HomeMy WebLinkAbout04185GARFIEL
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OUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
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INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner% Name
System Location 140706, r )'r
2\7044Y Salli-hrig Present Address I (P-704 4-jui
Legal Description of Assessor% Parcel No
SYSTEM DESIGN
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Permit
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Assessor's Parcel No.
This does not constitute
a building or use permit.
Phone 379-4) 24 Z.
237 3z2. 00 039'
J750 low
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached Pill-04JY /5 b- /�—etC#nc,/d4
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Inspector
Special Setback Requirements:
Date G' 29, O o
FINAL SYSTEM INSPECTION AND APPROVAL. (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
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System Installer
Septic Tank Capacity
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Septic Tank Manufacturer or Trade Name Cie
Septic Tank Access within S" of surface h"1"--
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
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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 Chapter
25, Article 10 C.R.S. 1973, Revised 1984.
2. This permit is valdonly 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 (5500.00 f ine — 6
months in jail or both).
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INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER' A ly Ski nvicy
ADDRESS I1o70(a iiloivlvYay 82
CONTRACTOR SAMe
PHONE '90 5(09
AnThre
ADDRESS PHONE
Expct.nslo-n Of tank
PERMIT REQUEST FOR. ( ) NEW INSTALLATION 04 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:
Near what City of Town Car b (rn d.a I C. Size of Lot .2. 5 a -c rc
Legal Description or Address Loi No. 23'91-32 Lot 39, Block No.32-7-87 Su_b. TR an 3t(p
WASTES TYPE: Cc) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER—DESCRIBE
BUILDING OR SERVICE TYPE: R eS i cLc i -110. 1
Number of Bedrooms Number of Persons 3
('5 Garbage Grinder (j Automatic Washer ('f Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (IS WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: +anCh ct1 Roarnnc for k
Was an effort made to connect to the Community System? NI0
A site plan 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 (septic tank & disposal field) to Property Lines: 10 feet
YOUR INDIVIDUAL SEWA E DISPOSAL SY TEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
Depth to first Ground Water Table
Percent Ground Slope
2
TYPE Ol`INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(4 SEPTIC TANK
( ) VAULT PRIVY
( ) PIT PRIVY
( )
AERATION PLANT ( ) VAULT
COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
INCINERATION TOILET ( ) RECYCLING, OTHER. USE
CHEMICAL TOILET( ) OTHER -DESCRIBE
FINAL DISPOSAL BY:
( J 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? No
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 kr perjury as provided by law.
Signed
gKw?? S AI ✓7 V7.lif .
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
Date 6,-23'200(p
3
PERCOLATION TESTS
The successful operation of your septic system depends on the rate the soil in which your leach field will be installed
will accept water. THIS IS CRITICAL. The rate of absorption is called the percolation rate and it determines the size
of the leach field needed for a particular flow of sewage and in some cases even determines the feasibility of the
installation of a septic tank and leach field system. PERCOLATION TEST MUST BE DONE AT THE GROUND
DEPTH WHERE ABSORPTION WILL AKE PLACE. SjANDARD SEEPAGE BEDS (LEACH FIELDS) Ala
INSTALLED THREE FEET DEEP. SO THE PERCOLATION HOLES ARE DUG FOUR FEET DEEP. AT LEAST
20 FEET APART. IN A TRIANGLE SHAPE. THE PERCOLATION TEST IS DONE IN THE BOTTOM ONE (11
FOOT OF THE HOLE:
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BALK }}oe AoLE
A postbole digger, auger or backhoe can be used to dig the percolation test holes. If a back hoe is used, dig the back
hoe hole three (3) feet deep, with a bite for steps, and put a test hole one (1) foot deep and 8 to 12 inches in diameter in
the bottom Installation of absorption areas (i.e. drywells) deeper than three (3) feet require the perrnission of the
Environmental Health Department.
Saturation with water will affect the percolation rate, and since the system will be expected to operate when the soil is
saturated with water, THE HOLES MUST BE FILLED WITH WATER AT LEAST EIGHT (8) HOURS BEFORE
THE TEST AND ALLOWED TO STAND, More water will be needed to perform the percolation test, so AT LEAST
FIVE (5) GALLONS OF WATER PER HOLE SHOULD BE ON HAND WHEN THE TEST IS PERFORMED,
AN EIGHT (8) FOOT PROFILE HOLE IN THE LEACH FIELD AREA IS REOUIRED IN THE STATE OF
COLORADO TO DETERMINE THE PROXIMITY OF GROUND WATER AND BEDROCK. (One soil profile hole
shall be drilled or dug to provide observation of the soil profile of the area of the soil absorption system. The hole shall
be prepared at least eight (8) feet deep. The hole may be terminated when groundwater or bedrock is encountered. The
hole shall be prepared in such a way as to provide identification of the soil profile four (4) feet below the bottom of the
soil absorption system).
4
(FOR APPLICANT'S INFORMATION)
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PERCOLATION TESTS FOR DRY WELLS (SEEPAGE PITS) ARE PERFORMED AT THE LEVEL QF THE
BOTTOM OF THE PIT (USUALLY 10 FEET),
(Reugd 14UcL
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Percola1-iota hs1 -�or Sone.? �-
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If you call for a percolation test or inspection and for some reason are not ready when the time comes, please call us
before 4:00 p.m. at 945-8212 to cancel the appointment.
THANK YOU FOR YOUR COOPERATION.
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