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This does not constitute
e a building or use permit. -,
i GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH d
2014 Blake Avenue 2. j 2.11
li Glenwood Springs, Colorado 81601 .Q cILA. Cl _ -
r. INDIVIDUAL SEWAGE DISPOSAL PERMIT N° 264 8- D 4 -
Owner Chuck Becker
iii ' System Location Lot 4 B. Asgard Subdivision. 2nd Filing - Rifle — .D I I' ` & -- cdtt_
Licensed Contractor owner
iii
Conditional Construction approval is hereby granted for a /0 /0 n gallon
Septic Tank or Aerated treatment unit.
Absorption area (or diapersal area) computed as follows:
Parc rate of one inch in minutes requires a minimum of �...3 0 sq. ft of absorption area per bedroom.
Therefore the no. of bedrooms 3 x 2 3 0 sq. ft. minimum requirement = a total of 4q. ft. of absorption area.
hi Sce/'/9ce 3 c Z S - /
May we suggest �` � 3 , Dee. P•
Date I ' " -C-'r 2 -2. /2 7,C Inspector • - _ .i
FINAL APPROVAL OF SYSTEM: s'
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.
A li" Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
Proper materials and assembly.
Yu e e Trade name • .r aerated treatment unit. 1991C-6
____ Adequate absorption (or dispersal) area.
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Adequate compliance with permit requirements.
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Adequate compliance with County and State regulations /requirements. l : f ° '
Other .
Date ,...›.._ — 767 Inspector c � fi
-, ,'Jd •
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE -' ;1.
*CONDITIONS: • /!� 9 3 j
1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations, adopted pursuant to a '-
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.
1 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, r,
Building Official — Permit White Copy Applicant — Green Copy Dept. — Pink Copy
_._W....... ................ W.... W... �..W.......�............�...... .—
Fees Paid SW, at)
INDIVIDUAL DISPOSAL SYSTEMS APPLICATION Date 1{- !( -7(Q
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner: v i
Mail Address: bra 5 �x 2c( 26,6 City: Zi
t� P'///;5Tr) Phone:n
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 r , i . _ . !,/ City or Town �-�lQ_2
Legal Description ate ' z _- Lot Size cf5 J
2. No. of Bedrooms Septic Tank Capacity / Aeration Unit Capacity
3. Source of Domestic Water: Public (name):
Private: Well Depth 7fj Other Depth to first ground water table 70
4. Is facility within boundaries of a city /town or sanitation district? 4,40
` 5. Distance to nearest sewer system: '; j rncj ,
Have you attempted to arrange a connection with the system? /// )
If rejected, what was the reason? c_____—_______
6. Rate of absorption in test holes shown on the location map, in minutes per inch of ft
drop in water level after holes have been soaked for 24 hours: .5 ,t(J--7Tj/t{ /
7. Name, address, and telephone of person who made soil absorption tests: n _
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.
p /Ll i go at i 1 ner
(TO BE RETURNED TO HEALTH DEPT.)