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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH S rl
201 Blake Avenue
Glenwood Spcings, Colorado 81601 1
Phone' (303) 845.72
INDIVIDUAL SEWAGE DISPOSAL PERMIT N � , k I h4 ” ^ l i ' ; II "
,
65
Owner W. A. BPOl.n 'N' :1"'^'
•+ , , System Location Out bit Colton* — Clenwaod 4 .
Licensed Contractor 4j(
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` Conditional Construction Approval Is here y granted for 6 /flS gallon l
fra Septic Tank or Aerated treatment unit. i Al, `I i
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Absorption area (or dispersal area) computed as follows: 14 i. - li
ii Pero rate of one inch in / minutes requires a minlrhum of jet sq. ft. of absorption area per bedroom. -
wl Therefore the no. of bedrooms •q x l‘f sq. ft. minimum requirement a / total of _ _s'q. ft. of absorption area. ( + i� u
May we suggest 497 t tw.ett 1 * r ,Gl�u• -s►a-' /C 1-4/04-1 e ' Iv [III R
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Date i !! /�/ Ins
f pector
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FINAL APPR OF SYSTEM; 'F` a — '` - 4'11 " 11 ° � h
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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 covi 4'. I l hii' -
ing any part. W ii
Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above gr ilnd ' +ti l
surface. N '
r�. Proper materiels and assembly. ' i „ rr4jh„
F f?IJD T rade name of
' /� / P.lic tank r aerated treatment unit.
fish, . a 4;"I
° .0r Adequate absorption (or dispersal) area. - ' i to
,„, t Adequate compliance with permit requirements. 1 �'-- -
Q77r Adequate compliance with'County and State regulations /requirements. i 0 -
ii d Other / � ��7 l li
II Date LO D 9 "1 r ` J "
Inspector .f -` - ecri-t • • I d I ' g i4 Ip"-
RETAIN WITH RECEIPT REP ORDS AT CONSTRUCTION SITE rI�l',
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*CONDITIONS:
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I , 1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations, adopted pursuant 10 0O,i" i- d ' t I' I , .,
, thority granted in 66.44.4, CRS 1963, amended 66.3.14,4CRS 1063. ! ,l I
2. This permit is valid only for connection to structures have fully with County zoning and building regu °,-
Connection to or use with any dwelling or structures noxt approved by the Building and Zoning Office shall automatically be a Viola 'l I' ',4 ',,
tion of a requirement of the permit and cause for both legal action and revocation of the permit, tl
y 3. Section III, 3.24 requires any parson who cohstructs, otters, or installs an Individual sewage disposal system in a manner w in " fo ' µ
volves a knowing and material,varietion from the termsyor specifications contained in the application of permit commits a ' ,G'l' as`s' 1 , 11-9' u f " ,
0 Petty Offense ($500.00 fine — 6 months in jail or both). „ it
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Building Official - Permit White Copy - Applicant — Green Copy Dept. — Pink Copy„ ° + , 7
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Fees Paid $
INDIVIDUAL SEWAGE DISPOSAL;SYSTEMS APPLICATION Date ,'a°
t ) NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE'
` ""' INDIVIDUAL HOME SEWAGE TREATMENT ;SYSTEM '
4 � /�
1 Owner: .:J� 6 -1 - the
-
Mail Address:4-7L. 4 . City: t.° ': . t ) Zip: 't) (0aI Phone:gar 7419
lc F° INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW
Attach separate sheets or report showing entire area with respect to surrounding areas, ;"
,4 topography of area, habitable buildings, 1pcation of potable water wells, soil percola W '
tion test holes, soil profiles in test holes. ,„
. 1 Location of facility: County car €i ld ....
City or Town Q,r.,2sL
II or
, 4,(CLw -q- bC.; Q l a .4-xi-ow
----« �.
Legal Description .7.;.,,.,o: 71,; Lot Size s/ Q Al e
n r , w. •
, 2. No. of Bedrooms .Q S eptic Tank Capacity (b Aeration Unit Capacity 6. 4
:. 3, Source of Domestic Water: Public (name): J „, flo ,
Private: Well V Depth Ise) Other Depth to first ground water table ,26 1
µ" 4, Is facility within boundaries of a city /town or sanitation district? `fir-
5. Distance to nearest sewer system: `72-e--01...c_ .
" Have you attempted to arrange a connection with the. system?
If rejected, what was the reason? y
6, Rate of absorption in test holes shown on the location map, in min es per inch.of ,
drop in water level after holes have been soaked for 24 hours: 114`"
7. Name, address, and telephone of person who made soil absorpit- sts: y r '„
• 8. Name, address, and telephone of person responsible for desi he y+s stem:
9. Express permission is hereby granted for the inspection of he above property by any , k^' a 1
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 u'
acknowledged by the County EnVironmental Health Department.
10. I have been given an opportunity to rea the Individual :Disposal 'Systems Regulations of'
Garfield County and I hereby agree to comply with all terms, conditions and requirement' _,
included therein.
Da }e Signatur of pp l c ant 4*
(TO BE RETURNED TO HEALTH DEPT,) q ' JT ,'_
PLEASE DRAW AN ACCUMTE MAP TO YOUR PROPERTY
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INDICATE BELOW THE LOCATION OF VOUR BUILDINGS WATER SUPPLY ANDDISTRI- p'
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES
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74ra - r ND_Gu SEA. '4 F*R6z "? S :ride t S_
WflT OF 'Dwelm\kNq.
(TO BE RETURNEQ TO HEAL
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