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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL ~~H(4
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2014 Blake Avenue
Glenwood Springs, Colorado 8160 I
PERMIT II s OS4 (this does not constitute
a building or use permit)
Owner--lt;,..j·/:.~.c,~.) ""''~) ar;;i..Jc..:.Jd.i..i.---J:.b......_, ...:fi:w->~.--l.J' -c~e:..._ _________________ _
"\
System Location (,A (!,;Hi> X\ C-1. el;j le?
Licensed Contractor 4-erz?. We:"s'f""'
• Conditional Construction approval is hereby granted for •I QQO gallon _
_ Septic Tank or )( Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate_...L. __ inches in 2. minutes f.S
absorption area per bedroom..Jnt1J..I...IJ;LI:::I£111iditlr.._ _______ _
II ofbedrooms .5 x iS" sq. ft. minimum requirement .. Z.I!Uf":r(R 11'-"1""
.:::a.s"b f.\l:!IM-ill!'l::>'lt-"l:>t.tcnou tiJ Flet-0 Sl~l!!: = 1'1\ &CI(.F'r. (VIIIo.)IMMK'\
MQ~~--
1 '2.1 x 1 t.: . .r \' s' s E'1F'P ~e sttt> L::-L-"' ~
Date "'*"""' 9 -·u.J Inspector 21'~/L' ~seEr Pe:1U.. rz._esu "Tllo Foe.. Wa:>~>A-u.. ~ .J «., y-~---""""""''-::c~,.-"/':-"a.::....4f":-h'-•)-::-(-=-f>rJo-, -u-, u-""-:i':-FlD-A!=Iili'f-_. ~
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.
~
<21'. ieptte Tank cleanout to within 12" of final grade or aerated access ports above grade.
<>& Proper materials and assembly.
9Jt' Adequate absorption (or dispersal) area.
'
M Adequate compliance with permit requirements.
D& Adequate compliance with County and State regulations/requirements.
Date-....::/.~p~-;.,:;i'L.;;-;.o=Z;.;i':T-..-------Inspector ___ ___.~:;...:;!:...::Jio::Lo~d::J..-------
· 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 and revocation of the permit.
8. Section lll, 8.24 requires any person who conf!tructs, 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. ___ , __________ ,_,,,_,,_,,_,,,_, __ ,_,_,_,,_,,,_,_,_,_,_,,,,,,_,, _____ _ •
·~ • . 'i.J14 C•RADC• D~f·.~-RTMENT OF HEALTH
~?tcr Pollution Control Division
IJ210 East 11th Avenue
Denver, Colorado 80220
PROPOSED DISCHARGE TO WATERS OF THE STATEt<
L HOME SEWAGE TREATHENT SYSTEM*•\
•
Owner:~-:t~~~~~~LL~~~~~------------~--------------------------------
Mall Address:& £oE Cl t-&?&-•dtW'-ilpi/6:~.3 PhoneC}/..r;=ff':!J:</
A.
1.
2.
INFORMATION REGARDING PROJECT SUBMITTED .FOR REVIEW:
Attach separate sheets or report showing entl re area wl th respect to surro.undlng
areas, topography of area, habitable buildings, location of potable water wells,
soli percolation test holes, soil profiles In test holes. ~;P.~-~LV9~,}
Location of facility: County4er:tc;.Ll City or town ~C"'470AI .
N Z.l' of Lo~z.s ~
Legal descrlptlont ot ZG.1 1--o+ Z.7 "'bsck 1~ Lot size /?'"'A' I_,_::J.':f'_"__ __
::? T~k-p-C...~
No. of bedrooms d Septic tank ca·pacl ty ____ __:Aeratlon unl t c.1p,1ci ty /tt>OO 6A-A..·
3. Sou·rce of domestic water: Public (name)=---------------------------------
Private: Well_t_Depth.,ZQ_other Depth to first ground water table. ___ _
4. Is facility 1vlthin boundaries of a city/town or sanitation district?
•
5. Distance to nearest sewer system:~_-e/?LI~(.~<~-~~~-~------------------
H~vc you at tempted to arrange a connection wIth the sys tern? ___ _
If rej(>Cted, what was the reason? ______________________ _:_ ___ _
6. Rate of absorption In test holes shown on _the location map, In minutes per Inch
of Jrop In water level after holes have been soaked for 24 hours ---
------------------------------------~~~er.~~~~~~~~LILT"---------·-----
7. Name, address, and telephone of person who made soil absorption tests: _______ _
. S~ 1'tF7U1A IT
8. Name, address, and telephone of person responsible for design of the system: __ __
Date Signature of Owner
*Required by Article 66-28-IZ(CRS, \963, 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:
described on the front of this
the discharge as shown below:
Date Approval
The undersigned have reviewed the notification
sheet and recommend approval or disapproval of
Disapproval
Signature for Local Health Department
Signature for City/Town Official (Title)
Signature for County Official (Title)
Cormnents =-----------------------------------
-------------------------------
Signature and Title
Note: The Notlfler (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:
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D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
~/P-33 (I 0-72-2) .