HomeMy WebLinkAboutApplication- PermitGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N^ 3698
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
Assessor's Parcel No.
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY T'I ^
Owner's Name ((�� v � JM Present Address155D 0 c (.4 rcl In . E ny kWpod
pGo ?6111.1
`System Location t0� ! r1 "o 1.5 I'{(€ OISP
/a 19D c_(o� � /Lr FLS
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
4 i
4 i
If 54041, 'A C. b` L n)(:)111) Wo,
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
i1
Required Absorption Area • See Attached
Special Setback Requirements:
Date Inspector
%1 V
This does not Constitute
a building or ase permit.
Phone3o3-7wy%
sr,&rl
FINAL SYSTEM INSPECTION AND APPROVAL (as Installed)
4 Call for Inspection (24 hours notice) Before Covering Installation
t
System Installer {
Qt
Septic Tank Capacity l
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface 4
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
7-19-02. �Icirwi��FO J s7k+4s 21/3 y�'4 -I2
Date Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
Other
*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 1, Petty Offense ($500.00 fine — 8
months in Jail or both).
t .. White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
1
OWNER .2; M CYO re
ADDRESS 1 S &O4att Eq/ta4 C PHOMattignf Sd3 -&O 4.3S-3
CONTRACTOEL 4, Ont / AiG
ADDRESS /•o.cecic Sia..4 l_O PHONE 970-331--3S7C
8ote 3
PERMIT REQUEST FOR (4) 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 F CILITY:
Near what City of Town O S/Are,GO
Legal Description or Address a0 7a 7 M"/ / 3
WASTES TYPE: ( ) DWELLING / ( ) TRANSIENT USE
Size of Lot His Qei° AcesetS
( ) COMMERCIAL OR INDUS RIAL ( ) NON-DOMESTIC WASTES
(C) OTHER - DESCRIBE% /4-1C-1-- D f
BUILDING OR SERVICE TYPE: &Pr(A&e 1 'S d t.sa c= AA.4CA v/
Number of Bedrooms 0 Number of Persons 7- /6
() Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL p< SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: )1/40
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: £#4 knot, -)Al,
Was an effort made to connect to the Community System? iD
A site elan is required to be submitted that indicates the following MINIMUM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach 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:
`. ()Cc 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:
V6 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.
Sign:-,
Date
PLEASE DRAW AN ACC • TE MAP TO YOUR PROPERTY!!
3
4
w
N N
H
t
zc
g
z
•eer---
--v.d"971Gu
agli9Plala
County Road (Note the Road Number and Name)
1
re
wrr•'�TZOQZ zrv.
1_(-<7'69
• (,Soncj/6/o
GARFIELD COUNTY SUILDINQ AND SANITATION DEPARTMENT
109 Mb Street Suite Bos
Glenwood Syringe, Colorado 01001
Phone (703) 046.1212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Name Gor` r T ; V 1 en r't �Ptresenrt Address (u0 F. QKTbrvi �. ��
System Location C7con ( rill 13 " t c.a BIUf
io
Legal Description of Assessor t Para, No
SYSTEM DESIGN (ASRG als" n' Ldf 0L 1 r�pc 14134
r1
� 11
o w aims*.
41 dam be Fr4C)lniaraeor 'N'
.P•rmR N° 3598'
Assessor's Paroel No.
IThis dose not constitute
a building or us0 perrnh.
Phona3o3 7a" am
Septic Tank Capeotty (gallon) Other RECEIVED
Percolation Rate (minuteNineh) Number or Bedrooms (or other II' 1 1 0
Required Absorption Arae • See Attached JUL 2002
Special Setback Requirements: GARFIELD COUNTY
BUILDING & PLANNING
Date Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (aa Installed)
Can for Inspection (24 hours nolloe) Before Covering Installation
System Mealier
Septic Tank Capacity
Septic Tank Manufacturer or Trade Name
Septic Tank Maes within 8" of surfaos
Absorption Area
Absorption Area Type anther Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
Other
Data Inspntor
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
•COUDrONNS:
1. All installation must comply with all regWnmentsdl the Colorado State Board of Health Individual Sewage DisposalSysteme Chapter
25, Artiele 10 C.R.S. 1972, Revised 1994.
