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HomeMy WebLinkAbout01145 ,. R GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 2014 Blake Avenue Glenwood Springs, Colorado 81601 Phone (303) 945-8241 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT 40 1145 a building or use permit. Owner Fdward R Funine Nicholson System Location 335 Road. Silt Licensed Installer • Conditional Construction approval is hereby granted for a 1 gallon . XX Septic Tank or Aerated treatment unit. Absorption area (or dispersal areal computed as follows: Perc rate of one inch in_ minutes require a minimum of sq. ft. of absorption area per bedroom. Therefore the no. of bedrooms 4 x. ft. minimum requirement = a total of t- sq. ft. of absorption area. May we suggest j ,. �f� O Z� X3 //� ''"'� G� , Date M 41 (1 8, t q P,,,-2...._ Inspector I - ,,,„ , , K 0.4.-1 c“.� 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. O r Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground CO K-- surface. materials .--lg Proper aterials and assembly. ' j l t ➢.1044_ (4 Trade name of septic tank or aerated treatment unit. / m, . Adequate absorption (or dispersal) area. - • Z .4 ' 7C �/ 7 b / Y © Adequate compliance with permit requirements. r' / /' � / / 09 /' Adequate compliance with County and State regulations /requirements. 1 1 Oyh�er Q (�� 711 // 4 Date Q �/` I S 1 1 Cl `"— Inspector / ( ma y �'L__I " RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION 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 1, Petty Offense ($500.00 fine — 6 months in jail or both). Applicant: Green Copy Department: Pink Copy INDIVIDUAL HOME SEWAGE 1REA1MENT SYSTEMS APPLICAJION PAGE IUO OWNER __Ci5:2sc ADDRESS Lko %. C�ov� �P. l CQ '. ^ o \•� - _ , �`V APPLICANT . ADDRESS O` . aS d C v \ • PHONE 1c- �.`-\ CONTRACTOR : 9 t& w ----- ADDRESS i , TESS PHONE -------- : -' -- IS PERMIT FORV (.New Installation ( ) Alteration ( ) Repair Attach separatesheets, or report showing entire area with respect to surrounding areas, topography of area, habitable buildings, location of potable water wells, soil percolation'test holes, soil'profiles in test holes. LOCATION OF PROPOSED FACILITY:, County, Near-what. or Town ''`3:" .•. _ Lot Size _C=.'.; - ' S Legal Description &I y' y(.. Sd� �a - /ems Pot, c -, . C� \ SOLI WASTES_TYPE: ()41-Dwelling; i ( ) Transient Uset s` ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe: BUILDING OR SERVICE TYPE: � Number of Persons Number of Bedrooms V (\, Garbage grinder ( ),Automatic washer ( goishwasher SOURCE AND TYPE OF WATER SUPPLY: ( 71 well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: _ If supplied by community water, give name of 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? C\ o,- TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (') 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: • ( )k) Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: =7 A . PAGE 1HREE , WILL EFFLUENT BE DISCHARGED _DIRECTLY INTO WATERS THE STATE ?____`______ SYSTEM IS DESIGNED FOR __ T GALLONS PER DAY If the system is to be designed by a Registered Professional Engineer (RPE), state ,' rate of absorption in test, holes shown on the location map, in minutes per inch ;. of drop in water level after hales have been'soaked for 24 hours: '__^ __ SOIL PERCOLATION TEST ,RESULTS:.i_,. •.:__i . 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. ___ Nance, 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 sane for purposes 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. Date ..„__,_)—_, ` V"1 Signed - 1 ale I PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY r Page Three PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY I.4 I 1/4.. I e ("c4 oak Qirtcsk• V ''' ce-C M • Y cmAes 1 "'"" „c.v. oc-F- 1 CS Cn-s•-c 11 :%Ic Z\ INDICATE BELOW THE LOCATION OF YOUR BUILDINGS, WATER SUPPLY AND DISTRI- BUTION LINES, STREAMS, IRRIGATION IITCHES, ROADWAYS, AND BOUNDARY LINES To20* C_t- a6° 6'•"\- • % ass. a o 0' c. „ c (TO BE RETURNED TO ENVIRON. HEALTH DEPT.)