HomeMy WebLinkAboutApplication- PermitGARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH 6
2014 Blake Avenue
Glenwood Speings, Colorado 81601
.Ownerr r�1. nit
System Location
PERMIT # S 066
) ,r e r A TT t"c"t l' t et
(this does not constitute
a building or use permit)
�L& 1 ,t'r)x: /01 Cl ',,,r /IL
Licensed Contractor 007 ii'e-el'' 1,13 aOF •s'°r'' i<". � ��`''�i'' 61` )
1-11NROR ICsI Pl P xrrtd, )
* Conditional Construction approval is hereby granted for a 2/11-? gallon
Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate / inches in .2,0" minutes —730, sq. ft.
absorption area per bedroom &
# of bedrooms # x sq. ft. minimum requiremento-46. 4, eSeQ.Arr #5+ / N
May we suggest .4"4'9'X . ' arepo 'fb ' 6 E`L
Date 7-49-74/ 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 fjdal 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 r7 a� *r Inspector -r
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 86.3.14, 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 aClass I, Petty Offense ($500.00 fine - 6 months in jail or
both.
COLORADO DEPARTMENT OF HEALTH
Wditer Pollution Control Division
, 4210 East )1th Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM**
OwnerA hi /t/fi46.44 ,„
it -AR
Mail Andress:.�d�a `P! R ///01), City,'/7 Zip?/% hone r7 rc ..jDS'
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, tcpography of arca, habitable bulidings, lvc; Leon of potable water wells,
soli percolation test holes, soil profiles In test holes.
1. Location of facility: County th ie -al City or town �1� LY -
Legal descriptionLOJ
Lot size Di 3'
2. No. of bedrooms 3 Septic tank capacityL p Aeration unit capacity. Y ,527 '
3. Source of domestic water: P 1 is (name) :
ther Depth to first ground water table
Private: Well 17D'epth
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?
If refected, what was the reason?_72___L,w
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:
S
8. Name, address, and telephone of person responsible for design of the systeri:_
J77V
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 (Art. 66-28-8(5), CRS) and/or areas in which there
is no local septic tank ordinance.
D. 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 Department
Signature for City/Town Official (titre)
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)
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P 7-/;t72 Crt9i 070 F2ie "740-714