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This does not constitute
• J a building or use permit.
lia - GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
.. .E9 P'1ft 4, &a R.lkT101.1 ,gc. 01Jhy Glenwood Springs, Colorado 81601
Phone (303) 945-7255 T
INDIVIDUAL SEWAGE DISPOSAL PERMIT NU 610
Owner A. h A,) to I AF ' y A- tJ t . > f'; -,t-iZ)
System Location 07 C J r , I':" .4"s . rn 1? .1h-'f.) 1' l f*-" t C.-,t 1 1
Licensed Contractor ( 1 t.S.
' Conditional Construction approval is hereby granted for 1 e-ir 1 37l 1. allon
_ Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in_r 0 minutes requires a minimum of . 1 C sq. ft. of absorption area per bedroom.
erefore the no. of bedrooms C
x ga sq. ft. minimum requirement = a total of 1 )sq. ft. of absorption area.
e CS>� t 1 W A- e /Jr C' f�
May we suggest 56= ,E"S:=>Pr4YGT EtN t�'a 1 .„1 x Clot X 1
Date_,> %" - - 7 Fri Inspector \
it t. NO ^s ft L34.,. 13- 2 -use' - n4.)o 15t`xl aau " - ^— L-t?Yre -fi F` 1 et-1 51 2 - t) rr it . it t�1 ,1 T /c R)
FINAL APPROVAL OF SYSTEM: fJF' A E. F.'t-'I itt-> I h_a r1,s,.E" )' ite, I) > h' ;•7;,ae r I',
I I, A .
�} i q Dtfle:4'�1 t18. Y S 4"y FSce 1 T �'. Tr r 1
'"Nb s e f, LT€ to 51 n gi / t a e D isp o sal L n 3e Ls f2.b le d s y s ti 1 p r o . { p ri r to X 1
�Y �'r�i de o be m co bent rt the ewage Asposal L until the assembled system is approved prior to cove;
ing any part. // —
� -' 7( � - Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground t
surface.
Proper materials and assembly.
Trade name of septic tank or aerated treatment unit.
15 W Adequate absorption (or dispersal) area. /,z /ter X.3 '
%/C Adequate compliance with permit requirements.
`' /G Adequate compliance with County and State regulations /requirements.
!��.(J,���T"J�_Other y/ //� ®
Date „,,e /0Z /n Inspector %4 4( e4.1.
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 1,
Petty Offense ($500.00 fine — 6 months in jail or both).
Building Official - Permit White Copy? Applicant - Green C6py Dept. - Pink Copy
Fees Paid $,Z
INDIVIDUAL SEWAGE DISPOSAL SYSTEMS APPLICATION
Date $= 7 ?._
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
,./ INDIVIDUAL HOME SEWAGE TREATMENT, SYSTEM
Owner: DVlrt5• )L)& (V \P W 1Leek -t
Mail Address: ,gip T oI irk City: (JA -cam- Zip: ?tc.,--15,CPhone: c 7't9c
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 1z-eriS t °) -u�=Z-
S�( TT8nt (- c-i ,- rte-16 cn O l 3 5 Or d ,
Legal Description Lot Size '7.
2 No. of Bedrooms Septic Tank Cap city eration Unit Capacity
F 1J . •• v° a- s 'f ►� ?� /tt P
3. �Source of oce i a er: blic (name):
sc3 4=0cCE soatcc CA -sTer -K.
Private: Well Depth Other X Depth to .first ground water table - •
4. Is facility within boundaries of a city /town or sanitation district? Mc)
5. Distance to nearest sewer system: ( V∎l. r= —
Have you attempted to arrange a connection with the system? LI c -,
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: -
7. Name, address, and telephone of person who made soil absorption tests:
S Pc- ezeu (T
8. Name, address, and telephone of person responsible for design of the system:
Sc-e permit
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.
8 ?_ 2 - "7 te ii /. . Il •
Date Signature of App ( cant
(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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�j _ (TO BE RETURNED TO HEALTH DEPT.)