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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH `VI
2014 Blake Avenue
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Glenwood Springs, Colorado 81601
\c- - C ( i PERMIT # s 070 (this does not constitute
a building or use permit)
T C IJ( r\L) "le.; ,-1., ,k fEA-LiT"
System Location -IC' Yv i r `%
;7,r, w r) 1-14 OF c,7 LE "l,JIt )C"_Y'3 r , nPtEt• f
Licensed Contractor ( A r: LA 6-'1-4 �...'"
* Conditional Construction approval is hereby granted for a gallonCrzop , pod
A> T c ~.- r)
-� -° Septic Tank or -- Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate - inches in '"— minutes sq. ft.
absorption area per bedroom f r= z.,r_ T' c'-'7"-' Lt)l QQE'i�,..,.' 51"7
".) .p -r -i (- y cwt
toy—.
-1z)
# of bedrooms x sq. ft. minimum requirement
- � ' �P OO o v �Z i A) 4. 6100 .e ' vn�i 5 rl '/' cav �
Date 7-- 9- 7'9 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.
,Xis7:4A)6 Tank cleanout to within 12" of final grade or aerated access ports above grade.
Proper materials and assembly.
Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
Adequate compliance with County and State regulations/requirements.
Date - - 70/ Inspector � -
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 automatically be a violation of a requirement of the permit and cause for both
legal action and revocation of the permit.
3. Section III, 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 (8500.00 fine - 6 months in jail or
both.
3 7,k1"-
%. C4ORAD0 DEPARTMENT;'OF' HEALTH
Wager Pollution iCorgrol Division
,V10 East llth Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM**
Owner:. er ._.... �'
�/ 9.2s -7p7/
Ma11 Address: ?Q; oX !'G� „�Clty_ S/ 4/✓ ZIp174/1 Phone _ s-�_
y' 1. `1N?oRMAT I QN .REGARDING PROJECT SUBMIT:I ED .FAR. REVIEW:
.Attnc: separate sheets or report-s.hcywing entire area with respect to surrounding.
.topography of area, habitab , 1.]d `n, ,,lpat1on of .po,ta.b1e. water v. e1.1,s,
soli percolet4tt-'teat holes,..s6l 1 ,' 1 ''es In test holes.
l . Location of facility County _City or town
Legal description i, Lot size k___5
2. No: of bedrooms- Septic tank :capacity 2OOPAeratlon unit capacity_
Source of domestic water: Public (rime): 04140m-,
Priv'`ate: We1Depth Other Depth to first ground water table �,•
Is facility within boundaries of a c:;ity/town or sanitation district?_11/O
Distance to nearest sewer system: V6°
Have you attempted to arrange a connection with the system?_
1 f rejected, what was the reason?
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__
Name, address, and telephone of person who made soli absorption tests:_
idA-tdG17
8. Name, address, and telephone of person responsible for design.of the ,y:,teT:
Date
S natur 43:441wner w'�
*Required by Article 66-28-12(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.
a. SIGNATJRES OF LOCAL OFFICIALS: The undersigned have reviewed the notification
described on the front of this sheet and recommend approval or disapproval of
the discharge as shown below:
Date
Comments:
Approval Disapproval
Signature for Local Health Department
Signature for Cityflown Cfficiai (Title)
Signature for County Official TT;iir—
Signature and Title
Note: The Notifier (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. AC1ION by THE COLORADO WATER POLLUTION CONTROL COMMISSION:
WP -33 (10-72.2)