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• 1 44 GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT 11 S 191 (this does not constitute
a building or use permit)
Owner lace^ , Sflt rwr-
System Location Nnar Carbondale
Licensed Contractor Aist« -=. -
* Conditional Construction approval is hereby granted for a 7S° gallon
k Septic Tank or, Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Parc rate / inches in d U minutes v sq. ft.
absorption area per bedroom Ja (n /N /wum
ii of bedrooms xa/O sq. ft. minimum requirement "' ' on a/ � N1'/7p(J
/24 X .3 .T X 3 , 17 C&P EPi9G Be
. E �.-.. Aft/Pre-
May we suggest � � �
'7
- �S - 7 S
. Inspector
D In s
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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.
Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
Proper materials and assembly.
Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
Adequate compliance with County and State regulations /requirements.
Date Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
•CONDITIONS:
1. All installation must comply with all req ents of the County Individual Sewage Disposal Regulations,
adopted pursuant to authority granted in 0 CRS 1988, amended 88.8.14, CRS 1983.
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, 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 of permit commits a Class I, Petty Offense ($500.00 fine • 6 months in jail or
both.
COLORADO DEPARTMENT OF HEALTH
l Water Pollution Control Division
421Q East filth Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO,WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATiIENT SYSTEM **
Owner: JAMES SALT
RP
Mall Address: 620 N. 3— sr City /}Spilt/ Zip ?/4f/ Phone e ki -3996
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography er area, habitab1c, buildings, location of potable voter wells,
soil percolation test holes, soil profiles in test holes.
1. Location of facility: County G/9 -2F /at .City or town ! Vice CAtdeN.DALC
Legal description
C C . r 7 S R 87W er 6 7-1 PM Lot s i z e 8/ Ac Res i i
2. No. of bedrooms / Septic tank capacity 7-CD 6• Aeration unit capacity —
3. Source of domestic water: Public (name): /Depth Private: Well V Depth Other Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? NO
5. Distance to nearest sewer system: VA//c4/Own/ – MRNy MU-ES
Have you attempted to arrange a connection with the system? AIO
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:
• Ala
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 da.u.e, of pcilutioo
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas in w;,ic.`, th'.r
is no local septic tank ordinance.
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
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 si,nature 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:
1f!'-33 (1O -22 -2)
• PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY ON THIS SHEET OF PAPER —
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