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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT /.1.• f - %_ - 't
2014 Blake Avenue
Glenwood Springs, Colorado 81601
Phone (303) 945-8241
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT :y;f1 1230, a building or use permit.
Owner Joe Dice
3
System Location Cnunty Rnad 214 NowtAsti (approximately 3200 blk)
Licensed Installer Elk Creek Construction
Conditional Construction approval is hereby granted for a 7;0 gallon
XXX Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in 2Z minutes requires a minimum of . sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms 2 x ■35:lif sq. ft. minimum requirement = a total of 4:74,,,_sq. ft. of absorption area.
May we suggest /3 / X s • X 3 • ..Serc-r 't= ,*
Inspector
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+144 Trade name of septic tank, aerated treatment unit. /Ooc} c fJ
(7,t1 -. Adequate absorption (or dispersal) area. 6:7 rfll (" { / -$`S / nal e e-
Adequate compliance with permit requirements.
Adequate compliance with County and State regulations /requirements.
Other l
Date " o — P2 " Inspector 4 ' V
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 wh"o 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 I,
Petty Offense (5500.00 fine — 6 months in jail or both).
r
/ Applicant: Green Copy Department: Pink Copy
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• INDIVIDUAL HOI1E SEWAGE 1REATMENT SYSTLIS APPLICATION PAGE TUD
C4/) ,l/ ' 3412.S. OWNER r7, 4/ G d�o2,7 L -
ADDRESS a . ,arrrar PHONE y ry 3 9v
APPLICANT rya e %) /G c. — 2?- P6ie-AA c•
ADDRESS S 9 ALA PHONE S ? h.
CONTRACTOR c , r / ,(-J Celt s D v / \ c9
ADDRESS 0 3 '/S A ij (t-1' ( t Chi cv - 06 L PHONE 7 YS S9'a
IS PERMIT FOR: ( New Installation ( ) Alteration ( ) Repair
Attach separate sheets 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 &"4/5(-i ld
Near.. what, City or Town Coonrry N.w c r'7 / /'c_ Lot Size 073 /9(14 S
Legal Description _ l— 92— Sic/ S.- N
WASTES TYPE: (7) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non - domestic Wastes
( ) Other - Describe:
BUILDING OR SERVICE TYPE: _ Number of Persons V--
Number of Bedrooms 1 —
(x) Garbage grinder ( x) Automatic washer (h) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (x) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: S — f r
If supplied by community water, give name of supplier:
GROUND CONDITIONS:
Depth to bedrock: _
Depth to first Ground Water Table: `/o j
Percent ground slope: R p
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
. e
Was an effort made to connect to community system? Ai
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(X) 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
• ( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond'
( ) Other - Describe:
:r,E ;•RFE
• WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? N 6 _______�
SYSTEM IS DESIGNED FOR 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 holes have been soaked for 24 hours:
1
SOIL PERCOLATION TEST RESULTS:
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: _
Aeplicant acknowledges that _
thecompleteness 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 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.
P
Date S�1%eODMtK�
Signed ` O
V
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPER Y
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PAGE FOUR
1 A
PLOT PLAN AND DESIGN FEATURES:
Include by measured distance location of wells, springs, potable water supply
lines, cisterns, buildings, property lines, subsoil drains, lake, water course,
stream, dry gulch and show location of proposed system by direction and distance
from dwelling or other fixed reference object, additional su missions in
support of this application such as data, plans, specificatif s, tatements and
commitments.
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