HomeMy WebLinkAbout00633 •
This does not constitute
• ` a building or use permit.
GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
Phone (303) 945.7255
INDIVIDUAL SEWAGE DISPOSAL PERMITN? 633
Owner Donald L. Klausner
System Location 0608 Miller Lane - Rifle, Colorado
Licensed Contractor 0 cc -' A/ [:-7
• Conditional Construction approval is hereby granted for a 4 C2l gallon
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
•
Perc rate of one inch in., minutes requires a minimum of /.a S' sq. ft. of absorption area per, bedroom.
- - .Therefore the no. of bedrooms.. IT x. I sq. ft. minimum requirement = a total of3?7S sq. ft. of absorption area.
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May we suggest.. -Sc c -.' i„,. /e C '- .5e-z2 ,./a.„1/11‹ 3s �X 3 ' '
Date j i : ,A. 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 cover-
ing any part.
Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
ii`i surface.
' Proper materials and assembly. fi
"" Trade name of septic-tank or aerated treatment unit. 0 i41 `'l"3a,
Adequate absorption (or dispersal) area.
r
Adequate compliance with permit requirements. •
'' Adequate compliance with County and State regulations /requirements.
Other. j'
/" 5171 ' L ,
Date t 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 and revocation of the permit.
3 Section III, 3 24 saq -s py person who Opnstr r s s r di r sew
Ives a knowl y, ' y e e l ioatlo e pe l a manner tfF
"A valves n I III A inJ Olt b f �� � u rfl tit 'n, bontol In bpal ; .clop of permit COrh, 6 � ,,
a r l i�r 1 Petty offense f �r','t � Ontga In Ion of �o , e1 s � a 1 s " ii J k y. '
N ' Ma I� a i ii" a ,.9 " �I�i - :- .
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u � IL I Sull CP Permit Whi te Co py �, �ii, YI am ree l rl Copy l + i�.w ylu
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Fees Paid $ - 75-C (
INDIVIDUAL SEWAGE DISPOSAL.SYSTEMS APPLICATION
Date /0 7 —
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM
Owner: n C / Dn2,eS
Mail Address: 06 x , ge . City: / ,,: Zip: $��_�(�
P= � /�-+ d Phone. - �}. - 711 -
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.
1. Location of facility: County Garfield City or Town (7 c c ( <) ,
Legal Description o o o s s vt L < < i «-ate c i & - - c f Lot Size cR A.f_ie ,
2. No. of Bedrooms .3 Septic Tank Capacity /o 0 o Aeration Unit Capacity
3. Source of Domestic Water: Public (name):
Private: Well // Depth Yoother Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? )24—'
5. Distance to nearest sewer system: Si it
Have you attempted to arrange a connection with the system? 6/(9
If rejected, what was the reason?
6. Rate of absorption in test holes shown on the location map, in min es 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:
8. Name, address, and telephone of erson responsible for design of of h�system:
P P 9
9. Express permission is hereby granted for the inspection of the above roperty 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_ep{wrtunity to read the Individual Disposal Systems Regulations of
Garfield County and I hereby agree to comply with all terms, conditions and requirements
included therein.
In ?- — l F ,C mW f oca 2 Q� env
Date Signature of Applicant
(TO BE RETURNED TO HEALTH DEPT.)
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
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X)°NALID KLAUSNER
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INDICATE BELOW THE LOCATION OF YOUR BUILDINGS, WATER SUPPLY AND DISTRI-
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES
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(TO BE RETURNED TO HEALTH DEPT.)