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dARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212
This does not constitute ,)
INDIVIDUAL SEWAGE DISPOSAL PERMIT ..\1 1731 a building or use permit.
Owner JOC Swtt
System Location 1555 NO Name Lane
Licensed Installer _ Professional Construction (Leroy ,Spaulding)
` Conditional Construction approval is hereby granted for a gallon
—. - -. Septic Tank or _ Aerated treatment unit.
) Absorption area (or dispersal area) computed as follows:
k J Perc rate of one inch in _ minutes requires a minimum of to 0 sq. ft. of absorption area per bedroom.
Therefore the no. of bedrooms 1 x /r C• sq. ft. minimum requirement = a total of , tit f) sq. ft. of absorption area.
l >; ? C?' X
May we suggest: v
Date %/'_ , SLY_
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. -
Proper ma pals and assembly. R O C v� - ( "' e 4 u -
f. �J < , -, I ,. t" [ - Trade name of septic tank or aerated treatment unit. /
Adequate absorption (or dispersal) area. ` x .c) /es ry r"r lam✓ 1 I' P /� ;' , 345 / �✓7
-- Adequate compliance with permit requirements.
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Adequate cornpliance with County and State regulations /requirements.
Other
? /
. -, �� Inspector — tS'/I�,L // t ) /l
Date `
,!.a
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
`CONDITIONS:
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems
Chapter 25, Article 10 C.R.S. 1973, Revised 1984.
2. This permit Is valid only for connection to structures which have fully complied with County zoning and building
requirements. Connection to or use with any dwelling or structures not approved by the Building and Zoning office shall
automatically be a violation of a requirement of the permit and cause for both legal action and revocation of the permit.
3. Any person who constructs, alters, or installs an Individual sewage disposal system in a manner which involves 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 or both.).
Applicant: Green Copy Department: Pink Copy
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
_! County Official:
OWNER ;?;1 . �oL C /
ADDRESS /1
, 5'S ,e4 !acme PHONE ;730 Oa1.25
CONTRACTOR &ss, ^v.�� / Cv�is c Chhn Cie & $ y
ADDRESS 71/a $ G%eiAdvoc( .904.f PHONE 919 =2q�6)
PERMIT REQUEST FOR: (s— New Installation �/ ( ) Alteration ( ) Repair
Attach separate sheets or report showing entire area with respect to surrounding areas,
topography of area, habitable building, location of potable water wells, soil percolation
test holes, soil profiles in test holes. (See page 4.)
LOCATION OF PROPOSED FACILITY: County £au44/j4
Near what City of Town 6/rlia9Gocf _S?, ,t Lot Size
Legal Description
WASTES TYPE: ('-1 Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE: &sic/eH1/21j
Number of bedrooms a Number of persons Om e
(v} Garbage grinder (4,4 Automatic washer (e-' Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system:
If supplied by community water, give name or supplier: ,e4 , /% ' , . _ /&4
GROUND CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table: _
Percent ground slope: 2
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: A. ,A-
Was an effort made to connect to community system?
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(✓j Septic Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
( ) Chemical Toilet ( ) Other - Describe:
FINAL DISPOSAL BY:
(4-1 Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? dil6
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