HomeMy WebLinkAbout00151 GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
uV:
Glenwood Epilogs, Colorado 81601
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PERMIT N S 151. (this does not constitute
a building or use permit)
- Owner S. J. Brunas
System Location East Elk Creek - Road #241
{ Licensed Contractor owner
* Conditional Construction approval is hereby granted for a(Oe gallon
w X Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate / inches in /s.. minutes /rc2 sq. ft.
absorption area per bedroom 77/Warr
N of bedrooms 3 x /9O sq. ft. minimbw requirement = 70.5ca FT. 42/ netwerpotte40
May we suggest7c2 X d•P 3 BD
c=
Date /Y - 7 .5 Inspector al/i
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.
Cier Septic Tank cleanout to within 12" of final grade or aerated access ports above grade...,
` ar L �
�s� Proper materials and assembly.
a Adequate absorption (or dispersal) area
Adequate compliance with permit requirements.
semuite cn 'an with owl and3tate re ul t'ons /requirements.
<d / LE 7-
u• ,. r E T per �7y c/t O , cv'z i �<.� a � r e A
Date. to — 3- I -' C ,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 66.8 -14, CRS 1983.
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
°;?ry and Zoning office shall automatically be a violation of a requirement of the permit and cause for both
legal action and revo ion of the permit.
8. Section III, 8.24 req' tes any person who con$tructs, 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'blass I, Petty Offense ($500.00 fine • 6 months in jail or
both.
1'- ' STAIOARQ BACTERIOLOG,1CAL WATER TEST
• Colorado Department of Flealth
4810 Eost, 11th Avenue.- Denver 80220 `
/ Yam- Phone 389 -6111 RESU CPI
s' c / Nome. ' .-.3- 1 6 p
S ZJ .R 4 t R . •, County C> A ti'r1h'
Somple token: Dote / ` 7 11
(N. Privote ( Well MF� per 100 ml . N v'
Type of Supply: Source: d3 i
( ) Municipal "(' ") Surfoce
l8
( ) Food Establishment ( ) Row Water Z4 48 V'
N! Chlorine • '
Sample Token by `J ( /J V 7 S,, Residual„_.mg /I BOB '
Fill In all hffoirmaflon • 24 48
, Return Report SPC
to: Lamont,�.lfinkarig. Sanitar .., MPN '
Gad. Co. Environmental Health SAMPLE IS: v
Address
t plenwood, Springs, Color 81601 '
City.Stote ' O UNSAFE '
SEE REVS" SIDE FOR ,-.l
TES
• ., UNSATISFACTORY FOR T.
'LAB MICRO 106 1970 1100141 Qe Sampling ipetrur:ticns Pins* re.ubmlt
4
'r COLORADO DEPART OF HEALTH •
Water Pollution Control Division
421Q East 11th Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE`
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM =*
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Owner: S . 4 . O12_VNS S
Mall Address: (3O)( 966 Ci ty /1(D.4 (4041pS /C4'7 Phone Non C
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography oF are habitable buildings, location of potable water wells,
soil percolation test holes, soil profiles in test holes.
1. Location of facility: County G,4-2Re (4 .City or town`
C f{o n Ze( f
Legal descrlptionLls/ 6,4 C IC Y et( 2 Lot size /sy /q etc r S
3 /2S
2. No. of bedrooms 3 Septic tank capacity /000 Aeration unit capacity
3. Source of domestic water: Public (name):
Private: Well 2( Depth ?8 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? `
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
/ /14.4.11 I
7. Name, address, and telephone of person who made soil absorption tests:
Il t/
8. Name, address, and telephone of person responsible for design of the system:
y3
Dater gnature of O •
*Required by Article 66- 28- 12(CRS, 1963, 1967 Perm. Sum. Supp.)
* *Required in areas which have been identified as areas in which da.nue of pcilutrou
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas in eir.ich !hen:
is no local septic tank ordinance.
Ar
er
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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: •
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:
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D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
U -33(10-72 -2)