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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT # S 095 (this does not constitute
a building or use permit)
Owner Harold 1. Blue
System Location 3/4 E 16 of a mice North of Catherine's Store - Carbondale
Licensed Contractor
* Conditional Construction approval is hereby granted for aJ oOO gallon
�( — Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pero rate 1 inches in1_ minutes /90 sq. ft.
absorption area per bedroom 1'H
# of bedrooms 3 x /90 sq. ft. minimum requirement— S70.5 4'Pr ter Ath e : 441 ` " IintvA > %t+ +f,
_
May we suggest /.? ' )f "/9'X nee' 'fitGac.!' ,B C7, e r :,,,ve.-t A ' ,1,/Q t
Date A,— a.r 79 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.
zee.- Proper materials and assembly.
zG�- Adequate absorption (or dispersal) area.
,�/ �, compliance with permit requirements.
1A�+<lGAdequate compliance with County and State regulations /requirements.
Date ∎ -Cr 6 73 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 68.44.4, CRS 1963, amended 86.3.14, 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 ($500.00 fine • 6 months in jail or
both.
4 COLORADO DEPP.RTMENT OF WEALTH
• Water Pollution Control Division
421Q East Ilth Avenue
Denver, Colorado 80220 •
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner: !I' 47,7" O /O. L DI t
Mall Address: O r 06 61, f'®4' City "`"7exne Zip Phone
A. INFORMATION REGARDING PROJECT SUBMITTED. FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography el aI 1G::atioin of potable Plater wells,
soil percolation test holes, soil profiles in test holes.
1. Location of facility: County_ 44 C City or town
Legal description % 2 ,o7Ncr3) .T°/ - Lot size /5(2 if.
2. No. of bedrooms Septic tank capacity / el' a 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? e4/"
5. Distance to nearest sewer system: / >/ tf
•
Have you attempted to arrange a connection with the system? y e2
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
5Fc— , 7
7. Name, address, and telephone of person who made soil absorption tests:
SEE= tar---
4 i
8. Name, address, and telephone of person responsible for design of the system:
/p - . 2L 7Y 77a -u-er-
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 danger of pcilution
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas in 1c.ich therr:
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
Signature for Local Health Department
•
Signature for City /Town Official (Title)
Signature for County Official (Title
Comments:
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. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
•
W'- 33(10 -72 -2)