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Home My WebLink AboutApplication- PermitBUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT N° 1874 Owner Kazhtierz Kozak System Location 0046 Apache Dr, New Castle ' Conditional Construction approval is hereby granted for a Septic Tank or Arrat d,t,t gent unit. 4. Absorption area tor dispersal area) computed as follows: *Ea"minimum of This does not constitute a building or use pemet. SCE ati /NAL A QiyjrP4Iz $7,2412-50604&o,4,JD� -f4� I Gla -t e1 • see 1Zs pC sq ft of absorption area per bedroom. Therefore the no. of bedrooms 4 x 24 4 sq ft. minimum requirement = a total of CL / sq. ft. of absorption area. May we suggest: �n stt! I ! t.Je /1 TC max/1.4w M1 !a„ "t_.4v4.4‘tech Date at fie only hcea ¢Ja.-� e4/%aid/9 C b- r QcctH&t' h,. ' 4/1191 FINAL. APPROVAL OF SYSTEM: InspeFtor r /0L��'•./ C No system shall be deemed to be in compliance with the Sewage Dispbial Laws until th} a}stmbied systean is approved prior to cow- ing any part. J� i J Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access pont) CU 1/)1...01 surface. Propermaterials#n b /Sin— sesh 7j' ,)s4Vt li s) �f® t i L Trade name of septic tank or aerated treatment ooi`t.'4r /Ce. tze a 1 _V a_ ea p�.� �j 1 . '7� fie 12.— e4 -O3 711..._„ . Adequate absorption (or dispersal) area. Adequate compliance with permit requirements. Adequate compliance with County and State regulations/requirements. �f Other //t 2 W , -2e Inspector Data RETAIN WITH. RECEIPT RECORDS AT CONSTRUCTION S '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. 1913, PalvISd 1984. 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 violation of 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 tams or specifications contained in the application of permit commits a Class 1, Petty Offense (¢500.00 fine — 6 months In fail or both.). Applicant: Gran Copy Department: Pink Copy • • N ;• OW(1ER 1 /642/flISM'z 1/60 /i ADDRESS j9614/1J-o el.F✓, n/oat:00 PHONE 981 3Sir • 1 l '' _ . � ADDRESS �� ' N / PHONE INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION CONTRACTOR PERMIT REQUEST FOR: ( ) New Installation ( ) Alteration ( Attach separate sheets or report showing entire area with respect topography of area, habitable building, location of potable water test holes, soil profiles in test holes. (See page 4.) LOCATION OF PROPOSED FACILITY: County 0sa L Near what City of Town ,,.�� -�-" �""" ®®® Legal Description dOij b / Application Approval by County Official: ) Repair to surround'ng areas, wells, soil percolation Lot Size Lofz /t3Jock G E/k vPP.KA)P✓/•J ( ) Transient Use TYPE: (/ )Dwelling ( ) Commercial or Institutional ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms ( aS WASTES �1- ) Non-domestic Wastes 06-0 �� Number of persons ( ) Garbage grinder ( ) Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring Give depth of all wells within 180 feet of system: ( ) stream or