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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
(this does not constitute
PERMIT # S 165 a building or use permit)
Owner Richard G. Bradley
System Location Silt Mesa - Lot 13, Asgard Subdivision
Licensed Contractor owner
* Conditional Construction approval is hereby granted for a4 2'%'n gallon
_S_ Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate /_ inches in .,7.s minutes,• 3n sq. ft.
absorption area per bedroom .c'e,'1
11 of bedrooms 4/ x 730 sq. ft. minimum requirement =
May we suggest 44 /X 77'X Se' 5�� "» e /3 &r7,"
Date /1-. -/ -- 75 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.
c-- Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
(4 - Proper materials and assembly.
Olt- Adequate absorption (or dispersal) area. 7- to yJ
Adequate compliance with permit requirements.
�`�/ Adequate compliance with County and State regulations /requirements.
Date -,/ - a - '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 68.444, CRS 1963, amended 88.8.14, CRS 1968.
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.
3. 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 • 8 months in jail or
both.
`COLORADO DEPAR VENT OF HEALTH
.'Water Pollution Control Division
421' Ea 11th Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
� �/
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner:_._Rc td a0 �-.
_S�- .. c / / 4" p - - --
Mall Address: 4, /2 £c3 City//, Zlp2 /jSt Phone A 2S _,g.rf y
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,
soli percolation test holes, soil proofiles in test holes.
1. Location of facility: County 'L
�1e %! City or town , c ' , � /Lae S'1
Legal description loLji l ,s.Iv f 4jz_ Lot size ct( o $
2. No. of bedrooms 'Y Septic tank capacltyjAeratlon unit capacity
3. Source of domestic water: Public (name):
Private: Well ✓ Depth2ou Other Depth to first ground water /, - /t
4. Is facility within boundaries of a city /town or sanitation district?
5. Distance to nearest sewer system: V .2,.1
Have you attempted to arrange a connection with the system?_ //r,
If rejected, what was the reason?
6. Rate of absorption in test holes shown on the location map, in minutes per Inch
of drop ir' water level after holes have been soaked for 4 hours
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7. Name, address, and telephone of person who made soil absorpt on tests:
8. Name, address, and telephone of person responsible for design of the system:
1 11" /i �l _
1 40P r a sid are
Date natur of Ow er
*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.
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B. SIGNATURES OF LOCAL OFFICIALS: The undersigned have reviewed the notification
described on the front of this sheet and recommend approval or disapprov3i 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:
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Signature and Title
Note: The Notifler (front of this sheet) must obtain comments and signature of at
l tea: r one of the above.
C: FOLLOW!NG FOR STATE HEALTH DEPARTMENT USE: Recommendations of the District Engineer:
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D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
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WP- 33(10 -72 -2)
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fi •� PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY ON THIS SHEET OF PAPER -
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