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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL. HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 61601
NO FEE REPAIR
PERMIT N S
1n (this does not constitute
E A
a building or use permit)
Owner Dnmthv Moreland
System Location Highway 82 - 0383 167 Road
Licensed Contractor Lael Hughes
* Conditional Construction approval is hereby granted for a /nnr)gallon
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate NM inches in At 4 minutes NW sq. ft.
absorption area per bedroom A/ /t
Z:>/ — l . t >2 c79
N of bedrooms /ll4- x Al» sq. ft. minimum requirement c" / 3 77 / 06, % t-
77 Paul it
May we suggest
Date Sc Inspector ee
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.
. . . . . . S e p t i c Tank cleanout to within 12" of final grade or aerated access ports above grade.
4 Proper materials and assembly.
//7! Adequate absorption (or dispersal) area.
/.,�,` Adequate compliance with permit requirements.
A dequate compliance with County and State regulations /requirements.
Date Cr', — (72 7 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 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 apd revocation of the permit.
3. Section III, 8./4 requires any person who constructs, alters, or installs an individual sewage disposal
'ph y t p i N9 1veg a W 1 v x at op Fps ,
or spepiftcatianacon.
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, COLORADO DEPARTMENT OF HEALTH •
Water Pollution Control Division •
4210 East llth Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM**
Owner: Pen 03��/ llo'l KeXl�4.
Mail Address: p Phone
A. INFORMATI V ' " PING PROJECT SUBMITTED FOR REVIE .
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 f a c i l i t y : Coun y ( . .City or towni /, .y,
Legal description Lot size
it
2. No. of bedrooms Septic tank capacity lip" j,' riatlon unit capacity
3. Source of domestic water: Public (name): /11
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 :5? ��
Have you attempted to arrange a connection with the system? ily
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, addre s, and telephone of pers who made soil absorption tests:
•
8. Name, .ft ress, '/ ,y ele."•ne of person responsible for design of the system:
Plate • y e � �
*Required by Article 66- 28- 12(CRS, 1963, 1967 Perm Sum. Su...
* *Required in areas which have been identified a reas in whi of pcllutin'i
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas in a;.ich then:
Is no local septic tank ordinance.
• jr
•
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:
N "- 33(1O -72 -2)