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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL FIEALTti
2119 Blake Avenue
Glenwood Sorings, Colorado 816•11
PERMIT* 172
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Syctetr. Iocation
Contract r S `z ., 2. YcN
Gonetruotton approval for 750 gallon Septic tank
=site Aerated treatmc unit
s' seines
and abcorotion area computed an follows;
Pgrc rote / __.. lrphee to 26 inutee- 230 .2tq. ft. gf
pbCoratton aLea net bedroom. b2f'I`trlrtWt
G ._ 3D ^q. feet 1,3 An eq. feet minimumreautrement.
Date_ L 4 - _._ w.. .__.,.tnt pc. etar...._ ±, Ir-0
di, Etnal aootuvat Gf °yctem:
Nti syrteta chat, be clamed to be in compliance with the Sewage DDnx rat
Lew* unto the ac aentt led ayetem is achieved prior to covering any nett
there.), .
Auks learwuf with aim-eat
[MA ss taenautC
Date .TAAZ _._._ In4aeetor
•• Retatt: with vett&It tectudc et cenctruction cite. C!. 1<
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, COLORADO DEPARTMENT OF HEALTH
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• Water Pollution Control Division
1 :210 East. 11th Avenue
Denver, Colorado 80220
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NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner: _ i . , _.:a4 : 'A er Mal l Address: 42,r 7 /a- CI ty g/P?Si4Gr Zlp F go-/ Phone9j79S r
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,
soil percolation test holes, soil profiles in test holes.
1. Location of facility: County(-y City or town
Legal description Lot size .4p . ••a,a
2. No. of bedrooms I
! Septic tank capacity Aeration unit capacity
' 3. Source of domestic water: Public (name):
Private: Well Depth Other /Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? /VTR
5 . Distance to nearest sewer system: / / 7 /,9 / C c .S
Have you attempted to arrange a connection with the system? /ve5
• 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
7. Name, address, and telephone of person who made soil absorption tests:
S,c P'. eim/7`
8. Name, address, and telephone of person responsible for design of the syste..•
— de /
/
Date s7 a .Irk � , e
*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.
B. SIGNATURES OF LOCAL OFFICIALS: The undersigned have reviewed the notliica ion
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 TftTe)
Signature for County Official (Titles
Comments:
•
Signature and Title
Note: The Notlfie.r (front of this sheet) must obtain ccmments and signature of at
least one of the above.
C, FOLLOWING FOR STATE HEALTH DEPARTMENT USE: Recommendations of the District Engineer:
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D. ACTION 2Y THE COLORADO WATER POLLUTION CONTROL COMMISSION:
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WP 33(10 -72 -2) •