HomeMy WebLinkAboutSP-2115GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 14 2 1 1
109 8th Street Sulte_ 303
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
( INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Name Margaret Ann Droyeen Present Address 4472 100 Road, Carlonda4hone 963-1770
4472 100 Road, Carbondale
Assessor's Parcel No.
This does not constitute
a building or use permit.
System Location
Legal Description of Assessor's Parcel No
SYSTEM DESIGN
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attac
3
Special 0/F3Setback Requirements:iDateInspector r•ril
iZiadb
FINAL SYSTEM INSPECTION AND APPROVAL (as Installed)
Call for
Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity ji`r)CaC//. /A
Septic Tank Manufacturer or Trade Name %_'> _7",Lj
Septic Tank Access within 8" of surface
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
�.L it/f--/A TA"./11,--;1‹
Adequate compliance with County and State regulations/requirements
Other
Date ' r 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 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 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 ($500.00 fine — B
months in jail or both).
Applicant: Green Copy Department: Pink Copy
9
1
4
1
1
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER Margaret Ann Droysen
ADDRESS 4472
100 Road, Carbondale, CO 81623
CONTRACTOR
ADDRESS
PHONE 963-1770 (h)
925-1400 (w)
PHONE
Application
Approval by
County Official:
0�
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.)
LOCATION OF PROPOSED FACILITY: County Gaifield
Near what City of Town Carbondale Lot Size 4 acres
Legal Description Lot 1, Englert Lot Split -- See attached full legal description.
WASTES TYPE: (x ) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non-domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: Manufactured home
Number of bedrooms 3 Number of persons 1
(x ) Garbage grinder (x ) Automatic washer (x ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( x ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: -----;
If supplied by community water, give name or supplier: "A ---
GROUND CONDITIONS: J
Depth to bedrock: V 4 I'k vLr� v"-'4-1
Depth to first Ground Water Table: Ur) kv,o
Percent ground slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: -C-
Was an effort made to connect to community system? /A%
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:
(x ) 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? A/C.)
Pant!, 7
SOIL PERCOLATION 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 No.
Nance, 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
purposes of the evaluation of the application; and the issuance of the periiift.i•s'subject to
such terms and conditions as deemed necessary to insure compliance with rules and regulations
adopted 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
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. 1 further under-
stand 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 per-
jury as provided by law.
Date
.5/07 C/0
Signed
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
(-.4/0,,J00,1 &11J6
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Subc,,tsioN
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CA71kar NC -S
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GrRtt 1. P,:;
/DO Road 0....44.114....a
AICA Crj*har#, L 5.6rc. goad "
Asps"(
Page 3
PLOT PLAN AND DESIGN FEATURES:
Include by measured distance location of wells, springs, potable water supply
lines, cisterns, buildings, property lines, subsoil drains, lake, water 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
conini tments
5ee Airt7tc�.ee�
Page 4
ENGLEPT SUBD/V/y/ON EXEMPT/ON: APFRtOV
SEC. 30, T 7 S., R.87 W., 6th FM.
GARFEE? D COUNTY, COLORADO
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descr!oed above nas these
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6 1
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FI.'per
Bedroom
1141
154
167
S02
llispersal
Area
FI"
247
202
423
563 .
2711
309
463
617
13 1
2
3
4
9
1
2
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4
179
1139
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a 41 AJ
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292
333
500
667
312
356
535
713
21'7
13 1
2
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14 1
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11
227
2:36
331
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567
756
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14113
627
1336
02
94
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1. E3E3
90
103
154
206
:3E1:r
436
655
1373
3943
454
601
909
413
471
71:17
943
97
111
167
222
119
1717
2 313
INFILTRATOR
A (0.5) A(0.6)
Trench Pieces lied
123 7 141:3
141 El 16'7
'211 1. 1 254
2132 15 3313
115 7 162
154 EI 1135
231 12 2714
309 16 370
CONT ACI'OIl.
A10.6)
Pieces Trench or Ilul
Fl s Pieces
1116 E3 175
167 9 21:10
.250 1.3 3111=1
333 113 400
156 13 1E17
0 148 9
9 169 10
14 254 15
10 330 20
9 162 10
1.0 1435 11
15 2713 17
20 370 22
9 175 10
11 21:O 12
16 300 113
21 400 24
1713 10 214
267 14 321
356 19 42E3
110
126
1E39
252
111
133
199
266
15 1
2
3
4
16
1
2
3
4
17
1
i
3
4
244
252
259
113
1
3
4
267
427
41313
732
9'76
441
504
756
11:1(1E3
455
5207
779
1.039
4613
535
002
1069
139
209
279
127
145
211.3
291
133
151
2')7
:303
1:38
157
236
314
165 9 190
11=.19 10 227
2E14 15 340
37E3 20 14:14
174 9 209
199 11 2:3'7
299 16 359
390 21 4 713
1113 10 219
209 11 251
313 17 376
410 22 ;.501
191 10 'a29
21E1 12 262
:327 17 393
436 23 524
195' 11 239
227 12 273
341 111 /109
451 24 545
206 11 2413
236 13 2113
359 15' 424
471_ 25 566
1.42
163
?411
325
147
16E3
25'1
21:5
244
366
401.1
221
252
:?7E1
11) 1E17 --
11 214 13
17 321 19
23 42(3 26
11 19(3 12
12 227 14
113 340 20
214 454 27 .
11 20'7 13
13 239 14
19 359 21 .
26 4713 29
12 219 _—i3 "_
13 251 15
20 376 23
27 501 30
12 22'7 11f ..
14 250 15
21 39:3 24
213 524 31
13 23'7 14
15 273 16
22 11139 24
29 545 33 » ..
13
13 240 15
15 203 17
23 4'4 25
0 566 34 _
11 256 -
13 293
20 4:59
26 5E36
14 256 15
16 293 10
2.3 439 26
31 5136 35
3,:36 5011
173 260.1
260 39(1
346 520.1
156 234
170 • 26!
267 401
:356 535
1'2
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20
27
1.2
1.4
21
20
12
11
21.
29
2615
302
454
605
x'73
:3:12
468
623
201.
321
401.
641
14 265 16
16 302 113
24 454 27
32 605 36
15 27.3 16
17 312 19
25 4611 28
33 623 37
15 201 17
17 321 19
26 101 2'7
34 641 313