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+ 3, GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH )-ti- da.7C.�4
2014 Blake Avenue
Glenwood Springs, Colorado 81601 ' ,
" Y1e...3 - (Zito tit • oti n Aa-
PERMIT N S 1 1.8 (this does not constitute
b1 "`� a building or use permit)
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Owner 4, . //. :e 6 es ..e •
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System Location f > .I
Licensed Contractor
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* Conditional Construction approval is hereby granted for avoAnC gallon
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate / inches in -.7P; minutesp /l? sq. ft.
absorption area per bedroom
N of bedrooms_ x ,Pin sq. ft. minimum requirement =
May we suggest is �.Y S3 x .'f' . e 7- '> Bel
Date 3 /fir 7 S Inspector •
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FINAL APPROVAL OF SYSTEM:
No system shall be deemed to be in compliance the Sewage Disposal Laws until the assembled system
is approved prior to covering any part.
CT.� Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
��// Proper materials and assembly.
/.�'2/ Adequate absorption (or dispersal) area.
Lam/ Adequate compliance with permit requirements.
Adequate compliance with County and State regulations /requirements.
Date — 7 S Inspector l4�t
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 86.44 -4, CRS 1983, 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.
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 jailor
both.
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_0LQRAD0 DEPARTMENT OF HEALTH • • -
Wter Pollution Control Division
4.-I0 East llth Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT TREATMENT SYSTEM **
Owner: lCj /A.- -&/ < ln 1���.0 - •
M a i l Address: ��3pi /„?„7 4 cit 4 , r Zip i cjA5Whone6,.: 5=/_3,?
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A. TNFORMAT•iON REGARDING PROJECT SUBMITTED FOR R IEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography of area, habitable buildiCgs, location of potable water walls,
soil percolation test holes, soli rofiles In test holes.
1. Location of facility: Count if s _.cif'/
/ / .City or town . _
Legal description i- /r (- � PL I oi size cq -' .--ig !-</
2. No. of bedrooms Septic tank capacity Aeretion unit capacity
3. Source of domestic water: Public (name): 62q/, /
Private: Well • Depth Other Depth to first ground water table ,
4. Is facility within boundaries of a city /town or sanitation district? iir a
5. Distance to nearest sewer system: ,- - frt _� --
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Have you attempted to arrange a connection with the system? -_
If rejected, what was the reason? _
6. Rate of ahsorption in test holes shown on the location neap, to 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:
J�C a>Z /T
8. Name, address, and telephone of person responsible for design of the system:
Date Signature o owner
*Required by Article 66- 28- 12(CRS, 1963, 1967 Perm. Sum. Supp.)
* *Required in areas which have been identified as areas in which thrive! of pcilutioi
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas in which them
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 Flealth. Department
Signature for City /Town Official (Title)
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—' Signature for County Official (Title)
Comments: _— —
Signature and Title
Mote: The Hornier (front of this sheet) must obtain comments and si,nature of at
least one of the above.
C. FOLLOWING FOR STATE HEALTP DEPARTMENT USE: Recommendations of the District Engineer:
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D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
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WP- 33(10 -72 -2)