HomeMy WebLinkAbout01957 ' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
I . 109 8th Street Suite 803
a Glenwood $linings, Colorado 81801
Phond(303)945 -8212
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��� This does not constitute
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INDIVIDUAL SEWAGE DISPOSAL PERMIT 4 a building or use porn*.
Owner Rotrert C. and Gail L. Clausen
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System Location Lot 014, Teller Springs. Glenwood Springs
Licensed Installer owner (k 6 .- Erdd✓.)
• Conditional Construction approval is hereby granted for a /2 SU gallon
V/ Septic Tank or _ Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
" 1 7
.„ Perc rate of one inch in 2 "7 minutes requires a minimum of sq. ft. of absorption area per bedroom.
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Therefore the no of bedrooms 4 x sq. ft: minimum requirement.= a total o f /.309 sq. ft. of absorption, area.
May we suggest: / 2XI09 X " 3 e l e e 1, 0k / (3 K1 s,"'L :Ier r't ' }, Lr 24 1(-
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Date a° /11 / 9 2- Inspector / , A1 1 i :. V / q , Nvf I re
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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.
/4R r 0 Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
'li1 Proper materials and assembly.
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Trade name of septic tank or aerated treatment unit.
III O� Ae absorption (or dispel sal) area.
(� / '�'" " Adequate compliance with permit requirements.
ill Adequate compliance with County and gtate regulations /requirements. 9`
Other
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I5 Date ' 14- 9. Inspector q-a`' ' ta- I I..
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
'CONDITIONS:
1. All Installation mustoomply with all requirementsof the Colorado State Board of Health Individual Sewage Disposal Systems
Chapter 25, Article 10 C.R.S. 1973, Revised 1984.
2. This permit la valid only for connection to struotutes 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 offioe shall
automatically be a violation of a requirement of the pgrmil end cause for both legal action and revocation of the permit.
3. Any person who construots, alters, or installs an Ind! dual 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
(8500.00 fine — 8 months in /all or both.).
Applicant: Green Copy Department: Pink Copy
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Application
INOIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
County Official:
OWNER QcY FOT ('r Ali) CA11 L r _
ADDRESS 465 /Ylf C Y Ls plioNEt327 j 6°'° � fr
CONTRACTOR (WIUE1'L ��= �5 /
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 (n(F,LL)
Near what City of Town raopa o'i(c Lot Si ze5 /Ac _
Legal Description r 4 mg, � ! . a Ul_S/&1)
WASTES TYPE: ()(*) Dwelling ( ) Transient Use
( ) Commercial or I»stitutional ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: /A)f)JUl F 'U771iL=
Number of bedrooms _ ^ Number of persons
(X) Garbage grinder ()<1 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: AWE
If supplied by community water, give name or supplier:_? �iV1 t 5/?_D/A)
GROUND CONDITIONS: 1
Depth to bedrock:_ 5E,77, EALT D . el/Fl() 4 L ____
Depth to first Ground Water Table: 64/AG—dons e 'er .—
Percent ground slope: YQJnf
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: LIZ
Was an effort made to connect to community system? No
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
Septic Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
• ( ) Pit Privy ( ) Incineration loilet ( ) 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: CE1 i761)
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF TIIE STATE? i/o
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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.
SEE S(TE A'M)
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Page 4
SOIL'PERCOLATION TEST RESULT.S: (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: —
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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 perdii't.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 _ ! v Signed a 4 1 or /
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
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