HomeMy WebLinkAbout00099=ui
'Owner
GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014.Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT # s 099
Clyde and Lucy Sievers
(this does not constitute
a building or use permit).,.
System Location
Slit
Licensed Contractor owner
* Conditional Construction approval is hereby granted for adiuw gallon
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate / inches in minutes l - sq. ft.
absorption area per bedroom •)
# of bedrooms 4 x Jam"., sq. ft. minimum requirement -7- 7 ("c'_ C°- -
May we suggest /..a,' x , d x '.'Er -w-79-40,16, Asara
Date //-49— 7f
Inspector
''iNAI, APPROVAL OF . SYSTEM:
No ten shall be deemed to be in compliance with the Sewage'Disposal Laws until the assembled system
is, roved prior to covering any part.
_Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
, ZS"' ' a -4-c. T7f7J/G / yT�'
-. Proper materials and assembly.
Adequate absorption (or dispersal) area.
,Adequate compliance with permit requirements.
'- .Adequate compliance with County and State regulations/requirements.
Date //— 2 4 " T 9 Inspector "./r.e/
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 66.44E-4, CRS 1965, amended 66.3.14, CRS 1963.
2. This permit is valid only for connection to struetures 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.
S. Section III, 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 (8500.00 fine • 6 months in jail or
both._________________�,____�Y____�__:.�
T_
111 COLORADO DEPARTMENT OF HEALTH
Water Pollution Control Division
421Q East llth Avenue
Denver, Colorado 80220
Owner:
Mail Address: / (�f - g C ' City r -
J zip
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire arca with respect to surrounding
areas, topography Ci :tri:, fi1F' i.:il:+y'+, Uf potable fluter wells,
soil percolation test holes, soil profiles in test holes.
1. Location of facility: County , t,L .City or town
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDWIDUAL HOME SEWATREATMENT SYSTEM**
Phone 48)2�-0,21/ 3
Legal description Lot size
360.310.44-
2.
)G -2. No. of bedrooms Septic tank capacity MQ OTAeration unit capacity
3. Source of domestic water: Public (name):
Private: W� DepthA00 Other Depth to first ground water table
6,I
4. Is facility within boundaries of a city/town or sanitation district?„41AD
5. Distance to nearest sewer system:
(hix..et
Have you attempted to arrange a connection with thesystem? mot
e_;)
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
�Cr oe'M 4 7
7. Name, address, and telephone of person who made soil absorption tests:
8. Name, address, and telephone of person responsible for design of the system:
wij
V 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 dancer of pcilutioi
of waters of the State may occur (Art. 66-28-8(5), CRS) and/or areas iheri;
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
Conimeots:
Approval Disapproval
Signature for Local Health Department
Signature for City/Town Official (Title)
Signature for County Official 1;Titlee-
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 HEALTI•: DEPARTMENT USE: Recommendations of the District Engineer:
D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
WP -33 (10-72-2)