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HomeMy WebLinkAbout00127A " C- 64 .544.0 ( eft a/Pri-an'' • 127fr Lael/ "iCerge occiAt& y yods t .7S0 e5AZ. /OCC) • / H5H 3OO * (a) ( 3ct, e"Ct2 • Sa cc?' 4.3 921 : r et, 1/-er7,3 ont L. Kinkade, Sanitarian . Co. Environmental Health / 14 Blake Avenue Tel. 945 -7255 SO s Glenwood Springs, Colo. 81601 NOTIVCATION OF PROPOSED DISCHARGE 10 WATERS OF THE STATE* INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM ** Owner: / ©/Zed /,ierh w2 A. Mail Address: &C+7 O pat City NE& WtSTL Zip Phone A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW: 4 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 6R2F /FG4 City or town /f/ W ' ,/ C , // Legal description Lot size e2CGS 2. No. of bedrooms 0Z. Septic tank capacity Mob Aeration unit capacifg_ 3. Source of domestic water: Public (name): /)2iA./C m Private: Well Depth Other Depth of first ground water table / 4. Is facility within boundaries of a city /town or sanitation district? NO or 5. Distance to nearest sewer system: 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: 87- / /s 73 ; �k kill Sign re of er *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. t 4' - - . c / Please use the following space for directions to your property site. if r me , / t r , 4,2rAiG0 0 CO \ 0 4 1 ' 'IP . ,,vs. $�P* `s ° II... • 4 -1 a _ - __ s • • • I • /p • it ' itiAt V I ? * I Ja ;k . ' ar‘'' ■ VAT- • . q P g ce 1 a7;a;t04 Air , ‘„„. / • 4,0