HomeMy WebLinkAbout00522 A r This does not constitute
f t a building or use permit.
GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
REPAIR — NO FEE — PERC ONLY Phone 13031945 -7255
INDIVIDUAL SEWAGE DISPOSAL PERMIT Nrch 522
Owner Lenore Cmgpbell
•
System Location South of Glenwood
Licensed Contractor
Conditional Construction approval is hereby granted for a 7-5 0 gallon
',Septic Tank or. Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in /0 minutes requires a minimum of 44..•(__sq. ft. of absorption area per bedroom.
Therefore the no. Deep off bedrooms x / a J sq. ft. minimum requirement = a total of f et sq. ft. of absorption area. ,
p i J May we suggest Per / / 4 . /.5- of R' C 0 1 ° P L . ` / M ' e c PG 0 t.0 - /A6- `C
42471-4'1E-2 l '
Date 42471-4'1E-2 � / / if Inspector c ef,„, y�
FINAL APPROVL OF SYSTEM: C app A
No system shall be deemed to be in compliance w tisposal Laws until the assembled system is approved prior to cover•
ing any part.
Septic Tank access for inspection and cleaning within 12" of ground surfactr aerated access ports above ground
surface. _
?; t: Proper materials a"a'nd assembly.
?'J • f' C - \ a 4 - '1" / // - 1/ " /,l c- t J
Trade name o epuc tan or aerated treatment unit. / 1 '`' .""e)
f , j Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements:
:7 ece "" Adequate compliance with County and State regulations /requirements.
Other
Date Inspector .G ;:c4 " rr`.`
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 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 not approved by the Building and Zoning office shal automatically be a viola-
tion of a requirement of the permit and cause for both legal action and revocation of the permit.
3. Section 111, 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 1,
Petty Offense ($500.00 fine — 6 months in jail or both).
Building Official - Permit White Copy Applicant - Green Copy Dept. - Pink Copy
Fees F Paid $ `7)
INDIVIDUAL SEWAGE DISPOSAL APPLICATION
_f, Date <�—(� 7Q
ps NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM
a
Owner: .L e n c r a ,„ Ae / //
Mail Address: i oA 91'L City: 6' /enwoct r. -Zip: ?' /6c / Phone:54..r
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.
/ 7 ) 5 co-urn c9
1. Location of fac „County Carii City or Town c Cc=?/CUIrJe96 26S_
Legal Description 4�c f'/37,e' 627 Lot Size a
2. No. of Bedrooms -3 Septic Tank Capacity / 000 Aeration Unit Capacity
3. Source of Domestic Water: Public (name):
Private: Well ' Depth Other Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitatio district? /era 5. Distance to nearest sewer system: 1 -2 4 / -f -)
Have you attempted to arrange a connection with the system? /l4'_
If rejected, what was the reason?
6. Rate of absorption in test holes shown on the location map, in mirk tes per inch 09
drop in water level after holes have been soaked for 24 hours:
7. Name, address, and telephone of person who made soil absorption sts: {
—mac.
8. Name, address, and telephone of person responsible for design of the system:
9. Express permission is hereby granted for the inspection of the abo
sAti
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. 1
1 7 g lei 171A ate Sig tune” f Applicant
A o C ya
(TO BE RETURNED TO HEALTH DEPT.)
/J
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPE' Y
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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 B RETURNED TO HE LTH DEPT.)