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X,' p GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Sulte 303
Glenwood Sptinge, Colorado 81801
• Phone '(903)945.8212
REPLACEMENT
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT N 1945 a building or use pent*.
Owner Marry S Ali rA Sitnil Antt
System Location 47R1 C.R. 117 Gleenenrd Springs
Licensed Installer flora a Rrravati
,
* Conditional Construction approval is hereby granted for a /000 gallon 04/5 ' c r ��: , , -/
Septic Tank or Aerated treatment unit. > /
.. /'PY C f r/ 7 e C i 1 1
Absorption area (or dispersal area) computed as follows: L y C4 r/ r'�i cAA , jive /
Perc rate of one Inch in '3 minutes requires a minirt)um of 3 S t' sq. ft. of a area per bedroom o
Therefore the no. of bedrooms ___3____ x 3 C / sq. ft. minimum requirement ei a total of l igasq. ft. of absorption area.
• c,sniefe r'6 teen 4c?/" r4,S teni . : 6,32 S 1'F.Ci M ✓� ? 1 "�ri;-. l
May we suggest: ' ,^r+ // / ✓ '� //'' f
. hi ///'r!7...�� .'�ilrl'fherc y 71,:.✓, -� I✓ S 4 ; '( :' 34 / I c C '.
Date /V/ 4717 J Inspector , /// // • �.
L / /�`
FINAL APPROVAL OF SYSTEM:
No system 'shall be deemed to be in compliance with the Sewage Disposal until the assembled system is approved prior to cover-
ing any part.
/.2 C . 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.
de a. so
� �
° qu8te'66rl5tiocj l or dispersal) area.
`fi — Adequate compliance with permit requirements.
{� I Adequate cornpliance with County and State regulations /requirements.
Other
Date/ -4 / ' -(7/
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 1994.
2. This permit Is valid only for connection to structures which have fully compiled 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 Indivl,gual sewage disposal system in a manner which involves a knowing
and material variation from the terms or specifications oontalned In the application of permit commitsa Class I, Petty Offense
($500.00 fine — 6 months In Jell or both.).
it
Applicant: Green Copy Department: Pink Copy
•
Kerry Sundeen
Hydrologist
Water Rights, Water Quality,
asix\ Computer Applications.
302 Eighth Street, Suite 325
P.O. Drawer 160
Glenwood Springs, CO 81602
ENARTECH Inc. (303) 9452236
Application
'° INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
• County Official:
OWNER Ke gewk s C =v+,aeer
ADDRESS 41 iS - Gov. Ra 1f PHONE 9 -" 1()55 ?b , .Ih'
CONTRACTOR IJOCAIS ((+ `
ADDRESS 13:230 vv n T �an,, Lurt)o-aolv PHONE q63- 67 „ L .
rr )
PERMIT REQUEST FOR: ()() New Ins ( ) Alteration ( ) Repair
Attach separate sheets or report showing entire area with respect to surrounding areas,
topography of area, habitable building, location of potable water wells, soil percolation
test holes, soil profiles in test holes. (See page 4.)
LOCATION OF PROPOSED FACILITY: County 6- 0,r ;%41 •
Near what City of Town (r \cw,nn.l S Lot Size )$O X IRh�
Legal Description W,W„■ Lnk., ). A �w s `l OW& 10 T l5, P., Si9W tr
WASTES TYPE: (>() Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: St,\c. ;„,:„S fct,da,lh.\
Number of bedrooms - 1�tcv (,'J� Number of persons 3
( ) Garbage grinder (X) Automatic washer (X) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( )() spring ( ) stream or creek
Give depth of all wells within 180 feet of system: },//
If supplied by community water, give name or supplier: N /p/
GROUND CONDITIONS:
Depth to bedrock: Id0 CoriA r —
Depth to first Ground Water Table: (rca.� *r 1) 4c4k
Percent ground slope: ic40, %o,.. 5'1e
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: N ! k
Was an effort made to connect to community system? th
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:
FINAL DISPOSAL BY:
(' .) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCIHARGED DIRECTLY INTO WATERS OF THE STATE? N A
,
couNT iI C DPY
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. \\ ``
1'�vtit pa 44", = 3\ �5 n va- tn.\
�G9v�CCd✓ h\bor{pite, 1 st oo r
T 04.3\ }acv, = <-tUO 't Cam. * 3 kcdtoon.s = `oo t cy
G on,rbr Gcoh°v\ —«.. 5�
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5 e;‘, To SIZE. = 1Z-5b cllo.s
Page 4
SOtt PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer.)
Minutes 40 per inch in hole No. 1 Minutes 25 per inch in hole No. 3
Minutes 35 per inch in hole No. 2 Minutes 25 per inch in hole No. 4
Name, address and telephone of RPE who made soil absorption tests: Peter Belau. P.E. #217n1
Enartech, Inc., 302 Eighth Street, #325, P.O. Drawer 160, Glenwood Springs, CO 81602 (303)
Name, address and telephone of RPE responsible for design of the system: 945 -2236
Same as above
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 permtt 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 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.
Date Oc* 115 laa\ Signed <
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
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