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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Sorngs s Colorado 816'1!
PERMIT* 1112 1l
Sys Location 4.eSC.te .o. . n c.P.son/
Contractor evonveri `tom
'. Canttruotion aporovat for e / Core2 _gallon tank
Aerated treatment unit
and absorotton area computed as follows:
berc tete / inohe• in S mtnuae_- ,[mss su. ft. of „ „�_,.
pbparotton area per bedrooml3)
Al X /s S ca. feat ' `,376" ea teet mjntmum reoutrement.
1 euaa$et /vim X 3} X 7 i Self i'ee Age* yam' �.
bate // /q" ;3 IntpectarM_
?, Final approval of system:
No system shall be darned to be in compliance with the Sewage Disposal
Lae until the eesembled system it aoproved prior to covering any Part
thereof.
17 ,1- q" aentte tapk olearout with (atr sal
1 � 1 ' .. ` . ' v1' ' f'rOet ili terSblo IInd a4Aembiv —_
�1 A denua to nbevatiQri area w ��...__�._—
[Lk al Meouai& owtcrete cover fdry well° ortly)
al - goveuaute aired _
Date /-7._---1? "Z,'1 Lnrpector
**Retain with peumit recwrde at eonrtruction cite. c K
4 nont L. Kinkade, Sanitarian
/Garf. Co. Environmental Health
201A Blake Avenue Tel. 945 -7255
Glenwood Springs, Colo. 81601
NOTItICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
II HOME SEWAGE TREATMENT SYSTEM **
Owner: /� !Y 6 *
Mail Address: 9."4 / City . ./7 71p J //c C2 Phone 8111-295:7
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 c , City or town '!/
.Gait 3 -4 /-Ey Swdy 4'1V4 - s y swi ivw y -
Legal descriptionSE44'14 Sn!.v nv,..e - !frA 92W- /rweALot size /7,7
2. No. of bedrooms . Septic tank capacity Yea' Aeration unit capacity Je O
3. Source of domestic water: Public (name):
Private: Well X Depth /0,4 Other Depth of first ground water table
yg/
4. Is facility within boundaries of a city /town or sanitation district?
•
5. Distance to nearest sewer system: ,,.°1%. Ail/Er
Have you attempted to arrange a connection with the system? NO
If rejected, what was the reason? p/Sri9'/r F
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 Sea os&zmir
7. Name, address, and telephone of person who made soil absorption
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.
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