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Property transferred to Burt Stokes and Gary Case
r Itrleigat Box 322 - Silt, Colorado (11-7-75)
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- !rater eo11ution ..ontrol Division
h?I0 1,ast 11th. %venue
Denver, Jolorado 50220 p Q—" y-)
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Applicant (Owner): ' ., t e qBR °lte tAi T
Nail Address; yyti , On Lie y & Cltys� ig,� r.i� c, n'onez C t
A. I'. URMAf10iJ REGARDING lit(1JLCT SJ 1.11rreo FOR RS'J ':
Atta-h e;,Mr.. • 4 .I set. m• re rt s!,owi rig cn re area with -aspect to surround..
in,; areas, topodral.hy oi area, nab' table .11dings, location r,1 1� • table water
wells, soil percolation ter:t holes, soil �roVilea In test holes.
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2. Location of 'r'acilit; : County L a /
J . ,City or Town s j , (. y N
c Legal Description Nk 7 4i Nl- j ' * Lot size: /O, .7 S () cibei
&rc'yro,. .:ii -, -1u. Ss k 9 :. :. m,
". TA. of area and facility - Nuz .r of persons served: ,
Subdivision Motel_ Restaurant Trailer Court
- ne r, i >vese �lsaitw�t , a m Fa (S (yl,(
i) reCQ ) ( -
3. Source of domestic water eublic (name);
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Private: Well //1
_pth Other Depth to first ground water table
ellIMININI
4. Is facility within b. ndariea of City Sanitation Districts 47m
- It so names
5. Distance to nearee sewer systems (L,n JAl�
have negotiations bee° , „. aer , i cona,frT A..e
—
If rejected, gi reason ;_
1(6. Rate of absorption in teat holes in minutes per„ Inc of drop - i • n water level after
holes have been soaked for PL hnurss &Od , ea iii
k - 7. Name, address c tclephor,e of parson who made soil absorption testa:
Wi
B. e, address and to).oph(,ne >f person res,.on.3ibit, for estgn of the systems
9. Let. bid ope•aing dates Bt. ' i et Est. rroject Cott:
Dater 4 - 73
• /> : n ire o : ner
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Fees Paid $�sj°'°
INDIVIDUAL SEWAGE DISPOSAL SYSTEMS APPLICATION lQ
Date t4,. _
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM
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Owner: ]3ccl Y�, � /4 ..22 -4-1/L Q Q,) . �n
Mail Address: �-� /// City: co- C t Zip: my? Phone:
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 percola-
tion test holes, soil profiles in test holes.
1. Location of facility: County 6 cur-F;dcf City or Town S,• /r Meso
Legal Description NF$241A ui /4c Lot Size /h, A
2. No. of Bedrooms Li Septic Tank Capacity j 1,s b Aeration Unit Capacity
3. Source of Domestic Water: Public (name):
Private: Well t./ Depth 0.. Other Depth to first ground water table i mat
4. Is facility within boundaries of a city /town or sanitation district? 4.
5. Distance to nearest sewer system: J /z rnA
Have you attempted to arrange a connection with the system? „u1
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:
9. Express permission is hereby granted for the inspection of the above property by any
member of the Garfield County Environmental Health Department and /or such persons as
they may designate. Any withdrawal of this permission shall be in writing and receipt
acknowledged by the County Environmental Health Department.
10. I have been given an opportunity to read the Individual Disposal Systems Regulations of
Garfield County and I hereby agree to comply with all terms, conditions and requirements
included therein.
_ _� 3 / / 9 b . � -
ate Signature of Applicant
(TO BE RETURNED TO HEALTH DEPT.)
-dr PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY
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INDICATE BELOW THE LOCATION OF YOUR BUILDINGS, WATER SUPPLY AND DISTRI- .
BUTION LINES, STREAMS, IRRIGATION DITCHES, ROADWAYS, AND BOUNDARY LINES
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(TO BE RETURNED TO HEALTH DEPT.1I