HomeMy WebLinkAbout00472 "
This does not constitute
a building or use permit.
1- D COUNTY DEPARTMENT OF ENVIRONMENTALHEAL' 1-I
1� GARFIEL
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2014 Blake Avenue r , , ps 1 s
Glenwood Sl(rings,:Colorado 81601
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' INDIVIDUAL SEWAGE DISPOSAL PERMIT NV 472 v
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Owner Wag 7wy I L W i l l iamt
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"= System Location Cortn+y Pond 2 117 - Si if
Licensed Contractor n cc) overee-
• Conditional Construction approval is hereby granted for a //o/90 gallon
X Septic Tank or Aerated treatment unit.
Absorption area (or diapersal area) computed as follows:
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Pere rate of one inch in .f/:b minutes requires a minimum of • 90CI sq. ft- of absorption area per bedroom.
li Therefore the no. of bedroomk ,.3 x 3a)sq. ft minimum requirement = a total of 9c%sq. ft. of absorption area.
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i May wesugge . a ''X 7S - 7 .,k S/ sc.tt: /9E • G /3C- „✓7,
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1 Date .04", 3 -
7� Inspector r 0- ir y ,
541
11 FINAL APPROVAL OF SYSTEM: A itlu- c.A._i'-
IV � I , No system shall be deemed to be in compliance with the ewage Disposal Laws until the assembled system is approved prior to cover•. i
l v " r - ; ing any part.
I ll tt Septic Tank cleanout to within 123'' of final grade or aerated access ports above grade. 0
Proper materials and assembly. t -
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,l • �a�� . tc 4rade name of septic tank or aerated treatment unit. ' P
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$ ' a Adequate absorption (or dispersal) area. !
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al y + +� �•'� Adequate compliance with permit requirements. i
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S ,.h' l _a e Adequate compliance with County and State regulations /requirements.
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1 ir ,..,. , Date A Z Inspector 4Gs`
1
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
li" "CONDITIONS: � ke
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II 1. Ali, installation must comply with all requirements of the Co Individual Sewage Disposal Regulations, adopted pursuant to au-
thority granted in 81.44.4, CRS 1963, amended 66 -3 -14, CRS 1963.
2. This permit is vale only for connection to structures which have fully complied with County Zoning and building requirements. r
Connection 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 revoctdion 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 in- i
volves a knowing and material variation from the term or specifications contained in the application of permit commits a Class 1, r?
y ii0 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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Fees Paid $ 7S, °D
.- INDIVIDUAL SEWAGE DISPOSAL.SYSTEMS APPLICATION Date
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lU - 1 C)- ?7
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NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM •
Owner: [Q)ESCEY M., ( Q )/Jt! I /� , f1' . /1 1 S
Mail Address: Roy lr'dfO ' &ib1 i /'e Zip: 1;76,5 Phone: ij7 fO l
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 tes holes.
1. Location of facility: County !M/ P/& LL) City or Town
Legal Description ¢ Cif `!! Lot Size / 4012! .
2. No. of Bedrooms 3 Septic Tank Capacity Iwo Aeration Unit Capacity
3. Source of Domestic Water: Public (name):
Private: Well X Depth 9; Other Depth to first ground water table_ML
4. Is facility within boundaries of a city /town or sanitation district? An —
5. Distance to nearest sewer system: --C to it eS —
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: ,:,(:- A<- ,,n i 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:
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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.
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Date Si.y re of Applicant
(TO BE RETURNED TO HEALTH DEPT.)
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY ......._
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INDICATE BELOW THE LOCATION OF YOUR BUILDINGS WATER SUPPLY AND DISTRI-
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES
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(TO BE RETURNED TO HEALTH DE .)
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