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Home My WebLink About01368 ., c., cyr ;. i GARFIELD'COUNTY BUILDING AND SANITATION DEPARTMENT 2014 Blake Avenue Glenwood Springs, Colorado 81601 Phone (303) 945.8241 g er0, r r INDIVIDUAL SEWAGE DISPOSAL PERMIT This does not constitute 3 68 - a building or use permit. Owner (Zen C o'2 -flr3 O n r'_.r /j7T -SCA` )/'? .0 System Location ,A* ' .3t /l�� d� // _J « Licensed Installer - 7 - 0;p n t9/ r _ , a„ Conditional Construction approval is hereby granted for a gallon __ Septic Tank or Aerated treatment unit. Absorption area (or dispersal area) computed as follows: Perc rate of one inch in .af minutes requires a minimum of /ef-V sq. ft. of absorption area per bedroom. Therefore the no. of bedrooms 3 x /t / sq. ft. = e mu min'm re uiremnt a total of'V 7 _ erp q. f�f absorption area. May we suggest — ".--- Lv€ �3- � ,c. / .Y c3�-C.k 29rt'— �e='s.s >u d <a.,2_ - 7r�1 QF7;` S Date .5_ 4/ £ V Inspector r 7) l Z -/ 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. 622 Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. E2 Proper and assembly. o Cr Trade n»� f septic t or`aer /0 un it . / ) C Adequate absorption (or dispersal) area. ( /�� Adequate compliance with permit requirements. `J s ` Adequate compliance with County and State regulations /requirements. .. ---Y-- Other f 5 /z� r Inspector dr e iii Date ...44 „At ETAIN WITH RECEIPT RECORDS A ONSTRUCTION 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 663.14, 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 ($500.00 fine — 6 months in jail or both). Applicant: Green Copy Department: Pink Copy Appiicatlon .o • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by Cou y Official: OWNER ( dc� e ,SC jr 'Y /0 ADDRESS ,/=-/e a (eel /0c0 _ PHONE 9� .,e5 / CONTRACTOR :4,440:4‘;..e. t — Ur PHONE PERMIT REQUEST FOR: ( Wilew 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 la-1 ' -2 c:rc. J Near what City of Town ar., � c> Lot Size 3eod> Legal Description ';10 WASTES TYPE: ( Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: , .4)(27c c Number of bedrooms 3 Number of persons ( ) Garbage grinder (0— Automatic washer ( ) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( we ld ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: >c% --ie._)-c If supplied by community water, give name or supplier: GROUND CONDITIONS: Depth to bedrock: /�� _ f- Depth to first Ground Water Table: /v Percent ground slope: » —/ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: . n -y / c C— .Was an effort made to connect to community system? WO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( Septic Tank ( ) Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable e ( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use ( ) Chemical Toilet ( ) Other - Describe: FINAL DISP� BY: ( 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? /1/e) • Page 2 GARFIELD COUNTY Department of Developnient N2 001554 A Building r ❑ Planning 2014 Blake Avenue Glenwood Springs, Colorado 81601 DATE: G / Telephone 303: 945 -8241 / 945 -8212 / 625 -3321 7 / / I RECEIVED •M/ / d /O 1 - .. / / \ ❑ CASH agate I FOR: 4,0-;<---0- / - J 1 / 4Y / * a v v BY: ��'' 11 StiiL CERCOLATION 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. q Date , Signed d,� g% -.ct 1/4 4: (/ PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY /3 321- �r�wc_ ii‘ arc s. - Page 3 •, . 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, and additional submissions in support of this application such as data, plans, specifications, statements and commitments. • 1 r 1 • Page 4 •