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CARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Sp ring o Colorado 816
PERMIT# 1 (J4
System Lgoation BARKSDALE, CLIFFORD T.
Contractor cz.t7.t+1_ _
`.. Conetruotion aporovel for a I fltr gallon Septic tank
Aerated treatment unit
and absorption area computed art follows:
pg ,rate / inohe• in as minute° _ ft. of
pb +orcttoa wee oer bedroom. ( 3)
,j X a/n ea. feet 4;30 eo. feet minimum reautrement.
1 e leet / 'A' eY 9 sickrz ° €8L2r__ - - ------
Date,_„'—'' - 74r In`pector
2. Final aoorovat of nretem:
No *y°tern *hall be doomed to be In oompliance with the Sewage Disoosel
L ew' until the e*xernbled *yetem ie approved prior to covering any Dart
thereof.
E .-4 R" eeotic tank pleannut with as °eat _,_,_�_,
Ed t ; p[ Etlaf and e'ceprbly _,,._,,,,_
Ea Adeauete abeorotion area - ,
1;2 Ca i A*aua pgnorete Dover (dfY welt° onlyl __
,L:aveuauteigned _._ _ .
DateJ&c__R- 7S! , Ineoector, ,,,_,_
** Retain with Dewitt ►eoorde at oonetruction ette.
Lan' nt L. Kinkade, Sanitarian
. Co. Environmental Health
2014 Blake Avenue Tel. 945 -7255
Clietwood Springs, Colo. 81601
r
NOTItICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner: C 1 /7 DY.1 fi it 7-/ f L�2
Mail Address: 71 X 64 $ �j ei.2 City [ yC 71pY %>3 Phone94JryZjy
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_ cg y- City or town Cjaith._ eio4/
.corms 6 of Set . /7 )NSfr 7S.
Legal description' 1ft °P & fit "' Lot size
2. No. No. of bedrooms Septic tank capacity /,-7{7r, Aeration unit capacity
3. Source of domestic water: Public (name):
Private: Well D Depth 76 Other Depth of first ground water table
4. Is facility within boundaries of a city /town or sanitation district? A/!)
5. Distanbe to nearest sewer system: ryj /GLS —
Have you attempted to arrange a connection with the system? NO
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 T
7. Name, address, and telephone of person who made soil absorption tests:
5 e Pc77�» /T
8. Name, address, and telephone of person responsible for design of the system:
/a - 7 3 / �
Date S ignature 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 ogcur (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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