HomeMy WebLinkAboutApplication-Permit•
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Adequate concrete cover (dry wn . o r== l v
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COLORADO DEPARTMENT DF HEALTH
`. Water Pollut1;on,:Gonro1 Division
-4210 East lith AventW
Denver, Colora.do.:."80220
NOTIFICATION OF PROPOSED OISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME 10AGE TREATMENT SYSTEM**
Owner: Leo,gri A PAv.'S
Hall Address: City. �f/G-x1 pgfw Phone9re-..2.21p4r
A. INFORMATION ffEGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography of area, habitable buildings, location of potable water wells,
soil percolation test holes, soil profiles In test holes. '44#
1. Location of facility: County k �I. , /01/
City or town�,y ,�%.$ �, sf y� L s
Legal description• 5',. / 6 ?Ivo,'g„,_ Lot size %.'(, Ate_s
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2. No. of bedrooms,_,_Septic tank oapacltr • Aeration unit capacity
3. Source .of domestic water: Public :(name): ,l/,p/,•,,,
Private: Well Depth Others Depth to first ground water table
4. Is facility within boundaries of a city/town or sanitation district?_/„
5. Distance to nearest sewer system:/:2. ,4,/s _ _ _ _
Have you attempted to arrangea connection with the system?
If refected, what was the reason? ;;..
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6. Rate of absorption In test holes shown on the location map, in minutes per inch
of drop In water.level after holes;''have;been soaked for 24 hours
Name, address, and telephone of person -who made soil absorption tests:
8. Name, address, and telephone of person responsible for design of the system:
Date
• Ign=tura o Owner
*Required by Article 66.28-12(CRS, 1963, 1967 Perm.:Sum. Supp.)
**Required In areas.which have been iderltlfled as areas in which danger of pollution
of waters of the State may occur (ArtV66-28-8(5), CRS) and/or areas In which there
is no local septic tank ordinance.
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3. SIGN URAS Qr 4.1PAL j OFFICIALS: TI under. igne(',have. rev 1ewed :the. notification
descr be On a brant of this shee;t end recommend approval or disapproval of
the discharge'as. shown (below:
Date Approval Disaprprpval
Comments:
tignature'for Local Health Department
Signature frarcwwwimmilirill
ignature or'County Official Tit e
i
Signature and Title.
Note: The..Notif.i;er ..(front of this heat)' must obtain comment's and signature of at
least one of, the, -above.
. FOLLOWING FOR STATE: HEALTH DEPARTMF lT VSE: -Recommendations of the District Engineer :4
;ACTION BY THE ,COLORADO WATER POLLUT) ON CONTROL COMMISSION:
WP. -33 (1 0-72-.2
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HAP
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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT # S 033
Owner_.. �. (�[ ,ENA rel 1-4)6 t C
(this does not constitute
a building or use permit)
System Location 6t S
Ali -,e/1/
Licensed Contractor
* Conditional Construction approval is hereby granted for a gallon
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate inches in minutes sq. ft.
absorption area per bedroom ,.
# of bedrooms x sq. ft, minimum requirement
May we suggest
Date Inspector
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 covering any part.
Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
Proper materials and assembly.
Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
Adequate compliance with County and State regulations/requirements.
Date Inspector_
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
* CONDITIONS:
1. All .installation must comply with all requirements of the County Individual Sewage Disposal Regulations,
adopted pursuant to authority granted in 66.44.4, CRS 1963, amended 66.3.14, CRS 1963.
2. This permit is valid only for connection to structures which have fully complied with County Zoning and
building requirements.• 4Connection to or use with any dwelling or structures not approved by the building
and Zoning office shall automatically be a violation of a requirement of the permit and cause for both
legal action and revocation of the permit.
3. Section III, 3.24 requires 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 specifications con-
tained in the application of permit commits a Class I, Petty Offense ($500.00 fine - 6 months in jail or
both.