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D COUNTY BUILDING AND SANITATION DEPARTMENT
�� ; „� OARFIEL
2014 lake Avenue
Glenwood Sp"P Colorado 81601
Phone 0503) 945+6241
This does not constitute
i ” INDIVIDUAL SEWAGE DISPOSAL PERMIT N0 1 r1O5 a building or use permit.
„ , Owner Robert W. 8 Rene Dlerkes
System Location 3 #92 Cnunty Rnarl 311 --Silt, CO
Licensed Installer
Conditional Construction app roval is hereby granted for a` ,e7�j ' D gallon
/ X Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in /0 minutes requires a minimum of / 6.0 sq. ft. of absorption area per bedroom. , ..
Therefore the no. of bedrooms x /GS ft. Minimum requirement = a of 3 } fsq. ft. of absorption area.
May we suggest / " X )(2 r )r3
Date J " e( 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 cover•
ing any part.
Septic Tank access for inspection and cleaning within 12" of ground surface or aerated access ports above ground
surface.
a Proper materials and assembly.
I //apt =•. . r . 1- Trade name of septic tank or aerated treatment unit. iw
. � , .
dequate absorption (or dispersal) area Z X Zito ��,/ 3/
Adequate compliance with permit requirements.
et V 164 Adequate compliance with County and State regulations /requirements.
Other ,
Date 4/2.38/5 Oth Inspector c ...t y . ;
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,aCRS 1963.
2. This permit is valid onlV� ?r connection to structures which have fully complied with County zoning and building requirements.
Connection to or use %S t tiny dwelling or structures 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 requi ny person who constructs, alters, or installs an individual sewage disposal system in a manner which in
volves a knowing and " filial variation from the terms or specifications contained in the application of permit commits a Class I,
Petty Offense ($500.06 = 6 months in jail or both). `
Applicant: Grain Copy Department: Pink CoPV
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS WU CATION praxe 7-a"- _ 7
w I
7 ( � /� (�
Gwner: Knb2ri �(�. r alarlSC Rent 1(l jPrkeR
Mail Address: 7slm Snpric ibiehu? City: C /Pna. o s PDZip: V/ /6o/ Phone: 9vssIn
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 G
Lega Dn Address &/o v -{ I1 J #' /� •
Legal Description CD � Lot Size 14.35 acres
2. No. of Bedrooms 4' Septic Tank Capacity Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name):
Private: Well 1' Depth 0,13 5/t.Other Depth to 1st ground water table
4. Is facility within boundaries of a /town or sanitation district? /70
5. Distance to nearest sewer system:
Have you attempted to arrange a connection with the system? 40
If rejected, what was the reason? kin
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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9 / /e /8.7
Date Signe -re o 'pp leant
(TO BE RETURNED TO BLDG. & SANI. DEPT.)
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