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OARPIEt.D COUNTY BU i�d ILO1 t'a sir AND
e Av SANITATION gnw DEPARTMENT
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„ 1MI Glenwood d �I ) I s colprado 81601
`1�V Phod' 303) 0 „ 454241
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This does not constitute r , II
h l �' I, I ° INDIVIDUAL SEWAGE DISP,OS19LPERMIT I aiuildingorusepermith t : '.
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I „ l Owner Robert J. 0 flacauj1ne C. Hatlll I ti ino
III J System Location x2604 tHlghway 6 & 24 a
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1 1 4 11' 1 : L icensed installer j ; �� "0 sr
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'I ” C onditional Constrtfction approval is rante '- „ 1 12 §0 gallon y +
iml hereby lql'
� 11 Septic Tank or Aerated treatment It +s y 1,
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l Absorption area (or dispersal area) computed as follows: p R h1
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_- I ii Perc rate of one inch In 4 ^ minutes requires a mipl I I of ,w i,, sq. ft. of absorption urea per bedroom. X14 , f •
^, a m � „ i l a il,'
Therefore the no. of bedrooms x / scl."f`t (rnhmuM°requlrement , s a total of 1! tq• ft. 01 absorption arse, I ,I °f 41
l 'May we suggest / u „ 1 '1 ' ^ -
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Date $2 pastor li+�+i ' ',(11 u, , 4'
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i l l 11 INAL APPROVAL OFr „SYSTEM: il'”' r1
.17 ' No system shall be deemed to be in compliance with the • ° age Disposal Laws until the assembled syste1tl4rr„approved prior to coyer mp 1 '
I I p ing any part. 1 ye f
,a ° i 1 Sep lank access for inspection and cIe' rting within 12" of ground surface or aerated access ports above ground . ' q l"'f �
�� P roper rnaterl`als and assembly. 1p ^„, ) 4IL
i ti Trade name of septic tank or aerated treatment unit, - 11 ii'i, ;III ®/� , 11'1
Adequate absorption (or dispersal) area': It ' 11 ; •
d/4 Adequate compliance with permit requir ants.
Adequate compliance with County and S to regulations /requirements.
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Date )okpe
RSTA(N WITH RECEIPT R
:fu ORDS AT CONSTRUCTION SITE
w "CONDITIONS
1. All installation must comply, with all requirements, after County 'Individual Sewage Disposal Regulations, adopted pursuant to au " +
f thority granted in 60444 CRS 19(53, amended 66-3-14, • RB I If 3,
2. This permit is valid only,for connection to structures dip have fully complied with County zoning and build requ F r � r ; 1
` Connection to or use with any dwelling or structures no r p p'roved, by the Building and Zoning office shall automatically be a viola- , 'a
" tion of a requirement of the permit and cause for both 1 ••• eotioorl end revocation of the permit,
3. Section III, 3.24 requires any person who constructs, 511 i y"or 1In amindividual sewage disposal system In a manner which In- ,
" volves a knowin and material variation from the terms µ . t/specifications contained in the application of permit commits a Class 1, i I
"" "i 1 Petty Offense (5509.00 fine — months in jail or both). I ' ';N I''
,. my.._. �r�.. .r...i.:u,.,..wu1L,u.wsuu.o,...
r , APPlicant Orton 0o'e bepartihant Pink CPPV
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s..._.:.:.....__u�.,�.�.leu .wmyurvtie.,.r . -. yiwis:
INDIVIDUAL HOME SEWAGE TREATMENT - SYSTEMS APPLICATION luate q2j :/p /
Owner: /4-6-Phl, r .tzt:xv, &. 7F1az w...ho.c2
J J/y3S 5f� :af5-763�
Mail Address: PQ.,� 0/6 City: G�i�,Q,�,�Q, Zip:
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).
Near What
1. Location of Facility: County GARFIELD City or Town 4,4,9 Cq/ u r E
Location Address & /or
Legal Description I6 Xha, 4 fat Lot Size 4 0_t,
2. No. of Bedrooms r Septic Tank Capacity /025o Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name):
Private: Well Depth Other Depth to 1st ground water table d5.,_,
4. Is facility within boundaries of a city /town or sanitation district? o
5. Distance to nearest sewer system: /y�W
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.
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46 / D 9 �/ ` 4_ _ ' Signature O 77 cant ' '
(TO BE RETURNED TO BLDG. & SANI. DEPT.)
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110.
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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 BLDG. & SANI. DEPT.)