HomeMy WebLinkAbout03337 000 # 90 v I
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N° 3 3 3 7
109 8th Street Suite 303 Assessor's Parcel Flo.
Glenwood Springs, Colorado 81601
one (303) 945 -8212
� I j This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT / (''//( a building or use permit.
PROPERTY LL 'On Owner's Name 1 W`" , 1 " , n Present Address 1 � "i-0 1 e c f J - Phon d 59 / " .- 5
Sy Location / I M 3 &t o Se c U AS • Si 0 / CA
Legal Description of Assessor's Parcel No.
it. P CPAt el YI i= n-D. 7_ f' o
� 's ) S . iiv- P_t -(J
-
SYSTEM DESIGN Allr
Sep is Tank Capacity (gallon) Other /`(C
IS TleM
Percolation Rate (minutes /inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date — Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area
Absorption Area Type and /or Manufacturer or Trade Name
Adequate compliance with County and State regulations /requirements
Other
Date Inspector
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 Chap ter
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 jail or both).
White - APPLICANT Yellow - DEPARTMENT
•
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(• SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE US
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE
FINAL DISPOSAL BY:
(4 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?
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.
,� 1
Signed " s Date r 7, —C>C>
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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L CONSTRICTION La4L 9( IN ACCORDANCE IN 54 THE GMI 1 1( (L) p = ROY
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K 41(05 AND SLOPES 11E1 TIPS( 1 005000.
m M44LM m °- ,LMe. U M�1XNG°( DRAINAGE (S u SURFACE WATER MAY rPOIN AmPTIw
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/ SOILS APO RENOVATION RATE w 5 300 ON TESTING M W 930 M
_ ' )000. 00. JOB AVNER sM.
; 10. IRIS CRANING WCs 107 CONSTITUTE AN 1505 PEPSI T. 4(•11 KIST SL
� OBTAIN FRw APIRMR4T( CITY M (08115 404( 93935
,— ( INEER WS1 OBSERVE CONSTR./OM SYSTEM 93rµ[ SA0tr ILL
NO /— 5 REPORT TO CaB
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, M FLUSHING 1 FOR 0(30430 OSMOSIS was M WATER SOFTENERS
M 110E45 1/0.710 SOT SC W Wm INTO THIS SYSTEM
1NST4LMURORRO INSU.AT ION OVER SIRS PIPE 411007(5 DEPTH IS
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1050 / / I' . TR ENCH LA SHALL N O T (.OLEO 100 FEET 110 LENGTH. 0 r
5. 110 507780 O EACH TRENCH LATERAL SHALL M LEVEL. 11
.M / ��/ / _ 5• NECESSARY. 10 M0LNT SURFACE RUNOFF *400 EN ENTERING ASSyPTION AREA. NAMPO TRENCHES. AS
.I /—\\ I __II A. TRENCH LATERALS SHALL *OWN 03P18403.
S. INSTALL INFILTMTM IN ACCORDANCE WITH W404K10S[S MLO4LWK IONS.
4. W NL114TM LO-]( UNIT S. 1 01106 A(0 5 WSl RAYED r0 R[MN[ 811E MARE
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NCR000 WRING nu'Ar11R1. PROJECT N0.
7. 40 (SC.vAl1ON µ ABSORPTION FI(10 IS 70 w MB WRING WET RAMS,
NO
140 0 PAWS TIRE RH10.ES µER TRM 40
1 AREA IS 011°17(0 10 200000416
TRFNCH CROSS SFCTION (TYP.1 N N 0000 SOIL STRUCTURE.
10.1.1 °. IN ALL TRENCH CONFIGURATIONS. SERIAL 01510110104 SMALL RC MSLO
'K0(30 a CUHUTERN 01530,13U71014 r0 I0 AS( SOIL INC 11K 40 SHEET 1
PROTECT MOVER I AL SI FWI.
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