HomeMy WebLinkAbout01312 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
2014 Blake Avenue
Glenwood Springs, Colorado 81601
Phone (303) 945.8241
REPAQUFBR ALTERATION OF EXISTING SYSTEM - PERC RATE KNOWN - NONE FEE
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT tn 1312 a building or use permit.
O wner Mountain Fuels Resources
System Location Parcel R Cnunty Rnarl 264 2 mi west of Rifle
Licensed Installer ___ Jerry Baysinger
Conditional Construction approval is hereby granted for a 1,000 gallon
XX Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in 0 minutes requires a minimum of sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms 3 x 37. as sq. ft. minimum requirement = a total of 5 9sq. ft. of absorption area.
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Date 7 .cf 2 Inspector 6 ..N
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.
n� -- Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
?9r_ Proper materials and assembly.
e� era rade name of septic tank or aerated treatment unit.
Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
..O Adequate compliance with County and State regulations /requirements.
_.._ Other
Date 'c — 0.3 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 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 I,
Petty Offense (3500.00 fine — 6 months in jail or both).
Applicant: Green Copy Department: Pink Copy
Application
• INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
— — County Official:
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$ c.k l /� /,C� a te �. r -c,frz!5a7PHONE , j?' .-t z: rz?��w»m
,DDRESS
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CONTRACTOR /mac ,C'7 747rcrse 40cocP 6 e_ -snorter—
ADDRESS__ _ /'i / - e (r PHONE /c3i/ Fc'.e -
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. (See page 4.)
LOCATION OF PROPOSED FACILITY: County e5 ern, r _ /
Near what City of Town /z_ //Gc_ r _ _ Lot Size ,9z-._,ec s,
Legal Description ('P, c= c= -z_
WASTES TYPE: ()C) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other Describe t X$.5-./fcu
BUILDING OR SERVICE TYPE: / cc cc
/ / — Sn
Number of bedrooms .2r of persons
( ) Garbage grinder (x) Automatic washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system:
If supplied by community water, give name or supplier: c',- rj o ,C i' / , CCe
GROUND CONDITIONS:
Depth to bedrock: /
Depth to first Ground Water Table: it " "
Percent ground slope: ,'7 T/7 5<>.E.)
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to community system? 'tic)
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(A) 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:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? /Nd
Page 2
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. ((�
Date 7 --8-3 Signed yiU �1 /� " ice_
At, e
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
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