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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
REPAIR PERMIT N S S1. (this does not constitute
a building or use permit)
Owner +'r, Ho11i WOK Tuf1v
System Location 0051 County Road 223
Licensed Contractor ce -eme,C
approval is hereby c�X�3riNfe
* Conditional Construction
app y granted for a gallon
_A— Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate / inches in y minutes ` sq. ft.
absorption area per bedroom 7?7 -qe -
N of bedrooms 3 x ,S sq. ft. minimum requirement
May we suggest. P-9 /X <r'/'X $ /.aert -tre .- e - -(A „, i . ; . s -
Date A-'S' 7.a Inspector 42r-751- < ' "y
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.
■ex /snn , ,Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
ate— Proper materials and assembly.
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OCc Adequate absorption (or dispersal) area.
" Adequate compliance with permit requirements.
d4C ✓Adequate compliance with County and State regulations /requirements.
Date 3 — 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 1968, amended 66.8 -14, CRS 1968.
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.
C(3'7RAD0 DEPARTMENT OF (HEALTH
baiter Pollution Control Division
' 421Q East filth Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
/ INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner: 7� 0 ` L
Mall Address: /05/ (VAL? A City Zlpf //,fOPhone4 %'..
A. INFORMATION REGARDING PROJECT SUBMITTED FOR EVIEW:
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 �C7ao City or tow
Legal description – � Lot size 95/47
2. No. of bedrooms ,? Septic tank capacity447 Aeration unit capacity
' • 3. Source of domestic water: Public (name): d/Ze --
' 4.r
Private: Well Other Depth to first ground water table_t_' __.
4. Is facility within boundaries of a city /town or sanitation district? WD _!
5. Distance to nearest sewer system: _. s.,,,t
Have you attempted to arrange a connection with the system? t\
If rejected, whit 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
Name, address, and telephone of person who made soil absorption tests:__ — _�_
5 r e i
8. Name, address, and telephone of person responsible for design of the system:
Jger 1?I/
Date Signature o9 5w r
*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 pollution
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas in which there
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)
Comments:
Signature and Title
Note: The Notifler (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:
WP- 33(10 -72 -2)