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Home My WebLink About00091A III t,AR'1 :41 ) <;,%f'tt1N";'Y t)El'f+Ier E ` TO ENv'1'f'.rtiMi:Nlidt Iti,t.,'V 2014 i l ke Avenue C41erwnud Sprtig', Coto,bcL., r L , li j'ERbitt 4 . 91A c; . Fretn Lp'Cirtitatt 7,L.fie.r.1,Z..c ,. b.K�..„,.....,..... »___.. .. ..,. ai , ,,antra ctat 1 (.,,. rlS :ninttrn aqu,f,rval iur a: gryitc " t - 1 ntit tan ‘ : to ,t no if °I'; a di buartatiarx eat C!&irsnuted as (taltuwa: f ! lrtt _..,.!_.....___1ric arts to ' triarts:.s1.4?,‘ — ``' .a.. t:. _I . . IL rtaktri2testila 1.41111.0...21. t t)tt9: °n 4 . J_2.3 ''x . ,... . _..5 teEtt O ......9., tertt tr}rrrurr 10$,.' . _ t)bleci:..e7.. ____ IrI,itpectot_. ./ _ .... i >„ hue! aupp. of system: , 1:i'. system t3 hall be deCtsed Lc. be in cc.nipktan( :e with the Sew.'gc i -f ' ',. + " I Laws until the anrernbled nysteti is aponivt'tl pr ct 1.; t,vves :.9 on; f)i.f1 •I tti(3rec�f f ' ' i .. 8 '' 1.? . op k. U1eamgu.1. t.*1t,„ i,,,ga ig;Si .._ — ... _. ._. A _upi iwatert 1� irx , _._..� _.._.i..,..�s?H a r. s .,USX. a . ....l_, .c eeouair.,absor.t..3n erred. .,,.._.._.._..__....._.,._.... . _ .._. . - .... . NA I c19, td" to oprwre.tr. t ovgt cit well! only) _ . , Nf1 l w t r>v name sisats:G ..._._ ii, 7 Crvv -y`e' :.vvsi ev a err— i ;4) re ::- g . „,....„.,_, 1 4,1riS OtC trfln . Sa , tr. .1. " "rite i6ilk Wt t}: PE: tit i1: rt "C,c.t, aLI: :,(d'.;til'r;tt " ; sj it ft .. — �wMaV� ' . "uM' '1�Yh wdi. Wdu ui m Yan ,: . a . xie. �v a..'..I . ,.E{YYU.� n•w. :.n...�, a ��•� IP / /D 7- /9 -7 COLORAARTMENT OF HEALTH Water Pollution Control Division 4210 East 11th Avenue Denver, Colorado 80220 Pos r /9 r s /r6 APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS Applicant (Owner): O.RC Ad l ('p/S e Mall Address: 0 ) C4ff3Qr0✓.9 4F. City: CQ/n Phone: fi; 3 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, soli percolation test holes, soil profities in test holes. 1. Location of Facility: County 2?7 City or Town Aj Legal Description SA$7/ (((/// , Lot Size: , 2. Type of area and facility - Number of persons served: Subdivision Motel Restaurant Trailer Court Other: 14,z40f. ( 3. Source of domestic water: Public (name): /its /. Private: Well / _ Depth to first ground water table ' 4. Is facility within boundaries of City or Sanitation District: Wei If so name: 5. Distance to nearest sewer system: 7 az= Have negotiations been attempted with owner to connect: If rejected, give reason: 6. Rate of absorption In test holes 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. Est. bid n opening date: n _ Est. Completion Date: Est. Protect Cost: ) --CA Date: 1/A o I % 1973 . - &,,, -�-a- gnature of Owner w B. SIGNATURES FOR LOCAL GOVERNMENT OFFICIALS: The undersigned have reviewed the proposal for the location of the above- described septic tank system and RECOMMEND APPROVAL or DISAPPROVAL in the space provided below: DATE APPROVAL DISAPPROVAL / -/ / -/ Signature for Local Health Department Signature for Mayor or City Manager Signature for County Commissioners Comments: _ Signature and Title Note: The applicant must obtain the 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 - (Rev. 5 -70 -100) . ,% /D 7 -/9 7. ' COLORAI 'DEPARTMENT OF HEALTH Water Pollution Control Division 4210 East llth Avenue Denver, Colorado 80220 °lMS- 7. SS APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS Applicant (Owner): 9 /yc_c - tr. :,Q /L.t : ,�_, Mail Address: l ,'n n'Ldre_QQ City: C- Phone: 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 / n �� City or Town Legal Des criptIo ? /of -/Q /x7.8/9 sec , 9/ Lot Size: /Q/a,04 /5) 46 I e 1 C 3 a - 7 -87 2. Type of area and facility - Number of persons served: Subdivision Motel Restaurant Trailer Court Other: ' - , 3. Source of domestic water: Public (name): Private: Well Depth 6SOther Depth to first ground water table L,ld.t 4. Is facility within boundaries of City or Sanitation District: `n.0 If so name: 5. Distance to nearest sewer system: `7 J yy Have negotiations been attempted with owner to connect: If rejected, give reason: 6. Rate of absorption in test holes 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 aqd telephone of person responsible for design of the system: 9. Est. bid opening date: I( Est. Completion Date: Est. Project Cost: Date: \IA I9� / % 7 l Qir cii !L 0 nature of Owner Air B. SIGNATURES FOR LOCAL GOVERNMENT OFFICIALS: The undersigned have revie*ed the proposal for the location of the above- described septic tank system and RECOMMEND APPROVAL or DISAPPROVAL in the space provided below: DATE APPROVAL DISAPPROVAL Signature for Local Health Department Signature for Mayor or City Manager / / Signature for County Commissioners Comments: _ Signature and Title Note: The applicant must obtain the 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 -10 (Rev. 5 -70 -100)