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• IA This does not constitute
Z— a building or use permit.
• GARFIELD COUNTY DEPAR OF ENVIRONMENTAL HE LTH /
2014 Avenue '
Glenwood Springs, Colorado 81601 /y.i_&y n
,PERC WAIVJ 11 R.P.E. SYSTEM -FEE ONLY Phone � $303194 . 5.1265 � ` , / t *" I
INDIVIDUAL SEWAGE DISPOSAL PERMIT N� 774 ! i� Ge snip ? • 1 1,11
,, '
r' Owner Duane Van Why
, System Location 4907- 04 -06 -08 Hi 4hway 154
bt1'o iin l"
ur„ ° Licensed Contractor uwl
tr
ilil • Conditional Construction approval is hereby granted fore 7,500. gallon 1
, iI
X Septic Tank or Aerated treatment unit. - ,
ili . SEE ATTACHED ENGINEERED DRAWING 1
II Absorption area (or dispersal area) computed as follows: - -� .._.. 1
Perc rate,of one inch in minutes requires a minitum of sq. ft. of absorption area per bedroom. ii I I h „I , "-
lt
ii Therefofe the no. of bedrooms 10 x sq. ft minimum requirement ®a total of - •q. ft. of absorption area. ' 1 p O A,
Ili^
1 I + Ma wdsu st Plans & specifications of R.P.E. approved as attached, 1
y e bar 20, 1979 _.._�y. ,/: 11 II '
Date ^ 'n,,t FO , Inspector r .-" - ‘%/L... ,+' , re 1i -'r
FINAL APPROVAL OF SYSTEM;
14
No system shall be deemed to be in compliance with the Sewage Disposal Laws until,the assembled system is approved prior to egyerrt1, I, u
4,. ing any part. "s•
�, ' Septic Tank access for inspection and cleaning within 12' of ground surface or aerated access ports above ground aee
surface. 1
1 + 6,1 ii ' f Proper materials and assembly. -. X 1 1 11 11”
�i1 O K e Z / 1 . Np Trade name of tic ter k ar aerated treatment unit. 1 }iA �4
If f � i "
I^ 'n Adequate absorption (or dispersal) area.,,: 1 " ".,f1 14 iii 11
CA Adequate compliance with permit requirements. , °', PI
/C Adequate compliance with County and state regulations /requirements.
iii it Other p
µ'
..�/ _ l it y �r
Iii Date +< 1 -. „ Inspector / r
A . µ1 „ 1 "!41
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE i E1P
CONDITIONS: r f1 1 111 `
1. All installation must comply with all requirements of tkie County Individual Sewage Disposal Regulations, adopted pursuant to aOh I °
thority granted in 66.44.4, CRS 1963, amended 66-3-14, CRS 1963. " 11111
2. This permit is valid only for connection to structures *hich have fully Complied with County zoning and building requirements. 1CI1 r
Connection to or use with any dwelling or structures n t approved by the Building and Zoning office shall automatically bee viola 1 ",
von of a requirement of the permit and cause for both egal action and revocation of the permit.. : ,,•
3. Section III, 3.24 requires any person who constructs, hers, or installs an individual sewage disposal system in a manner which i u I IA
,
volves a knowing and material variation from the term or specifications contained in the application of permit commits a Class 1111116', r1t1,
Petty Offense ($500.00 fine — 6 months in jail or both). "
Building Official — Permit White Copy Applicant Green Copy Dept. Pink Copy A 1111 1e. "d
-- -1r „ . ��. ______.-......,... ._ ....._...-....'_ _---, . ...........-.�..-.____.,... . .,._.�....,._._.. �'1'Wr'1
Page Two Fees Paid.00 :6D
J .
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date — )
,' Oh : Du et. I /G VA-A/ Ct/ //7�
Mail Address: 407 to 9 fJJ[[: City: C/.� " Zip :R6po/ Phone:S
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 (see Page 3).
1. Location of Facility: County GARFIELD City or Town
Legal Description e90 2., fit /69 Lot Size / -. :
2. No. of Bedrooms la Septic Tank Capacity 2.5 O Aeration Unit Capacity
3. Source of Domestic Water: Public (name):
Private: Well ✓ Depth Other Depth to 1st ground water table CO
4. Is facility within boundaries of a city /town or sanitation district? A/0
5. Distance to nearest sewer system:
Have you attempted to arrange a connection with the system?
If rejected, what was the reason?
6. If R.P.E. tested, state 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:
Dea W 1 • 6-0 A/ /5 SQ7
7. Name, address, and telephone of R.P.E. who made soil absorption tests:
CI ' ,t A-ss G . (ev
� A-N 3
8. Name, address, and telephone of R.P.E. 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 Building & Sanitation Department and /or such persons as
they may designate. Any withdrawal of this permission shall be in writing and receipt
acknowledged by the County Building & Sanitation Department.
10. I have been given an opportunity to read the Individual Sewage Disposal Systems Regula-
tions of Garfield County and I hereby agree to comply with all terms, conditions and
requirements included therein.
9 — 2 0 — 2 de -y--�-^—
Date / igna u`-/o 'pp scan
(TO BE RETURNED TO BLDG. & SANI. DEPT.)