HomeMy WebLinkAbout03294 /ovv 5q' ( c ,usfil�
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: . spo 5a / new
(/ 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 THE STATE? '°
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the E_ ng.ineer dpes the
Percolation Test) Ste- ij iTR` N ED 6.4 REQo,Cr in" ax °n wb' Lt 1c
O ca.va4-i 5ree- -A avl
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 purposed 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 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 understand 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 perjury as provided by law.
CM
Signed (V\ 4- Date l
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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ARFIELD COUNTY q `C r7
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a AND SANITATION DEPARTMENT
3 m a 109 8th Street, Suite 303
8 E Glenwood Springs, CO 81601
C \ \ o y ; 0 o 970) 945-8212/(970) 285-7972
r V > > D n
r - s s ro 0 m PLIANCE WITH T'^" ^ ' ^""• ^ ^^ ""'"" ^r••, • ^" ' SPOSAL
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o ual Sewage Dispost / /� � Planning
i m :t, Suite 303, Glen 40 % / 2 or 285 -
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mm tion, map to propel / Wing and
y ;es 2 and 3) and bi Y l/^ ecie C :SPOSAL
m ° > > 3 L N BE ISSUEI PERMIT.
m v 0 0 er p to "Garfi' 6 4 4 4 a, ic.rt. `-Y c tit fee and
o a v a` z or if a Registered P t, the cost
0 I 0- in 3 ?S ARE NOT REFL At i .
• 0 z `� - )isposal Permit will ovided no
1 o v 1 ncountered.
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0 :� - ` . r. ETAILED INSTRUCTIONS ON PAGE 6 ,Dg r L ,. _ E 3 m holes 4 feet deep, 8 to 12 inches in diameter, and 20 feet apart in the area
. v,. y , r I area (Instructions for post hole or back hoe holes are on page 4).
co c- , (f Z water once for the required eight (8) hour soaking period.
Xi 1 m by Sanitarian. (To avoid construction delay, we suggest arrangements for
lk t least 24 hours prior to the end of the soaking period). Please have at least
N Dr each hole available at the site for the percolation test.
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3 A that if the Sanitarian's initial field visit to your property reveals any unusual
high water table, excessive percolation rates, bedrock, etc., the services of a
— 03 'ed Professional Engineer and /or Board of Health approval will be required.
tr-
lb
. e in place, connected and ready to cover, request a final inspection by the
Sanitarian.
B. DO NOT backfill any part of the system prior to the inspection.
C. The initial fee covers the percolation test and one inspection before cover up. Any additional percolation
tests will be charged at $100.00 each and additional inspections will be charged at $42.00 each.
D. Upon final approval, carefully cover the entire system.
1