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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 81ake Avenue '
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Glenwood Springs, Colorado 81601
PERMIT H i; 050 \ (this does not constitute
a building or use permit)
System Location.--i!l..l' c .... ·· ''"')o~,;C.,~,i ,.....:;~:;:_.~~.t0.u.•3...~-_-l~;;;lj'-l.,,._.r~c·..~.;.-"i.,.'Q:;L.;~'Yl::i. • ..c.',.,;c:4.'1 --1-~::.:~lwG:.;.' -..'.74• a::a....--------
Licensed Contractor__;O~-u.:>~· ~~:::::::;S?!I:O~"'-!::=·'--------------------------
' / * Conditional Con ruction approval is hereby granted for a I • C'YC>p gallon
___1L_ Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate_.,--.J.I __ inches in I<> minutes I~ IS"" sq. ft.
absorption area per bedroom_11-tf?.u;.J.!!:;;.:!¥::,~.!::..--------
# of bedrooms 3 x I G? s-sq. ft. minimum requirement'" "1C!S :;(-,, Pt ~' 1 ,,, , : ·,' ·
May we suggest I '2..1 X "' 11 X 3 1 :Selii!'P""~ \3e:<'D
Date 9'-.z.L-z"'t'
FINAL APPROVAL OF SYSTEM:
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Inspector ____ __!:;·?.:..>"'.:..;_1'_, '::.IC.:..i..:.·,.,.1, . .,..:_ _____ _
' ' No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system
is approved prior to covering any part.
R/'? Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
-.L~qA'"'':.,../"" __ Proper materials and assembly.
_ .. t!k:,.., .. ~:;;;;___,Adequate absorption (or dispersal) area.
~-Adequate compliance with permit requirements.
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Date
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 authority granted in 66·44·4, CRS 1968, amended 66·8·14, CRS 1968.
2. This permit is v.alid 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 antomatically be a violation of a requirement of the permit and cause for both
legal action and rev,ocation of the permit.
3. Section Ill, 3.24 requires 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 con•
tained in the application of permit commits a Class I, Petty OffensE> ($500.00 fine • 6 months in jail or
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•'COLORADO DEPARTMENT Qf HEALTH
: .. [j , •. 4..WJ!t or Pollutl.on Control Division
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tn'i'O East 1 I th Avenue
~ ·Denver, Colorado 80220
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NOTIFICATION ~F PROPOSED Q.ISCHARGE TO WATERS OF THE STATE*
1 INDIVIDUAL I:IOME ~,EWAGE TREATMENT SYSTEM**
owner :_...~.Q.w:. :.::i:..:.~lllc.-~W ..... .......,SS.,.·~·..,., ..... --'~..,....;""'H""'t/~:fl!'-1 ----------__,..-------
Ma.ll Address :-t·A-1~· o~~.uou"'Z}""'E,.,~/-------~~i~1 Cl ~y Cke.a 14""'y ZlpJ'l'AtlS: Phone ~85-77('
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INFORMATION REQARDING PROJECT SUBMITTED FOR REVIEW: . 1 . .~
Attach separate sheets or report sijpwlng entire area with re$pect ·to surrounding·
areas, topography of area, habltllble hulldlngs, location of potable water wells,
soil percolation test holes, soli ~roft les In test holes. . ~ .
Location of facility: County <7A;f?f-7£LI> City or to~m aRAn!l> l/At.L¥
Legal ~escd,ptlon7fl~ ~' 3,1!m1811M~A .A?.t'A ·Lot size. /12 A c&-1'
No. of bedrooms :f Septic tan~ capacity [Q1!1e. Aeration ,,u11lt capacity __ _
), Source of domestic; water: Public (name): ________________ _
Private: Well Voepth_:__Other Depth to fl rst ground water table (,...s-ft-
4. Is faclll ty wl thIn boundar les of a ,cl ty/town or san I tat I on dl strl ct? ____ __,..
S. D I stance to nearest sewer s ys tern :-4~~~"111/it.O.~I!. ... · d-m:£~~:a.t.l.~oL..tiAwBQ.k£.:ll£;._ _________ _
Have you attempted to arrange.a co~nectlon'wlth the system? __ .,:_ _____ _
If rejected, what was the reason?-il-'------..:...--------------
6. Rate of.absorptlon In test holes sf:jowl'l on the location map, In minutes per Inch
of drop In water level after holesi]!.have· been soaked for 2lt hours ______ _
7. Name, address, an(! te.lephone of person ·who made soli absorption teH~: ____ _
8. Name, address, and telephone of petson responsible for design of the system: ·
• ' Date
*Required by Article 66-28-12(CRS, 196), 1967 Perm. Sum. Supp.)
**Required In areas which have been Identified as areas In which danger of pollution
of waters of the State may occur (Art, 66•28·8(5), CRS) and/or areas In which there
l.s no local septic tank ordinance.
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$1QNATURES OFd.:ocAL OFFICIALS:. Th~: undersl9ned llave,revlewed the notification ~~escrlbed on the front of this shee,~ and' reconvnend approval or disapproval of·
the discharge 1,15 s~own below:
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Approval. D lsapprova 1 . ""
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signature for _LoeaLJ:[~ 1 th Departmel)t
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Signature for City/Town Official (Title)
· Slgnature for County Official (Title)
Comments:._,-~----------~--'---~-----------------....,-
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-·~·--~~--~--~~~~------~ Signature and Title
Note: The Notlfler (front of this ,j;heet) must obtain comlll!lnts and signature of at
1 east one of the above. ·
C. FOLLOWING, FOR STATE HEALTH DEPARTMENT USE:. ,Recommendatl'ons of the District Engineer:
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D. ACTION·ev·THE COLORADO WATER·POLLUT!ONCONTROL.COMMISSION:
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