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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
2014 Blake Avenue
Glenwood Springs, Colorado 81601
Phone (303) 945-8241
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INDIVIDUAL SEWAGE DISPOSAL PERMIT
1310
Owner /4 ( e r C i ci rL e-Ne9 Y` Jr Uj�!
System Location /3 JCgi -{'' rt.( -6Q
Licensed Installer l�C-A),V
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This does not constitute
a building or use permit.
" Conditional Construction approval is hereby granted for a 756 gallon
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area computed as follows:
Pere rate of one inch inminutes requires a minimum of f�' sq ft of absorption area per bedroom.
Therefore the no. of bedrooms 7 x ,/(n / sq ft minimum requirement = a total of ft. of absorption area.
May we suggest ,/..=><Je 7 7,x
Date —7— Inspector
FINAL APPROVAL OF SYSTEM:
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.
(Vie_ Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
Proper materials and assembly.
ade name of septic tank or aerated treatment unit. /19 -BCD
Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
Adequate compliance with County and State regulations/requirements.
Other
Date / O cf� Inspector 461/4q -77---e6
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, 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 (5500.00 fine — 6 months in jail or both).
Applicant: Green Copy Department: Pink Copy
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
®WN k R% '0 is Fie r ' / ke . 4 /4e.e moi'
ADDRESS 0,,s72.0 // 3 or enc. 3c /OA2f PHONE 9.1/.5--.5 ;.U;
CONTRACTOR TtcL /`7
ADDRESS PHONE
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Approval by
County Official:
PERMIT REQUEST FOR: (1%f 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.)
LOCATION OF PROPOSED FACILITY: County Oj e, , ri Ore ,U
Near what City of Town 0.4 .e43o vD-4 C 4r Lot Size 3 O. 9 4
Legal Description
WASTES TYPE:
( ✓) Dwelling
(
( ) Transient Use
) Commercial or Institutional ( ) Non-domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: 4,1'4 P /Yer,y 7 p ON
Number of bedrooms /z Number of persons' ,--
( ) Garbage grinder (tomaticwas er ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( Dwell ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system:
If supplied by community water, give name or supplier: -D-A4�
GROUND CONDITIONS:
Depth to bedrock:
L!C►� /"G
Depth to first Ground Water Table:
Percent ground slope: �o
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to community system?
TYPE OF INDiV UAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( Septic Tank
( ) Vault Privy
( ) Pit Privy
( ) Chemical Toilet
FINAL DISPOSAL BY:
(absorption Trench, Bed or Pit
( Underground Dispersal
( ) Above Ground Dispersal
( ) Other - Describe:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?
) Aeration Plant ( ) Vault
) Composting Toilet ( ) Recycling, potable use
Incineration Toilet ( ) Recycling, other use
) Other - Describe:
( ) Evapotranspiration
( ) Sand Filter
( ) Wastewater Pond
Page 2
r7
Ma PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.)
Minutes per inch in hole No. 1 Minutes
Minutes per inch in hole No. 2 Minutes
per inch in hole No. 3
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 permit is 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
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
°p
/13 /ed
CATV C1 C6J
Signed
Page 3
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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.
Page 4
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