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11 i GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
2014 Avenue
i Glenwood SS Colorado 61601
i Phoife303)9454241
4
This does not constitute
II INDIVIDUAL SEWAGE DISPOSAL PERMIT 142 i i 17 ( a building or use permit. l 1
ID i
owner Colony Shale 011 Company
q System Location k mlla north of Pnrarhutn ,
µ
,. - Licensed Installer
um " Conditional Construction a is hereby granted for 9 gallon
'Holding tank) "
XX Septic Tank or Aerated treatment tptit.
ii „ Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in minutes requires a minlrfl
u um of sq. ft. of absorption area per bedroom.
µ Therefore the no of bedrooms x sq. ft, minimum requirement - a total of sq. ft. of absorption area.
dGl i 1 May we suggest
k ill Date Inspector
FINAL APPROVAL OF SYSTEM:
� µ 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.
Septic Tank access for inspection and cleening within lr of ground surfeoe or aerated access ports above ground
surface. [
Proper materials and assembly.
Trade name of septic tank or aerated treatment unit.
c ,
u Y Adequate absorption (or dispersal) area. a^ Vi
� Adequate compliance with permit requirpirnents.
Adequate compliance with County and State regulations /requirements
t -0
Other
Date 4 -41 -94,14 c1.ti{ z- S 1 H I /y 8 t Inspector '
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
'CONDITIONS:
1. All installation must comply with all requirements of th County Individual Sewage Disposal Regulations, adopted pursuant to au•
thority granted in 66.44.4, CRS 1963, amended 66.3.14, RS 1963,
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 nq approved by the Building and Zoning office shall automatically be a viola.
Lion of a requirement of the permit and cause for btith le al action and revocation of the permit.
3. Section I11, 3.24 requires any person who constructs, al rs, or Installs an individual sewage disposal system in a manner which in• k i
volves a knowing and material variation from the tarns r specifications contained in the application of permit commits a Class 1, i
Petty Offense (5500.00 fine - 6 months in jail or both):
Applicant: Oren CopY b.polrtm.nt Pink COPY
i
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Page Two Fees Paid $So
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INDIVIDUAL HOME SEWAGEE TREATMENT SYSTEMS APPLICATION Date 44 44 /4, My
001a Owner: #a .s . c,/ C.o.u,4•cY
Mail Address: Pea/eV oZO6 City: /%raekccl`C,C1—hip: A /4JJ Phone :i 7 /,'J/
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 p // //
1. Location of Facility: County GARFIELD City or Town / sehci& (1'.
Location Address &/
Legal Description I / 444 I ts ,,. f M,b 4✓. 44 4Lot Size A/A
.44/afro/,
2. No. of Bedrooms Soptic Tank. Capacity ?JUL' Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name): 0,4 a l , 47^A-e%t�
Private: Well Depth Other Depth to 1st ground water table
4. Is facility within boundaries of a city/town or sanitation district? /1
5. Distance to nearest sewer system: %y /yt, /e
Have you attempted to arrange a connection with the system? _ Mn,e�.rS
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.
1 ad, -
• late Signature /Vfll{pplicant
(TO BE RETURNED TO ENVIRON. HEALTH DEPT.)
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