creek If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( ) Septic Tank ( ) Vault Privy ( ) Pit Privy ( )0Chemical Toilet fINAL DISPOSAL BY: per) IW e-) i (x) Absorption Trbnch, Bed ( ) Underground Dispersal ( ) Above Ground Dispersal ( ) Other - Describe: ) Aeration Plant ( ) Vault ) Composting Toilet ( ) Recycling, potable use ) Incineration Toilet ( ) Recycling, other use ) Other - Describe: iX/2% /S' ( ) Evapotranspiration ( ) Sand Filter { ) Wastewater Pond WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? --- r • • SOIL PERCOLATION TEST RE§ULTS: (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 P/afif PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY Signe kISCP 3 0 NN >'I>A> mmrmr > Z rw 00♦ O O-- 1110 Anw,n I 1 DA 2010 Nom A fQC>0 1Q 0 to z z0 0 AA g3] o o s Am m mnm(C 8 N. Oy.. I 0 OQ00-I 09 mOr Oym• Omr1-2 1 2- 1 CZy *>N Z>f 0Q1 1J O'Z m0N 0-r Q ' vaR on YAnZrm mx 05- r•m 1�wro 0 om <ZMZ QNON_ -A go 0 A 1'1�Nnn Or = n R 2 -AMO ZR N O • rnoOA > u g^_•p. 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TO /\ GROUNDWATER • /\ TNNOVB 1VH0IVN l3NNVHO ON J W W 4. 4 r 4 N y2y�2 zm Z m mA m O� 00 N 0 mD >NO DO r> rD O zm< 04 r :00 4 8.1-,0> > 2i i `m2 Op z -z r 00 TW 99 O Ompm >>mW m p Hm nm YAW < - Op -Czlm [y(0 9 I- 0<CO C - -0 > £ Am y 00 g { g - m, 9 mr m Ti g G o 00m vzi n i m- E Z TO AW D > 44 O 1 riM 010 4 it m z zG m> r y m a ti0 < -2m 2 C mA Om 1z r m m' 2 1 m PO 014 D 4= MA RITW- zN 0>A. z y 0 01 4 m to A) _ 1 TRENCH LATERALS SHALL NOT EXCEED 100 FEET IN LENGTH. 0) 1 rin N >s m> n {C r m D O c 0 P1 D r 0 m W W P L 014 r- m O24 >0104 ON TV >r E- Seo �1n >7 2 - mm= 22017_ >0 -A mg z >O Oym m JC �Y -4 ilm 0_>m r<< >> 2y ow mm yD > -r LZ- -N O- - -D WO mmn z -z a rCW 010120 0 r- Zr 0- r1 2 > ro it m< 00101: r> >0 0 >r <4 0 s > 1'1201 <MO> 02 z cz 0 4 r1-4 gy -z zm z z-4 - a 0 8 m mz -n 20z oz IncmCA2 09 r mnZ p CO ZA N4 > rN 9 pi nA 200 SA (>YYYY�� p Om O 4n 0 Z L 010 / 0 - AmTN <D nm Or r � � yr 712 m A ➢4 00 yn O m • C HIM V- oo Om CO ymr m ;m i -120 4<40 p2 In n m zr m m p amz- r 4 22 m Om < 0(410 mm U r mmA nnao mz mm Wm IWn DS- z- O g Y 01 09 ZO (0 pp0o ay v nm My > ZA< n4 N O 20 V1 z< 0 o'0 20 o0 P1 800 �0<0 0DC4 WO WF. ro i q r W cum 4001 8 mA o zm o- m z s m O> >> mm m- i m 2 m O 0018 <2- mm 1n< 0 Hr mm 1011 m L zW mo/ Hzzen Y ms ma a 8 m$ �z TC4 40 m> r 4 m m oz- r<m z 01141 40 r 0 y1 0 4n 0104 '1 WA 4 > 2 Az > - n im99E> mrrl p£ 61>i1 0 z p_4s r W 5 101/1 WON mn • > 0012 V1 Zr i -1 II W im < NDm mr4 2 +� pm yW >z Y 2 < > 440 ➢0 2 A 001 .40 ia2 n 4 O Cm r X 01 4 i D 2 0 >> < n o g 0 - o > o< W > r z 9 4D r 4 O 0 N O O 2 mn m o y o o _ 2 i1> m m g o 2 0 ESTER KOZAK z GARFIELD COUNTY, COLORADO 0 NDMDUAL SEWAGESYSTEM anew nN MOW d\ A 11 OOfel HIGHCCUMMIr 92010110C a am00O ! 1OJJ Oz FO aw 0 w rc CD W Qm Oa z F mo w W 4 Si Nn £t — >— Y "y IG :2 FZ 22 UQ_ Mw O Q Z~ I- 3 Er M OJ Q�nr WF>. 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