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I � I a This building or t use permit. II ',
1, ,) t GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH l ye
�I - tN 2014 Blake Avenue
1 ,9
201
Gl Springs, Colorado 81601 c
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l id" ��.INDIVIDUAL SEWAGE DISPOSAL PERMIT Q.' 469 ;//
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I ui l l li it 'Conditi Construction approval is hereby granted for a �G717C" gallon
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I IMh . _K. Septic Tank or Aerated treatment Unit.
L bsorption area (or diapersal area) computed as follows: I r. sl
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117 I hi I Potc rate of one inch in /S minutes requires a minimum of / 2 sq. ft. of absorption area , per bedroom.
Therefore the no, of bedrooms --3 x 1 ft minimum requirement = a total of =1ssq. ft. of absorption area.
I May we suggest , oa 'X 4"F 'X / .S - ' e' al
Date dkG� 'ss/""' 77 CB 16 Inspector °:,,."•':' �y"
FINAL APPROVAL OF SYSTEM:
system shall be deemed to be in compliance with the Sewage No s Laws until the assembled system is approved ri r
Y p S 9e P Y prior to cover•`
ing any part.
PIG Septic Tank cleanout to within 12" of final giade or aerated access ports above 9 rade.
igle Proper materials and assembly.
�- Trade name of septic tank or aerated treatment unit. e n /✓
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Adequate absorption (or dispersal) area.
� Adequate compliance with permit requirements.
646. � Adequate compliance with County and State regulations /requirements.
Other i
Date w / e 7 7 Inspector
I -4 (
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All installation must comply with all requirements of ttie County Individual Sewage Disposal Regulations, adopted pursuant to au - r:
thority granted in 66.44.4, CRS 1963, amended 66 -3.14 CRS 1983.
2. This permit is valid only for connection to structureshich have fully complied with County Zoning and building requirements.
Connection to or use with any dwelling or structurall''n It approved by the building and Zoning office shall automatically be a viola•
tion of a requirement of the permit and cause for both .gal action and revocation of the permit.
3. Section III, 3.24 requires any person who constructs, Plters, or installs an individual sewage disposal system in a manner which in-
volves a knowing and material variation from the term or specifications contained in the application of permit commits a Class I,
Petty Offense ($S00.00 fine - 6 months in jail or both.
Building Official - Permit White Copy Applicant - Green Copy Dept. - Pink Copy
_.............. ..... ............................... . - ...a..W.....,.......... ..s.... _ ______L
Fees Paid $s* cam,
INDIVIDUAL SEWAGE DISPOSAL.SYSTEMS APPLICATION
Date 10-4-1-1
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
• INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM L�Z A t Ai
owner: 6 I. 1 /Ole
•
Mail Address: (p, / y4 & +// 4Z Cit zip: a / Phone:90
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 j/, i,�/ City or Town 4,
Legal Description e?r ,,I al Lot Size ..5 1-
2. No. of Bedrooms _..j Septic Tank Capacity 4' a9 Aeration Unit Capacity
3. Source of Domestic Water: Public (name): jUJ
Private: Well Depth //' Other Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation dist
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'5. Distance to nearest sewer system: Y' /50 a r j, / `4 tr - SS G
Have you attempted to arrange a connection with the ystem? -I is
If rejected, what was the reason?
6. Rate of absorption in test holes shown on the location map, in mi •'es per inch of
drop in water level after holes have been soaked for 24 hours: 3 - ♦ _ . ,,
7. Name, address, and telephone of person who made soil absorption ts:
.O-- fr�r-re-c r t
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.
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Cf rJ —Th/ r -J e•-f----
licant
(TO BE RETURNED TO HEALTH DEPT.)
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PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY }''"' 2,� _
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a, , $ ao , _.
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N LOCATION
�ICAT BELOW THE IGATION T
ITCHES AND P BOUNDAR YI LINES 4 � ., Gb 1 x c, \ .
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(TO BE RETURNED
HEALTH DEPT.)
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