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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH # , r . r.+ (2
. u,' v" 2014 Blake Avenue
. Glenwood Springs, Colorado 81601 1 ' 0 -1 . f a '
e 4' } I':.:. C- I ....e.. 1! 7111.,
PERMIT b S 16t ( this doer not constitute , , r . I
a building or use permit) i-,,
Id
Owner C1 aUrta R. Rurnott '
System Location Directly behind Co •op - S1t,
Licensed Contractor ``''.,.,
IIII
"` Conditional Construction approval as.he by granted for a gallon
Septic t
Tank or Aerated treatment fitment Ylnit.
Absorption area (or dispersal area) computed as follows: 1
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: k`
No system shall be deemed to be in compliance t'ith the Sewage Laws until the assembled system
is roved prior to covering any art.
aPP P g Y P
Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
Proper materials and assembly. ti '
Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
Adequate compliance with County and State regulations /requirements.
Date Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations,
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' DEPARTMENT OF HEALTH •
Water Pollution Control Division
$121Q East llth Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO,WATERS OF THE STATE*
INDIVID HOME SEWAGE TREATMENT SYSTEM **
Owner: e /401e /1i e ,ene //
Mail Address :64p eel ,Bo){ ,249 Ci ty Mk/0: 4 Zip /lyy Phone
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,
s o i l percolation test holes, s o i l + profii�les inn test holes.
1. Location of facility: County (p a/"/�✓,G /d .City or town s, /T 1
Parcel 1, Sec, 2, T. 6 S.,
Legal description Range 92 W„ 6th P.M. Lot size 4 Ct e/e S
2. No. of bedrooms Septic tank capacityipp Aeration unit capacity
3. Source of domestic water: Public (name):
Private: Well ✓Depth Other Depth to first ground water tableijp Hle/
4. Is facility within boundaries of a city /town or sanitation district7,3p0 7c/ -
5. Distance to nearest sewer system:
Have you attempted to arrange a connection with the system? /10 _
-
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 hour •
d —
7. Name, address, and telephone of person who made soil absorption tests: -
ow_il = 7fl/
•
8. Name, address, and telephone of person responsible for design of. the system:
Date •Signature of Ovine
*Required by Article 66- 28- 12(CRS, 1963, 1967 Perm. Sum. Supp.)
* *Required in areas which have been identified as areas in which damei of pcilution
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas In //rich ?her.:
Is no local septic tank ordinance.
9
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
C i
Signature for Local Health Department
Signature for City /Town Official Title?
Signature for County Official (Title —
Comments: _ S
1 • ---
Signatur `2+nd Title
Note: The Hornier (front of this sheet) must obtain comments and signature of at
least one of the above.
C. FOLLOWING FOR HEALTH DEPARTMENT USE: Recommendations of the District Engineer; '
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D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
l&- 33(10 -?2 -2)