HomeMy WebLinkAboutApplication- Permit5
r0
11 Owner
im
v
GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue V.013 -S
Glenwood Springs, Colorado 81601
PERMIT # S 054111 (this does not constitute
a building or use permit)
M. . CA.) • C U.)4 rr CA -Kt (*R67 -P A R --)
System Location 4s" s 1!C" 1.'1
Licensed Contractor J1 ' Q PX Qk'ri C>L)
* Conditional Construction approval is hereby granted for a 76.0 gallon
_y1/4_, Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate / inches in /0 minutes /6' 5" --Sq ft.
absorption area per bedroom'4''
# of bedrooms .. x /OS sq. ft. minimum requirement = 3 U /-7-
7-7,412,<-1
"rri 4W6P X,
May we suggest /'p, . '"' ,t• /#.. dolir0017— e<eade
Date d' -. / `° 74 Inspector
FINAL APPROVAL OF SYSTEM:
-I/ -1/-0(
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system
is approved prior to cgvering any part.
oe-�. Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
Proper materials and assembly.
d Adequate absorption (or dispersal) area.
- :C. Adequate compliance with permit requirements.
1 Adequate compliance with County and State regulations/reuir9ments.
/,OOH 423•41-4
Date— /fir �,
� � 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 1968, amended 66.8.14, 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 vidlation of a requirement of the permit and'cause for both
legal action and 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 involves a knowing and material variation from the terms or specifications con-
tained in the application of permit commits a Class I, Petty Offense (500.00 fine - 6 months in jail or
both.---- ---
4 ' C(4RADO DEPARTMENT OF HEALTH
ater.Pollution Control Division
421Q East 11th Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM**
Owner: ?•, / :) . .
Is. if
Mail Address :��___Zeta_ thi7___
City . _ Zip
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surroundincJ
areas, topography of area, habitable bui ldi:;y:;, location of potable ;vcl is,
soil percolation test holes, soll profiles In test holes.
i. Location of facility: Count ity or town' �f
Legal description Lot slze�
U. of bed rooms__ Se tic tank capac i ty7p Aera t 1 on unit capacity__ __
3. Source: of domestic water: Public (name): � � /!? ,(, , z.e-
Private: Well Depth Other Depth to first ground water taL1e
44'1
4. Is facility within boundaries of a city/town or sanitation district?____
5. Distance to nearest sewer system:_aa
Have you attempted to arrange a connection with the system? 440
If refected, 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 214 hours
21-72-071 /7-
7. Name, address, and telephone of person who•made soil absorption tests:______
e7
8. Name, address, and telephone of person responsible for design of the sfstc:__^_
6
Date ignature o Owner
*Required by Article 66-28-12(CRS, 1963, 1967 Perm. Sum. Supp.)
* Fecuireo in areas which have been identified as areas in which danger of pollution
of woNrs eF the State may occur (Art. 66-28-8(5), CRS) and/or areas in which there
Is no local eepiic tank ordinance.
0
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
Comments:
Approval Disapproval
Signature for Local Health Department
Signature for City/Town Official (TITTT)
Signature for County Official tTItleT—
Signature and Title
Note: The Notlfier (front of this sheet) must obtain comments and signature of at
least one of the above.
C: FOLLOWING FOR STATE HEALTH DEPARTMENT USE: Recommendations of the District Engineer:
D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
WP -33(10-72-2)
r'
•
OWE r
CONTRAC ' )R a
-1'27/9-•/v
GAR 'i.R:l.,1 C.(.iJfr., E:s11'r:ORhN? 1 NTA1
?M6 BLIXE
SP! TTIr`--, CoLOR;ii✓.
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
RECEIPT V 42j3..
ADDRESS:deb_ xektexf _._Pf lON :
__--
ADDRESS ;dip _'e r,.,�/�' oZ '7 MOUE: E: g// 94-
tier, OF 13LDRCor o 0" SIZE OF LOTS t2dd�fr
SITE IOC'ATION:
App], c:f;A.ion for an individual :sewage disposal permit Is oereby submitted The
individual sewage disposal system will be constructed In accordance wl h the
regulations concerning individna) sew.ge disposal systems within Gar°fle].d County.
This: , ;; :l.icat.i_on is valid for six (6) months from date s$gned
DATE:
Percu1ati.ort test results:_.,
SIGNATURE:
Minutes per .Inch:
Recomr;n4 •th d minimum size of let;chinq system:_! jb
RecoRL3:.mded minimum size of tank Ycoo
1'
DATE:
/74z
PLOT PIAN
SANIT?'.RIAN: