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Im'11U' GARFIELD COUNTY BUILDII$ AND SANITATION DEPARTMENT
1. 2014 lake Avenue
Glenwood S rigs, Colorado 61601
Phone (303) 94548241
This does not constitute "
INDIVIDUAL SEWAGE DISPOSAL PERMIT #40 1114 a building or use permit.
Owner Kenneth R. Mattlnoley 4
System Location 4 miles South Silt
Licensed Installer +
°° * Conditional Construction approval is hereby granted for a 1.250 gallon
_XX— Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
I II ; Perc rate of one inch in 0 minutes requires a minimum of ' 5 U sq. ft. of absorption area per bedroom.
m
OL //
Therefore the no of bedrooms _4_— x .sc• ft.tninimum requirement so total of �Lsq. ft of absorption area
. May wesi jest /0 1 0 if I - 1` "
ill Date 0'U . / (q&( In spector �4 m (i '
J
FINAL APPROVAL OF SYSTEM:
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved prior to cover
ing any part .
//
G_
01 - O/ Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
'1 ► Proper materials and assembly.
ii
+ III i
Ip,' 51 51"....—. r:..: Trade name of septic tank or aerated treatment unit. •
ry tut' Adequate absorption (or dispersal) area
Adequate compliance with permit requirements.
i ll
y, et-- Adequate compliance with County and State regulations /requirements.
°I Other
" . (3 / 3 8( Inspector
Date : ' -�
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
:
'CONDITIONS:
1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations, adopted pursuant to au.
thority granted in 6644.4, CRS 1963, amended 66.314, CRS 1963.
iii 2. This permit is valid only for connection to structures which have fully complied .with County zoning and building requirements.
Connection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a viola•
tion of a requirement of the permit and cause for both legal action and revocation 01 the permit, + '
3. Section 111, 3.24 requires any person who constructs, & Mters, or installs an individual sewage disposal system in a manner which in. .
volves a knowing and material variation from the terms" or specifications contained in the application of permit commits a Class 1, M
Petty Offense (5500.00 fine — 6 months in jail or both),
Applicant: Groan Copy Daputm.nt: Pink Copy
.. .—.u�W..S..................- - --.. . ..,..w.....
Page iwo
Fees Paid $
d • INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date X . /( ; /0 7/
Owner: Al? ) it . ' i F:4
Mail Address: 7,7yo 31 /?/ City: 4/ J Zip: Phone: ?7 /
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 :4/_
Location Address & /or
Legal Description 1/77,/ > /7` Lot Size
2. No. of Bedrooms Septic Tank Capacity /%2,,r Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name): is c (
Private: Well Depth / //, / ,( 1 Other Depth to 1st ground water table / /4(7 /
4. Is facility within boundaries of a city /town or sanitation district? ;(>,
5. Distance to nearest sewer system:
Have you attempted to arrange a connection with the system? fr
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. / " 40 I
Date / Signature of Applic4t
(TO BE RETURNED TO ENVIRON. HEALTH DEPT.)
Page Three
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
INDICATE BELOW THE LOCATION OF YOUR BUILDINGS, WATER SUPPLY AND DISTRI-
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES
(TO BE RETURNED TO ENVIRON. HEALTH DEPT.)