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GARFIELD CUJNIT DEPA.Rr4.'4'r OF E'.WiR3;• )'NTAL fft<H
20/4 Blake Avenue
Glenwood Springs, Colorado 81.601
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Flan& and location are hereby approved.
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Final approval of 2r3om.:
!`10 system shall be deemed to k in c; nrtp].:..'e.,ct's th the Sewage
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r-* Retain with permit records at cAcrratru tl.on s1tte.
4
GARFIELD COUNTY ErJ TTORNT ENTiL HEALTH
201.4 BLAKE AVENUE
GLEI+iWOOD aPRITJGS s COLORADO
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
RECEIPT # ILL
OWN : 1 0 i s ADDRESS: PFIONIJ :
-__ll. r� rs 26y
CONTRACTOR: S G t. ADDRESS: PHONE:
SITE LOCATION:
R ' 1.121V—•.,NO. OF BEDROO S : SIZE OF LOT: g 72,6_11264_
Ac�p
Application for an individual, sewage disposal permit is hereby submitted. The
individual, sewage disposal system will, be constructed in accordance with the
regulations concerning individualsewage disposal systems within Garfield County.
This application is valid for six (6) months from date signed.
DATE:
SIGNATURE:
Perculation test results:
Minutes per. inch:
Recommended minimum size of leaching system„, . s
Recommended minimum size of tank:
DATE:
a
1'tcT PL H
SANITARIAN:
GARFIELD CCUUTY EUVIROM•EUTAL HEALTH
Field Test Data Sheet on Percolation test
PROPERTY OWNER
MAILING ADDRESS
PHONE -2 e g- ? L 41 y
DESCRIPTION OF PROPERTY,_.
L OCAT3.L OF TEST HOLES,_,
Two (2) tem—'les required per syEt.tn
Test Hole Depths ---
Diameter of test holes, .'tiggest 1.
Water Re; 41 ini ng after 24 hour .o 9i
Soil indicated adequate soaking
4' Minimum
Yes
R8t&Pgieg ed
No
-----
TEST HOLE IF:TEST
HOLE #2
Drop
Time t'i utes
D_D_�
1 in.
Time
Min.
2 in.
2 in.
33 irk.
3 in.
f4in.
4in.
5 in.
_
5 in.
1 6 in.
6 inr
1 7 in.
7 in.
8 in.
8 in.
gin.
gin.
10 in.
10 in.
11 in.
-
11 in.
112 in.
12 in.
Percolation Rate Average East Hole
Average Combined Rate ..�
Soil Description -
pi 1/4 /
Comments - ( Wells, Strep is , Water Table, Terrain etc. )
NAME OF PARTY RUMP• IUJ TEST PHONE
SIGNATURE
DATE