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HomeMy WebLinkAbout02066 . e ov - i GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit h 2 0 6 6 i 109 8th Street Sulte 303 Assessor's Parcel No 1 Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 II This does not constitute ! INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permi 3 I. PROPERTY t Owner's Name Samuel B Potter Present Address 0598 Rd 323 Rifle Phone 625 -2882 i System Location 0598 Rd 323, Rifle Legal Description of Assessor's Parcel No. j SYSTEM DESIGN i A200 Septic Tank Capacity (gallon) Other / S es. Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 Required Absorption Area - See Attached Special Setback Requirements: Date / 7 0 3 Inspector J C ,rho). .9' . (- N 9 FINAL SYSTEM INSPECTION AND APPROVAL (as installed)) Call for Inspection (24 hours notice) Before Covering Installation j System Installer -"_ _ I I t' ,'Ot'tA"7houn ai Septic Tank Capacity . 0 0 0 : D / j1�u'_'�010 1 Septic Ta Manufacturer or Trade Name ( 1 p- ' (4', Septic Tank Access within 8" of surface $ Absorption Areai 7'TT 0..644. / ieteur 1 1 t 1 /V,. ' Absorption Area Type and /or Manufacturer or Trade Name 1 7 i 2' I ' n .4 t 0 r Adequate compliance with County and State regulations/requirements I. Other �-/ �� pr /f� Date €C Inspector tb'rj `tiW - tM 4 RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE ttt *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. Con- nection 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 involves a knowing and material variation from the terms or specif ications contained In the application of permit commits a Class I, Petty Offense (5500.00 fine — 8 months in jail or both). 1. Applicant: Green Copy Department: Pink Copy Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: OIWNER �+1 1 / /!= z_ 06 . P�'�7'- �`- / - 62 -564 0 ADDRESS OS S )C0 3� / M.1 & PHONE 62SC ` Z 1 % CONTRACTOR V uti Ci9s i 6110 • ADDRESS ©2r? 03z-0 / ay& ( & PHONE O 33‘ 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 n 4.) LOCATION OF PROPOSED FACILITY: County C>r42'C ,, l Near what City of Town 1 011(eS WSJ- tD Vei`tu Lot Size Pip Legal Description — WASTES TYPE: (*)---) ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: \ Number of bedrooms (3) �-cc Number of persons Fvice,/ ('L( ) (Garbage grinder ( •)- Automatic washer (\---) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( tr.—spring ( ) stream or creek Give depth of all wells within 180 feet of system: 49O A - ` If supplied by community water, give name or supplier: GV /.q GROUND CONDITIONS: Depth to bedrock: ----- — Depth to first Ground Water Table:_ Percent ground slope: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system ?_ TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: eptic Tank ( ) Aeration Plant ( ) Vault ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use ( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use ( ) Chemical Toilet ( ) Other - Describe: FINAL DI POSAL BY: ��`11R• Absorption Trench, Bed or Pit ( ) Evapotranspiration y �p,w (SG) Underground Dispersal ( ) Sand Filter 54 ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? Alp _ Page 2 • • 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.) 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 permit 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 2 / C7J Sign 6 _ PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY Page 3 i J • /1/ I S 2 5 /,. ll C "� 5fils � n -L/1: . , C\( •Cf r @ e ), 1 . r 11 6 i( a /77% 4 !E LI ��reS r p^ I' M II '� ° S c R 3a3 \ i il ■ i __ .. ___ _ .