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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212
4 + This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT Ng 1 a building or use permit.
Owner K e n Young — P.O.Fit:ut 442, Silt, CO
System Location (Damn Tmivg,__Dry 1ioum:, Si If, (7)
Licensed Installer Colorado Structures, P. 0. Box 1527, Rifle, CO 81650 ( —085g)
• Conditional Construction approval is hereby granted for a gallon
____. Septic Tank or _ Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in _ minutes requires a minimum of sq. ft, of absorption area per bedroom.
Therefore the no. of bedrooms TWC) x sq. ft. minimum requirement = a total of sq. ft. of absorption area.
May we suggest:
Date— _ _— _ . Inspector ._
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.
Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
Proper materials and assembly.
Trade name of septic tank or aerated treatment unit.
Adequate absorption (or dispersal) area.
_ Adequate Adequate compliance with permit requirements.
Adequate compliance with County and State regulations /requirements.
Other
Date- - -. - _ - -- - -.. -- Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All Installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems
Chapter 25, Article 10 C.R.S. 1973, Revised 1984.
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 violation of a requirement of the permit and cause for both legal action and revocation of the permit.
3. Any person who constructs, alters, or installs an individual sewage disposal system In a manner which involves a knowing
and material variation from the terms or specifications contained in the application of permit commits a Class 1, Petty Offense
($500.00 fine — 8 months In (ail or both.).
Applicant: Green Copy Department: Pink Copy
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OWNER No � County Official:
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ADDRESS P0 13 no„ �i t, y S, / r (.1 PHONE OS 0/R9
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CONTRACTOR Co / S l r v 'c.)i —,, s
I s ADDRESS Po 13,1. ir, Z R h Flee C-10 53 1 C5 D PHONE C7 S OSS9
PERMIT REQUEST FOR: (I-4—New Installation ( ) Alteration ( ) Repair
Attach separate sheets or report showing entire area with respect to surrounding areas,
; topography of area, habitable building, location of potable water wells, soil percolation
test holes, soil profiles in test holes. (See page 4.)
LOCATION OF PROPOSED FACILITY: County & - r ,tit
Near what City of Town 5 r Lot Size 3 O
Legal Description f ti
C cr,"1-�, R g7 w�zt r-f,ti 4 h
WASTES TYPE: '''` � Gc ..,. 1 -<: ( („�„� ,(',��
(R 3) Dwelling ) Transient Use j
( ) Commercial or Institutional ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: R r
Number of bedrooms 'Z Number of persons Q „ •c_i
( ) Garbage grinder ( ) Automatic washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( v- well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system: v
If supplied by community water, give name or supplier:
GROUND CONDITIONS:
Depth to bedrock: 3 r (
Depth to first Ground Water Table:
Percent ground slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /0 Pre taw
Was an effort made to connect to community system?
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( •7Septic Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
( ) Chemical Toilet ( ) Other - Describe:
FINAL DISPOSAL BY:
( ' Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? /(I
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PLOT PLAN AND DESIGN FEATURES:
'Include by measured distance location of wells, springs, potable water supply
lines, cisterns, buildings, property lines, subsoil drains, lake, water course,
stream, dry gulch and show location of proposed system by direction and distance
from dwelling or other fixed reference object, and additional submissions in
support of this application such as data, plans, specifications, statements and
commitments.
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