HomeMy WebLinkAboutApplication-PermitGARFIELD CO[f NTY DEPARTMENT OF E'1viR0Tll1 i'rAi. ifl Ai,'PH
20Th Blake Avenue
Glenwood :springs, Colorado 81601
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2, Construction approval:
Plans and location are hereby approved
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2, Final approval of systems
No system shall be deemed to bei in compliance with the Sewage
Disposal Laws until the assemtsed system is approved prior to
covering any part.
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-' Retain with permit records at construction site.
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GARFIELD COUNTY •WIROa i ,NTA3:., HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER ✓
PHONE
HANG ADDRESS
LEGAL DESCRIPTION Or PROPERTY
LOCATION OF TEST DOLES
T (3) test holes required per system
Test Hole Depths (24" minimum) ---4.
Diameter of Test Holes
Water Remaining after 24 Hour Soak
x_14
1
•/
Percolation Rate Each Hole
.,,
Average RateJ 4.„.1%,4:^^
41141.41' 11
NAI1E OF RESPONSIBLE PARTY RUNNING TEST E., 'Ric/NA-APE, PHONE74--7S"4 G
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SIGH UATURE
DASS, 14-13/ 713
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OWNER:
GARFIELD) COUNTY ENVIRONMENTAL HEALTH
2014 BLAKE AVENUE
GLENWOOD SPRINGS, COLORADO
APPLICATION POR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
RECEIPT # w_
ADDRESS,
CONTRACTOR:
4111•00011111MONOIVEr
SITE LOCATION:
PHONE:
ADDRESS: PHONE:
NO. OF BEDROOMS:
LOT SIZE, - 0A".
Application for an individual sewage disposal permit is hereby submitted. The
individual sewage disposal system will be oonstructed in accordance with the
regulations concerning individual sewage disposal systems within Garfield County.
This application is valid for six (6) months from date signed.
DATE: SIGNATUREs�
Percolation test results:_
Minutes per inch:
Recommended minimum size of leaching systems� __-
Recommended minimum size of tanks
PLCM PLAN
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N3
DATE: __ __ SANITARIAN:
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WFC' I,
COLORADO n;PARTi NT OF HEALTH
water Pollution Control Division
1.210 East 11th. Avenue
Denver, Colorado 80220
Ar!'LICATION FOR U PR01AL OF LOCATION FOR SEr•I`IC TANK SYSTEMS
.-"r• •.•�
TM is Of AC Ater
Applicant Owner):_L) a . PA).Afry,,,
Mail Address, [�o7L City:G"-• ,NAA,A.c.. i'hon s S -G3- 72
A. INFORMATION REGARDING PROJECT SUBMITTED FOR R1 TiF.W:
Attach smparate sheets or report d iiowing entire area with ;respect to surround
ing areas, topography of area, habitable buildings, location of potable water
wells, soil percolation test holes, soil profiles in test holes.
1. Location of Facility: County _ City or Towns
Legal Description l7 gl p� , Am Lot Sleet
k. Type of area and facility - Number of persona served: "
Subdivision :hotel Restaurant
Others
Trailer Court
3. Source of domestic water: Public (name):
Private: Well K Depth Other Depth to first ground water table
4. Is facility within boundaries of City Sanitation Distriot: /11"1"
If so names
;. Distance to nearest sewer systems
Have negotiations been attempted with owner to connects
If rejected, give reason:
6. Rate_of absorption in test holes in minutes per inch of drop in water level after
holes have been soaked for 24 hour:
70 Name, address and telephone of person who made soil absorption tests:
8. Name, address and telephone of person responsible for design of the eyeitem:
9. Est. bidpeni date: at. Completion Date:__ Est. Project Cost:
Date:
gna ure o • ner