___��__ SB2 INFILTRATOR CONTACTOR FL'per Dispersal A (0.5) A(0.6) A10.6) PERC 13ED Bedroom Area Trench Pieces Bel Pieces Trench or Bed t : • t 6 • u 01 al FT Pieces 5 1 247 82 123 7 14E3 El 118 9 2 141 2E32 94 141 8 169 9 169 10 3 423 141 211 11 254 14 254 15 4 563 188 282 15 338 18 338 20 ,, 270 90 35 7 162 9 162 10 2 154 309 103 154 8 185 1.0 185 11 3 463 154 231 12 270 15 278 17 4 617 206 309 16 370 20 370 22 7 1 292 97 146 8 175 9 175 10 2 167 333 111 167 9 200 11 200 12 3 50c) 167 250 13 300 16 300 18 4 667 2'.22 333 18 400 21 400 24 0 J t .0 J ./ .. (3 t 2 179 356 119 178 10 214 11, 214 13 3 535 178 267 14 321 17 321 19 4 713 238 356 19 428 23 428 26 9 1 331 110 165 9 198 11 198 12 2 1E39 378 126 189 10 227 12 227 14 3 567 189 284 15 340 18 34 0 20 4 756 252 378 20 454 24 454 27 0 9 16 174 9 209 11 209 13 2 200 398 133 199 11 239 13 239 14 3 598 199 299 16 359 19 359 21 4 797 266 398 21 478 26 47E3 29 ,s66 122 13 10 219. 12 219 13 2 209 418 1:39 209 11 251 13 251 15 3 627 209 313 17 376 20 376 23 4 E336 279 418 22 501 27 501 30 12 1 382 127 191 10 229 12 229 2 219 436 145 210 12 262 14 25E3 15 3 655 21 327 17 393 21 393 24 4 873 291 436 23 524 28 524 31 13 1 39F3 133 199 11 239 13 239 14 2 227 454 151 227 12 273 15 273 16 3 6131 227 341 18 409 2:2 409 24 4 909 303 45 24 545 29 545 33 14 1 413 138 206 11 248 13 248 15 2 236 471 157 236 13 283 15 203 17 3 707 236 354 19 424 23 424 25 4 943 314 471 25 566 :30 566 34 15 1 427 142 213 11 256 14 256 15 2 244 4813 163 244 13 293 16 293 18 3 732 244 366 20 439 23 439 26 4 976 325 48E1 26 586 31 586 35 16 1 441 147 221 12 265 14 265 16 2 252 504 16E3 252 302 16 302 18 o 756 2`i2 37E1 20 454 24 454 27 4 100E3 3 36 504. 27 605 32 605 36 17 1 455 152 227 12 273 15 273 16 2 259 520 173 260 14 312 17 :312 19 3 779 260 390 21 46E1 25 460 28 4 1039 346 520 28 623 33 623 37 18 1 46E3 156 234 12 281 15 2E31 17 2 267 535 178 267 14 321 17 321 19 3 802 267 40:1 21 481 26 481. 29 4 1069 356 535 29 641 34 641 38 S132 INFILTRATOR r CONTACTOR Ft.sper Dispersal A (0.5) A(0.6) A10.6) PERC BED Bedroom Ares Trench Pieces Bed Pieces Trench or Bed RATE ROOMS via q' FTs FP Pieces 5 1 247 8 123 7 149 13 1413 9 2 141 282 94 141 E3 169 9 169 10 3 423 141 2.11 11 254 14 254 15 4 563 1E38 2132 15 338 1 8 339 20 6 1 270 90 135 7 162 9 162 10 2 154 309 103 154 8 185 10 1.95 11 3 463 154 231 12 278 15 278 17 4 617 206 309 16 370 20 370 22 7 1 292 97 146 8 175 9 175 10 2 167 33: } 111 167 9 200 11 200 12 3 500 167 250 13 300 16 300 18 4 667 22 333 18 400 21 400 24 8 1 312 104 156 8 187 10 19/ 11 2 179 356 119 178 10 214 11, 214 13 3 535 178 267 14 321 17 321 19 4 713 238 356 19 42E3 23 428 26 9 1 331 110 165 9 198 11 198 12 2 1E39 3713 126 189 10 227 12 227 14 3 567 189 284 15 340 113 340 20 4 756 252 378 20 454 24 454 27 10 1 349 116 174 9 209 11 209 13 2 200 399 133 199 11 239 13 239 14 3 598 199 299 16 359 19 359 21 4 .797 266 3913 21 478 26 478 29 1 i 1 366 122 183 10 219. 12 219 13 9 209 41E3 139 209 11 251 13 251 15 3 627 209 313 17 376 20 376 23 4 836 279 418 22 501 27 501 30 12 1 382 127 191 10 229 12 229 14 2 219 436 145 2110 12 262 14 2513 15 3 655, 210 327 17 393 21 :59:3 24 4 873 291 436 2:': 524 28 524 31 13 1 398 133 199 11 239 13 239 14 2 227 454 151 227 12 273 15 273 16 3 6(31 227 341 113 409 22 409 24 4 909 303 451 24 545 29 545 33 14 1 413 138 206 11 248 13 2413 15 2 236 471. 157 236 13 283 15 293 17 3 707 236 354 19 424 23 '124 25 4 943 314 471 25 566 30 566 34 15 1 427 142 21 11 256 14 256 15 2 244 4813 163 244 13 293 16 293 18 3 732 244 366 20 439 23 439 26 4 976 325 48E1 26 586 31 586 35 16 1 441 147 221 12 265 14 265 16 2 252 504 168 204 13 302 16 302 18 3 756 9 52 37E1 20 454 24 454 27 4 100E3 336 504 27 605 32 605 36 17 1 455 152 15 7 1 2'' 12 273 173 16 1. t./ 1 y i 2 259 520 173 260 14 312 17 312 19 3 779 260 390 21 46E1 25 4613 28 4 1039 346 520 28 623 33 623 37 1E1 1 46E3 156 234 12 291 15 2131 17 2 267 535 170 267 14 321 17 321 19 3 802 267 401 21 481 26 481 29 4 1069 356 535 29 641 34 611 30