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HomeMy WebLinkAbout01889 mr rnT-v'I -- n gc'w," 1 '( �, yj 1 a me iaNJI��W`dl�xr a G`6 µr'd. ?h?e�;.. ' { GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 8th Street Suite 303 Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT 1'4 1889 a building or use permit. Owner 9415 Hwy 325 Rifle System Location Robert Kelley Licensed Installer ___ Owne! • Conditional Construction approval is hereby granted for a l - gallon Septic Tank or Aerated treatment unit. Absorption area (or dispersal areal computed as follows: Perc rate of one inch in minutes requires a minimum of " sq. ft. of absorption area per bedroom. Therefore the no. of bedrooms 1 x " -' sq. ft. minimum requirement = a total of ' ■ 2< sq, ft. of absorption area. / .. )! 3 I X 3 1 er.' c.) -F 43 e d O) / 2 0 L/ 1, A -1. S/ i . May we suggest: (9't" / 9 0 g J. l 'l' n jTh -f , 7 t / t> 'r r y- / i rbe a , n Date h / ' / Inspector 1..... 6 I �:�`..- - FINAL APPROVAL OF SYSTEM: j- 9 ,pt"1/27^Z' LJt.c..-p( No system shall be deemed to be in compliance with the Sewage Disposal Laws it the assembled system is approved prior to cover• ing any part. . Septic Tank access for inspection and cleaning wi n 12" of ground surface or aerated access ports above ground surface. - Proper materials and assembly. I�t .0�'' /(y�� Trade name of septic tank or aer. -d treatment unit. LF't /l` d .� Adequate absorption (or • persal) area. iraAkivierflt Adequate complia, e with permit requirements. Adequate cs pliance with County and State regulations /requirements. Other Date_ _ Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE 'CON DITIO"5: 1. •11 installation must complywith all requirements of the Colorado State Board of Health Individual Sewage Disposal Sy stems 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 tine — 6 months In (all or both.). Applicant: Green Copy Department: Pink Copy npplrcati INDIVIDUAL SEWAGE DISPOSAL SYSTf APPLICATION Approval by IJNLR }�© A County Official: O — .L.s sj LT b k'c LLeY v4s-79 -e( /.'l ° c � ADDRESS_ a1s,_ Lrrrcou ��itrwoue r# g,4'F Co PHONE /IoM *s- -929/ CONTRACTOIt_t re& 13i&s n ADDRESS_ _ PiIONE — 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 potabl e water wells, soil percolation test holes, soil profiles in test holes. (See page 4.) LOCATION OF PROPOSED FACILITY: County Cna2a Near what Ci ty of Town _ ietF CO Lot Size t z. tel Legal Descrip lion _Jevgp. - ca p ISk( tainic- 1fpnir- ArnicAnoty _ WASTES TYPE: ( Nei ling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: C,e,,v Number of bedrooms ()pea 4v/to- SP,vice COwc BEbZ Number of persons ©w bCGarbage grinder Auton(atic washer Irk Dishwasher ,one SOURCE AND 1YPE OF WATER SUPPLY: ( f well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: ,- -z6o' If supplied by connnunity water, give name or supplier: -- GROUND CONDiTIONS: Depth to .bedrock: ± 23/ Depth to first Ground Water Table: S-80' _ Percent ground slope: t/ARmett C' Z% io 37%> DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_—'' iz/Yr._e3 Was an effort made to connect to connnunity system? 16 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (,/j Septic Tank ( ) Aeration Plant ( ) Vaul t ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use ( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use ( ) Chemical loilet ( ) Other - Describe: FINAL DISPOSAL BY: ( /Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: __ WILL EFFLUENT BE DISCIIARGED DIRECTLY INTO WATERS OF THE STATE? No SOIL'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. Nance, 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 perintt,is'subdect 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 — — Signed ___ PLEASE DRAY! AND ACCURATE MAP TO YOUR PROPERTY • • 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 coumit.ments. • Page 4