HomeMy WebLinkAbout00163 This permiCvalid only for the tim in the Mai,/ 15, 1976 Poarrl • '\dlr,str^ont
derision er
rdih eOUNTtBE ' *RTMENOF ENVIRONMENTAL HEALTH
RF pLD 2014 Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT # S 163 (this does not constitute
a building or use permit)
Owner Jessie Waldron
System Location Rifle
Licensed Contractor Ols'/y (r•••?/
* Conditional Construction approval is hereby granted for a 757) gallon
&( Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate / inches in -' /S minutes 3/x7 sq. ft.
absorption area per bedroom_ /O
b of bedrooms _ x xib sq. ft. minimum requirement 600 .5Q f"/ ei +' ,A /.-' < ers
May we suggest /� %X 6-0 /A 3 ' - e ! zy
Date 4 _. //_ 75...... Inspector---/-09-nrONT • /e/n/h•'i/ (7�=
73
FINAL APPROVAL OF SYSTEM: e
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.
,:fe# Proper materials and assembly.
ec2—' Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
, _Adequate compliance with County and State regulations /requirements.
Date >... /" - .r C Inspector y •
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 60.44.4, 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 A
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
14' 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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'r. COLORADO DEPARTMENT OF HEALTH
Water Pollution Control Division
4210 East filth Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO,WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
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Owner: re qs, e WA) o
Mall Address: 44,- ,c727 Mn.;Ay ,3 City R. •l'L r ZIpfi/6.CA Phoner_,ti a /q:;
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography of area, habitcble buildings, location of potable water wells,
soli percolation test holes, soil profiles in test holes.
1. Location of facility: County tAR P e� n .City or town R { �
Legal description/yr * s {� R7e4' 4 22`7 size 7. 9 7 A
2. No. of bedrooms 4 0 2. 6 eptic tank capacity/ 440 Aeration unit capacity
3. Source of domestic water: Public (name): <, -,x-27
Private: Well Depth Other Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? N n _
5. Distance to nearest sewer system: ,2 z - >-7 / (I-
Have you attempted to arrange a connection with the system? .'72 A , _
If rejected, what was the reason?
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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:
X-1-(' A te'
8. Name, address, and telephone of person responsible for design of the system:
to — 9 - 75 �
Date •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 dance of rcilutio'r
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas in ,Rich them:
is no local septic tank ordinance.
s
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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 Approval Disapproval
Signature for Local Health Department
Signature for City /Town Official (Title)
Signature for County Official (Title
Comments:
Slgnature and Title
Note: The Notifier (front of this sheet) must obtain comments and si,nature of at
least one of the above.
C. FOLLOWING FOR STATE HEALTH DEPARTMENT USE: Recommendations of the District Engineer:
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D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
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l&-33(10-72-2)
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PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY ON THIS SHEET OF PAPER -
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