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• GARFIELLO COUNTY BUILD4f1,) AND SANITATION DEPARTMENT .
al 20t4 lake Avenue
, ,, Glenwood Sp ngs, Colorado 81801
Phone (03) 9454241
•
•
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT ; i (1 1 n90 a building or use permit.
Owner Waffle Hall
System Location 246 Road - Rifle y
r i
ii Licensed Installer
• Conditional Construction approval is hereby granted for a j ad e° gallon
X Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
G Perc rate of one inch in_ ,� minutes requires a minim,Um of 15 - sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms 3 x (S2_ aq. ft. minimum requirement • a total of 4q)—sq. ft of absorption area.
• May we surest � - �. ' ' '
_ 3B . 3
1 r�_
Date �� 47 Insp ecto r
i
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. .
et-- Septic Tank access for inspection and cleaning 12" of ground surface or aerated access ports above ground
O surface.
I Proper materials and assembly. --►
• . / =.J Trade name of septic tank or aerated treatment unit.
d /C-- Adequate absorption (or dispersal) area ,
Q‘,i.,— Adequate compliance with permit requirements.
0/ ---- Adequate compliance with County and State regulations /requirements.
A * Other
In Date 1 t _ r I a l (A( Inspector
RETAIN WITH RECEIPT Rg 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 to structures ' ioh have fully complied with County zoning and building requirements.
1 Connection to or use with any dwelling or structuresnti approved by the Building and Zoning office shall automatically be a viola-
tion of a requirement of the permit and cause for both I gal action and revocation of the permit.
3. Section 11I, 124 requires any person who constructs, a ,tars, 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 (5500.00 fine,— 6 months in jail or both). l,
Fill, Applicant: Organ Cotiy Department: Pink COPY
Page Two Fees Paid $ 2 00
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date 9 -M - y/
�s
Owner: ,,, ,, v \\,o1QJ
Mail Address: 0)q3 315' RA City: S:;\ Zip: Phone:87 OW@
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
Location Address & /or
Legal Description Lot Size le) rte._
2. No. of Bedrooms 2) Septic Tank Capacity Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name):
Private: Well N Depth Other Depth to 1st ground water table
4. Is facility within boundaries of a city/town or sanitation district? �o
5. Distance to nearest sewer system:
`"a —)
Have you attempted to arrange a connection with the system? PO
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.
ace -- (� -cot Casa Ee.:
ate Signature of pplicant
(TO BE RETURNED TO BLDG. & SANI. DEPT.)
Page Three
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
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�\ , �' off,
11■
1:
INDICATE BELOW THE LOCATION OF YOUR BUILDINGS, WATER SUPPLY AND DISTRI-
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES
(TO BE RETURNED TO BLDG. & SANI. DEPT.)