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HomeMy WebLinkAbout01525 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT • • 109 8th Street Suite 303 Glenwood Springs, Colorado 81801 "Bp- 331- ea - 034 Phone (303) 945 -8212 iG n r' This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT i'e a building or use permit. Owner David Eberhardt System Location o'o f3 e,,e . toe — lot 13, Itnipson Ice SUixl. , Carbondale Licensed Installer _ Jim Clough Conditional Construction approval is hereby granted for a /00 0 gallon — Septic Tank or — Aerated treatment unit. Absorption area (or dispersal area) computed as follows: Perc rate of one inch in minutes requires a minimum of A a / sq. ft. of absorption area per bedroom. Therefore the no. of bedrooms x / t< / sq. ft. minimum requirement = a total of Z_? sq. ft. of absorption area. / / May we suggest: /12 x ,K ee Of /v .X Z i Sec � � C 1 - 24 Date 4/ / z—A!. 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. 0 v` - Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. U Proper materials and assembly. 0 // t, Trade name of septic tank or aerated treatment unit. Cop e / to � ) n—"o Co ne O t'C Adequate absorption (or dispersal) area. 7 Z / �i © frc — Adequate compliance with permit requirements. Adequate compliance with County and State regulations /requirements. /' /fat _ /Otther t Date _ (( // 3 -A_ __ —_ Inspector 2/Zidt RETAIN WITH RECEIPT RECORDS AT ONSTRUCTION SITE `CONDITIONS: �. \ 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter 25, Article 10 C.R.S. 1973, Revised 1984. 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 violation of a requirement of the permit and cause for both legal action and revocation of the permit. 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves 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 2 4 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by ,/ County Official: $YNER ��7✓Io 4&'f4 ✓10 ADDRESS x/30 (dam /E/! /BSP PHONE ?o2S3o610 CONTRACTOR ell,, �Jc ADDRESS 1/0 l ✓i /(ay.a. d G PHONE 9(3 /53 PERMIT REQUEST FOR: ( as ew 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 Gam- i.4e Q Near what City of Town c2.Pd Lot Size____ Legal Description ina 0 et.,✓p 1 /-0T WASTES TYPE: ( 'Dwelling ( ) Transient Use ( ) Commercial or Ins titutional (, •) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: 5 /7RYXer X iatAi4 Number of bedrooms 3 - y - QED Number of persons y ( c4- Garbage grinder ( 4- A0tomatic washer ( [_4- Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( vYwell ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: ;ltp-mo 7.r 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: ,4-7Oz1 ft — crieetinJO4kt- Was an effort made to connect to community system? )if TYPE nE TNnTVIDU - P. AL- SEWAGE - DISPOSAL -- SYSTEM.ROP-OSED: — — .__._.--- _ ---- -' _T ( •-v 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: {MILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE ?____ / V Page 2 SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) o 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 ts 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 ' df my knowledge'And belief 'and are_designedrto'be relied 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 bylaw. Date /I/ V( 6 Signed ;2-- �,��E / /// / _ /J PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY 4JM c on/ / 6 sei Co1.2a O /M iG� f�P'- /6 yT 417. f T ,9r 4, O Page 3