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System Location
GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
ti
Licensed Contractor ri I
PERMIT#S 069
(this does not constitute
a building or use permit)
4.1
* Conditional Construction approval is hereby granted for a 7-s) gallon
Septic Tank or _ Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate / inchelg in., r minutes •6z) sq. ft.
absorption area per bedroom 7C' -e-'[.)
# of bedrooms_ x sq. ft. minimum requirement w : ' ,50%3/4 ;Y -
May we suggest
Date /2
FINAL APPROVAL OF SYSTEM:
Q
Inspector
No system shall be deemed to be in compliance with the Sewage Disposat Laws until the assembled system
is approved prior to covering any part.
0/d Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
,/e/ Proper materials and assembly.
0.e Adequate absorption (or dispersal) area.
.01e Adequate compliance with permit requirements.
11% Adequate compliance with County and State regulations/requirements.
Date
*CONDITIONS:
94z/77
Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
1. All .installation must comply with all requirements of the County Individual Sewage Disposal Regulations,
• adopted pursuant to authority granted in 88.44.4, CRS 1963, amended 66.3.14, ORS 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 1, Petty Offense (8500.00 fine - 6 months in jail or
both.
,O RADO DEPARTMENT OF HEALTH
er Pollution Control Division
42 00 East i l th Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
,�f/ �jINDIVIDUAL HOME SEWAGE TREATMENT SYSTEM**
Owner: 17At 4FV:Td
;s4/
Mail Address: 00/ — 6U- 16,0 C1094. Z I p lido. 3 Phone
A. INFORMATION REGARDING PROJECT SUBMITTED TOR REVIEW:
Attccl' separate sheets or report showing entire area with respect to surrounding
areas, topography of area, habitable buildings, locution of potable water wells,
soil percolation test holes, soil profiles in test holes.
1. Location off ci l I ty: County rg0.4i 19 4e City or town
Legal descr eron/6—/7 • Lot size 6.2-/9-:
2. No. of bedrooms Septic tank capacity Airation unit capacity_] 5d
3. Source of domestic water: Public (name) :
Private: Well Depth Other
Depth to first ground water table
4. Is facility within boundaries of a city/town or sanitation district?
5. Distance to nearest sewer system:
j2G4
Have you attempted to arrange a conn ction with the system? "24---d
If rejected, what was the reason? :1 C.16.5.
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
8. Name, address, and telephone of person respo .Ible for design of the system:
AT/
Date r Signature of Owner
*Required by Artic'.e 66-28-12(CRS, 1963, 1967 Perm. Sum. Supp.)
s•lcReq:!irt_d 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 total septic tank ordinance.
I. SIGNATURES OF LOCAL OFFICIALS: The undersigned have reviewed the notification
described on tha 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 (Iitir:)
Signature for County Official TitlTY—
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)