HomeMy WebLinkAbout00297 II I.
This does not constitute
a building or use permit.
GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
'' REPAIR - NO CHARGE
, ` INDIVIDUAL SEWAGE DISPOSAL PERMIT Ns 297 •
Owner " Floyd Bruckner \. TL ` ,,Q; r • • A a — c -
A.
System Location Grand Valley
, Licensed Contractor owner colt C �( 1 1, ,!7 l l / + ' F tJs.„ i ,
* Conditional Construction approval is hereby granted for a /r- — gallon Erriik. / '5 7 �„.
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..irt --SC Septic Tank or Aerated treatment unit. ' - "
Absorption area (or diapersal area) computed as follows: •
,y' Perc rate of one inch in sl-_ minutes requires a minimum of _sq. ft of absorption area per bedroom. ',R x.
N
Therefore the no of bedrooms 5 x _30 ft minimum requirement = a total of Jsq. ft. of absorption area. 3r,
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May we suggest aej �..k 5t" .�C a + y -+ /c e . c-. •*, 1 j j '
k a
Date /2--- Inspector '
l , FINAL APPROVAL OF SYSTEM: �� '� N
� i
No system shall be deeme o,,pe in compliance with the Sewage Disposal Laws until the assembled system is eppr veU ctSt gt"s
ing any part. Septic Ta snout to within 12 " :of final grade ataerate
r* cF g d access ports above grade
�o� r is ly
go; ii F
rb at erla s':a assembl
t
Trade name of skstic tank or aerated treayient unit. +` '
Adequate absorpton (or dis rsal) areal`
Adequate compliaill with permit requirements. sT-
5. / / { /� A dequate compliance' with County and State regulations /requirements. •
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Other r 4 • ` a
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Date ,/,� / Inspector
Pdat �1
ceros
RE+fKTN/Nl KECEIPT RECORDS AT
'CSNITI S:
1. installation must comply with all requirements of the County Individual Sewage Disposal Regulations, adopte 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 nbt 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 requires any person who constructs, Otters, or installs an individual sewage disposal system in a manner which in-
volves a knowing and material variation from the terms or specifications 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
l -`- ----_— ..,..� -.- -- - -..- --
Fees Paid $ 0
INDIVIDUAL SEWAGE DISPOSAL SYSTEMS APPLICATION
Date to / - 1A - 1(0
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
ern _ 00C NIVIDUAL HOME SEWAGE TREATMENT SYS FM
Owner: 0 I U C��y1 �F' loci.? 1
f u o i( fel Cit d D ye y Zip: w
Mail Address:
R � Y��'ra � 4 ?/ Zip: ��63.�' • one: aRS -79e1)
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 r q. r - t I a City or Town C) O li (
Legal Description Se q tf Q ( rrf Lot Size A/° .4 •
2. No. of Bedrooms 3 Septic Tank Capacity /go v Aeration Unit Capacity
3. Source of Domestic Water: Public (name): c ).,� yi 4 O i1ei� C "8t e d 'f -er v� ti
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Private: Well Depth Other Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? 7/ cZ
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:
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.
n Lczice
41 4I •''t' �yla/ *cloture of App icant
(TO BE RETURNED TO HEALTH DEPT.)
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
INDICATE BELOW THE LOCATION OF YOUR BUILDINGS WATER SUPPLY AND DISTRI-
BUTION LINES STREAMS IRRIGATION DITCHES ROADWAYS AND BOUNDARY LINES
Gv
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f ,
(TO BE RETURNED TO HEALTH DEPT.)
2 / fr ' PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY ON THIS SHEET OF PAPER -
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