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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH 0
2014 Blake Avenue
Glenwood Sptings, Colorado 8160 I
PERMIT # S 082
Owner \91~ I:J.. .f. Shdo.r~ ~: Nati.no~
System Locatio~k JJe:J::~ J;-~ '\ ~; ~·~
(this does not constitute
a building or use permit)
/9
Licensed Contractor--------------------------------
• Conditional Construction approval is hereby granted for a;""oao gallon
~Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate_,.,t/:_ __ inches in ..¢5"" minutes :?oo sq. ft.
absorption area per bedroom--ii!ZZ:..c;.~*=:"';.:e~~~;;:..-------
# of bedrooms 3' I x =saa sq. ft. minimum requirement.:::-Y'e:>o .:SC? ;:::r -'.1?.:~-""c."/?"'?'?""".c.l
.47.2--679
May we suggest -:> ...Y'"""' 38'/ x 3 1 ;:s~/9t:Pe-,<!'J eiO
Date .=s--.3t-z...,/ Inspector ~4
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 covering any part.
t/ __ ,:__ __ ;Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
_ _,.,//~_· __ .Proper materials and assembly.
__ /_-,----.:Adequate absorption (or dispersal) area.
--"~-...,.---J.A.dequate compliance with permit requirements.
____ __n.dequate compliance with County and State regulations/requirements.
/t7/.z ~~~ -/ //· L / Date ____ ,.~:;.......;._,,~;.L:2.....:;-'___..z:_~----Inspector 4"5 ~ 7 7
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 1963, amended 66·3·14, CRS 1963.
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 antomatically be a violation of a requirement of the permit and cause for both
legal action and revocation of the permit.
8. Section Ill, 8.24 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 pennit commits a Class I, Petty OffensE\ ($500.00 fine • 6 months in jail or
both.
' ·-~
~ -~OLORADO DEPARTMENT OF HEALTH
:1 Water Pollution Control Division
4210 East 11th Avenue
--------------~Building Official
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE•\
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM**
Owner: JAt?fG'S ,4. M!J . S#t'lft"tfJI{/
9v.,--rr?.r {4us)
Y/6o/ Phone ~~b<l'</{_""'"6) Ma II Address : ..,l) ... a"<t..___.f/.~:..l'-'~0~---------C.I ty GU/1/ta>l>t> ~ z I p
A. 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,
soli percolation test holes, soil profiles In test holes.
1. Locution of facility: County@&E/E<.L> City or town _________ _
t>/l,c 4/64bt:u'S S:£./4./>Wr.S/If>,/f.J
Leg a 1 descr l pt l on l=t?14)<Z 1ft-2. · Le:>r 19 Lot sIze -z.,o b 3 ,4c,ee S
2. No. of bedrooms __ 3;:;_ __ Septlc tank capaclty/00czAeratlon unit capacity __ _
3. Source of domestic water: Public (name):
--------~--~-----'(J:)/{K 41'64/)bu/5 ("<6--t/Ti'CA'L SUI"/"L I"
Well __ Depth __ Other Depth to first ground water table ___ _ Private:
4. Is facility within boundaries of a city/town or sanitation district?_&"p ____ .
5. Distance to nearest sewer system=--~.~~~t-z~~,-~~~---------------------
Have you attempted to arrange a connection with the system? __ ~cZY~~??~-----
If rejected, what was the reason? __ ~AY~~--------------------------------
6. 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 person who made soli absorption tests: ____ _
8. Name, address, and telephone of person responsible for design of the system: ___
~
.c-30-7V
Date '
*Rtqulrcd.by Article G6-28-12(CRS, 1963, 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
Is no local septic tank ordinance.
B. SIGNATURES OF LOCAL OFFICIALS:
described on the front of this
the discharge as shown below:
Date Approval
The undersigned have reviewed the notification
sheet and recommend approval' or disapproval of
Disapproval
Signature for Local Health Department
Signature for City/Town Offlclar-\TTtle0
Comments=·-------------------...,-----------·----------
-------
-------------------------------------------------------------·
Signature and Title
Note: The Notlfler (front of this sheet) must obt~ln comments and sign~ture of at
least one of the above.
C, FOLLOWING FOR STATE HEALTH DEPARTMENT USE: Recommendations of the District Engineer:
D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
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WP-33 (10-72-2)