HomeMy WebLinkAboutApplication-Permitr
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C;1t:IiwooCl. Springs', coIoJ &ao 816'31
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PERMIT
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y 7) , aion R.C. Jolley Ranch Box 1154 Road 245 New Castle
app.r:o x'41 for a
11':.:orption Berea computed as `tallows:
Akonwer)
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r. f.:R7 etc d 0..r::1 't
....»...incihesa in 1 :! ntten sq. Itt c
ab.;r;:-r c on area per bedroom
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i:1 �.� `-F .� �.�' s t -wear+.✓: �.:.. �,. ..-......
�+ wZogrfa �"' +C,.` /W Oma '.. 0� r ` '
nr:i le V / .spector
74____.
sq. feet. n_ ti • feet: :5. n i nEium R?clair ; :;.rt
Final , 4pp:+: ca =a1 of System:
No system shall be c ornccl to ba in complirmc3 with the Sewage
Disposal sal Laws until the assembler) systFn is wpp :ovd p::' or •,:.c
eking any part thereof.
' " septic tank cleanout with ares soLtA IAF/0.0 _
: Proper materials and assembly. .- ..._ _..w
r___,
.-.... Adecrua :es ahspKpt;ion area ,�.� ..�.. ,...,M.. �....._._ r.
4Adequate concrete over {dry c€:lsM1 _1y)
..M_.�. ...
10/A--1Covenants signed
DP rnspc.ctor
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L
COLQRADO DEPARTMENT OF HEALTH
4 Water Pollution Control Division
42fb East i lth Avenue
v'Denver, Colorado 80220
Building Official
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
IlflIVIDUAL HOME SEWAGE TREATMENT SYSTEM**
e 0. --aa //e.yy
Mail Address:$i;vf/54' CFP/P-'6-15 City/Au/Gs:sat_ Zip faCt7Phone
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Owner: r 1
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 rCity or town // (/`�"
Lega 1 description
Lot size / -0 ce r{ S
2. No. of bedrooms S Septic tank capacity /40PQ Aeration unit capacity
C/.71`' e..44C.
3. Source of domestic water: Public (name):
Private: Well Depth Other Depth to first ground water table
4. Is facility within boundaries of a city/town or sanitation district?
5. Distance to nearest sewer system: i/
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
Nemo, address, and telephone of person who made soil absorption tests:
,per r i
//l-6
11
7.
8. Name, address, and telephone of person responsible for design of the system:
ature 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.
B. SIGNATURES OF LOCAL 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
Comments:
Approval Disapproval
t,
Signature for Local Health Department
Signature for City/Town Official Title
Signature for County Official (Title
Signature and Title
Note: The Notifier (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:
W733(10-72-2)