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J GARFIELD COUNTY BUILOIN AND SANITATION DEPARTME
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• GlenwoodSp ngs,Colorado61601 (I"
n o ft +' Phone 0S) 945.8241 " //o ch 1:14
P 'REPAIR - NO CHARGE i�y-1' This does not constitute i
31 tNDIVIDU " SEWAGE DISPOSAL PERMIT Ng '1 103 V , a building or use permit,
Owner ew Castle KOA Ka ..round "` i
System Location OSA1 County Read ?Al . Nam p ctle
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Licensed Installer l l. Ni
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• Conditional Construction approval is hereby granted for a I na t . gallon. W 6000 Q 0 .Q_ 1 M %%' "
n stelled C1I >
■ .-11k___ Septic Ta or X Aerated treatment 1,1 it. j py
Absorption area (or dispersal area) computed as follows: d °"
Perc rate of one inch in N/A minutes requires a mininj'bm of N/A sq. ft of'aborption area per bedroom.
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Therefore the no of bedrooms . N/A x N A sq. ft.' rninimun requirement - a total of sq. ft of absorption area: . 1° I '
May we suggest Reconnect pipeline to tank. 1
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Date July 1 s 1981 4 ' Inspector
Ii
FINAL APPROVAL OF SYSTEM':
Nyy� system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to cover I:
.fr Itlg any part.
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Septic Tank access for inspection and clehning within 12 ground surface or Berated access ports above ground r l r
surface.
u Proper materials and assembly.
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Trade name of septic tank or aerated treatment unit. 1
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+` Adequate absorption (or dispersal) area, 1. '
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n Adequate compliance with permit requir
• Adequate compliance with County and State regulations /requirements.
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i Other
Date Inspector
RETAIN WITH RECEIPT ROCORDS AT CONSTRUCTION S1TE
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'CONDITIONS: ir
NI 1. All installation must comply with all requirements of the County IndividuarSewage Disposal Regulations, adopted pursuant to au-
thority granted in 66.444, CRS 1961 amended 66.3.1/4'CR$ 1963•
2. This permit is valid only for connection to structureqit$i have fully complied with County zoning and building requirements.
Connection to or use with any dwelling or structures n approved by the Building and Zoning office shall automatically be a viola - ,
Con of a requirement of the permit and cause for both et action and revocation of the permit,
3. Section 11 I, 3.24 requires any person who constructs, 4 tars, or Installs an individual sewage disposal system in a manner which in
volves a knowing and materiel variation from the termt,or specifications contained in the application of permit commits a Class I,
I Petty Offense (5500.00 fine — 6 months in jail or both),"
III
Applicant: Oran Coat' beaartmanu Pink Copy
IN
Office Use
Page Two Fees Paid $ N)L
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date q7-(--X
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Owner: (Og Q L kW)
Mail Address: ds /'/ ' C)/ City: ke4 /6OSfjLQ Zip: 0Fjdf'7Phonetkr Zzv
INFORMATION REGARDING PROJECT SUBMITTED. FOR REVItW
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 404
Location Address & /or
Legal Description s
OSr/ a P. 17 Lot Size L s
2. No. of Bedrooms Capacity ,3O0U5.c.lF6ration Unit Capacit alsciel
3. Source of Domestic Water: Public (name): C/
Private: Well t/ Depth 3S Other Depth to 1st ground water a�ter table _ /_e,<_
4. Is facility within boundaries of a city /town or sanitation district? t'. 0 ��
5. Distance to nearest sewer system: " /2- /
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:
7. Name, address, and telephone of R.P.E. who made soil absorption tests:
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.
O GVAL) —(2 -._
Date Signature o pplicant
(TO BE RETURNED TO BLDG. & SANI. DEPT.)
, ( 4 1 0 , 0 5(- -- Page Th
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERT (r
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INDICATE BELOW THE LOCATION OF YOUR BVI VISU° t ANAIST• •- ,
BUTTON LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND B1UNDARY LI EC
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(Tt : 7 REIURNEDL TO BLDG. & SAN . 1 EPT. )