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HomeMy WebLinkAbout1469This does not constitute I a building or use permit. • 54 V44 -4147,N) fee. C-borne/4. GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT / 2014Blake Avenue � l�C 1 Glenwood Springs, Colorado 81601 Phone (303) 945-8241 INDIVIDUAL SEWAGE DISPOSAL PERMIT f. Owner System Location Licensed Installer Cao/0 �G in 1469 * Conditional Construction approval is hereby granted for a f eve -91 , gallon Septic Tank or Aerated treatment unit. Absorption area (or dispersal area) computed as follows: Perc rate of one inch in /00 minutes requires a minimum of Z 63sq ft of absorption area per bedroom. Therefore the no. of bedrooms x JZesq ft minimum requirement = a total of Reksq. ft. of absorption area. May we suggest �¢ `X 14 5< 10' de e/6 / J / r Date Inspector /+iv "G'iCr FINAL APPROVAL OF SYSTEM: No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to cover- ing any part. ©,( Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. Proper materials and assembly. 1; tJ Sot-e;-4-'� r� ,44-52' S hie e Trade name of septic tank or aer4ed treatment irr Adequate absorption for dispersal) area. Adequate compliance with permit requirements. Adequate compliance with County and State regulations/requirements. Other Date *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 111, 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 pr specifications contained in the application of permit commits a Class I, Petty Offense (5500.00 fine — 6 months in jail or both). Inspect RETAIN WITH RECEIPT RECORD CONSTRUCTION SITE Applicant: Green Copy Department: Pink Copy INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER 1. - i R ,Ir O(7 IQ Cattn� d 1/1 PHONE 9't3--024?) ADDRESS CONTRACTOR C r R 37AL yer T Bich �v� /8613 S' W 1/ ADDRESS i t , I ,,� 1.'4 .'. I of jj f� PHONE 7i0 -a a 0 PERMIT REQUEST FOR: ( 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. ( e page 4. LOCATION OF PROPOSED FACILITY: County ,* Near what City of Town Cian i, 1 Lot Size Legal Description ��,py, titen/ S Approval by County Official: WASTES TYPE: ()() Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non-domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: ' Number of bedrooms 1j-tcQn&JYt,G Number of persons ( ) Garbage grinder ( ) Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: (9 If supplied by community water, give name or supplier:* GROUND. CONDITIONS: Depth to bedrock: 41 Depth to first Ground Water Ta le: Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort. made to connect to community system? A) c mi. TYPE OF INDIMUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (v 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: ( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration (X) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? Pace 2 rU� . SO1U.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. Datg 31td- c3,5 PLEASE DRAW AND ACCURATE MAP TO YOUR'PROPERTY W fi cr ft 0 a E Signed P 4.1,0e0 A deter - from etc test Asults 3'f net tit SYsILM 10 BL CONSTRUCTED (111" to 21" Clean Gravel Required Unless Otherwise Approved) TOP TOP 1‘ 4" perforated pipe r . 4" solid pipe r .. from tank n -.. .t. '10 n e'M K m CI C3 a'n oa CO a C1_0_1:6406 v o0Ooa4004OOO C:4 430 ea o too•0 O. O w ea en 'Jwoo OOQa o 6 Backfill 3' 3 1 SIDE VIEW 40( aka Backfill $400°0000"g'o06,0 00090 4000°0 0 00 00c00 0 00� 0' ob$ad 040000 000 0 x00000 ° �e o4e�oo 000 00 000 ° *06off '+'��.._�..• Gravel 4" solid pipe ex- tending into drywell 1' 4" hay or straw over rock �.—.. �. * ..�..� *Size determined from perc test results SIDE VIEW 4" pipe n avel 6" Gravel under pipe w is a�pqo � 9< o6Do.rpd�o f---1 Seepage Bed e J -J Other Backfill 4" solid pipe to tank 4" hay or straw Gravel i o bottom Drywel l JAN 28 '98 10:4 AT&T FAx 5300 \.....•' B & R .., Septic, Rooter & Jetting Service 1555 Hwy. 133, Carbondale, CO. 81623 920.2059 063-3814 I PIA IIIIIII ))."17 AC AIM MN MUM 41111011111111111. MEMMIJ7'.PX-AMI IMMO now 118898 Recd b as -16 CRVI AL VALicr MIN ea11p4NipAbg, ea Dees 0111.1/19. n/N•AM PAGE 2