HomeMy WebLinkAbout02109 1 - a
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N. 2109 i
109 8th Street a ,.- Suite 303 A is Parcel No.
Glenwood Springs, Colorado 81801
Phone 003) 945-8212
This does not constitute I,
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. r .
PROPERTY 0
0
Paul 3. Ritter Box 423, Silt 984 -0256 a
Owner's Name Present Address Phone
1104 County Road 214, Silt
System Location
F
Legal Description of Assessor's Parcel No.
'z
SYSTEM DESIGN
1, O 0 0 Septic Tank Capacity (gallon) Other # +
tn, J 7 4.1.141A _. #
- Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3
llp
Required Absorption Area -See Attace 4
Special Setback Requirements:
il
Date Inspector / RI 1; a I FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for inspection (24 hours notice) Before Covering Installation
System Installer 4 o V - flt y- aerie 't , s " ` r r "Y1
G
Septic Tank Capacity / t � 1) 0 /(,. pQ
Septic Tank Manufacturer or Trade Name C D q-�/1
Septic Tank Access within 8" of surface /4" ----- "
' t o
Absorption Area ', , ' < ( l' 9..n. CA ' / pA , .
Absorption Area Type and /or Manufacturer or Trade Name -- - l U l 1.n"
Adequate compliance with County and State regulations/requirements l
Other c^Y - �T'`� �� NW Date L al - / ? Inspector c : _.. l 1 Pi+^./.. .
• 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
26, 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 bgllding requirements. Con - y,
nectitr to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or 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 Involy s a knowing and material 1
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine —8
months in jail or both).
Applicant: Green Copy Department: Pink Copy
Application
• ".''. INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
County Official:
OWNER \ COvovl tt3 12s _ d p
ADDRESS__ rtI c1wri C'f�6.f1 F.1t0 PHONE n‘.. 557 a,
- CONTRACTOR t 1)L 2 11Ttc✓L Y��
ADDRESS ac»c 4 . - A C1 - i C'OLN() PHONE v7G, -5c '
PERMIT REQUEST FOR: (i-o''r 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 Q.,0eP\I' LtS
Near what City of Town SLi.V C(j4,G, Lot Size '7» ACQcS
Legal Description
WASTES TYPE: (X) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Lion- domestic Wastes
( ) Other - Describe _
BUILDING OR SERVICE TYPE:
Number of bedrooms l tecc C � Number of persons S'
( Garbage grinder (X) Automatic washer (X) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( \ X) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system:
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: \YYwLCi
Was an effort made to connect to community system? NCI.
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
()(1 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:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF TIIE STATE?
nomn _?
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.
• Z 5 sr ¢RcK O
1 . bos,8,5 y c ol )c 2E- 7i
wI u L ''L
House C- _ _
1 l _
L i 96 8( -', (-15\a c r 0 1 ___,, _ t_ ._,,,,,_
S S ' it low / o�1D 1
pit A 3
N
Zl„,
1 Lo
/0.5 5 2 0
z
• Pegg- ." 6 -arts
r/i 'tY 00 No rjflos'
he imm ec refit( P6 N To
AoceT:- r# /1a/sec.
yoc. T14y wrtNr TG
rigtrr To Tit it /1119-t" _V /f ?ry /o rte4raoc
$L C. coma l r Oro "Nee
F lc OaEhvorr
S
Page i
SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.)
Minutes per inch in hole No. 1 Minutes per inch in hole No. 3
Minutes per inch in hole No. 2 Minutes per inch in hole Mo.
Nance, address and telephone of RPE who made soil absorption tests:
Name, address and telephone of RPE responsible for design of the system:
Applicant acknowledges that the completeness of the application is conditional upon such
further mandatory and additional tests and reports as may be required by the local health
department to be made and furnished by the applicant or by the local health department for
purposes of the evaluation of the application; and the issuance of the pe rmftis subject to
such terms and conditions as deemed necessary to insure compliance with rules and regulations
adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies
that all statements made, information and reports submitted herewith and required to be
submitted by the applicant are or will be represented to be true and correct to the best
of niy knowledge and belief and are designed to be relied on by the local department of health
in evaluating the same for purposes of issuing the permit applied for herein. I further under-
stand that any falsification or misrepresentation may result in the denial of the application
or revocation of any permit granted based upon said application and in legal action for per-
jury as provided by law.
