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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014. Blake Avenue
Glenwood Springs, Colorado 81601 f)i) 'C._
PERMIT # S 036 (this does not constitute
a buil ing or use permit)
Owner �"� [ .' b f 1-t (,) ),,,r / t ertp" ru n tr Td. C -t t_ri 1 .
System Location Cti U 1 BR ("T't x,11 ‘1-1'1"'d `-_� t .1 n c^ eS
Licensedrk) ( �
Contractor C�[�1; a� or? c),�� r � � � nz1
* Conditional Construction approval is hereby granted for a 1. • . gallon
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate / inches in 4/6 --minutes .3 sq. ft.
absorption area per bedroom ic"".Q.
# of bedrooms "9 x .3e:242 sq. ft. minimum requirement or /aa?e:0.5c 'arra- '9 7 Ye W
"�3 ��'.��4Z',cT/t.�n/O fi! N/.t r9 F› zit*
.6167:1-7r c
May we sugest d° "� . d'c ca ,' ;
/.5""' X 4-4/r A. 3! 'eF7a G' ,pr&"D
Date --// -~ ?/0" Inspector �.•
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.
Tank cleanout to within 12" of final grade or aerated access ports above grade.
zelfr Proper materials and assembly.
®jam Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
Adequate compliance with County and State regulations/requirements..
Date
-7t
Inspector
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 66.3.14, 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.
S. Section I1I, 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 "di -permit commits a Class L Petty Offense (8500.00 fine • 6 months in jail or
both.
KORAN DEPARTMENT OF HEALTH
Water Pollution Control Division
• 4210 Etas: 1 i t:.h Avenue
Denvar, Colorado 80220
Owner:
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOM EWAGE TREATMENT SYSTEM**
Mall Address: U mfr City
eNwoe
%pf/46/ Phone /V 44 88
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
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, sol A prof les in test holes.
r /,%/
MM....
1. Location of facility: County
Legal descriptionfsnin ! 7—
2. No. of bedrooms f V SS p
City or town
Lot size
tank capacity Aeration unit capacity
3. Source of domestic water:
Public (name):
//
Private: Well $ Depth 7 Other
Depth to first ground water table
__8
4. Is facility within boundaries' of a city/town or sanitation district?
0
5. Distance to nearest sewer system:
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 wat_r level after holes have been soaked for 24 hours
Pe -772-1M r-7
7. Name, address, and telephone of person who made soil absorption tests:
1?---///
8. Name, address, and telephone of person responsible for design of the system: -
c-/11- 7g
Date
*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.
4
B. SIGNATURES OF LOCAL OFFICIALS: The undersigned have reviewed the notificaeion
described on the front of this sheet and recommend approval or disapproval of
the discharge as shown below:
Date
Comments:
Approval Disapproval
Signature for Local Health Department
Signature for City/Town Official (Title)
Signature for County Official (Title)
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 -3010-72-2)
•. 6
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