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w1 - A Ip "v' a OARFIELD COUNTY SUILDI G AN SANITATION DEPARTMENT r t. ll i !1i
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201 .I.vu I t d
lit 1 Gienviood,1 otie, Col r ado 61601 I "
1 1 W 1 ' motif flat 9 546241
II I REPAIR - Pert Only S60.00
, s, .. y � This does not ebh(titute
= 14 4 r SEWAGE DISPOSAL PERMIT 1 al 1 a building or us
y1 O Mark A. Cosa , 1,. ' I i , F
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e n0 W . Qit.3 ¢th , Street - !ifs -_ ,
(l i st m Location mIr 11
_ 1i - „lid II Installef ....,W__ — j ai i In „
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- ' 1 1'+ I Conditional Construction approval is hereby granted for 1 a Y C. g �I 11
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, I t Septic Tank or , Aerated treatment u fit.
. Absorption area (or dispersal area) computed as followsr 1 I i i 11 1 1 z
f1i'1 I 1 1 Parc rate of one Ineb ...0 v l minutes requires a mini 1 -' m Of • ! sq. ft. of absorption ere er bedroom. 411 1 ,
T „ i t itnerefore the no. of Oldrooms, , 2 x (2 sq. ft ” inlr um me total of 4 ? - ft. of absorption area., lu 1 u 1 '
May we suggest *S 2 ' , ,, 3' de e ✓� /Gi 35 X 3 cie o f • i iifidi
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II ga te ' .� ; In �tcr -'a 6 — 1,
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51 1 ° #NAL APPROVAL OF SYSTEM: 1' L
- 1 1 "I li * No system shall be deemed to be in compliance with the : age Dispo3el Laws until the assembled system is approved prior to cover iii i u t
• "1 ' ing any part. f
of G 1r , 1 „ up1
6:2 Septet Tank aooessfor inspection and 6'l 1 Ind Within 12r ", ground surface or aerated access ports above ground r„lw
u,p surface, ° a r e d1 i
11
, a P roper Materials a d asse bly. rµ T 11
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di d __(!?...1±<: p is k or Z e l l hr the unit.
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0K Adequate absorption (or dispersal) area. ) „ 1
' \ Adequate compliance with permit toggle ants.
1H 1, � Adequate compliance with County and e4e redulations /requirements. t r ?I,
."-- -- Other 1 / :\ '
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R` ' Date ��� inspect. fa- . .. �� d �,� . ii i
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1 RETAIN WITH RECEIPT R • RD , • CONSTRUCTIQN SITE
- "CONDITIONS:
1. All installation must comply With all requirements Of t r. County individual Sewage Disposal Regulations, adopted pursuant to au I ?`
thority granted in 66.444, CRS 1963, amended 66.4.14 RS 1963. ` -,..
2. This permit is valid only for connection to structures, ( ich have fully complied with County zoning and building requirements. ,, ; ":
Connection to or use with any dwelling or structures approVod by the Boding and Zoning office shall automatically be a a viola• PI i' °
u on of a requirement of the p mit and cause for both � 91,ac #I n and revocation of the permit. 1
3. Section III, 3.24 requires any' erson who constructs,, 1 er(r br installs an individual sewage disposal system in a manner which in.',, I "
volves a knowing and material Variation from the term 1 •r s contained in the application of permit commits a Class Ir " li
- P ° Petty Offense (5500.00 fine • inonths in jail or both).11 w
V I.. Applicant: Groan dor y' D .p.rtm.nt: Pink Copy ” 1 '
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Fees Paid $
• INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date ;1:2 S. 2/
Owner: /114, X A Cos
Mail Address: A 4,,.f , L,✓ Arr.4� 4; '4~24/42,0 Zip: kW) ? Phone: l%J'.. 01
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 What trip
Location Address & /or
Legal Description 7a0 4.y, /A : *r re f . • Lot Size , f H .p
2. No. of Bedrooms ® Septic Tank Capacity Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name): en, 7 O ' j JVie
Private: Well Depth Other Depth to 1st ground water table
4. Is facility within boundaries of a city /town or sanitation district? /2/0
5. Distance to nearest sewer system: goo- raa .9/2 AS
Have you attempted to arrange a connection with the system? //�,, v r ;f
If rejected, , what was the reason? 7 , S 1,,„ p
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.
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r ifat� g a re o 'pp scan
(TO BE RETURNED TO BLDG. & SANI. DEPT.)
Page Three
4 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
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Po r et each SY9j44>Z
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/�ous, 1 ,anr dIL $ -e
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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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(ID BE.RETURNED•TO BLDG. & SANI. DEPT.)