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I, GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
? 2014 Make Avenue
Glenwood Springs, Colorado 81601
PERMIT # S ler (this does not constitute
.-.. a building or use permit)
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System Location Lry l ,..4 44 ,, , , 4
Licensed Contractor rj 4 i- 1« E, 1C-C.11 L c
* Conditional Construction approval is hereby granted for a gallon
Septic Tank or Aerated treatment unite NE 5 w.r9r ?'' 77/ we c - -t ist rI. -4
Absorption area (or dispersal area) computed as follows: &'4c. C. On/ e 7- " - ,(.; e 7,k .()
/A/ NP- /2/770 Al 729 & et. 77i
Pere nth" ru erinches iir ---- minutes L/ tic / ref o» AS?) r'9-c&, - r;
absorption area per bedroom ('/' . ` ' ctrl r ; A eve- e '" )
/ c cJU l— -ter 7"ri N
# of bedrooms x sq. ft. minimum requirement >
9 -- lac. 4, , r y - r�.yr /M/ r1!•4.>
May we suggest /.:') ' >i /fir. r =-may
Date Inspector r
FINAL APPROVAL OF SYSTEM: .
No system shall be deemed to be in cofnpliance,*ith the Sewage Disposal Laws Until the assembled system
vi is approved prior to covering any part.
Septic Tank cleanout to within 12 of finij�g�rCa�dde or�gsrat d access ports above grade.
p Jl'/S77.ve �r "lam° r9rpJ,C. ord C. ,
SJC; Proper materials and assembly.
C , ' Adequate abs9rptio41(or dispersal) Brea.
Adequate compliance with permit requirements.
Arm dequ a col ran ith Cou and State regulation /re uir ments.
r �so ACIPvsta" a u�as , ' �,�y�� Mi s es.,i s.rtivs
7`• 'tr cere er OA an friffitet.
Date -/s h— 7, Inspector sys °.
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 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 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 (5500.00 fine - 6 months in jail or
both.
COLORADO DEPARTMENT OF HEALTH •
Water Pollution Control Division
4 4210 East 11th Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE"
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner: l i"y f77s'EE
Mall Address: & X /29 C1 ty jFLt Zip R/65b Phone 4.2.5-2.5:30
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography c. aroma, i abi ;: ul i ;r.ys, is y aLicd of potable •:::ter wells,
soil percolation test holes, soil profiles In test holes.
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1. Location of facility: County >G(E49 .City or town eFaE
Legal description4 4ys°,67-1, Lot size / /0/4.t' /ld.A
2. No. of bedrooms oZ Septic tank capacity 7500 Aeration unit capacity
3. Source of domestic water: Public (name): (10 Cr @FRE
Private: Well Depth Other Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? N
5. Distance to nearest sewer system: ° Alit-c3
Have you attempted to arrange a connection with the system?
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, address, and telephone of person who made soil absorption tests:
8. Name, address, and telephone of person responsible for design of the system:
/y /Tv % i at
Date // S gnature ot Owner
*Required by Article 66 - 28 - 12(CRS, 1963, 1967 Perm. Sum. Supp.)
`Required in areas which have been identified as areas in which dander of rcilutioui
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas in to ich ?hero
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
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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:
•
•
WP- 33(10 -72 -2)
•
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY ON THIS SHEET OF PAPER -
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