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"Lamont L. Kinkade, Sanitarian �/
✓ Garf. Co. Environmental Health //Y//) 7
2014 Blake Avenue Tel. 945 -7255
Glenwood Springs, Colo. 81601
NOTI : tICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner: /Aim" O. J o /wsa
Mail Address: / /OSijZ -fg4e f? CityK,cww�C. s. ,�r Zip Phone FH��'4
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW: grt! -° ` /
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 6: .act City or town 7-4- 1/4/
.Lei I/ of sn 4 7owns4 G $e,476 An. z 9/ wat7
Legal description 6 pr/ Lot size /3 76 A.
2. No. of bedrooms 3 Septic tank capacity 4000 ya k Aeration unit capacity
3. Source of domestic water: Public (name): w'- //
Private: Well )( Depth Other Depth of first ground water table
4. Is facility within boundaries of a city /town or sanitation district? it/?J
5. Distance to nearest sewer system: a /-r: /�-s
Have you attempted to arrange a connection with the system? ,t/O
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 a? S•• s yj (-144
7. Name, address, and telephone of person who made soil absorption tests:
944 -.vg 5" C m K.ert.Q
8. Name, address, and telephone of person responsible for design of the system:
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E. 0 av a-o - l S - _ O
Y. -t 73
Date Sifature 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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Ditch Is Walters Enlargement of a
' a *Ke( Thompkins Ditch also known as The
.0 + west 4 CM• Roseman DI tch 4 En I orpiment. x ACA''
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This Is to certify that on the 5th day of Apr(I, 1973, there was a
survey made under my supervision of the Improvements on a parcel of
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■ s ` , land sFtuated In Lot 4 of Section 4, Township 6 South, Range 91 West +-.
of the Sixth Principal Meridian, County of Garfield, State of Colo+
- I i, redo. The house, septic tank, leach field, and other Improvements �
f , to be Constructed ere loped within the boundary lines of the Jar- .".n �.
csI as shown on this plat. The location and dimensions of all IIe1Fa�tr 4 Try
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$i N "I nts ono rights -of -ways In evidence or known ' Jilt
I, OnCfp00100011. by . or 6406 papilswis ere accurate 1 y showlls
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GARFIELI) COUNTY 1,NVIROUIENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER doMkR e, °I' 404CIA A. reh4 so,v PHONE 915- c 9R
BAILING ADDRESS 1/0 8 RA /Ma sT 4 /•-Nw .94n "1s .. /0
LEGAL DESCRIPTION OF PROPERTY J i Lr
LOCATION OF TEST HOLES /� /J n ,z."C
"is
Three (3) test holes recuired per system
Test Hole Depths (24" nininun) - - -- 2 7' 3/, Sd N 3o. D
Diameter of Test Holes /�. '*
a
Water Remaining after 24 Hour Soak ,!/O,/.C. 4/04/AC .441 .4
TEST HOLE #1 7 '2 5 -
TEST HOLE 1+�2 7,' 2 S 1 - -_ TEST H�Ef 03 7 2 _S
Drop Time DE92 Time I Drop 4 Time
/. tin n - — 7.3 Z _ - 1. .O - 7.8$
:4S
1. Cl --- .2$ __ _ - - .'.S5 — 25 - sus
z5 8: 45 l - _ - 0;25 - 2SJ _ E' 24 --
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Percolation Rate Each Hole 3 O 3 0 .27
Average Rate az 9
I{ ! / < .,
NAIL OF RESPOtNSIBLE PARTY RUNNING TEST A / SC//, -,'y ,F_..SG/Z PHONE 910 $3 //
DATE _. 7/93