HomeMy WebLinkAbout049' .9
~~·
• ~ ' . q ~ '? -16' e-._ 'Ax-\?~~
. ~' i'.:!.: ~~(4~0
GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014Blake Avenue
Glenwood Sptlngs, Colorado 8160 I
l
•
PERMIT H S 0 a a (this does not constitute
'IJV a building or use permit)
Owner·--l..C..~..I u.O.J..Jco"'n~C;.(ji~;......t:F::.. . ........z;~L-·.w.·5o.,M:Ji±~~:,Li'-"£~--..l.b.JJa~;:~.~.,.ul...l'i.:ii;Si.it'OXl;;LX.~,..,..---------
system Location--_,'Bo::;"~o ... ai::IL.jd ..... ~<? ... :$~3 ...... ____ , __________________ _
Licensed Contractor---'o..,.. • .,., ... ? ... !Y....uff£2=-4~<'--------------------------
'L. *.Conditional Construction approval is hereby granted for a J, ~e;· gallon
--4--Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate_,L, __ inches in :!C minutes /. zs= sq. ft.
absorption area per. bedroom~z;,..~.,....,tl!f?JC"""'"---------
H of bedrooms . f1 x ~:!IC sq. ft. minimum requirement .. 37S" ..scv. 1'!'7': c>P hB~rN::M/
.-?;#.' "'~¥' May we suggest/.:> , ; .!t.&. ',.lc i!l;
Date 9-c.,-z'¢"
FINAL APPROVAL OF SYSTEM:
Inspector ___ -s:~~~~..:'(':,.p,~(~_-------
I
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.
__ t#iC.:.·~--·Septic Tank cl!lanout to within 12" of final grade or aerated access ports above grade.
__ o;c:::..:...;;=---Proper materials and assembly.
-~..:;:r:';;.":-__ ..~Adequate absorption (or dispersal) area. /..::>/.Jt' HttJ"' .k ~" /P:S~'-e-eafJ
__.?<'"""'o:::;;.-.....t\Adequate compliance with permit requirements,
..:~:;;;.o'---===---'Adequate compliance with County and State regulations/requirements.
Date-...&.9;__-_6~~---2~;/;.=:;.-...;,_---Inspector ___ __,~~;...::Jia,.""~::(-·-----
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 1968, amended 66·8·14, CRS 1968.
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.
8. Section Ill, 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 Offenst> ($500.00 fine • 6 months in jail or
both.
_,.
COLORADO DEPARTMENT OF HEALTH
Wa~r Pollution Control Division
4i10 East lith Avenue
Oenver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMH
owner/}i;ye nee £ -./ Be icY g, /2a w 5d ~/
. Mall Acldress:,.$.'-"-.t-A-'f--L-1-+1---· _ _:CltyleW e4$&Zlpf/k1Phone.if!/..:_:l/$/
A. INrORf1ATION REGARDING PROJECT SUBMITTED .FOR REVIEW:
Att<>ch separate sheets or report showing entire orea with respect to surrounding
are~s, topography of Jrca, habitable buildings, lo~~tloil of potable water wells,
soli percolation test holes,~:es1 I~ test holes.
l. Location of facility: county~'JL .CIty or town ___ _
Leg a I descrIptIon ~;3 · Lot sIze $£, f r::lt.A e4 ../
2. No. of bedrooms ~ Septic tank capaclty!tJOv Aeration unit capacity ___ _
3. Source of domestic water: Public (name):
Private: Wellbepth __ Other Depth to first ground water table ____ _
4. Is facility within boundaries of a city/town or sanitation district? · /VV()
~ ------
Distance to nearest sewer system: _J_/) . ./11 ' -------5.
Have you attempted to arrdnge a connection with the system? __ _
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: __________ __
8.
Nam_e_,_a_d_d_r_e_s_s_,_a_n_d-te-le_p_h_o_n_e __ o_f_p_e_r_so_n __ r_e_'~~~~~'::.::.;;·:: ---
____ 1.::-,52_-~1±-~-----LV ~~£_,7-?
Date S~ture of 01mer ------c=
*kequired by Article 66-28-12(CRS, 1963, 1967 Perm. Sum. Supp.)
;,:,Required In areas which have been Identified as areas in which danger of pollutlor'
of waters of the State may occur (Art. 66-28-8(5), CRS) and/or area• In whith there.
Is no local septic tank ordinance.
----------~-~-----,
t I
B. SIGNATURES OF LOCAL OFFICIALS:
dcr.crl-bed-on the front of this
the dl~charge as shown-below:
nate f.pproval
Comments:
•
The undersigned have reviewed the notiflcDtlon
sheet and recommend approval or disapproval of
Disapproval
Signature for Local Health Departn~nt
Signature for Cl ty/To•1n GfiTCTaT\TI tie)
Signature for County OfficiaTl'iTtieT--
Signature and Title
Note: The Notlfler (front of this sheet) must obtain comments and signature of at
least one of the above.
C. FOLLO\.JING FOR STATE HEALTH DEPARTMENT USE: Recommendatfons of the District Engineer:
-----·-----··---------------
----------~------------~------------------
D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
-----------------------------------------------
---·-----------------------------·--------
WP-33 (10-72-2)
•
Y"· HAP
/