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( dI a GARFIELD COUNTY BUILDI AND SANITATION DEPARTMENT
# ..t 2014 lake Avenue
Glenwood 6pngs,,Colorado 81801 '
Phsne 303) 845.8241 rill- O.t /-. 00 -.0_4z,
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT all ' 1028 a building or use permit.
Ih
Owner John V. A Dornthy D. N*iimth
System Location County Road 306 - Una 4//4 a. t'd. d06 slini 4, gti.
ill Licensed Installer
r
.1 ' Conditional Construction approval is hereby granted for a /Ma gallon
it
— Septic Tank or Aerated treatment Unit. `
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in 1 minutes requires a minirfum of /19 sq. ft of absorption area per bedroom.
Therefore the no of bedrooms '. x ..,c,��sq. ft.MWninImum requirement - a total of f j sq. ft of absorption area.
,. May we suggest i t D .C ,E`Ae11 Fe/ 1:( , )
.....•
Date ��� y/$ 4nspector »'C. ��%f : .ate
. FINAL APPROVAL OF SYSTEM:
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to cover• •
iv ing any part.
,/,1( Septic Tank access for inspection and cleaning within 12” of ground surface or aerated access ports above ground
�� surface.
�,, )1 y Proper materials and assembly.
<retedne0 Trade name of septic tank or aerated treatment unit.
c/f Adequate absorption (or dispersal) area
/2/1 Adagdate compliance with permit requirements.
4 /1 " A dequate compliance with County and State regulations /requirements. //,
Other /
Date 0:03 Inspector . t,�r '`AV _" n�� i/
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
'CONDITIONS:
1. All installation must comply with all requirements of thh County Individual Sewage Disposal Regulations, adopted purAiant to au.
thority granted in 66•44.4, CRS 1963, amended 663 -14, WCRS 1983.
2. This permit is valid only for connection to structures wfiich have fully complied with County zoning and building requirements.
Connection to or use with any dwelling or structures not approved by the Building end 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. y
volves a knowing and material variation from the terms or specifications contained in the application of permit commits a Class I,
Petty Offense (5500.00 fine — 6 months in jail or both). ;
Applicant: Green Copy D.partmenr Pink Copy
_— ......u.�..,.- .tens- .ura...urr.... - ru a.. ua... u.. r . �� ....,............°.....rrr....J
Page Two Fees Paid $7S', crU
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date 6-73 — �(
Fe
Owner: Aka . b... k p. a Ala • RECEIVED JUN 2 s 1981
Mail Address: /y /ey g2 q u 4w. City: fi� I � /,9 Zip: y/(50 Phone:ta5 -/079
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).
Near What
1. Location of Facility: County GARFIELD City or Town Ap i� r,/rr /v
Location Address & /or n4b41v4M 2 . 4 24.,/T 5Egeo(A)th
Legal Description ,vb .s __. ,r.Lot Size ID() Ar_Rrs
•
2. No. of Bedrooms __3 Septic Tank Capacity /00 Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name):
Private: Well X Depth .9S0' Other Depth to 1st ground water table /..37
4. Is facility within boundaries of a city /town or sanitation district? No
5. Distance to nearest sewer system: / ,ni /e
Have you attempted to arrange a connection with the system? /Vo
If rejected, what was the reason? Pa S.ctm
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:
7. Name, address, and telephone of R.P.E. who made soil absorption tests:
8. Name, address, and telephone of • 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.
D ate gna ur- o 'pp scan
(TO BE RETURNED TO BLDG. & SANI, DEPT.)
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