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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
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2 014 „„' lake Avenue
as Glenwood SptIngs, Colorado 81601
Phone 303) 9454241
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el PERC WAIVED - RATE KNOWN - FEE ONLY '` ,
This does not constitute
t INDIVIDUAL SEWAGE DISPOSAL PERMIT Nit I 16 a building Or use permit.
' 8111 Motz
I' Owner
System Location Parachute
ii
III Licensed Installer 631 '
t • Conditional Construction approval Is hereby granted for a 1250 gallon
X Septic Tank or Aerated treatment unit.
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Absorption area for dispersal areal computed as follows: SEE PR # tin tin JOHN RICE E FOR PERC
Pere rate of one inch in mi 1
__lam minutes requires 90
s es a minim of s. ft f
4 q t. o absorption area per bedroom.
10 Therefore the no of bedrooms .,....4____ x 1 sq. ft minimum requirement • a total of 76f1 sq. ft. of absorption area. ”'
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May we suggest 12 x 64 x 3 or 18 x 43 x 3
Date a V F Inspector _ ... /
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 gover• i
ing any part. \.
Septic Tank access for inspection and cleaning within 12" of ground surface or iterated 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 requirements.
Adequate compliance with County and Sete regulations /requirements. ;i,.
Other
Date Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
'CONDITIONS:
1. All installation must comply with all requirements of th County Individual Sewage Disposal Regulations, adopted pursuant to au "
thority granted in 66.44.4, CRS 1963, amended 66-3-14, RS 1963.
1 This permit is valid only for connection to structures lch have fully complied with County "zoning end building requirements.
Connection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a viola-
Bon of a requirement of the permit and cause for both 'seal action and revocation of the permit,
1 Section III, 124 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 r specifications contained in the application of permit commits a Class I,
Petty Offense (5500.60 tine — 6 months in jail or 6 0th). i
Applicant: Orin Cop Oopertrh.nt: Pink Copy
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INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION jDate Jr Z C ( r
Owne t; - / 7/ 1i 617i
Mail Address: JiS7 L /f Cit a r Zip: k /GSl /i
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 (see Page 3).
1. Location of Facility: County GARFIELD City What /3.tifc% t e
Location Address & /or Lot Size /� ,f <� 6 �
Legal Description
2. No. of Bedrooms l Septic Tank. Capacity / `g7/ Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name):
Private: Well Depth Other Depth to 1st ground water table
4. Is facility within boundaries of a city /town or sanitation district? NO
5. Distance to nearest sewer system: t &
Have you attempted to arrange a connection with the system?
If rejected, what was the reason?
6. If R.P.E. tested, state 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:
7. Name, address, and telephone of R.P.E. who made soil absorption tests:
8. Name, address, and telephone of R.P.E. 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 Building & Sanitation Department and /or such persons as
they may designate. Any withdrawal of this permission shall be in writing and receipt
acknowledged by the County Building & Sanitation Department.
10. I have been given an opportunity to read the Individual Sewage Disposal Systems Regula-
tions of Garfield County and I hereby agree to comply with all terms, conditions and
requirements included therein.
ggilat
Date Signatur of Applicant
(TO BE RETURNED TO BLDG. & SANI. DEPT.)
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