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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Brake Avenue
Glenwood Springs, Colorado 111601
PERMIT 0__89 __ GJJ ocs
system Ipoetton o t areea C . ,BsAsh TLdZ - -
Contractor vNa.
1... Construction aporovet for a zann g allon a Septic tank
Aerated treatment unit
and absorption area computed, as fellows:
7.{+p rate / *inches in /0 mince : €G&.r sq. ft, of
eb.Qrntoq area per bedroote.e )
g,? X MS aa. test- c'3Q_ Fq. feetptinimum revptrement.
Lyoae•t /a ,t ao'X 3/. blewr/9*e-Berw
Date_ 7-.0 7- Inspector
2. Final a l of system:
PPr+ y
No *rites shall be deemed to be in compliance with the Sewage Disposal
Laws until the assembled system 1" approved prior to covering any part
thereof.
r aq '''''] R" Renttp mtUC1�teanOu lYtiIl.ii1 iti
r a2 PropetraatarialA and assembly
lyl Ademiate ab _w.,,_
Adeoupt. a gjt g e (dry well ono, L , ,
#4 • • na et.aed _
1 -1 << .4 ,27 can '°n•G ? /✓� �.vspn L e?7
Dote l .0- 2 3 - 73 inspector • c ���
**Retain with permit moord' at construction site.
LamOn: L. 1\3111c.dUC, oala Lanai,
fl4r Co. Environmental Health n
-ton Avenue Tel. 945 -7255 p4 ti
G. nwood Springs, Colo. 81601
NOTISICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
/ I INDIVIDUAL HOME
f SEWAGE TREATMENT SYSTEM **
Owner: N/ i' ( 1 12wt C T1,1,1 k.4
Mail Address: Ger�I Dell C ity 'gyp 7ipii Phoney :as ))3:2
A. INFORMATION REGARDING PROJECT SUBMITTEb8 Qe/� 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 G City or town Ca 40n4di Q.-
Legal description Id- (3 Rock (ree S.. bdl l ✓S5 Lot size 5 acres
7! 2. No. of bedrooms , Septic tank capacity Aeration unit capacity
3. Source of domestic water: Public (name):
Private: Well Depth OtherS4 1 Depth of first ground water table
4. Is facility within boundaries of a city /town or sanitation district?
5. Distance to nearest sewer system: 1 mi le ( Car bnryAale)
Have you attempted to arrange a connection with the system?
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:
8. Name, address, and telephone of person responsible for design of the system:
7- x' — A C L- �.-
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 oticur (Art. 66 -28 -8 (5), CRS) and /or areas in which there is no
local septic tank ordinance.