HomeMy WebLinkAbout01067 11,' GARFIELD COUNTY BUILDI G AND SANITATION DEPARTMENT
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2014 lake Avue
Glenwood Sp nos, Colorado 81601
t Phone 1508) 945.8241
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This does not constitute
1 INDIVIDUAL SEWAGE DISPOSAL PERMIT No , 1 a building orusepermit.
owner Dean M. Knot(
System Location SW1 NE1 Sec 3 - T8 - R96S
Licensed installer d
' Conditional Construction approval is hereby granted for a ��At gallon
I hlir , ok Septic Tank or Aerated treatment unit. ___ Mi
Absorption area (or dispersal area) computed as follows: /
Perc rate of one inch in Sore minutes requires a minimtlm'0'y � sq. ft of absorption area per bedroom.
Therefore the no of bedrooms x . ft.tnInimum requirement • a total of asq. ft. of absorption area. ,
May we suggest /p( X SP, I ,,/�
Date r/.t _ `/Fr/ Inspector rate -e- G 'lam real
FINAL APPROVAL OF SYSTEM:
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No system shall be deemed to be in compliance with thq Sewage Disposal Laws until the assembled system is approved prior to cover. " I A
ing any par t.
elV` / Septic Tank access for inspection and cleening within 12" of ground surface or aerated access ports above ground
surface. J°
el),‹ Proper materials and assembly.
.42,01,c name of septic tank or aerated tr ment unit. p;
(7A Adequate absorption (or dispersal) ar .
u' - lf� Adequate compliance with permit re `iroments.
p/ Adequate compliance with County and State regulations /requirements.
Other
Date O/ / / .e' / i
p Inspector /� /._ ,., i .6!:„...... -.....- .r
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
"CONDITIONS:
1. All installation must comply with all requirements oftlteCounty Individual Sewage Disposal Regulations, adopted pursuant to au• "
thority granted in 66-444, CRS 1963, amended 66.314, RS 1963.
1 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 ndl approved by the Building and Zoning office shall automatically be a viola•
tion of a requirement of the permit and cause for both ll al action and revocation of the permit,
3. Section III, 124 requires any person who constructs, alters, or installs an individual sewage disposal system in a manner which In• u
volves a knowing and material variation from the terms or specifications contained in the application of permit commits a Class I,
Petty Offense (5500.00 fine - 6 months in jail or both) , i =
Applicant: Oran Copy Dspartm.nt: Pink Copy
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2 Fees Paid $
INDIVIDUAL SEWAGE DISPOSAL SYSTEMS APPLICATION •
Date
' NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
INDIVIDUAAL HOME SEWAGE TREATMENT SYSTEM•
'Owner: Q/� 2,
Mail Address: , / 1 / 5 - - 2,04 $ d City: PA C A y - Zip: 7/435 Phone:, —IY"
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
Legal Description 5'14/4 /1/'E4...20 3- 7Wtutf t Size
2. No. of Bedrooms 4 Septic Tank Capacity /040 Aeration Unit Capacity /* X 3'
3. Source of Domestic Water: Public (name):
Private: Well X Depth Other Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? .414
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: / ,iA, Q
7. Name, address, and telephone of person who made soil absorption tests:
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8. Name, address, and telephone of person responsible for design of the system:
9. Express permission is hereby granted for the inspection of the above property 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.
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Date Signature of Applicant -
(TO BE RETURNED TO HEALTH DEPT.)
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
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s / N F, -T 8- R 96
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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.)