HomeMy WebLinkAboutApplication-PermitA..
COtiTY DEPARTMENT O'k:'
2014 Bioko Ave.Hnc
f Sp.c4nc.,•o, CoLye,r.1.0
024
ci -2.3 :17 •Pke.Jr
4)
1)
)B.A. Haptonstall Box 221 New Castle: (panoramic mesa)
Owner
•. N,c,un'itpprovz71,1 fo4
ea • J.13.c.nt
C 7
area compll.ted,as fOrLoWs:
3!:i .7.i.te 4 • incheszq. ft. c..f
rOnntessiir40
an-.,:ptioa area par 1.7,edreomortia
sg. fefit ee &Argo . feat rsnum
nrigestitiVtittrit e ArdeNtoteoir 411P
Inspector
0..
. FinAl"Approval of Systnm:
Mo Systcn shall.bs actemed to be.in ccrAplinli with the r,aa-7
Dicca1 Laws until the'asseMLled oyflt is
el:ing any part thereof.
n
r
c" septic tank cleanout with 0e5 se7,1
Proper materials and assembly
Adequate concrete cover (dry, wel/s =-11,1.‘ko
Covenants signed
*mob nmsonis . •
inspoctox
..........,.....,•••••••••1••••,•••yelyn•••••4 //WA..
p,.,Erro wrril PY. P f43 RFC/ 'WV"; reNtovri.ittir-rTo.ti STIrC,
s
s
,
COLORADO DEPARTMENT OF HEALTH
'Voter Pollution Control Division
4210 East lith Avenue
Denver, Colorado 80220
Owner:
Building Official
PGRIL{ r r FeE 12.crut4 66-8
NOTIFICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM*
Nil Addre+ss:Ae Lc,A=Z•-/ Clt
Nez 12.01g57z-E
A. INFORMATION REGARDING PROJECT SUBMITTED F
if
^.�* iii r/ J!..:< .• .
R REVI W:
Zip 7/66 /Phone 9f 9 /DjJ
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 profiles In test holes.
1. Location of facility: County,, ,�C City or town_,,r
Legal description oe A„r
Lot slze
2. No. of bedrooms 0-- Septic tank capacity/e) Aeration unit capacity
3. Source of domestic water: Public (name) :,-..,,-- ,&c 60i9-77F7e, .S.Citteid-Y
Private: WelIN Depth Other Depth to first ground water table
4. Is facility within boundaries of a city/town or sanitation district? `p
5. Distance to nearest sewer system: .--Z 2. .
Have you attempted to arrange a connection with the system? j)
If rejected, what was the reason? ------ 2>1.?". ►' =—T
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:
AYYKl1V k4�
8. Name, address, and telephone of person responsible for design of the system:
Date
Signature of ner
*Required by Article 66-28-12(CRS, 1963, i967 Perm. Sum. Supp.)
**Required in areas which have been identified as areas in which danger of poi:ution
of waters of the State may occur (Art. 66-28-8(5), CRS) and/or area i which there
Is no local septic tank ordinance.
8. 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
•
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:
WP -;33 (1U-72-2)