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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH •
2014 Blake Avenue RRk kee _" , \ �'^"��
Glenwood Springs, Colorado 81601
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r 4 1 1 �an� PERMIT b S 088 (this does not constitute Gtira.e> --
4 l S F' F�q�id °o a building or use permit) q_2 S_g0
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Owner Norman L. Cook 40 T
System Location Lot 30, Sec. 1, T. 7 S., R. 89 W., 6th P.M.
Licensed Contractor Norman L. Cook j dot -fin- ° ar r4r//9 - 7 - r.'e.
• * Conditional Construction approval is hereby` gr"" ° Ci & or a 4a n> gallon
_A_ Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate / inches in .Z3" minutes - sq. ft.
absorption area per bedroom eoue-
H of bedrooms 4 it .ZSo sq. ft. minimum requirement = 9..Xo5c;:: gt. i n wv
May we suggest .. a/'X 3 9 k 3 r escap - 6,0 ear) �^
Date - /H - 7'/ Inspector f r`�
FINAL APPROVAL OF SYSTEM:
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system
P is approved prior to covering any part.
d3C- Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
SProper materials and assembly.
G?— Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
d - -Adequate compliance with County and State regulations /requirements.
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Date y Inspector. p
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.
8. Section III, 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 permit commits a Class I, Petty Offense ( *500.00 fine • 6 months in jail or
both.
COLORADO DEPARTMENT OF HEALTH
W. Wa'f'er Pollution Control Division
41210 East llth Avenue
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Denver, Colorado 80220
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NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE* '
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner: Mg ./maw L.
Mall Address: ,4a,C/4 •2 Ci tyl4, l P fk/ Phone 9r/C;$1,‘
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 /4a— a City or town
Legal description/17 Sec /Tpui Lot size — s _
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2. No. of bedrooms V Septic tank capacity ALSO Aeration unit capacity_
' 3. Source of domestic water: Public (name): J%,,,rs,etc Lvejf
Private: Well Depth to first ground water table 4/5
4. Is facility within boundaries of a city /town or sanitation district? 4,
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
7. Name, address, and telephone of person who made soil absorption tests:
8. Name, address, and telephone of person responsible for design of the system:
_� zs -; y = L, _ - -- -
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 whir, danger of pollution
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas In Nhich clsrs
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 (Title)
— — Signature for County Official (Title)
Comncnts:
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Signature and Title
Note: The Notlfier (front of this sheet) roust obtain comments and signature GI' tc
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)
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