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• GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
i -•- ► 2014 Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT # S 083 (this does not constitute
a building or use permit)
Owner ?rank or Shirley Arbaney
System Location SLAG, 331 . • Ali-
Licensed Contractor ofrtirer Service
* Conditional Construction approval is hereby granted for a gallon
_AC,_. Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate / inches in .26 minutes .x32 sq. ft.
absorption area per bedroom -r».e #;.r
H of bedrooms 3 x -.tan sq. ft. minimum requirement <: h ,. • 4 , f r. .vein ,ysr En
May we suggest /- SS' )1' f{ e- ,r ,, no
Date r /- 7'e2/ Inspector -- rn
fte:gr
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.
° Pc Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
0 5C Proper materials and assembly.
4,t Adequate absorption (or dispersal) area.
.Adequate compliance with permit requirements.
a!C' Adequate compliance with County and State regulations /requirements.
Date //— / 7 7 Inspector
.a ~a C, c teas AM/o.e TO .c.w* . • //v if °nneN ./OG 04/ 7' PAAC.
RETAIN WITH EIPT RECORDS AT CONSTRUCTION SITE
3C �►O�� eez' � �xo d, REC Dev c c v R I�2, am a rtoe&� .vsr eA4
*CONDITIONS: i0 "'Psi °Ic-s/4+V a»sly 7we ep.ta,non3 °As ribs lansit
1. All installation must comply with 1 requirements of the County Individual Sewage Disposal Regulations,
adopted pursuant to authority gr red in 66.44.4, CRS 1983, amended 66.3.14, CRS 1963.
2. This permit is valid only for co nection to structures which have fully complied with County Zoning and
building requirements. Connec ion 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 ($500.00 fine • 6 months in jail or
both.
\OtORADO DEPARTMENT OF HEALTH
W'ate {' Pollution Control Division .
42P3 East Avenue
Denveer, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner r5tJ /". / NC y S&q , 3 ? /.c
Mall Address: (yj- 7 fl City 5 -1rf SZlp P honefgg j o
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,
soil percolation test holes, soil profiles In test holes.
1. Location of facility: County -, &4 rp id Cit or town �[J]
Pc r' 424- DEPT
Legal description - 7 Lot size /}
2. No. of bedrooms 3 Septic tank capacity i/,r2 Aeration unit capacity__
3. Source of domestic water: Public (name):
Private: Well Depth Other Depth to first ground water table
4. Is facility within boundaries of a city / /town or sanitation district?_ �C _
5. Distance to nearest sewer system: 4 „wt
Have you attempted to arrange a connection with the system? 77).C.)
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,
7. Name, address, and telephone of person who made soii absorption tests:
8. Name, address, and telephone of person responsible for design of the system:
Date Signatu !■ Owner
*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.
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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
Signature for Local Health Department
Signature for City /Town Official (Titre)
Signature for County Official (Title)
Comments:
Signature and Title
Piote: The Notlfier (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. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
•
WP 33(10 -72 -2)
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