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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
2014 Blake Avenue
Glenwood Springs, Colorado 81601
Phone (303) 945-8241
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INDIVIDUAL SEWAGE DISPOSAL PERMIT An 1199 a building or usepe,
Owner Jim Dallen (Dallman)
System Location NXs!XRnsnkitNM WXX61 fl$M1(IIX 0467 Rose Lane Carbondal e
Licensed Installer Toni Wilker
• Conditional Construction approval is hereby granted for a 1,000 gallon
l( Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows: .T-n, (, i (s( Et RF) Sy s A�
- T"
ii
Perc rate of one inch in minutes requires a minimum 6f,, -t; sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms 3 x s q. ft. minimum requjremeni Q total of sq. ft. of absorption area.
May we suggest
Date Inspector
FINAL APPROVAL OF SYSTEM:
a
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is Approved prior to cover. 1
ing any part. ,
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Tank access for inspection and cleaning within 12" of ground surface or arated access ports above ground
surface.
Proper materials and assembly.
11 .. ' 4 G Trade name of septic tank or aerated treatment unjt.
��.____. Adequate absorption (or dispersal) area. ' c4.14 e 0 GQV 1(d� GR AVILt- F, L I ME s 0IC -4c 1 ✓sxs.1
I' - nth 6) // &7b t"'
01- - Adequate compliance with permit requirements. Dt( rti , 01 n
�' )I - Adequate compliance with County and State regulations /requirements. 4 l
Other / / �' .. Date i (o 1 4&z— Inspector :� Pa.. .4 b � ( ( - 2c.L / 1.L.1<<....i
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 66-44-4, CRS 1963, amended 66-3-14, CRS 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 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 of the permit.
3. Section Ill, 3.24 requires any person who constructs, alters, 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,
i Petty Offense ($500.00 fine - 6 months in jail or both).
Applicant: Orson Copy DaparunanY Pink COPY
a
.1 ' INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION PAGE TWO
ad
OWNER 3■..A. OA,LI,MAA) - +
ADDRESS b4 \ (Z.'��.t Co-. C_ CfslnovlJ42 PHONE %3. -s21to
APPLICANT S'iitwA•G 0
ADDRESS SA-e• • 1, PHONE
CONTRACTOR - 'C a a. WI 1/� f rt. l
ADDRESS ISM �w 135 C ►Spw►Q6lr PHONE Q6,- 24"(4{
IS PERMIT FOR: ( ) New Installation ( ) Alteration ( ) Repair
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography of area, habitable buildings, location of potable water wells,
soil percolation test holes, soil profiles in test holes.
LOCATION OF PROPOSED FACILITY: County Ct
Near. what .City or Town c o_O o „) ss Lot Size fl, (cAqt re.i
Legal D•, cription C. vA SoCite.4 3S 'Z,....44..p `1
o 6th pnac.:Q asL dki¢.t-icit 00.0
WASTES TYPE: (Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non - domestic Wastes
( ) Other - Describe:
BUILDING OR SERVICE TYPE: _
: (1. SL'Ao.00.o Number of Persons 3
Numby of Bedrooms '3
(t arbage grinder (Vi Automatic wa er (✓} Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: 35
If supplied by community water, give name of supplier:
GROUND CONDITIONS:
Depth to bedrock: 3`
Depth to first Ground Water Table: 21
Percent ground slope: V t C
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 4 *AA.
Was an effort made to connect to community system? 00
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( ) Septic Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
( ) Chemical Toilet ( ) Other - Describe: IJ.ltSenwr.T,1 s ^,evaJA
FINAL DISPOSAL BY:
( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal (4,1 Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
ilk • PAGE THREE'
40 WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? O
SYSTEM IS DESIGNED FOR L4fl GALLONS PER DAY
If the system is to be designed by a Registered Professional Engineer (RPE), 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: .404.40
SOIL PERCOLATION TEST RESULTS: `
Minutes 4 per inch in hole No. 1 Minutes 4v per inch in hole No. 3
Minutes 40 per inch in hole No. 2 Minutes 4p per inch in hole No. _
Name, address, and telephone of RPE who made soil absorption tests:
,
Name, ad and telephone of RPE responsible for design of the system:
Q orsd/Lte)S4- 1 — 3 ¢rd•i ssa J(tlut •
Applicant acknowledges that the_ of the application is conditional
upon such further mandatory and additional tests and reports as may be required
by the local health department to be made and furnished by the applicant or by
the local health department for purposes of the evaluation of the application; and
the issuance of the permit is subject to such terms and conditions as deemed
necessary to insure compliance with rules and regulations adopted under Article 10,
Title 25, C.R.S. 1973 as amended. The undersigned hereby certifies that all
statements made, information and reports submitted herewith and required to be
submitted by the applicant are or will be represented to be true and correct to
the best of my knowledge and belief and are designed to be relied on by the local
department of health in evaluating the same for purposes issuing the permit applied
for herein. I further understand that any falsification or misrepresentation may
result in the denial of the application or revocation of any permit granted based
upon said application and in legal action for perjury as provided by law.
Date L -11_ 9t Si gned
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PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
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