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HomeMy WebLinkAbout00418 This does not constitute , r +w ; a building or use permit. • GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH 2014 Blake Avenue Glenwood Springs, Colorado 81601 p INDIVIDUAL SEWAGE DISPOSAL' PERMIT N Y 41$. T Gwner pasta Filist Silt "System Location S ti , , 1 Licensed Contractor em ' * Conditional Construction approval, is hereby granted for a / ©p0gallon Septic Tank or Aerated treatment unit. Absorption area (or diapersal area) computed as follows: • Pere rate of one inch in 4:2.7 minutes requires a minimum of o23 6 -4q. ft. of absorption area per. bedroom. / Therefore the no of bedrooms x a•-• sq. ft; minimum requirement = a total of 696)sq. ft. of absorption area. .'' May we suggest ,..:: t ne - ' d 6 ' e. z' /a 61 ,1 - • Sr 1 X •3 Date'""' Inspector tl ii HI FINAL APPROVAL OR SYSTEM: lia No system shall be deemed to be in compliance with the Sewage Disposal' Laws until the assembled system is approved prior to cover'• ing any part. CSC Septic Tank cleanout to within 12" of final grade or aerated access ports above grade. . P roper materials and assembly. w rade name of Jaie aerated treatment unit. --f Adequate absorption (or dispersal) area ...... Adequate compliance with permit requirements. 4I Adequate compliance. with County and State regulations /requirements. ' Other Date assineigl' ' 77 Inspector 4 14 4 4( RETAIN WITH RECEIPT RgCORDS AT CkNSTRUCTION SITE *CONDITIONS: a 1. 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 663.14,, 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 viol!• ' tion of a requirement of the permit and cause for both legal action and revocation of the permit. c 3. Section III, 3.24 requires any person who constructs, alters, 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.. 1 t, N r rt Building Official — Permit White Copy Applicant — Green Copy Dept. — Pink Copy MA Sanaa di ansAnnaunua awn aaaaa as *lawn Fees Paid $/ INDIVIDUAL SEWAGE DISPOSAL. SYSTEMS APPLICATION Date 6-4- ( -'7"7 NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE / INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM Owner: di E441 f Z. L IS Mail Address: R/"/ ,1J0/ «<j7 City: 5/e-7 C6AI Zip: X/45 Phone: sX c 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 q-rythcuo City or Town 5i eac.a Legal Description 5 , / _ 6 i : ,' n Sp Lot Size 2, 2 i1e QeS Asj t 91 eito � /*hoe. erne 2. No. of Bedrooms 3 Septic Tank Capacity /Z AO-Aeration Untki4apacity 3. Source of Domestic Water: Public (name): /000 N / A✓ /A Private: Well )( Depth /2 Other Depth to first ground water table 4. Is facility within boundaries of a city /town or sanitation district? 111 6 5. Distance to nearest sewer system: % iii/La 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 miny es per inch of drop in water level after holes have been soaked for 24 hours: /, fj�� 7. Name, address, and telephone of person who made soil absorption te s: 8. Name, address, and telephone of person responsible for design of t e system: / ,--iii / ?it-c-, Ems" 9. Express permission is hereby granted for the inspection of t e 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. X1,16 p 19 7) .,c,, C A Date Signature of Applicant (TO BE RETURNED TO HEALTH DEPT.) e' PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY r . �5 1 i2 M des le tr./D& 6 5) Tirr p, JaDt o. RP/ v s Xi v INDICATE BELOW THE LOCATION OF YOUR BUILDINGS, WATER SUPPLY AND DISTRI- : U !E , R ,M , RR i D - . S, !wwp!s' , ,!p :ells/ ' CIkQI�C��( SOU") as • Hilth ;{Ouse 45 I (TO BE RETURNED TO HEALTH DEPT.)