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GARFIEl D COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
N Phone (303) 945-7255
INDIVIDUAL SEWAGE DISPOSAL PERMIT N: 646
Owner
Mr. & Kra. Gerald Langbons
System Location
This does not constitute
a building or use permit.
4771 County Road 117 — Glenwood Spina.
Licensed Contractor r"-.) c t•' A //La—X-7
* Conditional Construction approval is hereby granted for a �-a`gallon
- Septic Tank or Aerated`treatment Unit.
Absorption area (or dispersal area) computed as follows:
Pere rate of one inch in 00 minutes requires a minimum of 3-'3C") sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms x 'se) sq ft minimum requirement = a total of )sq. ft. of absorption area.
May we suggest 1 ._-' ' ?�.` ,. �. �%K` i fir�f ✓` c =:Z�J
Date ,........ ,;�;�. _.
FINAL APPROVAL OF SYSTEM:
Inspector -
ti.
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.
�•�— Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
�.--- Proper materials and assembly.
e>/( --
Trade name of septic tank or aerated treatment unit. / epe9C7 --
Adequate absorption (or dispersal) area. i'p 745 --
Adequate
$ -
Adequate compliance with permit requirements.
Adequate compliance with County and State regulations/requirements.
Other
Date
-7,tsfr—
Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
A
*CONDITIONS:
1. Ali 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, 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).
Building Official — Permit White Copy
Applicant — Green Copy Dept. — Pink Copy
1
•
Owner:
INDIVIDUAL SEWAGE DISPOSAL.SYSTEMS APPLICATION
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE'
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM
R`U l
Fees Paid $ 7,S
Date 1n -7C0 -7R'
Mail Address: 113i ID(T .. City: , p Zip: g'`/(04J Phone: ___ ___
CEVaeSelrjbAkas 441 ? 1 L
INFORMATION RulARDING PROJECT SUBMIT—ED 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 Garfield
Legal Description 4-11I CogetAr'
City or Town (2• G ---K)02)3 QTb WNE)S
Lot Size ( r)
2. No. of Bedrooms =_ Septic Tank Capacity 72D Aeration Unit Capacity
3. Source of Domestic Water: Public (name):
Private: Well \ Depth Other Depth to first ground water table/Gp --
4. Is facility within boundaries of a city/town or sanitation district? k( )
5. Distance to nearest sewer system: J-] ,u.. L .:Have you attempted to arrange a connection with the system?
v
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: _ 4V712-6(1.(—[
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:
Sc-77:F
[-r-
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.
qte 7Y
(TO BE RETURNED TO HEALTH DEPT.)
Signature of Applicant