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HomeMy WebLinkAbout01594 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 REPAIR — PFD(. ONLY Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 p � This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT N 1594 a building or use permit. Owner Hank[ Williams Estate System Location _ 43921 Hwy 6, Gletnood Springs Licensed Installer _ Owner (Eric Williams) Conditional Construction approval is hereby granted for a / 00 !J gallon /VS f e I ° T_`' y S ©t` i/ G — !�ASeptic Tank or _ Aerated treatment unit. S >~" / e h" d n `` c e a. / t ',— Mai sr./r -2 / 6014 Absorption area (or dispersal areal computed as follows: aces e 4 on Sah•r e ia/ iTf'str. Perc rate of one inch in 7 _ minutes requires a minimum of / ? l sq. ft, of absorption area per bedroom, J 114 g a•� err p ( ' 7 `Therefore the no. ofbedrooms _�_ x /9/ sq..ft. miipi num requiremen =;8 total of / s 3 3sq. ft of absorption ar May wesu f -s 4 ,' - r C /4/ Lo /• r� nU arta 41 a 999.-- r / er9C / 2– X 4.4 X 3 de e" o F• /61 t x .Z C« x 3 d r e j' Date_ / / / 7 _ Inspector 16 FINAL APPROV OF SYSTEM: w ! � No systisl}1` to be in- cgmpliance with the Sewage Disposal Laws until the assembled system is approved prior to cover• ing any part. r OK .- Septic Tank access for inspection and cleaning Within 12" of ground surface or aerated access ports above ground L -- surface. - "� Proper materials and assembly. '� • w Trade name of septic tank or aerated treatment unit. ( o el(&k L [ /250 // ��. 5 RJ, Cni c re f e, 62 Adequate absorption (or dispersal) area. /c .e3 / „( / / //1S / a." PG / OP; �.. Adequate compliance with permit requirements. Adequate compliance with County and State regulations /requirements. _ Date _ // /v / _!,5_7 _ Inspector Inspector ._ –•���' �. ___.___ RETAIN WITH RECEIPT RECORDS NSTRUCTION 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 I n the application of permit commits a Class I, Petty Offense ($500.00 tine — 6 months in jail or both.). Applicant: Green Copy Department: Pink Copy /ief'4 (I- — Pert. vnt F/0 0,0o INDIVIDUAL SEWAGE DIS SYSTEM APPLICATION A pprova l b y Approval b y u tie-- (4)1� County Official: OWNER qn..-, Cs (-o.- ADDRESS M A 1 2 v< 2„ aot PHONE Y -7 s V-I CONTRACTOR 541,4,-e ADDRESS PHONE 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 64c .C Near what City of Town Ne,j Ca s -t / Lot Size ("ou, ,'( `.y rGrr.0J•use Legal Description '/3 / /l )w., ( Crlr. Se.,.., fo AG y WASTES TYPE: ( 2C) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: « „.,-sue Numbe bpdrooms 111111&- 2 6„ .), "^ Number of persons y rbage grinder (k) Automatic washer ()C) Dishwasher URCE AND TYPE OF WATER SUPPLY: ( r/) well ( ) spring ( ) stream or, creek t Give depth of all wells within 180 feet of system: 17e p f 0/t- 1 r P ci If supplied by community water, give name or supplier: r GROUND CONDITIONS: Depth to bedrock: On `no wen Depth to first Ground Water Table: Percent ground slope: 3 643 I-, (/ „) ( DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: V ,T / Was an effort made to connect to community system? ii.) TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( )() 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: (y.) Absorption Trench, Bed or Pit ( ) Evapotranspiration ( `Ed) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? if. O 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 Z /4/8 S igned _/az.` �5 �� PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY P�pF.s �.etaI oS f � �`I'1 � � c C Q,,, r 4, PC S Q eciy Et" • I 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. s 2 J 8t Page 4 M .6 ,-i, MX4, a-t s //ta./i- / C- (ft/ 6 /r)- tt / " / 7 i ' M i '1' 1 Z X /rJ = 3 3 L_ s� A e 71- rt el u e. 2o7 '= _ d eo s• _ , 3x[77 S3 C "Z ° / ) �y s� , • /2-X ‘ X 3 c e efr or y I / z_A 7 , 4 i 4