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This does not constitute "
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_11 li l4 , , GARFIELD COUNTY DEPARTMENT OF ENVI,RONMENTAL'HEALTH
° " I I 2014J8lake Avenue
' Glenwood Splings, Colorado 81601 • 4 1
II REPAIR - JO CHARGZ - PERC KNOWN Phone (3031 945-7265 ' }:
INDIVIDUAL SEWAGE DISPOSAL PERMIT Nil
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' Owner Nr. Nark Arnow i. II •
System Location North of Glenwood
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Licensed Contractor ColIer ed _ _
* Conditional Construction approval is hereby granted for a 1 000 gallon - l H ill
existing • '1
dr X Septic Tank or Aerated treatment Unit. 8E11 PSRNZI'6 N17 end I � . ,.
R pate RATbS AV a 0
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ym Absorption area (or dispersal area) computed as follows: r ,... ' •'qNry�p Yi,u" „� -
' M I P'l I PIS I Perc rate of one inch in 30 minutes requires a minimum of 250 sq. ft. of absorption area per bedroom. dl j "VIII +,I'
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Therefore the no. of bed/ooms 3 x 280 sq. ft. minimum requirement e a total of 750 sq. ft. of absorption area. ll I ..
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May we suggest Seepage Bled 12' x 63' x 3' deep.
June 15, 2978 _ ...
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Date Inspector '�-,'� -�
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FINAL APPROVAL OF SYSTEM:��OU III iP +J', '_ K it
No system shall be deemed to be in compliance with the Sewage Disp Laws until the assembled,jystem is approved or to cove � -
, ing any part. IV I yh � I I '
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X /.ST�i✓G Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground i Nll_'
surface. ilir' Y
Proper materials and assembly. 5 -7'
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ii Trade name of septic tank or aerated treetrnent unit. f' . ""
L��f� Adequate absorption (or dispersal) area. ' , q �'• ! �'
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C /4 Adequate compliance with permit requirements. , '' " P
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Adequate compliance with County and State regulations/requirements. ,;
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Other /
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Date I " f ..c,et.t � f , , � 7 Inspector "Iv ...i,- ..t/r, l _ e t 9 fi d , 1� ,
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RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION .SITE ) ry
*CONDITIONS: r ural
1. A ll installation must comply with all requirem of the County Individual Sewage Disposal Reputations, adopted pursuant to u, � ' III
thority granted in 66-44-4, CRS 1963, amended 66 -3.14, CRS 1963. tl ;
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirementsr, `
Connection to or use with any dwelling or structures not appcpved by the Building and Zoning office shall automatically be a viola.. '"'•
Von of a requirement of the permit and cause for both legal action and revocation of the permit" +p'
3. Section 111, 3.24 requires any person who constructs, alters, or installs an individual sewage disposal system in a manner which In- 'l l'
valves a knowing and material variation from the terms or specifications contained in the application of permit commits a Class 1,
r • Petty Offense ($500.00 fine — 6 months in jail or both). `
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. Building Official — Permit White Copy ' Applicant — Green Copy Dept. — Pink Copy 1 1 I r
.
Fees Paid $ Fa -
INDIVIDUAL SEWAGE DISPOSAL. SYSTEMS APPLICATION
a Date
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE' ! C.
INDIVIDUAL HOME SEWAGE TREATMENT .SYSTEM sew q141T
feePI!? IC—
Seen fiteaseer
_JINX.. P#JMtr., tt..iv000E 4
Owner: _ 3
Mail Address: gc., ;7 g7-mpy City: p e Zip: g' /bpi Phone: s r2.
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 Garfield City or Town n �
Legal Description ttEPA-t (Z.. Lot Size
2. No. of Bedrooms 3 Septic Tank Capacity_ Aeration Unit Capacity
3. Source of Domestic Water: Public (name):
Private: Well )[ Depth Other Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? 0 v
5. Distance to nearest sewer system: 0 AA Le5
Have you attempted to arrange a connection with the system? NU
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: g iet LNr('t
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:
Se rar
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.
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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.
KD -- s - 7 r �i
Date S gna of Applicant
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(TO BE RETURNED TO HEALTH DEPT.)