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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Make Avenue
Glenwood Springs, Colorado 81601
PERMIT # S 153 (this does not constitute
w a building or use permit)
Owner 'S'/ C l �Q�1/- 177-9,7C7 t Al *7/1//0 —A/
System Location ! — -% _ / . _ .r .4/7
Licensed Contractor nee) /E. /P•
* Conditional Construction approval is hereby granted for a /rr)O gallon
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate / inches in .-? /.) minutes //) sq. ft.
absorption area per bedroom 7 Ha h N of bedrooms - x /id sq. ft. minimum requirement
May we suggest /.:.) /A' 5.3'X 3 SEEP— .. 73 7 f
Date [ 7 1 / - 7C; Inspector e 1
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.
t Proper materials and assembly.
i Adequate absorption (or dispersal) area.
✓✓
Adequate compliance.with permit requirements.
Are" Adequate compliance with County and State regulations /requirements.
Date 1/ 14 76 Inspector 4 0t 1t r
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 88.44.4, CRS 1983, amended 884-14, 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.
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9
C0Iy9RAD0 DEPARTMENT OF HEALTH /)% , 7
,'later Pollution Control Division •
- •421G East 11th Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
//
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM**
Owner: ( fi e e l e . i / y am ( HO M a l l l Address: f) '5 t ,, , 433 CitY fei /pi. Zlp7 /6.l Phone //47//4E
•
A. INFORMATION REGARDING PROJECT SUBMITTED. FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography of arca, habitcb12 buildings, location of potable water wells,
soil percolation test holes, soil profiles in test holes.
M
1. Location of facility: Count /,_ /6 .City or town
Legal description i � d .` eta ,�,, • . size __J ____ L '
2. No. of bedrooms 3 Septic tank capacity /& Aeration unit capacity
3. Source of domestic water: Public (name)
Private: Well X Depth %2 Other _ Depth to first ground water table 249
4. Is facility within boundaries of a city /town or sanitation district? itt'
5. Distance to nearest sewer system: 2 / /Y,741.1 , 64 ,1
Have you attempted to arrange a connection with the system? A `
If rejected, what was the reason?
6. Rate of absorption in test holes shown on the location neap, 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 abso tests:
Ai
i
/ i
8. Name, address, and telephone of person responsible for design o ' the system:
O 4. , - I
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Date Signa o 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.nue' of pcilutro'r
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas in i;ich them:
is no local septic tank ordinance.
.
t
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
Conuneuts:
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:
i &-33(I0-72 -2)