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Glenwood Sprttlge, Calcradt. rii6 1
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COLORADO ThEPARTMRNT OF HEALTH
mater Pollution Control Division
4210 East 11th. Avenue
Denver, Colorado 80220
Ar PLICATION FOR APPROVAL OF LOCATION FOR SEi TIC TANK SYSTEMS
THIS IS NOP A PERMIT
Applicant (Owner)s.1 CL. �y.e�a n..."
Mail Address: 3i( • C... �dr- City: Phone: 43- (a S`4
A. INFORMATION REOARDINO PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with ,,espect to surround-
ing areas, topography of area, habitable buildings, location of potable water
wells, soil percolation test holes, soil profiles in teat holes.
1. Location of Facility: County m . /A _ City or .t__s _ _ 1
e a 39 5...i r1� 'ms1-5 -s-
Legal Description $ 7 to 1 6 On. Lot Sizes 3 ac..%.e.,"/
. Type of area and facility - Number of persona served: A Asd-vrnn•.•..1
Subdivision Motel Restaurant �- T{ailer Court
Other :_ r ,..._.._._,
3. Source of domestic waters Public (name):
Privates Well Depth Other Depth to first ground water table
4. Is facility within boundaries of City Sanitation Districts /ny
If so name:
5. Distance to nearest sewer systems 41 f,
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:
7. Name, address and telephone of person who made soil absorption tests:
8. Name, address and telephone of person responsible for design of the systems
9. Est. bid opening date: lst. Complet / •n :/ _: Est. Project Cost:
Date: ' -- R a7 /9 7.3 • , -
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