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' This does not consstttdt d r wII
II1�� IND CVIDUALSEWAGE goal ° ^,y1 1120
a buildingorusegermttim u•'
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owner Chprrlpne, Spri ngsteel
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System Location
011 crtp ►venues , Car f T 1 ,
Licensed Installer
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u , • Conditional Construction approval is hereby granted fdt 4 ”' 1 ,?5D gallon - e r 4 11 I I J� , 'r
XX S T ank or Aerated treatment 11
up ; II Absorption area (or disperse) area) computed as follows: i , h11 4 1 r'r
II
„ Perc rate of one inch in minutes requires a minl m ✓ of r ) sq ft. of s Ion the er.bedroom , R , `
1 H uh Therefore the no. of bedroom! T x .7-1 ( 5sq. ft, ln + a total of , 0 sq, ft. of absorption �iµ�ll
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♦1 % i 1 1 x
May we suggest ,/z II f 11 l8 X " 8 'T'" s f ..w ' f .1,�4 I lm0
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, vol 1 Date 1\1 l L 114 l 1 Inlpetto )CfitG- \ ,
:4h FINAL APPROVAL OF SYSTEM; �� a l " _
11 No system shall be deemed to bedri compliance with the" S age Disposal Lews until the assembled system is approved prior to do -, ve.
Ii d d ing any part. i F
1 r Septic Tank access for inspection andiele nine within 12•' of ground surface or aerated access ports abbe ground ,u Iota 1 a`
surface. ' " ._
Proper materials and assembly. J th i' s
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Trade name of septic tank or aerated treat unit. ' ,I
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Adequate absorption (or dispersal) area. 011
Adequate compliance with permit require °
Adequate compliance with County and State'regulations /requirements.
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Other ,,
Date ,1 Inspector 1 1 � „ ,:
RETAIN WITH RECEIPT R Et O ADS AT CONSTRUCTION SITE
*CONDITIONS: i i i,"
1. All installation must comply with all requirements' oft County Individual Sewage Disposal Regulations, adopted pursuant to au• rs1 „i°
thority granted in 66 -44.4, CRS 1963, amended 86.3,14 118,1963. I
2. This permit is valid.only for connection to structures oh "have complied with County zoning and bu requirements 4„, .
Connection to or use with any dwelling or structures n tipproved by the Building and Zoning office shall automatically be a vlola - - ! ^ .
tion of a requirement of the permit and cause for both al !potion end revocation of the permit, a w 1 1 ' 1
3. Section 111, 3.24 requires any person who constructs, A Grp, or,tnttells an individual sewage disposal system in a manner vthioh In• 1 1 ,� i*
volves a knowing and material variation from the terms r specifications contained in the application of permit commits a Nass 10 til „;.W
7 ' 11 110 Petty Offense ($300.00 fine — 6 months in jail or both),
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I Applicant: Grson ''tq' py plpartm.nt: Pink Copy 1 1i1 �I`
14a ��uW �____ ..__,W,L,..Lw. ”. ^I.,..,u.,i.u,.r•Y.._ Y .Is :_.. — :...;a_......�r�_,is._.wu,_.: _rr:a. ...._ —uv� �1.— ru.m..t —„_
oyL 'WU Fees Paid $
/ 111111r INDIVIDUAL HOME SEWAGE TREATMENT SYSTEMS APPLICATION Date
•
Owner: C, hal- le vwF ()r S le ^ e I
Mali Address: rjlit .Sn A oc. City: Caw -loon lie i Zip: /613Phone:cfi),- .2,3R5
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
1. Location of Facility: County GARFIELD City or Town �w �cn,r.a Lc
Location Address & /or
Legal Description Lot Size
2. No. of Bedrooms y Septic Tank Capacity 'ISO Aeration Unit Capacity N/A
3. Source of Domestic Water: Public (name): eti m 6 l C cur bay\ da lr
Private: Well Depth Other Depth to 1st ground water table
4. Is facility within boundaries of a city /town or sanitation district? N
5. Distance to nearest sewer system: jy 0,('p
Have you attempted to arrange a connection with the system? YP S
If rejected, what was the reason? �, ( c d C' 110.4 7(.,
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.
,/ Date Signature . app rant
(TO BE RETURNED TO ENVIRON. HEALTH DEPT.)
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY Page Three
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.)