2. This permit is valid only for connection to structures which new fully complied withCounty zoning and bud ding requirements Con-
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatloalry W • Notation era
requirement of the permit and oause for both legal action end revocation of the permit.
3. Any person whoconstructs, alter, Or Installs$n Individual sewage disposal system In a manner MI. 'oh involves a knowing and material
variation from the terms or speoiliostlona contained in the application of permit commits a Claes 1, Patty Offense (5500.00 firm —e
months In jail or both).
White • APPUCANT Yellow - DEPARTMENT
RAKER
Engineers * Surveyors
1790 W. Victory Way - Craig, Colorado 81625
Telephone (970) 824-3435
FAX (970) 824-3102
EVAPORATION POND DETAIL
SHEET 1 OF 2
- 3' MIN.
4" P.V.C. PIPE
48" WOVEN
WIRE FENCE
TO SEPTIC TANK
MIN.
r-6" TOPSOIL
IMPERVIOUS
(1000 GAL.) CLAY (2' MIN.)
TYPICAL CROSS-SECTION VIEW
N.T.S.
NOTES: 1) SEE DATA SHEET FOR OTHER SPECIFICATIONS (SH. 2 OF 2)
2) SIZE "A" & "B" CAN BE CHANGED TO FIT THE SITE, BUT MUST
CONFORM TO THE MINIMUM SQUARE FEET AS SHOWN ON THE DATA SHEET
TYPICAL PLAN VIEW
N.T.S.
—f—FROM SEPTIC TANK
-
\
/
T -
\
BOTTOM OF POND
SPLASH GUARD -1_ 4' P.V.C.
OUTLET PIPE
/
B
TYPICAL PLAN VIEW
N.T.S.
—f—FROM SEPTIC TANK
PLOT PLAN
ADDRESS: eon 7 :/wo / 3 Obi �'/c C'o , F(‘-5.6
LEGAL DESCRIPTION:
PERMIT NO: 35n -
SITE AREA
JNSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF
NOT LESS THAN 1" - 20' ARE FILED WITH PERMIT APPLICATION.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1" - 20'
// /77(7/, I7
o
/
lnri ce
(
V/%1 l i ✓l
7
rit
it
M.
_` Deep
•
ao
Your;
opos
mc on con onn
above and that no changes ees wilcons made without first obtaining mens al. an uses a own
B
/r/ B approval.
NAME(S) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT)
SIGNATURE(S) OF OWNER(S)
• L • At
• • .• up
/n,5pecded OW 7/j/oa
Data Sheet
AxB=4900SFMin
.
Surface Area @ 2' from bottom = 6700 SF
Notes:
I) Pond bottom to be at least 2 feet into impervious clay material.
2) Sides of pond to be covered 6" deep with clay material.
3) Evaporation Rate = 40" year
Precipitation Rate = 13"/year
Net Loss = 27"/year = 2.25 feet/year
4) Excess material may be used to increase height / width of berm. Perimeter of
pond to be fenced with 48" woven wire.
5) Goff Property:
10 Persons/day max
30 gallon/pers/day
300 gallon/day
260 work days/year
78,000 gallon/year
10,400 C.F./year
10,400 x 1.3 = 13,500 C.F./year
(Safety factor) 1.3 safety factor to allow for variations in precipitation rate and
consideration that 80 percent of evaporation occurs in a six month peroid.
Pond bottom area = 4900 S.F.
Elevation 2' depth = 6700 S.F.
Sheet 2 of 2
RAKER 6Y
SSOCIATES
Engineers - Surveyors
RECEIVED
JUL 22 2002
GARFIELD COUNTY
BUILDING & PLANNING
Garfield County Building Dept.
109 8th St. Suite 303
Glenwood Springs, Co 81601
RE: Jim Goff Property
To whom it may concern,
1790 W. Victory Way - Craig, Colorado 81625
Telephone (970) 824-3435
Fax (970) 824-3102
July 19, 2002
The evaporation pond and septic system at the Goff Residence -
20727 Hwy 13, Rifle CO 80110 was inspected on 7/1/02. The
installed system was in general conformance with Garfield County
Specifications pending the installation of the fence around the
pond. If you have any questions please call me at (970)824-3435.
Thanks,
Bob D. Baker, PE 10755
Baker & Associates