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I�, 'q GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
�. -' I - 2014 Blake Avenue
I wood Springs, Colorado 81601
PERC FEE'Wt VIED 11T. SYSTEM - FEE ONLY Poona #303)945 -7265
!� INDIVIbUAL SEWAGE DISPOSAL PERMIT NV 733
owner Peter uobrovolny & David Shore
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System Locate n Lot 23, Kings Row Subdivision o eg4 1r , / ell,— •
Licensed Cantr4
* Conditional Construction approval is hereby granted for a gallon
Septic Tank or Aerated treatment unit. SEE PLANS & SPECS. OF PLAN "C"
Absorption area (or dispersal area) computed as follows: -
Perc rate of one inch in minutes requires a minimum of sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms x sq. ft. minimum requirement = a total of sq. ft. of absorption area.
4 -' May we suggest Plans & spDecifications of design by Registered Professional C:ngineer
approved as attached.
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Date uric 25. 1979 Inspector E k 4. - 1 2 f::1
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-
-. ing any part.
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.
Adequate absorption (or dispersal) area.
* . Adequate compliance with permit Zequirements.
Adequate oomp,jance with County and State regulations /requirements.
ether
Date Inspector
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 tq,;structures which have fully complied with County zoning and building requirements.
Connection to or use with any dwelling or strOctures not approved by the Building and Zoning office shall automatically be a viola-
tion of a requirement of the permit and cause for both . legal action and revocation of the permit.
3. Section III, 3.24 requires any person who constructs, alters, or Installs 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 Class I,
Petty Offense ($500.00 fine — 6 months in jail or both).
Building Official — Permit White Copy Applicant — Green Copy Dept. — Pink Copy
Fees Paid 5t
INDIVIDUAL SEWAGE DISPOSAL SYSTEMS APPLICATION
Date ( D - 2.5
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM
Owner: p €igg DO(3R&JOt JY s tI.O SHoe
Mail Address: 130( 130 City: 5S Zip: e ( ( .j4' Phone: W 3369
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 Garfield City or Town
Legal Description L..O"( 23 KIP(', COO Lot Size Z.6¢'7
2. No. of Bedrooms 3 Septic Tank Capacity Aeration Unit Capacity
3. Source of Domestic Water: Public (name): C6 0112.0M--
Private: Well Depth Other Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? 1JO
5. Distance to nearest sewer system: 6 M IL1=5
Have you attempted to arrange a connection with the system? N O
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: N1/49
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:
�cZ /'Cram /S
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.
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.
Jv&E 2 ��te 977 �/
Signature of Appli. t
(TO BE RETURNED TO HEALTH DEPT.)
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
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•-( Bic T °z D;� .
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INDICATE BELOW THE LOCATION OF YOUR BUILDINGS WATER SUPPLY AND DISTRI-
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES
(G (w1 cJ S ra - cam
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(TO BE RETURNED TO HEALTH DEPT.)
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RECEIVED JUL °2 4 1979
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July 23, 1979 .'
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g z Mr. Ed Feld
$ Garfield.County Environmental Health Departfent
2014 Blake Avenue
Glenwood Springs, CO 81601
RE: ET System'- Lot 23
• z w Kings Row Subdivision
5 - Dear Ed:
$ .. Please find enclosed three prints of the above system. If you have
$ any Questions, please contact me.
. .$ o Sincerely,
` � d RA;),
, ..:Z Rick Kinshella
RK/Jlw
s2 a Enclosure
w xc: Mr. Ron Shore
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