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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH O13 t 1'1A'VK.t31Dtt1r`
2114 Blake Avenue fcto.i0 3 r UF '
Glenwood Springs. Colorado a16n1
PERMIT* 17.14 4
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System Lpoatton Llie tA_ 0 t4-ak_' 5
Contractor 1 ,561 /pryO 4twVs T2G/GT/ OA/
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Conetruotion approval for a ,eooO gallon Septic: tank
Aerated treatment unit
and abiorotion area computed at follows:
Derr. tote / Maher to 6o minute 33e-t so. ft. of
tutomtiontea Der bedroom/eV) _
.-3 .12 ea. feet // a -O en, feet minimum reuutrement.
Date Inap.:ctoe.___ a
'>., F" ta c it aootoval of °y °tern:
Na '"y^tem *bail be dunned to be in compliance with the Sewage L)iscDeal
Lawc until the a °aentbled cyatem 1a approved prior to covering any part
thereof.
{ 4_. .._."_ "_°!? .tits gleanout with an teat
i.,vL�.. ►'t+tR�}- .]181.1eLfstalifirtemblY
L_.. _htgtiatit.dkerption area
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Inooector
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GARFIELD COUNTY
ENVIRONMENTAL HEALTH
GLENWOOD SPRINGS, COLORADO 81601
2014 BLAKE AVENUE PHONE 945-7255
SEPTIC SYSTEM
(WO t ab ,.
C ec & 1m 0 <6
W. C. Milner, Building Off cial
- .COLORADO DEPARTMENT OF HEALTH Lamont Kinkade, Sanitarian
1 Water Pollution Control Division Garf. Co. Environmental Health
4210 East 1lth Avenue 2014 Blake Avenue Tel. 945 -7255
Denver, Colorado 80220 Glenwood, Springs, Colo. 81601
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE "STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM * *.
Owner: 7ACK i f N 1V 1 W G ( S/ Th're/4W17 t,vr)
M a l l Address: t A.e N woo D Yft6. 1 t co /O 21p F /GO /Phone yqr- O.//
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 wells,
soil percolation test holes, soil profiles in test holes.
1. Location of facility: County ‘,Q4'f /E!/7 City or town 04 ire /?9EADrIA's
Legal description Le 7 - y lei), 2-- Lot size -2 . //S ,1 C4'gs
2. No. of bedrooms 3 Septic t r_^_^ _ Aeration unit capacity /oo,p
3. Source of domestic water: Public (name): tu ./e/Z / C _ _
Private: Well Depth Other Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? /y b
5. Distance to nearest sewer system: _
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
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:
/7 -- -- 7 (utr Aeo rtr7 A
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 dang, of pollution.
of waters of the State may occur (Art. 66- 28-8(5), CRS) and /or area; "� which there
Is no local septic tank ordinance.
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d
B. SIGNATURES OF LOCAI. 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
•
Signature for Local Health Department
Signature for City /Town Official (Title)
Signature for County Official (Title)
Comments:
Signature and Title
Mote: The 4Jetlfier (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:
D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
WP- 33(10 -72 -2)