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GARFIELD COUNTY BUILD G ANIS SANITATION DEPARTMENT
109 801 treat rc Suite 303
Glenwood Sal' nos, Colorado 81601
Pf10ns (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT N2 "1980,.
Owner
William G. Knight
This does not constitute
a building or use permit.
System Location
507KInge Row Avenue, Kings Row Subdivision, Carbondale
Licensed Installer
Owner
• Conditional Construction approval is hereby granted for a gallon
Septic Tank or — Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in /7 minutes requires a minimum of . sq ft of absorption area per bedroom.
Therefore the no. of bedrooms,_ x sq ft minimum requirement = a total of sq. ft. of absorption area.
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Date
4 •— 7 -7
Inspector a l': 1.k C' A4J
FINAL APPROVAL OF SYSTEM:
111,
•
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.
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Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
Proper materials and assembly.
Trade name of septic tank or aerated treatment unit.
Adequate absorption (or dispel sal) area.
! Adequate compliance with permit requirement!.
r Adequate compliance with County and State regulations/requirements.
Other
Date G''i C-' �lL
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All installation mustcomply with all requirements of the, Colorado State Board of Health Individual Sewage Disposal Systems
Chapter 25, Article 10 C.R.S. 1973, Revised 1984.
2. This permit is valid only for connection to struotutes 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 violation of a requirement of the permit cause for both legal action and revocation of the permit.
3. Any person who constructs, alters, or Installs an individual gewage disposal system in a manner which involves 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 — 8 months in jail or both.).
Applicant: Green Copy Department: Pink Copy
OWNER
ADDRESS �dfG 4/ -?264.,
CONTRACTOR 5-4/411b-
ADDRESS
4 bADDRESS PHONE
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
PHONE 7 5 IJY
Application
Approval by
County Official:
PERMIT REQUEST FOR: (Y-4 New Installation ( ) Alteration ( ) Repair
Attach separate sheets or report showing entire area with respect to surrounding areas,
topography of area, habitable building, location of potable water wells, soil percolation
test holes, soil profiles in test holes. (See page 4.) 1
LOCATION OF PROPOSED FACILITY: County J
Near what City of Town q[„,i e -r C% .iC %
SOIL PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.)
Minutes per inch in hole No. 1 Minutes per inch in hole No. 3
Minutes per inch in hole No. 2 Minutes per inch in hole No.
Name, address and telephone of RPE who made soil absorption tests:
Name, address and telephone of RPE responsible for design of the system:
Applicant acknowledges that the completeness of the application is conditional upon such
further mandatory and additional tests and reports as may be required by the local health
department to be made and furnished by the applicant or by the local health department for
purposes of the evaluation of the application; and the issuance of the periiii't.i•s subject to
such terms and conditions as deemed necessary to insure compliance with rules and regulations
adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies
that all statements made, information and reports submitted herewith and required to be
submitted by the applicant are or will be represented to be true and correct to the best
of my knowledge and belief and are designed to be relied on by the local department of health
in evaluating the same for purposes of issuing the permit applied for herein. I further under-
stand that any falsification or misrepresentation may result in the denial of the application
or revocation of any permit granted based upon said application and in legal action for per-
jury as provided by law.
Date Signed
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
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PLOT PLAN AND DESIGN FEATURES:
Include by measured distance location of wells, springs, potable water supply
lines, cisterns, buildings, property lines, subsoil drains, lake, water course,
stream, dry gulch and show location of proposed system by direction and distance
from dwelling or other fixed reference object, and additional submissions in
support of this application such as data, plans, specifications, statements and
commitments.
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