HomeMy WebLinkAbout00530 This does not constitute
•�; a building or use permit.
GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
V 2014 Blake Avenue
Glenwood Springs, Colorado 81601
Phone (303) 945 -7255
INDIVIDUAL SEWAGE DISPOSAL PERMIT N9 530
Owner Mit -A 'Rtott
System Location Lot 1, DJpc* 3 — Neetbank
Licensed Contractor
Conditional Construction approval is hereby granted for a /Qe , gallon
Septic Tank or k" Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in „ ,/,0 minutes requires a minimum of /4f sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms - x /j' sc(t ft. minimum requirement =a total of 7`7 S iq. ft. of absorption area.
May we suggest 9c Cs' (4,./C .4 L.� / �/ � / Syeel/CG N /0 t' ' Q-Eg4 ow / vz j-,.
Date L 02/ /J 2 . Inspector ?`jZ..- r et,.P' ;= �.�f;;.a'" ✓' .f.e.`
FINAL APPROVAL OF SYSTEM: Opp c
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.
CR/a Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above grqund
surface.
Proper materials and assembly.
Trade name of septic tank or aerated treatment unit. Is
Aclequre ,prption (or dispersal) area.
Adegl
aatb o Yilp(irce with permit requirements.
Adequate corhellir r County and State regulations /requirements,
Other i /i ocim- C. O,c A / C DC-=7Q
Date l0 " //y 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 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 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, 124 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 Paid $7c,
INDIVIDUAL SEWAGE DISPOSAL SYSTEMS APPLICATION
Date 4 1-71 - 7 -- 6? - 1 r
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM
ri
Owner: i /(L C'4
Mail Address: An P Q c� 22 City: G f Zip: /7/423 Phone: 94.3 .5.174
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 nark ye e City or Town C/e.„,zeinot 5
Legal Description L of / /,K s1''� Q ' of Size / �,
2. No. of Bedrooms 3 Septic Tank Capacire Aeration Unit Capacity > e-
3. Source of Domestic Water: Public (name): (797,,.t, ,,,/ a e//"
Private: Well Depth Other Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? / it p
5. Distance to nearest sewer system: _3 e,
Have you attempted to arrange a connection with the system? /4)
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.
Date ignature of AppTi - cant
(TO BE RETURNED TO HEALTH DEPT.)
GARFIELD COUNTY
DEPARTMENT OF DEVELOPMENT t G "•''r�
PLANNING: 945 "8212 / ENVIRONMENTAL HEALTH: 945-2339 / BUILDING: 945 -8241
AFFIDAVIT
I, / ^ tom _ , DO HEREBY SWEAR THE
1
FOLLOWING INFORMATION TO BE TRUE AND CORRECT IN REGARD TO THE
INDIVIDUAL SEWAGE DISPOSAL SYSTEM WHICH I WAS RESPONSIBLE FOR
THE INSTALLATION THEREOF ON THE PROPERTY OWNED BY Mika Rtc_Jt
SEPTIC TANK SIZE ?v cr.(
SEPTIC TANK TRADE NAME t
LENGTH OF SEEPAGE BED
WIDTH OF SEEPAGE BED .i
DEPTH OF SEEPAGE BED -
DISTANCE OF SEEPAGE BED TO WELL 04
DISTANCE OF SEEPAGE BED TO RIVER f/!
SIGNED: y�C�esL s
DATE: .. 4a � `f 4 s s •
ot ,MK I at 'vo 'that w �'cc.. net k & /Z f s p0 .y std'Ce
CPL- t /Ithtt Asp 74(3 5/3/t'
2014 BLAKE AVENUE • ' GLENWOOD SPRINGS, COLORADO 81601