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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT N S 129 (this does not constitute
a building or use permit)
Owner. Mar.iorle Sutherland
System Location
Rifle f
Licensed Contractor Loy Enterprises
* Conditional Construction approval is hereby granted for a T gallon
_A_ Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate / inches in a0 minutes ca /e sq. ft.
absorption ;6 per bedroom mecca) •
# of bedrooms cZ x a'Osq. ft. minimum requirement = " ' FT `ate ,4 .iedio—
May we suggest /,k3S %r3 't E 4r v J
Date / � Z5 Inspector
mil. 0eiree mfr /7 orc' >!>i'' / G. c= /ffsr>e ._ ._ `
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.
Qom Proper materials and assembly.
ct t— Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
Adequate compliance with County and State regulations /requirements.
Date V /a — 7S Inspector. e'
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 86.44.4, CRS 1963, amended 66.3.14, CRS 1963.
2. This P ermit 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
automatically be a violation of a requirement of the
and Zoning office shall au y permit and cause for both q p
legal action and revocation of the permit.
3. Section 11I, 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 (8500.00 fine • 8 months in jail or
both.
COLORADO DEPARTMENT OF HEALTH
Water Pollution Control Division
421Q East 11th Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE-;
INDIVIDUAL HOME SEWAGE TREATMENT S\STEM* ,
Owner: r Y! e Sd1heY')H )l d
Mail Address:. L n 2,4 ,/<//92 City 2 J� /l° TIp Phone ca2J
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography ci ari:;;, hab,.L.U1.. Lid, 1L•atiuil of potable wzater weils,
soil percolation test holes, soil profiles / in / test holes.
1. Location of facility: County / %F /C�. City or town � ^ �� 2/ I / ew� k
Legal description - Lot size Soo 1 'eel 3air E 44) i 7o /
/ h — a las a 7
2. No. of bedrooms r-2 Septic tank capacity 2 4 unit capacity
3. Source of domestic water: Public (name):
/I
Private: Well Depth,s(�Other Depth to first ground water table c50 1/
4. Is facility within boundaries of a City /town or sanitation district?_ .
5. Distance to nearest sewer system:_ 3 1)'t~112° S
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 map, in minutes per inch
of drop in water level after holes have been soaked for 24 hours
Sc �= 1 Dfcii-m CT
7. Name, address, and telephone of person who made soil absorption tests:
C, c=7= H OC =W2Hh
8. ' Name, address, and telephone of person responsible for design of the system:
'et
Wi% S %" —/_ ....Z—
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 danger of pcilution
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas in . ;ich there
is no local septic tank ordinance.
r
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 pisapproval
Signature for Local Health Department
Signature for City /Town Official (Title)
Signature for County Official (Title)-
Comments: M _
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 HEALTE! DEPARTMENT USE: Recommendations of the District Engineer:
D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
•
iJU -33 (1 O -72 -2)
Fituu for racora 14nrch 9, 1962 at. 3 :45 P.N• Book 340
kuception /j 2:16651 Chas S. he g Aecordcr Page 9 i
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