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• • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81801
Phone (303) 945 -8212
A n This does not constitute
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INDIVIDUAL SEWAGE DISPOSAL PERMTT t� J a building or use permit.
Owner ` R. Film
System Location 0190 149 H Rd. Glenwood Spe
Licensed Installer .foe ZA1nora
Conditional Construction approval is hereby granted fora / /20 f) gallon
Septic Tank or _ _Aerated treatment unit.
Absorption area (or dispersal area) com puted as follows:
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Perc rate of one inch in e minutes requires a minimum of 3 SP. J sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms 3 x S 3 sq. ft. minimum requirement = a total of /0-C / ft. of absorption area.
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May we suggest: _. • .. _... CO k'
Date r / / /7 0 - .Inspector ^
FINAL APPROVAL OF SYSTEM: ( C 46 p � Ces
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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.
6 0 Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface,
Proper materials and assembly.
, oitsom F� ��" name of septic Trade name of septic tank or aerated treatment unit.
n -�• A-T D '?
..r ��• �• Np7 2.t tk Ade absorption (or dispersal) area.
/�— Adequate compliance with permit requirements. t
---ice — Adequate compliance with County and State regulations /requirements.
Other
y Cal-
Date / -+ / •3 " / O Ins ector� •
.RETAIN WITH - RECEIPT; 'RECORDS AT CONSTRUCTION SITE
e CONDITIOt4S:
1. All Installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems
Chapter 25, Article 10 O:R.B• 1973, Revised 1984.
2. This permit is valid nlX MI' connection to structures which have lully with County zoning and;bullding
requirements. Connection toot use with any dwelling or structures not approved by the Building and Zoning office shall
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automatically be a violation of a of the permit and cause fpr both legal action and revocation of the permit.
3. Any persdh who constructs, aiters'br Installs an Individual sewage system In a manner which involves a knowing
and material varietiop4om the terms ogspecifIcetiOne cot)tained In the application of permit commits a Class I, Petty Offense
($500.001irie — 8 months In (all or botfl,)t K,, ..,,,
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k Applicant: Quoin Copy Depaitment: Pink Copy
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GARFIELD COUNTY
BUILDING AND SANITATION DEPARTMENT
PROCEDURE REQUIRED FOR COMPLIANCE WITH THE GARFIELD COUNTY SEWAGE DISPOSAL REGULATIONS:
Step I: Application
A. Obtain a standard "Individual Sewage Disposal System application"
from the Building and Sanitation Department, 109 8th Street, Suite 303
Glenwood Springs, Colorado 81601, 303- 945 -8212 or 625 -5571.
B. Return completed application, map to property, and diagram of site to the
Building and Sanitation Department (Pages 2, 3, R4).
- C. Obtain a receipt for the applicable fee. Make check on Money Order payable
to "Garfield County Treasurer ". FEES ARE NOT REFUNDABLE.
Step II: Percolation Tests SEE DETAILED INSTRUCTIONS ON PAGE 6
*A. Prepare three percolation holes 4 feet deep, 8 to 12 inches in diameter,
and 20 feet apart in the area of the proposed leach field.
B. Fill percolation holes with water once for the required 8 hour soaking period.
C. Request percolation test by Sanitarian. (To avoid construction delay, we
suggest arrangements for percolation test be made at least 24 hours prior
to the end of the soaking period.) Please have at least 10 gallons of water
available at the site for the percolation test.
D. Upon completion, you Individual Sewage Disposal Permit will be issued provided
no prohibitive problems are encountered.
*If a drywell (seepage pit) is proposed, consult with the Environmental Health
6epartment for percolation test procedures.
!!IMPORTANT!! Please be advised that if the Sanitarian's initial field visit to your
property reveals any unusual difficulties such as high water table,
excessive percolation rates, bedrock, etc., the services of a
Colorado Registered Professional Engineer and /or Board of Health
approval will be required prior to the issuance of your Individual
Sewage Disposal System permit.
Step III: Final Inspection
A. When all components are in place, connected and ready to cover, request final
inspection by the Sanitarian.
B. DO NOT backfill any part of the system prior to inspection.
C.. Upon final approval, carefully cover entire system.
Please feel free to contact the Building and Sanitation Department if questions
regarding your swage ' treatment system arise.
(FOR APPLICANTS INFORMATION)
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Application
• INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
OWNER (Igfl< Q', E (r► County Official:
ADDRESS 0190 (Nd.g Rd, PHONE ( 146 - 7736
CONTRACTOR - 7i0t A,1nora
ADDRESS 1 453 �� . Co..f�4a\t PHONE %3- 137 a I
PERMIT REQUEST FOR: ( ) New Installation »c) 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 pap 4.)
LOCATION OF PROPOSED FACILITY: County 6Q,F�'Itlt
Near what City of Town G[ehW06j1 - rii & Lot Size 1acrf..
Legal Description A�!¢ o
WASTES TYPE: () Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE:
Numb r of bedrooms 3 Number of persons a
Garbage grinder ()<) Automatic washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (X) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system:
If supplied by community water, give name or supplier:
GROUND CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table:
Percent ground slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to community system?
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(x) Septic 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 ::p Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe: •n i le-
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? AD
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SOIL PE9COLATION TEST RESULTS: (To be completed by Registered Professional Engineer.)
Minutes per inch in hole No. 1 Minutes per inch in hole No. 3
Minutes per inch in hole No. 2 Minutes per inch in hole No._
Name, address and telephone of RPE who made soil absorption tests:
Name, address and telephone of RPE responsible for design of the system:
Applicant acknowledges that the completeness 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 perruitt,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 sane for purposes of issuing the permit applied for herein. I further under-
stand 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 per-
jury as provided by law.
G ba qo
Date / / Signed n
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY 0 190 ILO Recta
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boo 14916 Rout .0
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Proposed Seth Site n , o 0 e
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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
comuitments.
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