� d
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Septic Tank Manufacturer or Trade Name C X S � / 1. {
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r, s Septic Tank Access within 8" of surface v
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Y r Absorption Area
1 0 V tit 1 5 (N O N2 TAC{.rC4 -/
1 N F/ t 1.. A 'r o vi 5 arr) f
Absor Area Type and /or Manufacturer or Trade Name g i
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Adequate compliance with County and State regulations /requirements 4.0'...-- t
.1 Other a °`
�' A o ;,
l,.$� ` . Date , ^ t (� `� 1 � Inspec � 1 `� �
,, I RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE F
g '. *CONDITIONS: t I
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter it
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- , I
e nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a 'i
(h requirement of the permit and cause for both legal action and revocation of the permit. I
.i, 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material '
7 r variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense (8500.00 fine — 8 f
months In )all or both). ? (
, White - APPLICANT Yellow - DEPARTMENT __
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• ' w ' c INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER SCo44 DOti_ a er-
ADDRESS 5334 C.@t`I Co1/4,S4 PHONE°) V 7b — S 1 $
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CONTRACTOR 6 ^�
ADDRESS PHONE
PERMIT REQUEST FOR ( ) NEW INSTALLATION 1ALTERATION ( ) 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:
Near what City of Town j P-AA C c s'1"12 Size of Lot ail ac
Legal Description or Address 533`\ C JR• atV
WASTES TYPE: V) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: ('CS; ka - 141
Number of Bedrooms 3 Number of Persons 3
( ) Garbage Grinder (4 Automatic Washer (�/) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: p() WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: a fpro7.. 3 m; le5
Was an effort made to connect to the Community System? Ati
A site plan is required to be submitted that indicates the following MINIMUM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leac4 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
2
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(51 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:
OC) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
( ) JJNDERGROUND DISPERSAL ( ) SAND FILTER
( `') ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?
PERCOLATION TEST RESULTS: (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 ' 0 Date Wa S Q
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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This does not constitute ) s1
a building or use permit.
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J GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH -- -VO • r
" � 201 Bie Avenue (. r r � `;
: � ' rd1l','c
' Glenwood Springs, Colorado 81601
Phone (303) 945 -7255 ` .•`;i
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INDIVIDUAL' SEWAGE DISPOSAL PERMIT NSA r
7 5 4 ,
Owner_ • Lorin Doolen
1,
System Location New Castle 5'33 G
7 Coil' . 2 1 1 - s
Licensed Contractor 1 6 (t - P./...4 /
Conditional Construction approval is hereby granted for a 7$✓ gallon - - -
, ,
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows: _
• `
Perc rate of one inch in /a •'.
minutes requires a minimum of /16 3 sq, ft, of absorption area per bedroom. ' st
... ..,il
Therefore the no. of bedrooms ,...- � °'s
x s fit/ min I re / qui 2 rement = a total of .� a nsq. ft. of absorpto n area. `
May we suggest (J.0 '�-^' ,.e � 2. 'X �t /-}{ ' �-Cd n i
Date ..G - - /i �/�- •��7 ,
Inspector / ` �. .-.,„t
FINAL APPROVAL OF SYSTEM:
No system shall be deemed to be in complianc with the Sewage Disposal Laws until the assembled system is approved r .'
ing any part.
GAL.
Y PProved pr r to �ovei ,
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!Joel, 2/2St/29 sr4 x e rat Ye .irf r :
--01.4_-- Septic lank access for in ection and cleaning within 12" of ground surface or aerated access ports above ground
/ surface.
CQ(` Proper materials and assembly. I
Owo e/"' Mid e., — /000
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C"/ \ . Trade name of septic tank or aerated treatment unit.
— at Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
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" Adequate compliance with County and State regulations /requirements- ,, `
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,577 asp ' r
Date / j - �� '
Insp , �` �` .
RETAIN WITH RECEIPT RECORDS ONSTRUTIO SITE �`
CONDITIONS: w• C. t 6 , t !;ii
1. All installation must comply with ; all requirements of the County. Individual Sewage Disposal Regulations adopted to au' ' , 11 ,;: '
, ' thorny nted 44 -4 S CR$ 1963 amendd 6 -, CR: ', `-
2. This permit is valid only for'conneeti on t stru which complied with County zoning and building requirements r � 4 %;.
Connection to or use with any dwelli o r u
structre not a ' S l c y t he Buildin of t he Zoning office shall automatically be aviolas � tion of a requirement of the permit and cause for both legal cd revd?ation of t permit e r , °.; '/' k, ' Y,.` , °•�l , S Section III, 3 24 requires any person who constrcts alterslli an individual sewage disposal system in a annetwhi i ; ` g s r wolves a knowing and ma te r ia l V ariation from the u terms or ions contained in he applidation of permit a Ciass (a1 A etty Offense gra ($500 in 66 - 00 T 6 months in e lad or b6 oth 3 -14` i "� <;� t ��rs�)��` 'xf 14, �.�pr., 4�, Da'
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r t Building Officials Permit ' ai i � , of � f t. 7/t .-�d � 4u'r 1 thc� �l
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Cody; r . d ! � PP l icar}t Green Copy r + + } � pePt ink COPY 2 ` "° y j �j h �'
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(TO BE RETURNED TO BLDG. & SANI, DEP
`k rage iwo Fees Paid $ ca
" A ' `x xVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date 7,'-( •
If '
:A e .dress: lP 33 City: Zip: »7 Phone Z/2 •
'RMATION REGARDING PROJECT SUBMITTED FOR REVIEW
Attach separate sheets or report showing entire area with respect to surrounding areas,
topography of area, habitable buildings, location of potable water wells, soil percola-
tion test holes, soil profiles in test holes (see Page 3).
1. Location of Facility: County GARFIELD City or Town XVI/ (
Legal Description (07, (DV 4 I Lk /I. Lot Size 4 7, 5 ' a :hi
2. No. of Bedrooms ' Septic Tank. Capacity -75Tho Aeration Unit Capacity
3. Source of Domestic Water: Public (name): Ce.41.ti-n
Private: Well Depth Other Depth to 1st ground water table
4. Is facility within boundaries of a city /town or sanitation district? Ivv
5. Distance to nearest sewer system: 3 ern
Have you attempted to arrange a connection with the system? "
If rejected, what was the reason?
6. If R.P.E. tested, state rate of absorption in test holes shown on the location map, in
minutes per inch of drop in water level after holes have been soaked for 24 hours:
1
7. Name, address, and telephone of R.P.E. who made soil absorption tests:
8. Name, address, and telephone of R.P.E. responsible for design of the system:
9. Express permission is hereby granted for the inspection of the above property by any
member of the Garfield County Building & Sanitation Department and /or such persons as
they may designate. Any withdrawal of this permission shall be in writing and receipt
acknowledged by the County Building & Sanitation Department.
10. I have been given an opportunity to read the Individual Sewage Disposal Systems Regula-
tions of Garfield County and I hereby agree to comply with all terms, conditions and
requirements included therein.
Date Signature o Applicant
(TO BE RETURNED TO BLDG. & SANI. DEPT.)
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�•�' CRAW AN ACCURATE MAP TO YOU PROPERTY r • `nree
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INDICATE BELOW THE LOCATION OF YOUR BUILDINGS WATER SUPPLY AND DISTRI-
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS; AND BOUNDARY LINES
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p .3 y a,R 'y6 y r . � • Mr y � _� To BEERETURNED.:TO. BLDG & SAN I. DEPT) a � • �rtFr.
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