HomeMy WebLinkAbout01473 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
ill 1473 I a building or use permit.
J
Owner Mr. and Mrs. William Bradford
System Location South of Silt 335 Road
Licensed Installer Ownear
* Conditional Construction approval is hereby granted for a /00 gallon 4.- /1-O lg.
v .0 r S, 0 £4 Leac <, r2e/q"
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows: / S al--
l L' /O X eep
Perc rate of one inch in minutes requires as minimum of I�P sq. ft. of absorption onn a rea per bedroom. /8 Sj(, dr/ 1( 3
Therefore the no. of bedrooms -� x 4 1psq. ft. minimum requirement = a total of Qq, ft. of absorption area.
May we suggest 2 '6 X75 x3 / ` % 6 /— Z4/ t
/`� x S x 3 a eP -
Date 7 2/0/93--- Inspector 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.
1 Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
O� surface.
Proper materials and assembly.
( 2 f5
, � ^ Trade name of septic tank or aerated treatment unit. `
vJ( x ,y l/
Adequate absorption (or dispersal) area. L (7 ' ' ' '7 S T r
Adequate compliance with permit requirements.
_42A Adequate compliance with County and State regulations /requirements.
Other r-� ,
Date /1 Z ,// � Inspector Aft/
RETAIN WITH RECEIPT RECORDS CONSTRUCTION SITE Or
'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 (5500.00 fine — 6 months in jail or both).
Applicant: Green Copy Department: Pink Copy r7"
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
OWNER $11- L. I3R- AOF°RD County Official:
ADDRESS PHONE
CONTRACTOR GA) R`I Nl_IS6L.
ADDRESS 022 AleADO'W LRA16 6tENW00n SikehU6 PHONE 9d•S G'bS -1P-
PERMIT REQUEST FOR: (c —)-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 G !}2 F I E(.D
Near what City of Town 5 ►t T— Lot Size
Legal Description
WASTES TYPE: ( v ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: I2 t7 /dENC - ET
Number of bedrooms 3 Number of persons Z
( " Garbage grinder ( 4 washer (dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( dwell ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: 8S
If supplied by community water, give name or supplier:
GROUND CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table:
Percent ground slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: U4/Kpocvtd ? s/z> 3 M /[.ES
Was an effort made to connect to community system? uo r Poss/6 L c
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( c-)'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
(`j Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? k
•
SOIL PERCOLATION TEST RESULTS: (To be 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.
!lance, 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 reports as - may be required by the local health
department to be made and. furnished by theapplicant_or bi_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 toil
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 misrept esentatiun may rebul in tlse den- tal --of -the appl- ieation
or revocation of any permit granted based _.upon sallapptication- and_in_ legal action for per-
jury as provided by law.
Date get 7 a Signed ►_
PLEASE DRAW AND ACCURATE MAP TO YOUR'PROPERTY
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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.
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