HomeMy WebLinkAbout001038 '' 'h �' f 'r' :?r-r ..i 4 ""‘ .,.iza -..o p- ...ri- "fAVE�P'•444•44.;,w•w 7 "'crwm•r : rwv F+str wr" xr .,e.., - w,•
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I[ I f� - G`1'RFIEL,p COUNTY BUIL,.OIN AND SANITATION DEPARTMENT 1
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2014 ke Avenue
a ; f' Glenwood a gs,'Col 81601
'III o Q/17 27, -*dQ 0l' Phone i 013) 94548241 f' O/IE #
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• II f This does not constitute I w '
INDIVIDUAL SEWAGE DISPOSAL PERMIT U 1 f7 1 3'$ { a building or use permit.
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own Ronald Le Gennann . ( arc
omE �qD�oee p
'Ih System Location (R 1 71.H 0 b y " 1R9 B R +3 . C CG R'\694) e /992 rn.Ref. / !
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Licensed Installer i,
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'Conditional Construction ipproyal is hereby granted for a &o gallon "
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r _.X— Septic Tank or Aerated treatMentu it. „
' Absorption area (or dispersal area)'oompyted as follows: ,, ”.
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" Pere rate of one inch in minut r es s requires a minimum of 3p sq. ft. of absorption area per bedroom.
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'' ; - Therefore the no. of bedroi ns _3.— p •F—F- a Osq. ft. ' Minimum requirement ■ a total of tq. ft. of absorption area.
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May we suggest /2 Q3�( o p 'is X S$ ' 3 de l,.
e. 7 „3 //g / II IniPector i
Dat - a, .�AijA.H
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FINAL APPROVAL OF SYSTEM: u
N system shall be deemed to be in compliance "with the Sewage Disposal Lews until the assembled system is approved prior to Cave I 5 A to 1
in ganypart. : ,.� rw
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S eptic Tank access for inspection and ,.„.:,
within 12" of ground surface or Berated access ports above ground -
surface. 1 G
Proper materials and assembly. I t i I �
Trad'I1 ti e t n erate re merit unit t
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Adequate absorption (or dispersal) area. i
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x � • Adequate compliance with permit r equiremehts.
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Adequate compliance with County,an'd State regulations /requirements.
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III Other rl. �'
ii' ete.� , ,, , (1 - 74± n Inspect. ' .� 1� ifi , i.i I '
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I �iI - -: RETAIN WITH RECEIPT ■
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�ORDS ' tSNSTRUCTION SITE I '
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"CONDITIONS:
s 1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations, adopted pursuant to au. II ` thority granted in 66-44-4, CRS 1963, amended 66. 314 CRS 1963.
2. This permit is valid only for connection to structures ich have fully complied with County .zoning and building requirements, 'I
Connection to or use with any dwelling or structures n t approved by the Building and Zoning office shall automatically be a viola. M1
tion of a requirement of the permit and cause for both 1 gal a9tion and revocation of the permit. � I,
3. Section III. 3.24 requires any person who constructs, tars, or installs 4n individual sewage disposal system in a manner which in- ' I"
I ,, volves a knowing and material variation from the term[ or specifications contained in the application of permit commits a Class 1,
W Petty Offense ($000.00 fine -- 6 months in jail or both).
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p APpllunt: Oren Copy COpartmont: Pink Copy
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Office Use
• Page Two Fees Paid $ 7.
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date 4,/WY
Owner: ie6 4evisiliattel
�� 9A 3
Mail Address: ,/7/ /7'wt/ /33 13 City: eitzt"senr4/r Zip: Watt Phone: S 9
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 62:.1/r1p�,
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Location Address &/o
Legal Description I.) u, —Kg Lot Size _'S teg AgC/IPZ's.
2. No. of Bedrooms 3 Septic Tan'K Capacity /cZ0 v Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name): ./e-7/
Private: Well Other Depth to 1st ground water table
4. Is facility within boundaries of a city /town or sanitation district? /1/D
5. Distance to nearest sewer system: 4/ /
Have you attempted to arrange a connection with the system? y //P
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:
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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.
l/ -f -- A 5 Co j a, a i a a2A-
Date i. a ure o 'pp scan
(TO BE RETURNED TO BLDG. & SANI. DEPT.)
Page Three
PLEASE DRAW AN CURATE MAP TO YOUR PROPERTY
1.
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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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(T B R[T RNU EO TO BLDG. & SA I. DEPT.)