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HomeMy WebLinkAboutApplication- Permit• GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 2014 Blake Avenue Glenwood Springs, Colorado 81601 Phone (303) 945-8241 REPAIR --- NO FEE PERMIT INDIVIDUAL SEWAGE DISPOSAL PERMIT 1424 c 5e (c?a , This does not constitute a building or use permit. Owner Carl E. Ward System Location 1164 County Rd- 113 Carhnndai o, Col nracin Tom Wilker Licensed Installer Conditional Construction approval is hereby granted fora 1.1)00 gallon { 9,1 Septic Tank or Aerated treatment unit. K Absorption area (or dispersal area) computed as follows: le/s" e //t/3'75( to 1 / /) r'/ Perc rate of one inch in minutes requires a minimum of sq ft of absorption area per bedroom. Therefore the no. of bedrooms x sq ft minimum repuirement = a total of /? x/3'X/U Date 44-////� S Inspector May we suggest FINAL APPROVAL OF SYSTEM: sq. ft. of absorption area, No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to cov. ing any part. C2Gc. Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface, Proper materials and assembly. Trade name of septic tank or aerated treatment unit. /Cie-) ! o H c e (7 L( Adequate absorption (or dispersal) area. /A. Adequate compliance with permit requirements. J /-'N Adequate compliance with County and State regulations/requirements. Other Date Inspector i//'44' (// / ,` .G / ( / RETAIN WITH RECEIPT RECORDS AT C�SNSTRUCTION SITE *CONDITIONS: 1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations, adopted pursuant to au- thority granted in 66-44.4, CRS 1963, amended 66.3-14, CRS 1963. 2. This permit is valid only for connection to structures which have fully complied .with County zoning and building requirements. Connection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a viola- tion of a requirement of the permit and cause for both legal action and revocation of the permit. 3. Section III, 3.24 requires any person who constructs, alters, or installs an individual sewage disposal system in a manner which in- volves a knowing and material variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense (S500.00 fine — 6 months in jail or both). Applicant: Green Copy Department: Pink Copy i• 1 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER E CAJA �0 ADDRESS t L ("4 CsnuoVN [ 1S PHONE 9451347r CONTRACTOR _ ADDRESS PHONE Approval by County Official: PERMIT REQUEST FOR: ( ) New Installation ( ) Alteration (i4Q 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 FigUD Near what City of Town 0642-goevOn4 Lot Size y4C Legal Description WASTES TYPE: (}c) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non-domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: 14.rarip4i_ Number of bedrooms (>) Garbage grinder Oc) Automatic washer' ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (x) well ( ) spring Give depth of all wells within 180 feet of system: -4/z Number of persons If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: { ) stream or creek Depth to first Ground Water Table: Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Tbn «eS Was an effort made to connect to community system? Ilio TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( ) Septic Tank ( ) Vault Privy ( ) Pit Privy ( ) Chemical Toilet FINAL DISPOSAL BY: ( ) Absorption Trench, Bed or Pit ( ) Underground Dispersal ( ) Above Ground Dispersal ( ) Other - Describe: ( ( ( ) Aeration Plant ) Composting Toilet Incineration Toilet ) Other - Describe: ( ) Vault ( ) Recycling, potable use ( ) Recycling, other use ( ) Evapotranspiration ( ) Sand Filter ( ) Wastewater Pond WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? Page 2 - 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. 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 purposes 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 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. I 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 3-a2---46 PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY !0' MA C us S t' ©9r Signed "&e.t0 Ga-COLcia R-sA C." f.1014. AICP faa C—� e4,411.1. G.w4a-P A/Q ui Page 3 CA -L fr< &-Ati (15) 260Np4cF c!!firo+ =4/D Pis ilaNtS2_ GS