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Home My WebLink About01566 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 4 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 ThIs does not constitute ",,� INDIVIDUAL SEWAGE DISPOSAL PERMIT � r V a building or use permit. Owner Phillip & Karen Gibson System Location �• 319, Rifle Licensed Installer Self • Conditional Construction approv. 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 inutes requires a minimum of sq. ft, of absorption area per bedroom. Therefore the no. of bedrooms x sq. ft. minimum req i irement = a total of sq. ft. of absorption area. May we suggest: Date. _ \\ Inspe tor FINAL APPROVAL OF SYSTEM. No system shall be deemed to be in c. pliance wi the age a isposal Laws until the assembled system is approved prior to cover• ing any part. Septic Tank access for i spection and 1eani g within 12" of ground surface erated ac I.rts above ground surface. (r Proper materials and arse ly. a Trade name of septic tank o aerated tr.; tment unit� /N,'''ypA/Yp /' ' t Q I �� Adequate absorption (or dispel,.l) are/ ° I ° � � Adequate compliance with permit re. irements. m 1111- III��"' ° ° ° ° "I Adequate compliance with County . nd State regulations /requirements. Other Date _ - - - - -- Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION 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 1, Petty Offense ($500.00 fine — 8 months In )ail or both.). Applicant: Green Copy Department: Pink Copy a INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by L ER (� County Official: OWNER and l <arr,K G;bsan ADDRESS 19ppft Tree, Part I(. New Cast'Ic, PHONE f$y -3.43 CONTRACTOR Same, as a bove. ADDRESS _ PHONE PERMIT REQUEST FOR: (X) 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 � r ri Near what City of Town R ;Fio Lot Size LID. aces Legal Description NW )y S E of Sea, 27 - 'nos _ Rc1,3W WASTES TYPE: ( )<1 Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe ''BUILDING OR SERVICE TYPE: *knit. Nome. Number of bedrooms : Number of persons L i (')O Garbage grinder OO Automatic washer (X) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( )( ) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: 350/ If supplied by community water, give name or supplier: GROUND CONDITIONS: . 4kDepth to bedrock: *Depth to first Ground Water Table: around 100i #Percent ground slope: r10 rnor'r, iti,an S% DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 6 M ls, Was an effort made to connect to community system? no 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: (X) 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? no 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: l 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-lny knowledge and 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. a Date 7 Signed Y1 .g .)C144.441 PLEASE DRAW ANTI ACCURATE MAP TO YOUR PROPERTY `.T t 2 "o u:ee4 Reet 0 it tnt N „r / pe p o 1' �. G'it `M O w f ill ', � v 4. O S o ta �4 -4 4 'Pr t f + 3 aRE - y o Page 3 -14- I — 0 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. r r,. 1 Pant! kb 8LM Wooded . Area r " ' IrrB� • CO °'i moot Nome ICI SEDT. - TANK fra �u lfl'vated Field I I _\ ' I�t y Pol Perr43 ' Pcirtel lasemart Parcel 3A ` r Parcel `IA Page 4