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HomeMy WebLinkAbout000724 Owner e 1;L4 GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH 2014 Blake Avenue Glenwood Springs, Colorado 81601 PERMIT # S 012 SAMUEL B. POTTER (this does not constitute a building or use permit) System Location 41)(it 1 e C70 Licensed Contractor Q4O 13' * Conditional Construction approval is hereby granted for al 5-0C' gallon Septic Tank or _ Aerated treatment unit. Absorption area (or dispersal area) computed as follows: Pere rate inches in ..1••`' minutes 4::•-1 C) sq. ft. absorption area per bedroom P f 0 € # of bedrooms_ x ,.$) 0 sq. ft. minimum requirement = 1) OS©s FT' of ot,) May we suggest .a. -/'x '''''X zE&°•90.eserZJ Date "" 7'� Inspector`��F'� 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 covering any part. G - Septic Tank cleanout to within 12" of final grade or aerated access ports above grade. Proper materials and assembly. Adequate absorption (or dispersal) area. Adequate compliance with permit requirements. Adequate compliance with County and State regulations/requirements. Date 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 1963, amended 66.14, 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 violation of a requirement of the permit and cause for both legal action and revocation of the permit. 5. Section III, 5.24 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,tlass I, Petty Offense ($500.00 fine - 6 months in jail or both. r (/ t (DR/.&O I)Ei'1R1 MENT OF HEALTH Water Pollution Ccntrc.l Division 4210 East lith Avenue (er,vc:r, Colorado 80220 NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE* INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM** Owner: q ,I le a l._. L ,s c_ e-RTh fe • Ma Address: OS98 .I+ 3Z3 C1ty' .' Ck.. i1pt(fl Phone4;22VM2.../ 't +SLS- z / pe C4i t A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW: Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable bu€ldinys, location or potable water wells, soil percolation test holes, soil profiles in test holes. 1. Location of facility: County +4 -2 -Ci eA40 City or town /?1,44t# Legal description Lot size t H«��c 2. No. of bedrooms Septic tank capacity /50 a dation unit capacity 2- 7r4,'/.er 3. Source of domestic water: Public (name): Private: Well Depth Other ✓ Depth to first ground water table _wn—___" /I.LN Ea +4. Is facility within boundaries of a city/town or sanitation district?. 5. Distance to nearest sewer system: Have you attempted to arrange a connection with the system? saC7 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 24 hours 7. Name, address, and telephone of person who made soil absorption tests:__T 8. Name, address, and telephone of person responsible for design of the system:__ 8- 2-7 ate `Required by Article 66-28-12(CRS, 1963, 1967 Perm. Sum. Supp.) **Required in areas which have been identified as areas in which danger of pollution of waters of the State may occur (Art. 66-28-8(5), CRS) and/or areas In which there Is no local septic tank ordinance. B. SIGNATURES OF LOCAL OFFICIALS: The undersigned have reviewed the notificGltlon described on the front of this sheet and recommend approval or disapproval of the discharge as shown below: Date Comments: Approval Disapproval 4.. Signature for Local Health Department Signature for City/Town Official (Title) Signature for County Official (Title) Signature and Title Note: The Notifier (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 THECOLORADO WATER POLLUTION CONTROL COMMISSION: C V- Q v. 1 r �i I 0,0 M £ 1-- u a ¢ 3 0 J L 9