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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
21l4 Slake Avenue
Glenwood Spring Colorado 8169t
PERMIT+* 17 6'1 -
y , ,, System Location y47/7 /l /, . iii9Y >e
Contraotpr Ct /it%E.‹.
? •. Conetruotlon approval for a //yGy/) gallon ptio tank
Aerated treatment unit
and abrorotton area computed as follows:
Pere rate / inches in /0 minute*- /6S5 4 a. ft. of
ab4orotton alma per bedroom.0
/0.t ea. feet r °a, feet minimum reautrement.
I tuaaeet /-a X 9$" XS
Date /-- </-7 / fn'pectar
?. Final approval of rystem:
No ° ystem *haft be dented to be in compliance with the Sewage Disposal
Lowe until the a'sembled /system i* approved prior to oovering any Dart
thereof.
L . R' gentle tank cieapout with cep real
� _�J.._..
rio Per nrateri *t/s and a 4 4jniji1y
LMeoliaj ..eb=orot;on "tea
/V'
: ' J C:oveuauta e tgned
inspector
•* Retain with ueimtt ieoordr at oonetruotion Cite.
A
OLORADO DEPARTMENT OF HEALTH
Water Pollution Control Division
4210 East 11th Avenue ,
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM ** •
Owner: sin hv, W. 5c< v et / 1
t
Mail Address: /?. / /3 's /0 7 City RsFle Zip 8' /$ Phone lv2S- /5.x.3
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding i1l
areas, topography of area, habitable buildings, location of potable water wells, +'w4_
sell percolation test holes, soil profiles in test holes.
1. Location of fac1Ilty: County Ca,r6 /ek/ • City or town /QVra"
9
/�
�� SEA 6 ��� T p
Legal description .$'/ �5 $ PC, JAS � ply. Lot size CO ctay.a.
2. No. of bedrooms R. Septic tank capacity eratlon unit capacity r----- 9,�' ',
Is' 3. Source of domestic water: Public (name): _ - 11 I
Private: Well )( Depth /ether.. - Depth to first ground water table_ 4'__.. I'
4. Is facility within boundaries of a city /town or sanitation district? _11,‘,0 °r .
7� q
5. Distance to nearest sewer system: 9rn lles _. -..; d °, I
Have you attempted to arrange a connection with the system? L' ,ii
" ^, ri
If rejected, what was the reason? p'.
} "
6. Rate of absorption in test holes shown on the location map, in minutes per inch 1, 4 1 µ11l '
i of drop in Clp
water level after holes have been soaked for 24 hours 'I1
1 r l 'ia
7. Name, address, and telephone of person who made soil absorption tests: 1 1 1 f"
1
ne of person responsible for design of the system: +'
8. Name, address, and telephone p p
,7o I1r 10. Scc I, . e fit / b 1
I , - i
1 u'
An, 2 % //977 �,ar
Date '" Signature of Own' 9 1
*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 i i0
Is no local septic tank ordinance. 'Ili?"'
It i i i# ii +u :'
•
B. SIGNATURES OF LOCAL OFFICIALS: The underslgned 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
Slgnature for Local Health Department
1 2/ the ari i , • _ii r /O.
Slgnature or City Town 0 fici- f " e
Signature for County Official (Title)
Comments:
Signature and Title •
Note: The Not( (front of this sheet) 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:
•
•
•
WP-33(10 -72 -2)
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