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This does not constitute
r 0 a building or use permit.
t GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
r - Glenwood Springs, Colorado 81601
INDIVIDUAL. SEWAGE DISPOSAL PERMIT N.► 490
Owner poll & man Fuller !Mary A. Sutherland)
System Location Lot 5, Block 2, Weatbank
tI Licensed Contractor 711"2/2`,7 (J G - 4 - 4
il 'Conditional Construction approval is hereby granted for a __,„ /r,Ii gallon
___}
Septic Tank or Aerated treatment unit.
Absorption area (or diapersat area) computed as follows:
Perc rate of one inch in • 0 minutes requires a minimtrm of -ace) sq. ft of absorption area per bedroom.
Therefore the no. of bedrooms - ✓ x „-Sam sq. ft. minimum requirement = a total of naekq. ft. of absorption area.
—1 / . % f' c - / . .f ret -- '_ --a 9
May we suggest / �'� 63' yre-3 �, ate[w -2
Date— I --- &' 7..- Inspector ' - r ' �/�
Yy
FINAL APPROVAL OF SYSTEM:
No system shall be deemed to be in compliance with the ` _ft - tcv -- J
Disposal Laws until the assembled system is approved prior to cover-
.1 ing any part -
rig Septic Tank cleanout to within 12" of final grade or aerated access ports above grade-
" or Proper materials and assembly-
/ Trade name of septic tank or aerated treatment unit.
ie
IJ , C) A:- Adequate absorption (or dispersal) area.
I tr'f7 - Adequate compliance with permit requirements. 1
rir
x• -" Adequate compliance with County and State regulations /requirements.
Irl
Other 1 / /
Oil / Z_ —. y .. z . 7 7 - l', ..
Date Inspector i '
I I '° RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations, adopted pursuer
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 req
Connection to or use with any dwelling or structures not approved by the building and Zoning office shall automatically
tion of a requirement of the permit and cause for both`Itegal action and revocation of the permit.
3. Section III, 3.24 requires any person who constructs, liters, or installs an individual sewage disposal system in a manne
votves a knowing and material variation from the terms or specifications contained in the application of permit commi
Petty Offense ($500.00 fine — 6 months in jail or both;
rt
Building Official — Permit White Copy Applicant — Green Copy Dept. — Pink Copy
•UTHCRLAND ENTERPRISES. INC. DETACH AND RETAIN THIS STATEMENT
THE ATTACHED CHECK IB IN PAYMENT OF ITEMS DESCRIBED BELOW.
OLENWOOD SPRINGS. COLORADO IF NOT CORRECT PLEASE NOTIFY US PROMPTLY. NO RECEIPT DESIRED.
DELUXE - FORM DVC -3 V-5
DISTRIBUTION•
DATE DESCRIPTION AMOUNT
ACCT. NO. AMOUNT
•
11 -16 -77 GARFIELD COUNTY - Perculation Test
and Sewage Permit- Fuller $75.00
EMPLOYE[
D L D U O T I O N •
•CRIOD TOTAL •DOTAL TOTAL NIT PAY
ENDIM• EARNIMO• •COURITY WITHHOLDIND INOOME DIDUCTION•
TAX W S. TAX TAX
Fees Paid $7.51
INDIVIDUAL SEWAGE DISPOSAL.SYSTEMS APPLICATION
• r Date k\-161
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM
Owner: eaN inia,ey 434 LLFe (2;; 4 . _urw8 -tv cn n,p)
Mail Address: 809 �TK4NO j j City: GiLessseno 5ZZ7ip: $1Go1 Phone:Clic -4
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.
1. Location of facility: County (C.;4 JC L o City or Town (L ervw oc,D ,
Legal Description Lot`�/SLK.. wEST1EIroK Lot Size 1 .a gaze .
2. No. of Bedrooms ..3 Septic Tank Capacity- Aeration Unit Capacity l o oo GAL
3. Source of Domestic Water: Public (name): G a *i i i - 15)2 t;sSc:.
Private: Well Depth 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: y 1 41 mite
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 minu s per inch of
drop in water level after holes have been soaked for 24 hours: ��
7. Name, address, and telephone of person who made soil absorption tes s:
8. Name, address, and telephone of person responsible for design of he s stem:
' 1 1 . 1 / i i ce.
9. 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.
10. 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
included therein.
v - 1 Date � 7
Sig ature of Applicant
(TO BE RETURNED TO HEALTH DEPT.)
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
4
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INDICATE BELOW THE LOCATION OF YOUR BUILDINGS WATER SUPPLY AND DISTRI-
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES
(TO BE RETURNED TO HEALTH DEPT.)