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GARFIELD000NTY DEPARTMENT OF 1 ( ENVIRONMENTAL HEALTH
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INDIVIDUAL UAL SEWAGE DISPOSAL PERMIT N2 404
Owner Patrick L. B Karen L. Groom
System Location Lots 11 i 12, Sec. 35, T.?B., R88W., 6th P.M. - 1 ai S, of Carbondale '
Licensed Contractor 61 s,r -y. on.. .
* *Conditional Construction approval is hereby granted for a /0),.m,) gallon s
X Septic Tank or Aerated treatment unit.
Absorption area (or diapersal area) computed as follows:
Perc rate of one inch in _A/4r_ minutes requires a minimum of A/ ) sq. ft. of absorption area per bedroom.
ii , Therefore the no of bedrooms x „41,4sq. ft. minimum requirement = a total of AL42 --sq. ft, of absorption area
f oar a ".. #' ,rte' . , .5.d?essor / �' /,?{i!- - 2.2 --7?-. n /trnaltn !'fe""r;
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May we suggest
I li Date Tr ,,... 7'",'. 7 7 0 Inspector ` � e% ,�. -•- 6 " -
FINAL APPROVAL OF SYSTEM: I o e
Nq system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is a proved prior to cover -'
ing'any part.
Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
ii
wave. Proper materials and assembly.
, Ira ✓ Trade name of septic tank or aerated treatment unit.
Adequate absorption (or dispersal) area
Adequate compliance with permit requirements.
n,,
a Adequate compliance with County and State regulations /requirements.
Other
I
Date �� — 9• —' '7 7 Inspector -
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
1`DNDITIONS: ip
I" i I. AI 111stallation must comply with all requirements of the Cptli`Ity In Sewage Disposal Regulations, adopted pursuant to au-
° gli P thdrlty granted in 66 -44 -4, CRS 1963, amended 66- 114:CA ,'003.
' I 2, This permit is valid only for connection to structures h1(A11 ve fully complied with County Zoning and building requirements;
i yr - ` Connection to or use with any dwelling or structures n aepr "401 by the building and Zoning office shall automatically be a viola
� Lion of a requirement of the permit and cause for both 9a a d�1 1A end revocation of the permit.
"3. Section III, 124 requires any person who constructs, titters, or stalls 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 CI$$s 1,
v ' Petty Offense ($500.00 fine — 6 months in Jail or both,
Building Official — Permit White Copy Applicant — Green Copy Dept. — Pink Copy
i
Fees Paid
INDIVIDUAL SEWAGE DISPOSAL SYSTEMS APPLICATION C1-21-1
• Date .41110111i
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
�• INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM
Owner: 2t'R'; ck L. And I<ARPf J • rr R n o M. •
Mail Address: R 6n City: 04RA ,nc444 Zip: 1,464)1 Phone: q /,3 - .2E' y7
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-
f tion test holes, soil profiles in test holes.
1. Location of facility: County G ARr) plod City or Town /rn). e. (ANA/dive
Legal Description/47 Stt,W7S'7SouA eev. ILLot Size /o,.,n? ,9c4s
2. No. of Bedrooms 5/ Septic Tank Capacity 7a Sb 9./, Aeration Unit Capacity
3. Source of Domestic Water: Public (name):
Private: Well !/ Depth 4/o' Other Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? no
5. Distance to nearest sewer system: A ,4c, ---co'
Have you attempted to arrange a connection with the system?
If rejected, what was the reason?
6. 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: E c-_e AL
7. Name, address, and telephone of person who made soil absorption tests:
8. Name, address, and telephone of person responsible for design of the system:
9. Express permission is hereby granted for the inspection of the above property 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.
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
included therein.
ay /o /q 77 4.0/1 9.e�r
d ate Signature o Applicant
(TO BE RETURNED TO HEALTH DEPT.)
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GARFIELD CO!!P:T1' '
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EXPENSE ACCOUNT SHEET
Name_ MONTH
Section I. •
Destination and purpose Tine of �� tlile oe real f.
Date of travel Departure Odor2te'�r Rea— dings r„ei Per Die'
and rr fir ro. Acct.
Return Beginning Ending '°il.eene
(1) (2) (3) (4) (5) (_) (7) (8)
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SIGNED �ti�<
r.. Knu 0 rr ...• �..�. I , r... DETACH A ND FILE FOR FOLLOW- UP - -
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PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
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INDICATE BELOW THE LOCATION OF YOUR BUILDINGS WATER SUPPLY AND DISTRI-
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES
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(TO BE RETURNED TO HEALTH DEPT.)