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GARFIELD COUNTY DEPARTMENT OF E 21NIMENTAL HEALTH s ',
2014 Blake Avenue`, 4••
Glenwood Springs. Colorad k0 ¢0l q . # Ob4
. PERMIT* 165f
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System Location 1 R. t; •• . •> _ _
Contractor oreoto-A.y'ae. _ it ,
Construction aporovel for a /APL'? grille Septic tank
Aerated treatment unit r
and absorotion area compttted'es follows:
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c rote / incha°eftadr minu te s_ , d.30 sq. it,.of —
ebnorptlon ate` yez b m
..? IE .a, 3o s0 . Aorta sa, i minimum reoutremest.
.w srw� --so
'X a 1 ..screlve oe''
• ' Date V" s-4'+ -74i :.Inspecto i / _
wr.,! ; ' l
?. final aootovet of system: ;
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No system shell be deemed to be in compliance with the Sewage Disposal t'
Law until the assembled Rye t.em is approved prior to covering any cart
I% thereof.
R" septic tank cleanout with car seal
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frocLtbyeaIst 1ln and n ..,..__.._____._.._... ' 1'
S J Adeauate absorption area _ —_____ �.
Adeuuete poncrete cover (dry wells onlvl
IT ' go •tgned .._____—
Ca ......-----
Date F- /H- 79 Inspector �% '°c •
•* Retain with permit records at construction site
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Lamont L. K e, Sanitarian 1 * ) •
G`rf. Co. En nmental'H
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/2014 Blake Avenue Tel. 945 925 4
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Glenwood Springs, Colo. /3i "'
NOTISICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE* ,
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner: Fie in le Re n
7.4
Mail Address: 6 A o R p/ City 6 d lip Phone 6c0c
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 (.AP P; p.. )p City or town i c /r Coin
Legal description $` A r P e,S Lot size $ 14 r Ip es
2. No. of bedrooms ,$ Septic tank capacity /0O r9 Aeration unit capacity
3. Source of domestic water: Public (name): tie, /f
Private: Well ' Depth Other Depth of first ground water table 70 P1-
4. Is facility within boundaries of a city /town or sanitation district? Me
5. Distance to nearest sewer system: N0Jl1E,
Have you attempted to arrange a connection with the system? A/6
If rejected, what was the reason? / STt9-fir.
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: z A it
8. Name, address, and telephone of person responsible for design of the system:
O rr 3/ / /973 ..2 , _ - I . de n __ ..
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 pollution of
waters of the State may odour (Art. 66 -28 -8 (5), CRS) and /or areas in which there is no
local septic tank ordinance.
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Please use the following space for directions to your property site.
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