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GATITIELD C.:011N TV DEPARTMENT I. )1ENVIRLAIMENTAL HEA1.11.4
2 114 Blake Avenue
Glenwood Soringo, GuItorado 816 11
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PERMIT* 004
/4,416tion Ahlswede, Juanel M on the CMC road
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' PARCEL No. 3: A tract of land situated in Lot 8 of Section 1,
et. 7 S'., R. 89 W, of the :6th .0.14, ;Garfield County; Colora4O44
',.lying Westerly':bi- the Easterl'yline 'of said Section 1 descr4b '''.
. w lizarr.
as follows: .i;DeOinning at a. pOint. on the Easterly line of
.':'..Sectioli 12whOcit...411 iron pin:**th.a:.13Fass cap marked for the
Quarter Porniit'Of'..said SectiO10bears S. 00°15' W. 30.00 ke'L
thence.N.$8.°151,14. 177.21140*; thence N. 000441361 E. 973.-.,,..,_
feet; thenOe4;:.87°p8! E. .10919 ..feet to . a point on the EaseeM_
line of-sa$4,„f0t#1.0ri ;; ti*o.c.03;ks 0 :%;to f 15 !... W. 970.59 feet along
the Easterilxlinkt'''ed .14ed.d:Sec on, A. ! to the Point of , beginning,
w ,
containing.:.p40/f,skres# FacivP:Rz%0 0
?ogether idith permarient easenlent 25 feet in width for ingress
end egress;t000:007e,deSck' 4i4g0t.:.0f.land.4r0 Colorado Stat
:HilthWa$,E*01,:..8.2to .andthrdtigh. 0'.44$01.64.n9 parcel Of land on the
...,04.,,.,
West; the. ''''',,:a.::'4:t....,ftiiii.olv..'i* vested,‘,.0 :00-06.01tne cpoen...
JC, COLORADO DEPARTMENT OF HEALTH
• .Water Pollution Control Division
e4210 East lith Avenue
Denver, Colorado 80220
Owner:
PA (D -7 5 . o D
2—yro-74
C
Bc.e i L Dr i) er,
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM**
It; . t
Mail Address vira5 Cl ty4;;gc ) 1 p tS/l D/Phone ?3 — %D(
9r 6>� z
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 welts,
soil percolation test holes, soil profiles In test holes.
1. Location of facility: County A - 4e /6 City or town
Legal description , et--
Lot size _=..:3)*Z,7 ?`"
2. No. of bedrooms Septic tank capacity ,eration unit capacity
3. Source of domestic water: Public (name):
Private: We112( Depth Other Depth to first ground water table
4. Is facility within boundaries of a city/town or sanitation district? ,f/a
5. Distance. to nearest sewer system: /14, ./;fr..5
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
541-Zgs pwj2 / 7
7. Name, address, and telephone of person who made soil absorption tests:
t5 F &�T�'!7 / 7-
8.
8. Name, address, and telephone of person responsible for design of the system:___
/i;Geit'
sSi nature of Owner
Date 9
5 rr�'7- T/T
`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 notification
described on the front of this sheet and recommend approval or disapproval of
the discharge as shown below:
Gate
Comments:
Approval Disapproval
Signature for Local Health Department
Signature for City/Town Official Title
Signature for County Official TTitleT
Signature and Title
Note: The Notifier (front of this sheet) must obtain comments and signature of at
least one of the above.
C. FOLLOWING FOR STATE HEALTH DEPARTMENT USE: Recommendations of the District Engineer:
U. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
WP -33(10-72-2)