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' 1rq, It4DIVIDUAL SEWAGE DI PERMIT I .; tf
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IW,� Qwnel RfglT nake,fF z ,ll lr'
I y1 " »System location L o1r 1 '{ t1l ing 3. Oak Meld r 1 1 1 1"` „ 3 t
eIVI4; Llfcensed Installer , � 4 ° ”" i � m..
" ' • Conditional Cogs ?ruction appfO`na1 Is hereby gragtp4 fgY 'ry ¶ f P . h gallon t » I lly Hd ,
mit 4, ' I H I m _x
1 ' Septic Tank or .' Aerated treatment t t, r , I)�11,,,-
t aa-
", " Absorption area (or dispersal rea) computed as follows) . a r ; 1
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Pere rate of one inch in , to minutes requires a mInj '1,11 1) , 719 ;sq, ft. of ab,sorptioq «n per bedroom h 'I 1 { _
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u r l W Therefore the no. of bedrooms 3 x 2 0 , t p. # t , + hum'requl re n ent • a total of' +� q. ft. „of absorption 4f” Ilu„
Msy we su ggest /� K K 3 i P' )c * S x - 3 °I H II
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X Date / 2- 3 / Inspec w h „ �
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$ , FINAL APPROVAL OF - SYSTEM: ° ` °, {I y 1 `
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,wi111 N system shall be d to be d in compliance with tffe ” age,,p sposal Law: until t h e assent ey °" is approved ? d0 f,' u " 'h i • 1 1 /
1 ing an part. (��� V ." .. r ,ili
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Septic p n k $ sot nspect en cI ,, ning Within 12" of ground surface dr feted access ports above'Iirfl an,
surface, . if + „ mr
Igpy1IIV1 !. I- ProperlYlalarlaisandossembly. , 1 � , {I i' llwwu , �,._ .
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a ry ' ' Trade neMe Of septic t or aerat tl` I m ilhtt "il
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y i . '0 , 1 1 ' .9F � r Adequ
1 ate absorption or dispersal) rere . 1
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A Adequat { D C{Im w per rhit'raoyi ° tneidts Y I i ,. r ., "i1 l w m 'Ir �� Agile ' quate Cbinpfianoe with County 4n f 4tti riligU etionslreauirements, „ l ul °
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a„,,, 1 Otber '' I S / 1 ' „Py II,wrV"I
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It D ate ' I s ctor
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' N WITH RECEIPT, . s p ° 1 ihM1+;h11h °°
l 1 RIETIAI 1OlOS A' CONSTRU S,, r � ��p
S. ,I IX 1„ ° o,16'e' r'
S " ', *CONDITIONS: A
1. All installation must c „With all requirements �Qlt 1 pr tv” individupl Sewage pis0Psal ( pg ulations, adopted pursua{f� 4#} acv • - thority granted in 6 44 4,CR 1 Dfi3 , amended O 3 l r N ' 1 ya
r 2. This permit is valid 0nt t connection to st :, , „ r Al il.h ye f }Mfl y Co(h p Iled .With botlntii aonind.and tfu re
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� i, Connection to or use My th any dwelling or struot{l �� ( V hV the 0u lldin g errs) Zo » { ffoe shall autoi*atioally b e e t ? , if a �yr bi o n x y oonta � contained th p i flcet) 1 1�,w
Lion of a requirement q the permit and cause for
1 i, 3. section III, 3.24 requires any parson who' constr VY Ct ,�,� „ „ i i , tl e # 4n indiWftival seW d sal $ stem in d manner Wh r I -
r volves a knowing end u(h serial Iv riation from the t t p on of pe rmit commits a;�t ry
11 11U1 , 1 Petty Offense dS8O *.0011na 1t- b months in fail or p4 )11 t " ` ^,1u " O
r a
III� lion,. °rNa$ y D Plnk 411' 1 I � v i_ •
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INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION -Date t /„ z9¢/
owner R(d IC () kcc C�
Mail Address: p0 FW : r .vwcOA 5 � 1 Zip: 814 Phone:
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 6 1..enlw 1 ri'RfrSJ
oci
aton Address &/ r
L Description Jo /( FRANK 3 Lot Size c j, 8lhc/Zrr
2. No. of Bedrooms 23 Septic Tank Capacity /00 Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name): Qf+K141C+02%'/ W SY3i£✓1Ci ),
Private: Well Depth Other Depth to 1st ground ater table
4. Is facility within boundaries of a city /town or sanitation district? d',
5. Distance to nearest sewer system: Ni 14- .
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:
or
pI 7 Name, address, and telephone of R.P.E. who made soil absorption tests:
it
it ,_
/ ,8..I e, address, and telephone of R.P.E. responsible for design of the system:
,1i1,
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.
dLi
/y/ Signature .' Applicant
(TO BE RETURNED TO BLDG. & SAN1. DEPT.)
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INDICATE BELOW THE LOCATION OF YOUR BUILDINGS, WATER SUPPLY AND DISTRI-
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES
787
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l 6.1 ' 19 Lir
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(TO BE RETURNED TO BLDG. & SANI. DEPT.)