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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2114 Blake Avenue
Glenwood Soringg, Colorado 8t6')t
PERMIT* 174 I
System Lt+cation 7 39r ,23CL,L
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Con ( Sumt9 I}cres)
vaotor �4'ZIG�/°f 5
1. Con*truotion approval for a /rcx7 gallon Septio tank
Aerated treatment unit
and ab*orotton area computed a* follow *:
Pero rate / tncbe' in /n minutes -/e s' ea. ft. of
pbeorotton *tea per bedroom. es)
3 X, /or ea. feet 9.5" *a. feet minimum recutrement.
I e Page at /e3 -'X /(' X /a
Date /3. -.z 9- 7 3 Inspector */
a
Final aaorovai of * y tem.
No *yetew *hall be dammed to be in compliance with the Sewage Disoral
Lew° until the ereembled *yetem is approved prior to covering any Dart
thereof.
M 1 R• genic tank cleawut with oaf *eat
le:1 Proper material and e*setbly
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( Adeouete concrete oovgr Pry well,! only)
(('`` ertaute eigned
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Date 3 // 2/7 I V In*peotor ,,� �%�
** Retain: with penult record* at cone/ruction *ire.
re- 1 " - pLORADO DEPARTMENT OF HEALTH
titer Pollution Control Division
"421Q East 11th Avenue
Denver, Colorado 80220
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner: at :' /
Mall Addre s �i/ e �a City Zip Phone__ _
A. INFORMATION REGARDING PROJ•• - EMITTED FOR REVIEW:
At *.ac.h 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: Count " City or town_
Legal description___ L or t Lot size •
2. No of bedrooms _Septic tank capacity /SOD Aeration unit capacity___,___
3. Source of domestic water: Public (name): 4 - 4 „„ y _______
Private: Well Depth __0_r—_ Depth. to first ground water table
4. Is facility within boundaries of a city /town or sanitation district ?.rL,
5. Distance to nearest sewer system: /
Have you attempted to arrange a connection with the system? ry",
If rejected, what was the reason? ,Z;,-47-r9- rc/ /r —
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
See ar: /2 t�/� —
7. Name, address, and telephone of person who made soil absorption tests: _
S c c= paean 7
8. Name, address, and telephone of person responsible for design of the system"
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S S t 1•f Owl
%•RequlreJ by Article 66- 28- 12(CRS, 1963, i96 %-rm. Sum. Supp.)
* *Required in areas which have been identified as areas in whic danger of pollution
of waters of the State may occur (Art. 66-28-8(0, .CRS) and /or areas in which thdre, a
is no local septic tank ordinance. d K
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D. 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 Approval Disapproval
—.w
Signature for Local hoaIth Deparzn" snt
—i —�— Signature for City /Tarn (f ic;al T It17
— _ Signature for County Official (Title)
Cumments
•
I } ^ `i ce
Signature and Title
Note: The Noticler (front of this sheet) must obtain comments ano 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(10 -72 -2) •