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•• GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT H i; 053 (this does not constitute
a building or use permit)
Owner __ FJ........LIJO!a>..l.'tu.en.G..L.:....__dr;,a._....~l,;:,.1 .u> ,~...~'l'""'m..u.s::a.-...:..(..ll)li;.lr....!L_,i;,.u;e:.,._ _____________ _
System Location D ( {\ k l e < pf'<i
Licensed Contractor------------..,--------------------
* Conditional Construction approval is hereby granted for a 7 -gallon
_._·. _ Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate __ .::./ __ inches in /"! minutes" " .. --sq. ft.
absorption area per bedroom ___________ _
H or bedrooms_.;;;__x ··· .-· sq. ft. minimum requirement --...... .. '
May we suggest
Date _ __;._·""'::::_J__;_' _. ---------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 covering any part.
g Septic Tank cleanout to within 12" of final grade or aerated access ports above grade,
« Proper materials and assembly.
--M:tY;..:K:::.::.--'Adequate absorption (or dispersal) area.
_....::,ff'.;.A. __ A.dequate compliance with permit requirements.
_ _,-&("-'-..._ _ __,Adequate compliance with County and State regulations/requirements. r;:-£J
/"".e::>.e::> tt!'~~e..-AI"s~ til ~"'-r.;:l.O/ .::s~·•>!!r.-6'6
Date 4!:-//-zt/ Inspector Zf?~.
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 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,
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 teJ:Ills or specifications con·
tained in the application of permit commits a Class I, Petty OffensE' ($500.00 fine • 6 months in jail or
both.
• ""COLORADO DEPARTMENT OF HEALTH J Wat~r Pollution Control Division
42TD Ea5t 11th Avenue
~enver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE
I NO IV I DUAL HOME SEWAGE TREATMENT SYSTEM*i'
STAT!::>~
"""'" .171; ~ttlb.v IL< ~ ~
Mall Address·_?/ Clt~.we44
A. INFORMATION REGARDING PROJECT SUBMITTED .FOR REVIEW:
1\tt-lc.~-snparntH sheets or report showing entl re area with respect to surrounding
arec.;,, topv~;·i•phy of ar.o<o, habit;;b]e building>, Joccllicn Vl pol<Jb\c Woter 1'/e\Js,
~ol! pPrcolatlon ~est holes, soli profiles In test holes.
1. Loc.<>tlon offaclllty: County 6JJ! City or town3~'j,,~/;-flatt{, lhrf of /.ot q 1 ~.,.
Leg~l ce~crlptlon_%s II_ N./ZA\Lef5 Sec/4 Lot size //0 t1-A£.-y-{_~~
-""-}?{. A. [(it I S<:e 15-8-B'O r:J{)
2. No. of bedr~oms .g Septic tank capaclty __ 7So Aeration unit capacity ___ _
3. Source of domestic water: Public (name) ~U t;y ~
Private: Well __ Depth __ Other _____ Depth to fl rst ground water table ____ _
4. Is facility within boundaries of a city/town or sanitation dlstrict7 __ 7~----
5; Distance to nearest sewer system: 3 />~·--·-------·
Have you attempted to arrange a connection with the sy5tem? _________ _
If rejected, what was the reason? -----
6. Rate of absorption In test holes sho>tn 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 l'!ho made soil absorption tests: ____________ _
--------------------·--------
8. Name, address, and telephone of person responsible for design of the system, ____ _
--------
Date
*Required by Arclcle 66-28-12(CRS, 1963, 1967 Perm. Sum. Supp.)
:1.\l\c'.qui •·•!j ln areas which have been identified as areas in l'lhlch danger· of pollution
of waters of the State may occur (Art. 66-28-8(5), CRS) and/or areas In which there
Is no loc~l ~eptlc tank ordinance.
ll. 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
.,
•
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~
,(
Signature for Cl ty/Town Offtc.lal (Tl tie)
Signature for County Official (Title)
Comments=-------------------------------------------------------
Signature and Title
Note: The Notlfler (front of this sheet) must obtain comments and signature of at
least one of the above.
C. FOLLOWING FOR STATE HEALTH DEPARTMENT USE: Recommendations of the District Engineer:
D. .(\_CT I ON BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
·-------
WP-33(10-72-2)
•1 ..
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CONSERVATION PLAN MAP
PJIEPARED IY U. S. DEPARillfloiT OF AGRICUI.nJRE, SOIL C(J;SERVAJIOO SERVICE
N
COOPEUTII8 WITH ----"-M:.:t.:::·...::.So""'p"-'r:.:i:.::sc_ ______ soIL CON SERYA Tl ON D 1 STR 1 c T I
COUII1Y ------"-G..:;a;:.rf: _i::.;ec:l:..:.d-<., ....:..Co.:.:l:.coc:r..:.a..:;d..:;o___ 0 ATE 1-? 7-61:
o•ER/OPO. ______ .:,;F.:,;l:.:a:..:.v~en:..:._!.:.;'.:::W:.:i~lm:.:a~A:.:·~C~e.:,;r~is~e~----------
·.~.··.·], ,,
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PUll !If.~ AC. llu APP. SCALE ~"/MI. PHOTO MO._::D:::..LT,_-.:::6:..-:::.:l2:.::tl:___ ____ _
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