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II' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
2014 Take Avenue
s Glenwood 9 ngs, Colorado 81601
I li Phone 303) 945.8241
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" This does not constitute
1 44 INDIVIDUAL SEWAGE DISPOSAL PERMIT 40 1116 a building or use permit.
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u , r Owner Csrtus Vallfly Construction
i S L o c a t ion County Road 233, tilt
' Licensed Installer
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" * Conditional Construction approval is hereby granted for a, +A' gallon
XX Septic Tank or Aerated treatment wilt.
Absorption area (or dispersal area) computed as follows:
Perc rate of one inch in I JE minutes requires a min
— m of 2.3 r sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms _' 3 x Zsq. ft.kninimum requirement • a total of 11 7 sq. ft. of absorption area. '," ,ul:.
May we suggest � /x 90 X 3 /
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Date _ • L L z-- Inspector /i LiI
FINAL APPROVAL OF SYSTEM: '�"k key Wcwctr"
No system shall be deemed to be in compliance with the $4wage Disposal Laws until the assembled system is approved prior to cotter. II 4
ing any part.
i Q /e—. III
Septic Tank access for inspection and cle(ning within 12" of ground surface or aerated accest ports above ground
surface.
A " ,Proper materials and assembly-
. . -t+;A ' � I •., a rade name of septic tank or aerated treatment unit- e
0 —• // " Adequate absorption (or.dispersal) area. �Z / x IVQ " 3 /
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l/ Adequate compliance with permit require
4 K I Adequate compliance with County and State regulations /requirement .
Other / j /
Date inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
"CONDITIONS: r,
1- All installation must comply with all requirements of ti4 County Individual Sewage Disposal Regulations, adopted pursuant to au•
thority granted in 6644.4, CRS 1963, amended 66- 3-14,bRS 1963.
2. This permit is valid only for connection to structures wwiich have fully complied with County zoning and building requirements.
Connection to or use with any dwelling or structures no t approved by the Building end. 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, alfers, 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 orboth).
Applicant: Groin Copy Dapartmant: Pink Cony
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F "‘' „ "” Fees Paid $
c. ,' INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date
Owner:
•
Mail Address: S I % VD„. City: R Zip: 56( 0 5/) Phone :(,).5 —k*,
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 p
ty or Town J..X1C
Location Address & /or
Legal Description _ C ,, „ � 4 ):20, Lot Size
2. No. No. of Bedrooms '1 Septic Tank Capacity W5O Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name):
Private: Well Depth 15t6 Other Depth to 1st ground water table
4. Is facility within boundaries of a city /town or sanitation district? 0
5. Distance to nearest sewer system: .3
Have you attempted to arrange a connection with the system? N A
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.
ON \� — ^z31 5a.,.
Date Signature o pplicant
(TO BE RETURNED TO ENVIRON. HEALTH DEPT.)
I Page Three
1 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
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INDICATE BELOW THE LOCATION OF YOUR BUILDINGS, WATER SUPPLY AND DISTRI-
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES
(TO BE RETURNED TO ENVIRON. HEALTH DEPT.)