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Home My WebLink About01976 14{2: erWWW x , GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 109 1Ith Street Suite 909 Glenwood S Mints, Colorado 61601 Phone x(609) 945.8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT '1970 a building or use pent Owner John Legg System Location 4671 C.R. 311, New Caet]s 1 Licensed Installer Legg Construction iil I.. pt 4 Conditional Construction approval is hereby granted for e � " I gallon °+ Septic Tank or -" Aerated treatment uhit. Absorption area (or dispersal area) computed as follows: ' Perc rate of one inch in 20 minutes requires a minimum of » .p. sq. ft. of absorption area per bedroom. '+ a u Iul Therefore the no. of bedrooms $ x sq. tt. requirement s a total of ft. of absorption arse, " " „r +� ” _ ,-•r AA .r`' fr G f y �• •� y- p May we suggest: . ;..,.• �$..' 4. .r Q, /Ft �X f � r X3 + 1. ne �Y�}.l.,vT- µ. ?'Y� U 1 0 P LIB 4 . !' Ill Il '�7 n �y - f , :), / "7 d-.. 1 }} - p' i,.�.! Date / 1, Inspector . J i'' , C /I Illi FINAL APPROVAL OF SYSTEM: p , 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. , I V - Septic T ank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground h ,. surface. Proper materials and assembly. C. A.< I Trade name of septic la or aerated tree went unit. " - : l cr 0c , , ^ 7 'f �` Adequate absorption (or dispersal) area. i. `�• — Adequate compliance with permit requirements. I I Ade uate compliance with Count and S tate regulations/requirements. q Y S, Other 72 C � J + (�',,� Date` �,'" /. Inspector ~-a i �—" u✓ Lit:_^ r, b, RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE t. "CONDITIONS: "w'9 w 1. All installation must comply with all requirements of w olorado State Board of Health Individual Sewage DisposalSystems Chapter 25, Article 10 C.R.S. 1973, Revised 1984. P'. 2. This permit Is valid only for connection to struotq which have fully complied with County zoning and building „� 1 , - requirements. Conneotlon to or use with any dwellin or structures not approved by the Bulidin9 and Zoning office shall i, , , automatically be a violation of a requirement of the rmlt and cause for both legal action and revocation of the permit "n," l 3. Any person who conatructs, alters, or installs 98 Indl vat sewage disposal system In a manner which Involves a knowing 11 p: and material variation from the terms orspecifioallo talned Intheapplication of permit commits a Class 1, Petty Offense gsl'n5'1, (5500.00 tine - 8 months In (ail or both.) �n „� , ,Il r « mint Plnk Coy � ' w . 11 ' rmwN R! r i �P.I , t n a qe u rt o 4 1 17 ., a �, , r l'ryn �"V "I"P I " .I , v "" N t l a , h' I V Ng a P uiti b I, u , x ti, Ihil I u i " � w :'i a . � .i m rvRrv , m , t uri p i nq l' Ii v , �� w i u 11 n I , 9 ° i.. 7i ' � Wi i ' ' �ir -- iw. Zw '� gyp, �w�m� i1 �M�u n y .0 " on . d � I le V I I N , � , V Y ";, Vitl A Y " i ld ll � Application INDIVIDUALL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by O(JNER... (2_ & /�l� -pp�� 5-010 oicial : ' 7/ �GCJ 3// PHONE 7'7, CONTRACTOR_ -v Arrc / ADDRESS PHONE ` PERMIT REQUEST FOR: (.4-New Installation ( ) Alteration ( ) Repair Attach separate sheets or report showing entire area with respect to surrounding areas, Lopography of area, habitable building, location of potable water wells, soil percolation Lest holes, soil profiles in test holes. (See page 4.) LOCATION OF PROPOSED FACILITY: County 6 <_,d Near what City of Town �/G Lot Size i tG Legal Description 4(, 7/ Co / 2 c 31 / 2-/79- a&z - -oo - ¢Sr) WASTES TYPE: (welling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms Number of persons ( ) Garbage grinder ( Automatic washer ( ✓Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ell ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: "gob If supplied by community water, give naive or supplier: GROUND CONDITIONS: i Depth to bedrock: 6 O _ Depth to first Ground Water Table: %o-O Percent ground slope: 74; DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /6 k72( Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( ✓j 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: ( ) sorption Trench, Bed or Pit ( ) Evapotranspiration (derground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? - 1 4 U • Paae 2 pIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.) M inutes 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. lance, address and telephone of RPE who made soil absorption tests: lame, address and telephone of RPE responsible for design of the system: 1pplicant 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 lepartment 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 permftis 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. L y Date Signed P1 ?-C /� PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY • • Page 3 • v IA 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. • W QJ2 f2Bdd� '00 � y ' se/ -7 -ein> Page 4