Date G- Vc\Citi1/4., 5, S 1 CL e
1, 3 Signed
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
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5 D 5: 85' �h
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1 z, 010 ° jE / id //.57-
Page 3
-- ', Application
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by • OWNER ... Q ai4i 5 (./9.0vie 'P; / o L'I. 'r f 1 c
i. ADDRESS P 0 i$O� «2 3 S /G1- PHONE ?er -
CONTRACTOR /41 L' /`'/ .,m'e AUG 0 9 19931 It
ADDRESS / . Id. S r P H ONE „ i {
PERMIT REQUEST FOR: OO 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 (39iiez0
Near what City of'Town Lot Size
Legal Description
WASTES TYPE: 't s() ( ) Transient Use
( ) or Institutional ( ) Non- domestic Wastes
( ) Other - Descri be
BUILDING OR SERVICE TYPE:, W/rb94 1.2oe // y
Number of bedrooms ' t3 Number of persons c5-
( ) Garbage grinder (>4 Automatic washer (>4 Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ('•C) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: Meig'
If supplied by community water, give name or supplier: NM
GROUND CONDITIONS: n
Depth to bedrock: gi'ealis f . Qr,: 8 1 ,
Depth to first Ground Water Table: ( /Ghtr /Aa,,a 9ACP
Percent ground slope: <3 1n
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: / /9;4
Was an effort made to connect to community system? ' 'Alb ....
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(5>/...) 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:
(K) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe: A /
h
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE ? /
•
/gig ro f or
SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.)
Minutes /8.,3 per inch in hole No. 1 Minutes 4?, ¢ per inch in hole No. 3
Minutes •ZU.J per inch in hole No. 2 Minutes per inch in hole No.
Name, address and telephone of RPE who made soil absorption tests: 9re Pdtu oSez-F
/4 t /4 ez, g /GbZ c3) 87G o�VM
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 peniii't,is'subiect 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 DRAW AND ACCURATE MAP TO YOUR PROPERTY
•
--- :5c,onc ken m .
•
N
Paae 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
commitments.
`/ // cl ncwec✓ 4 manmom / ,r emEV/4 /n
Page 4
" • " TYPE OF SYSTEM TO BE CONSTRUCTED
(17" to 21/2" Clean Gravel Required Unless Otherwise Approved)
TOP TOP
A gg0o 00 o°oaa.0 Gravel
4" perforated
ength deter- .: --- • _, pipe bo po ° o o o p 0 0 0 0 o o °
,fined from oo0 C 0 a 0 0 00
,etc test 0 00 ° ,o ° oe 0 0 0 0 0 n
esults _�' - ® from tank 4" solid pipe o °0000 bo o ° 4" solid pipe ex-
r ^ ti ,. a — * 0 0 00 1 '�'�'�••� tending into
eva ^ •-• gOOQ • " drywell 1'
^^
^ n. �y� 4" hay or
`
0 c3 9 0: 0 0 0
o ,. • . � �•,i Y
~ o ; %,,o 0 0o0 ' 4• : • .0 straw over rock
� �� 4
I
04(SC3 AQ1Q b WGJ c0 g4OQ ° � , 000F'� ��1..II.
i'•F tl pA 0 4o OQOUO O p OD A U p Y pD�,t�Dep4 °'•�0.•t ..-
O p O o o d C d? o 0 O o * Y
• o o. Op Q o W O 0 4 r1 P O o
3' 1. 6' I 3' *Size determined from perc test results
SIDE VIEW
SIDE VIEW Backfill Backfill
Ba2kfill vy
2'+ /� �c,� 4 hay 4" solid pipe to tan
or straw
p° B' c9... &" 2" gravel over kb: Cone ,, 4" hay or straw
c o a g o o.. 4 4" pipe in pry
a QO g Q � D • P P f � ¢ ' . . . •v
chi.Oiar o Q p o gravel " `i r:• Gravel
1
OOO pO%ObO 00•.
n �� f,.
pD$ 000a), 6 Gravel F
o 4 0 00 0 o c, .-, * e; p f i` Concrete rings or
QPo e r o _G1_0
giTc, ,ge under pipe , � cinder blocks
pQ. � a � ° o a �o ° ,' c b C , 1' of gravel in
,nQ i ri t{ Iiii bottom
Seepage Bed . (> "lane Dr ell ri
a h;,,,y,/ ys • r� T24,5
vo- 7/oo %2' A /5 - 22I/ 7 • - Al N /O /,�
g I 97)0 . %7 it.? Btj� �7
= , t) /4, /2) = ¢- 4 1
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I Other .
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