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1' This does not constitute
a building or use permit.
III, GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
I i 2014 Blake Avenue
i, Glenwood Springs, Colorado 81601
t INDIVIDUAL SEWAGE DISPOSAL PERMIT Ni 285
III'
II� Owner ',P • 0 /12 /!7 /CA t /,70i -nr 1/ 0 4-
System Location t")0' •4' y 1 /n/ at' sr• ,7LJn ),c 72:1#1/ 0 e)
, /Cleansed Contractor OGC> /'✓ #r'
* Conditional Construction approval is hereby granted for a /irfl• gallon ( 4C_ c.- aaarz >rs3l e s
■
Septic Tank or x Aerated treatment unit.
Absorption area (or diapersal area) computed as follows:
Perc rate of one inch in d minutes requires a minimum of /tee? sq. ft. of absorption
,�area >�per bedroom.
Therefore the no. of bedrooms 3— x .[' - CvOsq. ft. minimum requirement = a total of . sq. ft. of absorption area.
May we suggest ./•S / A' ..30a CA- 4 7 3 G-t7t397ccc S€ - -; e)
Date C J " -3 — 71, I nspector
NI; 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 -
1 ing any part. / f J IJe
i
� /• t ! � fS DG v V !• /h �
✓ 6 t - (� optic Tank lea ut to within 12" of final'ade or aerated access nnrts above grade.
(9 c�
AC Proper materials and assembly.
J G Trade name of septic tank or aerated treatment unit.
0 ,l Adequate absorption (or dispersal) area-
•
l Adequate compliance with permit requirements.
CA Adequate compliance with County and State regulations /requirements.
Other
l
Date / D/2Z /7( Inspector .7-0 • f -lu
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 - --
Lion of a requirement of the permit and cause for both legal action and revocation of the permit.
3. Section I1I, 3.24 requires any person who constructs, alters, or installs an individual sewage disposal system in a manner which in-
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Fees Paid $ 7y,
INDIVIDUAL SEWAGE DISPOSAL SYSTEMS APPLICATION
Date (D =110
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM
Owner: L!'46cc e/' ` `ff") C p-�f te,na) .
Mail Address :0491 9/ litt_9, 0 City: e,,,'a#', / Zip: d// hone• 943P
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.
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1. Location of facility: County Q�qq__�� City or Town _.ti , A , A
Legal Descriptionc/� o23 P3V &5 % - k P Lot Size 13 /` /a, s±
2. No. of Bedrooms __ Septic Tank Capacity _ Aeration Unit Capacity // aov 6,0
3. Source of Domestic Water: Public (name): e4,.
Private: Well Depth Other Depth to first ground water table _
4. Is facility within boundaries of a city /town or sanitation district? j2.0
/ o A
5. Distance to nearest sewer system: , 0
� ,y
Have you attempted to arrange a connection with the system? _ J
If rejected, what was the reason? diS_J 0 c o
i( Rate of absorption in test holes shown on the location map, in mi$j es pe, inch of - e tp
drop in water level after holes have been soaked for 24 hours: ! £4__._ ,'
./ Name, address, and telephone of person who made soil absorption t sts: /
e 410
j /Name, address, and telephone of person responsible for design of he stem:
Express permission is hereby granted for the inspection of the above •roperty by any
member of the Garfield County Environmental Health Department and /or such persons as
they may designate. Any withdrawal of this permission shall be in writing and receipt
acknowledged by the County Environmental Health Department.
I have been given an opportunity to read the Individual Disposal Systems Regulations of
Garfield County and I hereby agree to comply with all terms, conditions and requirements ii
included therein.
ii
i
9 -- Date a ture of pplicant I
(TO BE RETURNED TO HEALTH DEPT.)
