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/14,''' ' a building or use ' GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
Phone (303) 945 -7255 •
INDIVIDUAL SEWAGE DISPOSAL PERMIT Ni' 608
Owner / l 7 .0 - , T z t o m , g 2 . . 'Y.e.e- a
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System Location C .4 -C- ..0 f- n79,9C1 -'
Licensed Contractor 0 O. 7d /&
Conditional Construction approval is hereby granted for a A o gallon
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�eptic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in._ / " minutes requires a minimum of , 'Pp fl sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms es l x ,� a p sq. ft. minimum requirement= atootal of 700 sq. ft. of absorption area.
May we suggest ,.a.,rJC e /w2 23,
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Date ! 2 3 1 971 Inspector , el.,,,/24., G<` „,
FINAL APPROV=AL OF SYSTEM: ®/ /
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to c
ing any part.
cc 7 "tom, Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground 4"
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surface.
0, Proper materials and assembly. -
/ t (.. Trade name of sep(c tank or erated treatment unit.
(J X Adequate absorption (or dispersal) area.
P, /CAdequate compliance with permit requirements.
e se v c, Adequate compliance with County and State regulations /requirements.
Other /
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Date a►�
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
'. - Inspector �-."'" .."' C"'C.�.�C�._ :�f�
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'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 t� 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
Fees Paid $ Ls.°o
INDIVIDUAL SEWAGE DISPOSAL SYSTEMS APPLICATION
Date T -�1-17
• NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
• INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM
Owner: ` OJ14 A E,
Mail Address: 7614 (460y g 4 City: _crie pf Zip: v‘0t Phone: ?Kr
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 C�,Jw8eb 5,47S
Legal Description L7, bilk MCA Do 05 Lot S'- . ' - /( ca£S
2. No. of Bedrooms ,3 Septic Tank Capacity /Oe Aeration Unit Capacity
3. Source of Domestic Water: Public (name):
Private: Well Depth �_ Other Depth to•first ground water table ail
4. Is facility within boundaries of a city /town or sanitation district? Kr)
5. Distance to nearest sewer system: /
Have you attempted to arrange a connection with the system? /110
If rejected, what was the reason?
6. Rate of absorption in test holes shown on the location map, in mi tes per inch of.
drop in water level after holes have been soaked for 24 hours:
7. Name, address, and telephone of person who made soil absorption t ts:
8. Name, address, and telephone of person responsible for design of he system:
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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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I a e Signature of Applicant
(TO BE RETURNED TO HEALTH DEPT.)
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
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INDICATE BELOW THE LOCATION OF YOUR BUILDINGS, WATER SUPPLY AND DISTRI- --
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES
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(TO BE RETURNED TO HEALTH DEPT.)