HomeMy WebLinkAbout01728 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phofte (303) 945 -8212
A This does not constitute
''
INDIVIDUAL SEWAGE DISPOSAL PERMIT . 4 A 7 2 8 a building or use permit.
Owner ."It t! an to Princes Mi 11s _
System Location 3412 Ct. RI. 151 Gypsum
frontier IAg lames •
Licensed Installer ___
* 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 : 2 - / minutes requires a minimum of `� > - sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms 4 x L:. � sq. ft. minimum requirement = a total of sq. ft. of absq�Qt
7 ,1 ; s'r 2 n s 7
e, O u
Ma we suggest: • % /S ..i 'y 4 S B .Z
Date • -' -
._ • ( ) Inspector '`> ' )
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.
in
�+5 S 0 t7 - Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
Proper materials and assembly.
Vi a' Trade name of septic tank or aerated treatment unit.
Adequate absorption (or dispersal) area.
— Adequate compliance with permit requirements.
v Adequate compliance with County and State regulations /requirements.
Other O [ /-- � `� --.�I
Date j ,►Z 4 -' / 4 _ Inspector Q ,
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 I, Petty Offense
($500.00 fine — 6 months in jail or both.).
Applicant: Green Copy Department: Pink Copy
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
County Official:
'OWNER John & Frances Mills
ADDRESS A e I k• • PHONE 524 -9328
CONTRACTOR Frontrier Log Homes Bill Stevens - Septic Install r
ADDRESS 60813 Maple Grove Rd Montrose, CO 81401 PHONE
PERMIT REQUEST FOR: (XX) 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 Garfield
Near what City of Town Gypsum Lot Size 210 Acres
Legal Description Sec 28,T3S, R87W
WASTES TYPE: ( XX) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: SF Residence
Number of bedrooms 4 Number of persons
(xx) Garbage grinder (xx) Automatic washer ( Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) well (xx ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: none
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: 30 miles
Was an effort made to connect to community system?
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(xx) 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:
:ILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?
Page 2
501L,PERCQLALJON 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 it 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.
� 4
Date � 23 /d " 1
Signed /'
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
7 W Gues lc, L
Page 3
, .[ �" AIABILL 3 [-� - n LI
/ 1 •' 1 �'-- YtE no i /IH{I [BI IOMftlNatlq[Ng CONTINENTAL IN°NANIII. PACKAGE yy�7y{ J ,
_ gua iv:At INNr{ANI�I[Y{(!°UN TO WO.
J Y 1 H
E FN[rrrNarra(taat IBU n(r. TRACKING NUMBER
913 = "., 3670738140
11. t
f:
R° 4, 7" ".. l lN t ll, -AA 1 M t��
Ir,V Dale RECIPIENT'S COPY
't t Ir '9 7 1 Q — ?1 -89 •
From (Your Name) Please Print Your Wine Number Wog Impo p p M
Cgnpen9 DaDerbnenl /Fbor No. — 71 ' 2 ) Department/Floor PM.
Street Address • • C "
EuM6treet Address (Wi Cat* to PAL Ions sP4- [4 tednj
• LOL13 i'AF`LE GACETE . RCAL 1 .
C State ,...,: Rt Gtrnnt- Ctlit- '4111 `s
ZIP Reeulrea dry State KmRequired
f. I nrun(vri c:rn- i nrig CO 1
YOUR DILLINO REFERENCE INFORMATION(VIRST 24 CHARACTERS WILL APPEAR OM INVOICE.) IF HOLD VOA PICK -UP, PNRI FEDEX Address Hwy
creel
Address
nrnnNr ,i sender ❑ BD axlpina Fecedt Asa No. 0 D ye peer EWE. Ace( No 0 BYI COMA card City Stale ZIP Required
_
❑Caen _ _ ''S 4,. — L.er '3n:.*_. �.:.'.tti 'ci>
"= SERVICES DELIVERY AND SPECIAL NANOLINB ML u. 78 ' SCAM ° °10 I Date Federal Express Use
❑ Cloth Received
1 0 ' N 1 gXS 6 tar 1 Q NDLD FOR PICK -UP Ne m. P.‘ ❑a maw mows
Base Charges
r.1 ❑Tent Puny ❑as To oa ❑ ai 1.0 Nyd
2 l �
WDELIVER WEEKDAY
S DELIVER SATURDAY Street Address Declared Value Charge
7 CBtlRNR�eR 7 ❑ Y° ...e,.su O
BWAxpx7 Other 1
..QYWLBFE• 4 ❑ SOON CM Stale riD
r 9 LJ.NEWNli 6❑ S❑ 7ANTSWxFLxq Valep) Tot° /. total .
Total
Other 2
�--� RYX Received
BWANNI/I 6 ❑ NTMf Total Charges
Receives At X
4 ❑ mpE g ❑ 7 ❑ dnn SMUT SERVICE 1 C Regular Slop
2 On -Cell Stop Date /Time Received F°dEx E I
a El Dr Box BS C. Smf Irployee Number Mfl r teli
I g ❑ YTtlRRAr NCR.NI W 101N SUE 10/65
dn. cnq,I FEDE% Corp . Employee No. RINTED IN .SA. PADA
Sender endereuthorizea Federal Express deliver this ship-
g
6 ❑ STANDARD 10 ❑ 10 ❑ I r merit nily an obtaining a delivery signature and shall o O C 9 N
AM r ( indemnify and hold harmless Federal Express from any
.
1 not der 9en 11 claims resulting therefrom.
e n.+heeF der ❑ D ate /TI for FEDEX i 1ss8 FEC
•oed vas um i+ao 12Q IIUIERI a...e / / 1/ : // Release
M. f Signature:..
)
i i t 1 . " •:—. 1 1 1 1 1 1 '
9 • 4 . 1)
....N.., /
0 (. • -----••• ,
/
. -
/
44 /......... r 4
Irir I
-.-
. I
- -‘ C '''• • . • - - — -_ __ __
----.„.........
N _ ...„... \ rjr- I --- ,....■
-..... \ \
.
4- 1.... „.„....
I I
....N1 I
"\, Nc..,•.
......„
......
--..,.
-..._
....,
....... „....
__...... ,
/**--
.... '
z ,
. . ..-/-
‘4-, ,..
, .
‘4 'N '44-. ...„ .„.. ..,. . . . a .
II
\
\ ...—
\
• 't \ ):\
. _ ...._
-- \\
• _ "--,,,, .
- \
/ ` - <"
:, cr. 1.7....-..,L_ \.., ..:, . . --- •. 1 / 2 ‘.., --....... - ?
,..
/.....----
\ ,
N. • •
'N. ‘
..,... ,
•
\\\ \
i \
, - ....
, I
)
' --
7 ' / t
,... -2-b. -----
\
• 41 \ - - I
N \ .......-
N \
■
.....
....,...
,..
...\\
\ ,
, \
e LI
1 , fi..,4" to •
a i-av
I e
..rt
i ?* : /I _S. st
n e l
P 1 tAI e eta a 11;;1%."------ \
// /