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"` '' +/ '1 1 dltFIIELD COUNTY BU ILD I ki ND SANITATION DEPARTM °w' i
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This does not constitute
i , l i 1 p,, I IDIVIDUAL DISPOSAL PERMIT M4 ° 'I + abuildinporusepermit,r ¢,I „?
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1, I {1 wner +1ohf £. ar�d wa1Jc hl m I'
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s em Location 4
1 , Installer �. , k' ,.n 1 , ' 1
1 I Ill ' ' ' ” Conditional Construction epp�royal Is hereby granted for 1 , . , g allon +Ih+ l ?�
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- t �)1 14 J d, x Septic Tank or - Aerated tr eatment , lt +! u N 1
1 N Fy Absorption area (or dispersal ar ea) computed as follows) +: '
' I l ni l " 141 `� • . �
H Perc rate of one inch in .PI ,L ":minutes requires a mini m of • 4 (p a3q, ft. of absorption area per bedroom. `, {t II, ""
1 Th erefore the no. of bedrooms x „0„, I
.h ; q .i Irllen re bnt ► a total of ,nq ft. of et}tprption eraa !,
+ 1 'c P
y yt f
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May we suggest f 2 1i / ( 4 14 X 3 . 11 1V 1 1,1,1'11;1,,
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fall 1 1 1 .. D ate Kim, + +,q� I 1, '�� M 1 In9PeQtor - I , 1 ,.i p r ".
I l FINAL APPROVAL OF SYSTEM; II �,
No system s hall be de emed to be in compliance with the , Wade Disposal Laws until the assembled system Is approved prior to Cover '''41';''',1„.., 1-i
ing any part.
10 11i i ` X11 1 r uA n IL 1
',q Septic Tank access f or inspection an m nl within 12 o groun surface or aerated a cess ports above ground 1li I 1
bK Proper
surface.
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materials and assembly. r� v 1r ll
111 1
, � o ' '' '' Trade nq a o f septic tank or aerated tare ment yriit.
I OA- - Adequate absorption (or dispersal) area.
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Adeq uate Gompfiance with permit re uft ants. ;� 9 ,
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,w ! �� Adequate compliance with County enq � puirements: to fegblations /ra r rl
' Oth r /1 ,
vi, 1 pate !L ', -16"� insPaotgr % a 1 p
' t RETAIN WITH RECEIPT RE'OP/DS AT CONSTRUCTION SITE 1„, 1i ”
` tl l ')CONDITIONS:
1. All installation must co ply with all requirements 0f,t u nty `Individual Sewage Disposal Re adopted pursuant 811
ant 10 . 1
thority granted in 66 - 44 -4 CRS 9863, amended 66-3-14 ,1 3,
2. This permit is velid'oni y for co n to struct re 4 , +
g u � y tally' complied .with County �Oning and building reggirerYient!', ;
Connection to or use with any dwelling or structures 4 � ' e4 by the Building and Zoning office shall automatically be a Viola , S
7 tion of a requirement of the permit and cause for both' al Isotion end revocation of the permit, H
3. Section 111, 3.24 requires any person who constructs 1 ' , s . or. Instal e ;indivi sewage disposal system in a manner I h "
volves a knowing and material ,variation from the 11I 1 1 r spacificetions contained In the application of permit commits a Class I,
Petty Offense IS60O OO f ine - 6 months in Jail or bo fi); "1
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va.,.:. APPliuht, 0 .:.. N ... __--- P- ic qY
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Page Two Fees Paid $ ?
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date ? -a 9 - 0
Owner: -1J k A, ° ll i I ?cc mAg h L,V f<
Mail Address: /V..7nSe LiNINS c R 0/ City: 4 /10,,/ Cufv Zip: -b'/U/ Phone :3:4 - Q
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 X I r
Location Address & /or
Legal Description 72 9'4 c 0233 obi /t ',J Lot Size jS ; g jlcrrs
2. No. of Bedrooms '3 Septic Capacity/24'0 Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name):
Private: Well x Depth ,QUO $(Other Depth to 1st ground water table /,2 5'
4. Is facility within boundaries of a city /town or sanitation district? ,'V'g
5. Distance to nearest sewer system: /c•s
Have you attempted to arrange a connection with the system? /v
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.
j irtA ; 41 D2t; / J Signature of pplicant
(TO BE RETURNED TO BLDG. & SANI. DEPT.)
Page Three
• 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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1 (TO BE RETURNED TO BLDG. & SANI. DEPT.)