HomeMy WebLinkAboutApplication - Permit' 1:''
... GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
· 2014 Blake Avenue
Glenwood Springs, Colorado 81601
MPAIR -PERC ONLY Phone (303) 945·7255
INDIVIDUAL SEWAGE DISPOSAL PERMIT N~ 168
This does not constitute
a building or use permit.
Owner __ ~M~r~~D~•L~~i~d~s~ta~oev:a _______________________________________________________________ ___
System Location __ ....C.:.Ju~).!Ufll:l.a. ________________________ _:__ ___ _:.. _____________ ....,._
Licensed Contractor-----------------------------------------------------
* Conditional Construction approval is hereby granted for a ~ (2c;(2 gallon
/ Septic Tank or ----Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in••'-'?4.._ __ minutes requires 8 minimum of '.J..,LO sq. ft. of absorption area per bedroom.
Therefore the no. of bedroo,;s ,J' x,? s'i1 sq. ft. minimum requirement= a total of 7$'o sq. ft. of absorption area.
. ~ ..
<."' .. JI'LJ,~,., ""'eo /'.'" J.t"'X"'O,.,,..P_ May we suggest •~' " ..., f f7 •"" U o. I' "f .,. "" ._ .,.
Date i"'''• , .._ t(; If ,7tf Insp. ector ;(I.:U.,.& c:J~1"" . . . tl
FINALAPPR0\1 LOFSYSTEM: ~~-.
No system shall be deemed to be in compliance with the Sewage Disposal ~aws 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·g~ound
surface.
()(C Proper materials and assembly.
:;, · ek{(;;rllt"':-frade nam~ of septic tank or aera~ed treatment unit.
c"P(_ Adequate absorption (or dispersal) area . .;::L.d )(, S"C> I X '::!.' I ~.J~-c <--t"h·
crt; Adequate compliance with permit requirements.
C!J(:_. · Adequate compliance with County and State regulations/requirements.
______ other An
I /") l a--~~ ~/,.··' Date __ _.,_u,o..:-=---..'1,.._ L--.1....1~;..----------Inspector ----~'--.......:(::..__A __ +-------
RETAIN WITH RECEIPT RECOflDS AT CONSTRUCTION SITE
*CONDITIONS:
f. 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.
Connectio_n 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 Ill, 3.24 ·requires .any person who constructs, alters, or installs an individual sewage disposal system in 8 manner which in·.
volves a knowing and material variation from the terms: or specifica'tions 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
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Owner: ~k R
INDIVIDUAL SEWAGE DISPOSAL.SYSTEMS APPLICATION
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE'
INDIVIDUAL HOME SEWAGE TREATMENT .SYSTEM·
---------------------CD
Fees Paid $.y:F
Date fo-s--Jr
Mail Address:c)<;_;,a-o QcDRD IO'L City:. C_lb~ Zip: ??I f;>;;;L~ Phone:'1l:i>-Q'-/ &-s-
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 __ G_a_rf_:i_e_l_a ____ City or Town 0--A:i<·lL>,;;c>I.__J·~
Legal Description It e EPA--1 R-.
2. No. of Bedrooms __ 3...,__ __ Septic Tank Capacity IDDO Aeration Unit Capacity __ _
3. Source of Domestic Water: Public (name):
Private: Well X Depth ___ Other ___ Depth to first ground water table?0::l
4. Is facility within boundaries of a city/town or sanitation district? _N~C~)~------
5. Distance to nearest sewer system: !:::. -==~~------------------------
Have you attempted to arrange a connection with the system? e> ~~~--------------
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: ..-=,s:--:-z.=· e~c-r
7. Name, address, and telephone of person who made soil absorption tests:
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.
Co-l-'"JP,
(TO BE RETURNED TO HEALTH DEPT.)
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
D -1--------
INDICATE BELOW THE LOCATION OF YOUR BUILDINGS WATER SUPPLY AND DISTRI-BUTION LINES, sTREAMs, IRRIGATION DITCHES, ROADWAYs, AND BOUNDARY LINEs
--------.. ----. ---------1)0 ~oD
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f v ~~---5~
(TO BE RETURNED TO HEALTH DEPT.)