HomeMy WebLinkAboutApplication-PermitOwner
System Location 14
GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT # s 037
Licensed Contractor •9 if
5.31r (1)1-5.i( 10 4
(this does not constitute
a building or use permit)
* Conditional Construction approval is hereby granted for a1"' "0 gallon
. X .Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Parc rate / inches in /4.— minutes /PO sq. ft.
absorption area per bedroom -rt rpt
# of bedrooms dit x /AO sq. ft. minimum requirement= 3? arkif,
f,
May we suggest "1.:2 mar /X .3• .14F*0i' E .d3!' 7
Date -5-- 7 — 7 h/ 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
17/2- g/
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. Connection 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 I1I, 8.24 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.
.OLORADO DEPARTMENT OF HEALTH
4 Water Pollution Control Division
4214.East lith Avenue
.Denver, Colorado 80220
NOTIFICATION OF PROPOSED tISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM**
Owner: 0 f26f h.. ) e a F. \f t)
Mall Add res s: to S"6"" C i ty Rn e 2,040 Phone 4:21/731
A. INFORMATION REGARDING PROJECT SUBM TTED 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, soli pro—
files in test holes.
1. Location of facility: CountyiAg\-`e ,r City or town
Legal description dlilik. 'f 'Lot size 9 Oce
2. No, of bedrooms Septic tank capacity /400 /eration unit capacity
3. Source of domestic water: Public (name):
Private: Well X Depth Other Depth to first ground water table 135
4. Is facility within boundaries of a;city/town or sanitation district? 1'10
5. Distance to nearest sewer system: Poo tries
Have you attempted to arrange.a connection with the system? tI
If rejected, what was the reason?
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
7. Name, address, and telephone of person who made soli absorption tests:
cAr
8. Name, address, and telephone of pe 'son responsible for design of the system:
Date
Signature of Owner
*Required by Article 66 28-12(CRS, 1963, 1967 Perm. Sum. Supp.)
**Required in areas which have been identified as areas In which danger of pollution
of waters of the State may occur (Arty 66-28-8(5), CRS)• and/or areas In which there
1,s no local septic tank ordinance.
SIGNATURES 01=4 CAL OFFICIALS: Thi( undersigned have ,reviewed the.notification
� scr lbed an tetont of this sheet and recommend approval or disapproval of
the discharge ;as shown below:
Date
Comments:
Approvai-
D1sapprova1
-01717a7; for Local Health Department.
Signature or C ty Town Off€cial (TItlo)
Signature for. County Official (T1tle) •
Signature and Title .
Note: The Notifier (front of .this OW) must obtain comments and signature of at
least one of the above.
C.- FOLLOWING FOR STATE HEALTH DEPARTMENT USE: .Recommendati'ons of the District Engineer:.•
D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
WP -33 (10•.72-2)