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'.DEPARTMENT OF ENVIRONMENTAL HEALTH
AND POLLUTION CONTROL
Garfield County
OFFICIAL NOTICE
DATE �J
TO .."7.10ra.teCet' , .^Yt�C /.CL-e.G �l.0 /i' �r�C�a ite76-.
ADDR ESS $.4" 4 p
LOCATION _ 4/0,-2 0",e
YOUR ATTENTION IS CALLED TO THE EXISTINGISVIOLATION(S) FOR WHICH YOU ARE
RESPONSIBLE ^'G 49-141-‘-'1-'.
9-141-• -4t.eee-"st,G'_�
YOU ARE HEREBY NOTIFIED TO ABATE THE SAME BY 073_0 19 74
(Legal service shall include posting of this notice in a conspicuous place). This office muss be notified
by letter or phone, as soon as compliance has been effected. If at the expiration of this time the same
remains unabated, such action will be taken as the Law requires.
i/.1 y
DATE DAT Apex_
SANITARIAN IJER &OCCUPANT
POSTED AT
COLORADO DEPARTMENT OF HEALTH
•iy Water Pollution Control Division
1210 East 11th Avenue
Denver, Colorado 80220
Owner:
>Yc /rte
pa,at 2 .0/‘
13�ct4 -
t -z9-74
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIV DUA/ HOME SEWAGE TREATMENT SWEM**
g' ) Y ee)
City I .- Zip Phone
Mall Address:
A.
�y3
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 .rof les In test holes.
.00'i �. // City or town
iv/ if
Location of facility: Count
Legal description ;Nei
2. No. of bedrooms
Lot size
X 0‘7° r'
Septic tank capacity _Aeration unit ca aclt
3. Source of domestic water: Public (name):
Private: Well Depth Other Depth to first ground water tabl
4. Is facility within boundaries of a city/town or sa j tation district?
5. Distance to nearest sewer system:
Have you attempted to arrange a connection with the system? 9a/
-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:
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 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:
Date
Comments:.
Approval Disapproval
Signature for Local Health Department
Signature for City/Town Official 1Tit10
Signature for County Official !T:c!e)
Signature and Title
Note: The Notifier (front of this sheet) must obtain commonts and signature of at
least one of the above.
C, FOLLOWING FOR STATE HEALTH DEPARTMENT USE: Recommendations of the District Engineer:
D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
WP- 33 ( D- 72-2)