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HomeMy WebLinkAbout00382 This does not constitute a building or use permit. GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL REALTH ' 2014 Blake Avenue Glenwood Springs, Colorado 81601 INDIVIDUAL SEWAGE DISPOSAL PERMIT NV 382 a `I Owner s 3, Gale Loesoh System Location 3 mi east of Rifle Licensed Contractor Conditional Construction approval is hereby granted fora 4 (00 gallon X Septic Tank or Aerated treatment unit. Absorption area (or diapersal area) computed as follows: Perc rate of one inch in rrzaC minutes requires a minimum of o 3 q. ft. of absorption area per bedroom. Therefore the no. of bet/Toms 3' x S.sq. ft, minimum requirement = a total of 1 7 9 ) -iq^ ft. of absorption area. May Vve suggest /cs� / it' efl9 "X 3 .set '- '9G°', 4 :- �3C ZJ. 77 Date �/ "• - `.. -77 Inspector � e• .!1 • FINAL APPROVAL OF SYSTEM: wt a. No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to cover- ing any part. caer Septic Tank cleanout to within 12" of final grade or aerated access ports above grade. C Proper materials and assembly. / 1 / C��G- Trade name o �.r aerated treatment unit. CL�' !d `'+ .X Adequate absorption (or dispersal) area. Adequate compliance with permit requirements. Adequate compliance with County and State regulations/requirements. .4W Other a 6521° Cmac Ce- - - AC / f� /- a'9"JB_-re? 5774 tto » ©U � 7 e n Date - 7 7 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 au- thority 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 viola- , tion of a requirement of the permit and cause for both legal action end 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 in- volves a knowing and material variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine - 6 months in jail or both. Building Official - Permit White Copy Applicant - Green Copy Dept. - Pink Copy 1 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY N d Li) q Rot .233 M L L A- N ,I ,r c fIA)1 (01 INDICATE BELOW THE LOCATION OF YOUR BUILDINGS, WATER SUPPLY AND DISTRI- BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES • .2, -r .�14- 5 'kV4 b I f 112(2; -- —• • (TO BE RETURNED TO HEALTH DEPT.) Fees Paid $ 7C - INDIVIDUAL SEWAGE DISPOSAL SYSTEMS APPLICATION Date -V S r7 NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM Owner: iE, I n /e L C e SG /7 Mail Address: (H 9? 1?c4_ 0257 City: m`r le Zip: $76St7 cone: 955.7v3/ INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable buildings, location of potable water wells, soil percola- tion test holes, soil profiles in test holes. of 1. Location of facility: County ( City or Town. 5 ern I of A-Pl Legal Description Sr 6' 3 � -� Lot Size Sae y-P. S Ci f 70 or re s 2. No. of Bedrooms 3 Septic Tank Capacity /PO O lei Aeration -Unit Capacity 3. Source of Domestic Water: Public (name): Private: Well ✓ Depth _ /5p -f Other Depth to first ground water table et t O rt7 4. Is facility within boundaries of a city /town or sanitation district? R) one 5. Distance to nearest sewer system: ,5 1 -)1 IC S Have you attempted to arrange a connection with the system? I. 0 If rejected, what was the reason? 6. Rate of absorption in test holes shown on the location map, in mini es per inch of drop in water level after holes have been soaked for 24 hours: it 7. Name, address, and telephone of person who made soil absorption t t s: t_e C� tir c r�T 8. Name, address, and telephone of person responsible for design of e £stem: / . t i• _mot. -ti 9. Express permission is hereby granted for the inspection of the above 'operty by any member of the Garfield County Environmental Health Department and /or such persons as they may designate. Any withdrawal of this permission shall be in writing and receipt acknowledged by the County Environmental Health Department. 10. I have been given an opportunity to read the Individual Disposal Systems Regulations of Garfield County and I hereby agree to comply with all• terms, conditions and requirements included therein. D 41,y-77 e � ja, ie 4rah_ Date Signature of Applicant (TO BE RETURNED TO HEALTH DEPT.)