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Home My WebLink About01930 IA ^ F Ois . t L . y a s . , t -P SANITATION DEPARTMENT UtLDING AND tg ' COUNTY B Suite 303 GARFIE 109 Mil Street Co lored • 818 • Glenwood Springs, 9458212 Phone ( 303) This does not constitute a building or use Per X413 INDIVIDUAL SEWAGE DISPOSAL PERMIT � �,t � David rr 'Vail Unswol th R1f l e Owner - -, 1 g allon ,.� t:,J. ., System location ON/Pier — ��Y ranted fora �., /. ; install l is hereby 9 i License n a pprova l unit. r ) ' r 1 C treatment ��.�'.,• om• • Conditional ..._Aerated edro f absorption area per b r 1/ Septic Ta °r follows' =sq• ft. o lion a �' computed as sq , ft. of absorP 1 areal come of 1 tor dispersal minimu a total of n areal requires a rn reQuirement = 7,71--1-1/. ' / ; Absorption / minutes reG minimum � , � one Inch to x 2' , t. rate of o Pert of bedrooms .3 �' �... �• .. .. I / Therefore the no. / _ , Inspector e ' MaY we su99es is approved Pr" �� until the assem bled system pate SY STEM isposal Laws orts ab' O ith the Sewage D erased access P FINAL APPROVAL F deemed to n compliance w d surface or a No system be a nd cleaning within 12" of gro s hall be deem ing any Part for Inspection / _Septic Tank access /1 (i `� surface' aterlals and assembW' ,� Prober m i ti s P c tank orlaera t� atment unit. e e name o - p c^ i T rad to � dispersal) "area. {" , 4 ` at abs ption (or ts. s pdeq ermit r8QUlremen uirements ;�c..i= compliance with P ulationslreq ` Adequate County and State re9 !" ■ Adequate compliance with Cou ` •" �� .. -- Other _ Inspector — ION SITE - - —�� Al" CONSTRU C j —` R ECEIPT RECORDS age piaP Date RETAIN tT11TH rd of Health Individual Sew eGoloradoStateBOa County zoning ants of the Why co with all re connection 1g st which have complied w D1T1 °NS Rev ised Lures tructuresnot approved by r gulldm9 and ° ac wh `cation .CON m C F •S. 1973, strut for both leg ma n tion ner and h 1nVOi 1• All Inhalant Co f mu wi t° dw ell'm9 ° s d cause stem Ina m UsaCl onI Chapter tic M ilstein o nly with any it an a se for b sY ermit cam phaP it ; valid lion to or use a nt of the perm application of P 2. This Pe poet re quirem ent n individual sewage disposal en COa v\olatlon rh a re a installs a c ontaine d requlrem cis, avers, automatically be co strU rsPaGtf arson who ffOm thetetm pO th .)� Pink Copy 3 and material variation a il or Department; 0 months in Copy 1S5p0 00 tine — Green ' _ _ ADPFresntl • ' 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 "a' 1930 a building or use permit Owner David t, Lynda U h nswort System Location Clog C.R. 259 Rifle Licensed Installer __ otmer Conditional Construction approval is hereby granted for a �' � �.l gallon // 7 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 bedrgoms 3 x , sq. ft. minimum requirement = a total of • 2 r sq. ft. of absorption area. h / _ • A . l t 4 r . 1-+ / ..' ,. f May suggest: Me we Date / � - Inspector / • J 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. Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground surface. • Proper materials and assembly. Trade name of septic tank or aerated treatment unit. � o - i ; 1' r: , ! d / ' r" / c' h a Adequate abs ption (or dispel salt 'area. _ Adequate Adequate compliance with permit requirements. Adequate compliance with County and State regulations /requirements. Other �l / Date / .: / / -- – Inspector / `e' =3�,/ l ` !,�J (1,1 - - - --- 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 (all or both.). Applicant: Green Copy Department: Pink Copy Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by OWNER AVID + l /AJM UNSu1a2Ty p aint County Official: /1 gNf �S�! i y( o ADDRESS no Rppl t 1? UL Pit AJ4.�a9ST i; Co /o PHONE 9 l —?tNa• /SO' o CONTRACTOR $ /f 41f /91 , ovC ADDRESS PHONE PERMIT REQUEST FOR: (4/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.) b. LOCATION OF PROPOSED FACILITY: / l� O County Fit/LO g Near what City of Town Or Lot Size toy.( Legal Description Lin - Aoilljjg f14fYDolnls Su6D. A)w I /4 Or-7 .,A)w' /�1 5 &WO 3q Twp s � c I , (LNG got w (&& e m. WASTES TYPE: ( v) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: INfoJwlnt 140"'ti 'by Mf)'Gaotti4 Number of bedrooms 73 Number of persons 3 Garbage grinder (✓) Automatic washer (✓j Dishwasher S URCE AND TYPE OF WATER SUPPLY: ( ✓) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: oZ 50 Pi If supplied by community water, give name or supplier: OWE- GROUND CONDITIONS: �` Depth to bedrock: (J r1, I( 1 ° w '\ — Depth to first Ground Water Table: Ch frig 0 • Percent ground slope: Flifyr DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: IUOA/C. Was an effort made to connect to community system? /V OAN. TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (l/f 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: (L4 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 TFIE STATE? AlQ • J 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. • Page 4 SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) 4 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 permtt 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. J / J Date cP' /9 " I Signed 40Q'vt /2i( tr PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY