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amont L. Kinkade, Sanitarian 49
eirs arf. Co. Environmental Health
014 Blake Avenue Tel. 945 -7255 0'0 q3 3
Glenwood Springs, Colo. 81601
NOTIsICATION OF PROPOSED DISCHARGE TO WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM **
Owner: s _ �E ) 0 aC,.
Mail Address: - ` _ a C. City Zip $ /6SOPhone t7&7
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW: ciD1-3-6•5
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. pp A ��I� f
1. Location of facility: County .�ay//j /,/,� City or town
Legal description i91T4C#FQ Lot size /7., 3 9 *en,S
2. No. of bedrooms a Septic tank capacity 7 57) Aeration unit capacity=
3. Source of domestic water: Public (name):
Private: Well ✓ Depth Other Depth of first ground water table
4. Is facility within boundaries of a city /town or sanitation district? G✓Cj
5. Distance to nearest sewer system: afi s
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:
C2 fri; ato
ate gnature 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 oticur (Art. 66 -28 -8 (5), CRS) and /or areas in which there is no
local septic tank ordinance.
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Please use the following space for directions to your property site.
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11.11. CCUNTY LUVIROU;INTAL iligifli
IA 1 Tc. Dcas Sheet on l'ercolntic...1 tcst
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Parcel 2: A tract of land located in Lot 4, Section 5, T6S, R92W, 6thP.M., : 1 .•
1;4
1 more particulary described by metes and bounds as follows, beginning : it
. h • at the NH/ Lot 4, running thence South 1083 feet, thence ti . tE
330 feet, thence N 1083 feet, thence E 330.feet to the point of
1 beginning, containing 8.25 acresp.more or less. . :
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• Parcel 3: A triangular tract of land in the SE Corner of Lot 4, East of the
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li gulch and containing about 21 acres, more or less,.located in Sec. 5,
T65, R92W, 6th P.M.
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0 Parcel 4: The Ut NUI of Lot 3 in Section 5, T65, R9211, 6th P.M. • • '
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