HomeMy WebLinkAbout00102A - ,- -.-
Cite_ Leve_ev•-_..icNopOr
„, 4 1‘ LA- 1 ;tv--° cknickatt----°
.,,‘,, '
' ;
4 '
GARFIELD COUNTY' DEI .04 litNIPONNII:N1V. HIA1.11t
2014 01 1-41 f4 41 /nillk°
Glenwood SOrtrtO • I.‘t -.tido 1I61
w
0'
, I
PFRillit j),,, , 1 0 2
1
Syrtent
........., .........„ . 0 ....... ..,...
/....
4 1 Catitrisetor—S11( al ..,
°
1. rierig truottott 0150t0V6 1 for a :4011000 qa lion 14,,,,btic ten'y
4A.-rate4 tic gatrece.t 'int.
- t r
yd absorption area computed as follownt-_____. __ ,..,
72-. • ,A, P te i laCILC.IIR 411 ... .2 f I, : ..te . c .
0 ... -, orptIon Per binif92-Nt. negiet ...._-$.--- . - -. • .
Natsito....5.5bs.et- g. -...20.1 k.et lailli00-11C.S.0
suggest /40 allillitelke-eiteli F
i",,ii i r te it" siveisr .............. in 8 PeCit . ...0., -. .... ..'• A I
/
E 2. Final aupr Aral of system: ... '
, •
No sirstern shell be deemed to be In comolialice with the Sewage ill -1.,
11 Nii Laws until the assembled system t si)oroved prior to covert:lc ostl avul t t t
thereof. v kl° dirif.l
, 4 f t pl
/* 4,4 i -
1 4 01 1 ; pit
ig
i I 1S antic teak cleanouirvirith tie t .. , 4008atigalle Sr ' 12
1, if ' r if
li ll ii. '
...".....4122.e.LITADJEL11.L. • ft..f..i.a, tir.--- ---------,................... „......
bin ,„,d'r a_bs9Lption area
, t
,/,,Ifhitclesolate concrete ceyen (dry well, oply) ,
>si
ig 4 /tv„,,triants signed __,,,1 . it
IF
_.,...,,.,.......,..",..,,, .
t )a te v• 1 " ---. .... 7 7.ar 'L in S OCCtor. , „,..„,„,,,,,
**Retain with permit record n et coontraction slte. ' ,
,1 1
COLORADO DEPARTMENT OF HEALTH n 5 I
Water Pollution Control Division �p
4210 East 11th Avenue
Denver, Colorado 80220
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
Applicant (Owner): j 63',959
Mail Address: 8/ / City: X /7 Phone: 1,
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, soli profiles in test holes.
1. Location of Facility: County ‘17/7, City or Town 5/Z7
Legal Description Lot Size: S 4' /P /
2. Type of area and facility - Number of persons served: 8 l'/2 4'6i/ l
Subdivision Motel Restaurant Trailer Court
Other: A/c N P
3. Source of domestic water: Public (name):
Private: Well X Depth _ Other _ Depth to first ground water table /_at
4. Is facility within boundaries of City or Sanitation District: ,4'a
If so name:
5. Distance to nearest sewer system: J 44 /
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: S ri= 19f- - n-rn - r
7. Name, address and telephone of person who made soil absorption tests:
e ,nc =n .47/ r
8. Name, address and telephone of person responsible for design of the system:
SC Pe /
9. Est. bid opening date: _ Est. Completion (/i on Dattee: Est. Project Cost:
Jr/
Date: y 1/43 ///.Y .
Signatur o er
A
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
/ ---- 7 / ---- 7
Signature for Local Health Department
Signature for Mayor or City Manager
/ ---- 7 / ---- 7
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)