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Owner
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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
Kg1th Trueblood
PERMIT # S 116
(this does not constitute
a building or use permit)
System Location Homes Mesa - Rullson
Licensed Contractor
owner
* Conditional Construction approval is hereby granted for a gallon
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
# of bedrooms x sq. ft. minimum requirement
May we suggest
Date 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.
Septic 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 Inspector
*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 thep ermit
8 Section III, j �' pdrson aiw ' � �' gni , . tern or installs ,an,,in vidual sewage disposal:
system in a f v ve a i '
r ria.ia0 rod ltbOil 0101$ or specifications:
ii"► of - erinit 'cOnt tt l .es I, Petty Offense (11500.00' 'tte - 6 months in jail of
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
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C4i4'1L`0 DEPARTMENT OF HEALTH
!later Pollution Control Division
4210 East filth Avenue
Denver, Colorado 80220
Owner:
1-1-10C) l77DTzvc)vu
f\k•OBt(- Et1 Y1&c
7 U CS
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE-
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM**
fY2,2`4--fir-sin'
Mall Address:
fi19X 6�ry
City A9 Z l p 57/40) Phone G,,7,5" --/-0G
A. INFORMATION REGARDING PROJECT SUBMITTED .FOR REVIEW:
Attach separate sheets or report showing entire arca with respect to surrounding
areas, topography cl urs..:, of potable water walls,
soil percolation test holes, soll profiles in test holes.
1. Location of facility: County City or town
Legal description $ 5At7/ ]807/P4 3.'�"� of size
2. No. of bedrooms Septic tank capacity. jAeration unit capacity
3. Source of domestic water: Public (name): f,,:„�
Private: Well Depth Other Depth to first ground water table
4. Is facility within boundaries of a city/town or sanitation district?
5. Distance to nearest sewer system: " %�
Have you attempted to arrange a connection with the system?
If 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
T
S 4-aCii�y-
7. Name, address, and telephone of person who made soil absorption tests:
5c ±
0426-7:00,A,/7--
8.
D671-0,A//T
8. Name, address, and telephone of person responsible for design of the system:
SG--
/O77/ %
Date Signature of Owner
*Required by Article 66-28-12(CRS, 1963, 1967 Perm. Sum. Supp.)
**Required in areas which have been identified as areas in which dancer of pci1utinq
of waters of the State niay occur (Art. 66-28-8(5), CRS) and/or areas in e.;ich therf.
is no local septic tank ordinance.
B. SIGNATURES 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 Approval Disapproval
Commeiits:
Signature for Local Health Department
Signature for City/Town Official (Title)
Signature for County Official (Title)
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 HEALT1-' DEPARTMENT USE: Recommendations of the District Engineer:
D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
WP -33(10-72-2)
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY ON THIS SHEET OF PAPER -