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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Spring: Colorado 81601
PERMIT # 12111. ,
System Location C0G.6Uktfl £'9Y
Contractor not Gew.5unNc
1.. Construction approval for a / ,t.?So gallon *Septic tank
Aerated treatment unit
and absorption area computed as follows:
,Para rate / towhee in /S" minute° - ,J9e? °q. tt. of
absorptiott am per bedroom /4')
hl X /9C> 'e. feet 7 'O ec, feet minimum reoutrement.
j *wart /.T'X aO'nRY,.e.47ll. in/ rt/ 3.2/A/6,5 fs r,
Date /O --/8 - 3 inspector - a(•* ----
2. Final approval of system: l
No eyrtem *hell be donned to be in oompliance with the Sewage Disposal
Lew, until the assembled Ryntem i° eoproved prior to covering any Dart
� the e rr ' e � of.
i l R" septic: tank otennout with cos *eat
I x 1 Prober materials and annemb(y •�
1 jideauate abeorottpn area
I /`1 Adequate oanoreta opver (dry well* only)
I r Covenants • toned
z •
Date ///.307.3 Inspector �� /—z • -,�
4 * Retain with permit record* at conetructlon °ite.
Lamont L. Kinkade, Sanitarian A
rt
r
a'Ff. Co. Environmental Health F
2014 Blake Avenue Tel. 945 -7255
Glenwood Springs, Colo. 81601
NOTISICATION OF PROPOSED DISCHARGE TO WATERS OF. THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner: TA-(1 c b , a) / 1 f. ✓4 (9/1`/ /
Mail Address: P 6. go r / Ob City NtudvG7r +. �/o Phone 994 7y.
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 (�AiPfy�A/ City or town // -
Legal description S' 7 ° 7...1._ ` /7 Lot size i /
2. No. of bedrooms 2/ Septic tank capacity Aeration unit capacity_
3. Source of domestic water: Public (name):
/e'; c" 7a9/Y)) .
Private: Well Depth JO Other Depth of first ground water table
4. Is facility within boundaries of a city /town or sanitation district?
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:
/0- /7- 1 73 e. J _.4 ' o
Date Sig f tore of 0 er
* 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.
A
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