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' M 1 afr olifir. GARFIELD COUNTY BUILD,f 0 AND SANITATION DEPARTMENT r' „ „, " p
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Pho 03) 945.8241
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sdh This does not constitute 1 � ,
I I INDIVIDUAL SEWAGE DISPOSAL PERMIT A " 1 1170 a building or use permit, lI :
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Owner Rex A. Coffman ,i 1 0;
'Ill System Location 1837 100 Road - Carbon401e , 'Ik
Licensed Installer ` 7 gwi yC /_Lk E-c,
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Conditional Construction approval is hereby granted for a`+ 1.000 gallon p , ui
X Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows: Ii 1,{
Perc rate of one inch in PR minutes requires a mini m of 930 sq. ft. of absorption area per bedroom. r
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' Therefore the no. of bedrooms __L._ x OH sq. ft.'Tninlmum requirement it a total of 69.1).sq. ft. of absorption area
r . May we suggest 12' X58' x 3' or 18' x 39' x 3'
Date 7/2 7/ , i Inspector // r -dz
i l' FINAL APPROVAL. OF' "SYSTEM: i w ilil
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No system shall be deemed to be in with the "Wage D isposal Laws until the assembled system is approved prior to cover.< ,l
Ing any part. I
9
Septic Tank aco inspection and ci `tying within 12" of ground surface or aerated access ports above ground
r ' surface.
d� Prope�r.(�ater d asser9 Iy. i ,N id
(5'1 Trade nam e septic tank or aerated tfea jnent unit. 1 d i
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d"c Adequate absorption (or dispersal) area. � �� `,
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�� Adequate compliance with permit requirements.
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Adequate compliance with County and Ste regulations /requirements.
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y r Other I 4
9/// �' ../ D ate L � 4 ! Inspector iY :A. /L `�/ i
RETAIN WITH RECEIPT t " 'CONSTRUCTION SITE
'CONDITIONS: I
1. All installation must comply with all requireme ' Dis Re !' "u
n is o Se wa a 9 P osal 9 ulations ado ted P u rsuant tO eU P
thority granted in 66.44.4, CRS 1963, amended 66 - 3. 1 fr th Co unty Individual RS 1963 +
2. This permit is valid only for connection to structures ` ich „have'Ifully complied with County zoning and building requirements. !
Connection to or use with any dwelling or structures no approvetdby the Building and Zoning office shall automatically be a viola, 0 9,
tion of a requirement of the permit and cause for bothh al action and revocation of the permit. ,1
3. Section 111, 3.24 requires any person who constructs, a era, br Installs an Individual sewage disposal system in a manner which In ' " ^I r
volves a knowing and material variation from the terms t specifications contained in the application of permit commits a Cless 1 I
Petty Offense (S500.00 fine 6 months in jail or both).” l µ
Applicant: Grain
APP CO Ce i1PPrOPOnt: Pink COPY
{ INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION JDate 8 h? 7 /RI
s
a4wnlr: R fr X A . C o F r YYN A n)
Mail Address: )g37 /Oo Roso City: CARRaNb4I-c Zip: 9162 Phone: 463-2373
INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW
Attach separate sheets or report showing 'entirr 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 CAR so AI m A L
Location Address & /or Lot Size IZA Nch acres - ?9
Legal Description / f' 37 10, RO-A /�
2. No. of Bedrooms 3 Septic Tank Capacity I oa o Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name): N
Private: Well x Depth o.o' Other��
41 Depth to 1st ground water table a - 8
4. Is facility within boundaries of a city /town or sanitation district? Mb
5. Distance to nearest sewer system: /• C .'l , /ex
Have you attempted to arrange a connection with the system? A
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.
g/ s7 241.4'
Date Signatul-e of Applicant
(TO BE RETURNED TO BLDG. & SANI. DEPT.)
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