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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT # S 103 (this does not constitute
a building or use permit)
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Owner Warren G. Bernard
System Location Asgard Subdtvlslon - 1ot'23 - 2A5S Odin Drive
Licensed Contractor OWfl r
* Conditional Construction approval is hereby granted for a /C'2c::L gallon
—! Septic Tank or Aeratedtreatment unit.
Absorption area (or dispersal area) computed as follows:
• Perc rate / inches in_ «_ minutes „'j /0 sq. ft.
absorption area per bedroom re►.e.rc
# of bedroonilt S_ s sq. ft. minimum requirement =4 , "resat .v.42
May we suggest Vol so ex a/seeneeteher 'e '
Date ✓- — c• 4.1 Inspector
n ^ _ ` s
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, FINAL APPROVAL OF SYSTEM: ( l
M,, 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.
oY Septic Tank cleanout to within 12" of final grade or aerated access ports above grade. ,S �`S7
Of,/ Proper materials and assembly.
_,SV Adequate absorption (or dispersal) area
�////''Adequate compliance with permit requirements.
adequate compliance with County and State regulations /requirements.
Date _ 7 S 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 66.8.14, CRS 1988.
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. __ .-
1 COI DEPARTMENT OF HEALTH
Water Pollution Control Division
;3:21Q East llth Avenue
Denver, Colorado 80220 -
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM ** •
Owner: 1.3ae2 i \ 1 .0 , e2Ytv-42t
Mall Address: `Otfl %(,' City 2, ft Zip SZII.S0 Phone
A. INFORMATION REGARDING PROJECT SUBMITTED TOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography ci ar‘.a, haL...:b1.. Lu i.:;ys, 1ccction of potable water walls,
soil percolation test holes, 1. Location of facility: County mei1 profiles in test holes.
: ie ft City or town_ C, 1+
Legal description Ils SJ, jt. 3 aoycOcl,'N , Ize (d. - aee
2. No. of bedrooms Septic tank capacity /NO Aeration unit capacity
3. Source of domestic water: Public (name):
i
Private: Well X Depth Other Depth to first ground water table ► 30
4. Is facility within boundaries of a city /town or sanitation district? n n
5. Distance to nearest sewer system: /jon e
Have you attempted to arrange a connection with the system? 7 0
If rejected, what was the reason?
6. Rate of absorption in test holes shown on the location neap, in minutes per inch
of drop in water level after holes have been soaked for 24 hours
_ x --- lT
7. Name, address, and telephone of person who made soil absorption tests:
5 era—P / r
8. Name, address, and telephone of person responsible for design of the system:
.77 -/VAIr 6 SL Az—le)
Date Signature of Owner
*Required by Article 66- 28-12(CRS, 1963, 1967 Perm. Sum. Supp.)
* *Required in areas which have been identified as areas in which dance' of pcilutioo .
of waters of the State may occur (Art. 66- 23 -8(5), CRS) and /or areas in dMch then:
is no local septic tank ordinance.
1.
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:
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Date Approval Disapproval
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Signature for Local Health Department
Signature for City /Town Official (Title)
Signature for County Official (Titter
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Comments: --
Signature and Title
Note: The Motifier (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:
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WP-3300-72-2) -
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.' PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY ON THIS SHEET OF PAPER -
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