HomeMy WebLinkAboutApplication- Permit•
1.»-44- V
GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT # B COW
Owner Mi - OCP f}1 1 1- 4 -plc}- L:1.N
System Location 1?O 1 r 7 oe, at -7
Licensed Contractor
(this does not constitute
a building or use permit)
* Conditional Construction approval is hereby granted for a.1.* gallon
__ Septic Tank or - Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pero rate / inches in /S minutes ./919 sq. ft.
absorption area per bedroom 7'"-ereF'
# of bedrooms _1? x /9e7sq. ft. minimum requirement $747 e?F "jj, s,r..IAA: V
May we suggest at /�.' .s rr,v,At.,r ",10/7" rote yi,f,ezz)
Date rS' —74/ 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. ft -Jo -7r'
Proper materials and assembly.
IPZ Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
(9,C Adequate compliance with County and State regulations/requirements.
Date fi?- 7V
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 1I1, 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 )lass I, Petty Offense (8500.00 fine • 6 months in jail or
both.
T,! 'QLORADO DEPARTMENT OF HEALTH
Water Pollution Control Division
4210 East Ilth Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOMESEWAGETREATMENT SYSTEM**
Owner: /110_014/7/0/-l)gii
Mall Address: _(D,od2,rd 767 QC11 Citya/'fi coszip gq4)Phone (FQs el/
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography of ari.:a, iEai:l ta.b1 boi ldiny,, to .ation. of potable water wells,
soil percolation test holes, soil profiles in test holes.
1. Location of facility: County aArP.e of City or town
Legal description Lot size a''0
2. No. of bedrooms 3 Septic tank capacity /0`01 Aeration unit capacity 10-r7)
3. Source of domestic water: Public (name):
Private: Well ,' Depth ‘71 -7, -Other Depth to first ground water table
4. Is facility within boundaries of a city/town or sanitation district?_�
5. Distance to nearest sewer system: � �— .
Have you attempted to arrange a connection with the system? `--
I f rejected, what was the reason? 7�l 7-74-x�G�
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 soil absorption tests:
c5/F_
8. Name, address, and telephone of person responsible for design of the system:
i
%11
e
Signature tuof Owner
*Required by Article 66-28-12(CRS, 1963, 1967 Perm. Sum. Supp.)
*Required in areas which have been identified as areas iri which danger of pollution
of waters of the State may occur (Art. 66-28-8(5), CRS) and/or areas in which there
Is no local septic tank ordinance.
B. SIGNATURES OF LOCAL OFFICIALS: The undersigned have reviewed the notification
described on the front of this sheet and recommend approval or disapproval of
the discharge as shown below:
Date
Comments:
Approval Disapproval
Signature for Local Health Deparrsn€nt
Signature for City/Town Official Tit]i)
Signature for County Official (Title)
Signature and Title
Note: The Notifier (front of this sheet) must obtain comments and signature of at
least one of the above.
C. FOLLOWING FOR STATE HEALTH DEPARTMENT USE: Recommendations of the District Engineer:
D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
WP -33(10-72-2)