HomeMy WebLinkAboutApplication-PermitV
GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL. HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT # 8 03
Owner a t&r•t`l ] f. tA j, 7r1.. Ck.fL
, �-�
l,System Location 581-71 (Y3 /6.11k Lv di 021i
Licensed Contractor 1^ )0',rt n ({ r , fir 4i , i o. i-
* Conditional Construction approval is her
(this does not constitute
a building or use permit)
by granted for a gallon
Septic Tank or X Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate J• inches in minutes sq. ft.
absorption area per bedroom //
ti of bedrooms x c• '�-''-'5—'5`' "-
May
ft. minimum requirement '"
May we suggest /e2 /0' Y c' ZG .vc. 7_ i4iei/c=.
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.
foap13-G,Bi�T�'�
o Tank cleanout to within 12" of final grade or aerated access ports above grade.
ele" 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. 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 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.
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COLORADO DEPARTMENT OF HEALTH
. dater Pollutlot CpntrolDivision
•4210 East 11th Avenue;
Denver, Colorado .80220.
Owner:
.
-NOTIFICATION OF PROPOSED ;JSCHARQETO WATERS OF THE STATE*
-INDIVIDUAL HOMESEWAGE TREATMENT SYSTEM**
Jki/hIJ.4 A9r'ol.y I J,4//
Mail Address:,J7/7/ 4/S ?.Z 1: City, A7✓ 0? ZIp 8160/Phone
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
?rr?o? 2
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography of area, habitabl,e buildings, location of potable water wells,
soil percolation test holes, soil profiles in test holes. •
Location of facilit County City or town •
Legal description 589 q q L 4 tailt Lot size , acTet f
2. No. of bedrooms s- Septic tank capacity Aeration unit capacity
3. Source of domestic water: Public (name):(. 77 r 1 r'pe/C w t7< ,P41/61
Private: Well Depth Other Depth to first ground water table
Is facility within boundaries of a;city/town or sanitation district?
5. Distance to nearest sewer system: $ /JierS
4O
Have you attempted to arrange a connection with the system? ry o
If rejected, what was the .reason?.
Rate of absorption in test holes -shown on the location map, 1.n minutes per inch
of drop in water level after hoies';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:
Sgnature o Owner
*Required by Article 66-28-12(CRS, 196), 1967 Perm. Sum. Supp'.)
**Required in areas which have been ideftifled as areas In which danger of pollution
of waters of the Stete.may occur (Art's 66-x2878(5), CRS) and/or areas In which there
Is no local septic. tank•ordlnance.
SJGNA
escr eon4t eV,.ront a t s she t end :recommend approval or disapproval of
the d i scharge';ari shown below:
OFFICIALS: T undersigned -have reviewed the notification
Date pprova1 •0 lea ` royal
Comments:
o-
Signature for .Local Health Department.,
Signature for City/Town Official (till
gnature or C•duhty0 ficin Tit
•
Signature and Title
Note: The .Not l f l er (front of Chis 4heet) must obtain comments . and signature .of ate'
least one of'theabove.
FOLLOWING FOR STAT HEALTH DEPARTM T USE: Recommendations of the District Enginaeri
�\k
D. ACTION BY tHE:COLORADO WATER PDLLUtpN CQNTROL COMMISSION:
WP -33(10-72-2i,