HomeMy WebLinkAbout01250 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 , .•j' ' 1 • 2! a building or use pergnit.
Owner ' here*! & 'Oendy �" lI b
System Location ui SPLs o f Secti 31m 1 i24 }21,'
Licensed Installer
• Conditional Construction approval is hereby granted for a 1, (106*. gallon ,n t13111,i, rimed
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one Inch in ,% -S ... minutes requires a minimum of S sq. ft of absorption area per bedroom.
Therefore the no of bedrooms x ` "' ''sq. ft. minimum requirement a total of S >'' sq. ft of absorption area. '
May we suggest v ..,. ,r • <a >,.y c': 6 /24: =2)
.. .. � r" rr .;: ; ;.
Date r` 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.
ii
rat Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
Proper materials and assembly.
67.G Trade name of se tic tan or aerated treatment unit. /`/S+o en . 90 a jy�a l
/ .Ting& /425' nCSt , }
+P 4 Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
` ni Ct. Adequate compliance with County and State regulations /requirements. -
Other
Date /00 � . ,._ Inspector
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 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 or specifications contained in the application of permit commits a Class 1,
Petty Offense (5500.00 fine — 6 months in jail or both).
Applicant: Green Copy Department: Pink Copy
C L R . l_�Y! I i_41., ___AIL_ _ lf , �?_,Y- L1_QC�/_ ., - -- - - -- - -- - -- - - -- - - -- -- - - - - --
A!1; PL SS 9X12 a 6/./___T_ - a,_0 s?-142A---„a__ - ____IdONE E .g76 -5L
APPLICANT _ .54,20f_- • - - -__ -- - - - - -- -- ---- - - - --
ADDRESS SM-mf c _ — PHONE s
CONTRACTOR i4%'�1. - — - -
A.DCRESS r,/9t41 9. _ PHONE 1iXl/?4C. • •
-
IS FOR: (X) New Installation ( ) Alteration ( ) Repair :' r
Attach separate sheets or report showing entire area with respect to surrounding
al as, tc; of area, habitable buildings, location of potable rater wells,
soil percolation test holes, soil profiles in test holes.
LOCATION OF PROPOSED FACILITY: County . K /f✓.AJ
—
Near t,hat.City or Town •2 Z - Lot Size /Odle $
Legal Description Atgprg:e" .694D 7,siN'- 71V-i CJT57 97sre4 -�,c lrf,2fi 45 '7/ /P/FFoC6
mss 2.ey1oiL124)/k r e/ S S 7eeATFl .,:id 7V# ld% 5 04 OP SFa7io t1 3I
/ 3 i ou7H /QAN4f.- 7„2. Ides; or lo/'' 0 evan'ry C1' oe4a)
WASTES TYPE: (X) Dwelling ( 1 Transient Use
( ) Commercial or .Insti.tutional ( . ) Non- domestic Wastes '
( ) Other - Describe:
BUILDING OR OR SERVICE TYPE: ellj_1n .P_g i`fo ___f_ /47-6AL,Number of Persons c5 -
Number of Bedrooms - ,.Q • —
( ) Garbage grinder (X) Automatic washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: OO well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: 7 0 &A1-.1-,S
If supplied by community water, give name of supplier:
GROUND CONDITIONS:
Depth to bedrock:/if/,tYcO
• Depth to first Ground Water Table: , 4/ a pe
Percent ground slope: /0 o .SZ.or°F. '
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: - n9/ /{<
Was an effort made to connect to community system? /0
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:
(X) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter.
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe: •
•• ... 1. ii F+nt :;T il<i!' - :GiD F'_:FCTL1';_ , i_.S DE ME . _S1__1L?
SYS 15 D1.S15;'FD FOR '•LI_C';S ;'ER DAY
if ILL system is to be designed by a Registered Professional Engin: =r (RPE), state
rate of absorption in test holes shown on the location cap, in :ri r,;tes tier inch
of drop in i;ater level after holes have been soaked for 24 hours: _I
SOIL i PERCOLATION TEST RESULTS: _ii _1:.'s.`
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 Ho. _
Name, address, and telephone of RPE who made soil absorption tests: —
_I ;ame, address, and telephone. of RPE - responsible for design of the system: _
Applicant acknowledges:_that_the _ compleiteness.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 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 perjur as ;rovided by -lair I
Date /0 22 f�2 Signed - /. a 4 L' /�`"'� •
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY '
t
V
15.1
-3 1 $I
Ot
�� _