HomeMy WebLinkAboutpitkin.eh.264335105011 (1970)_APPL FOR SEPTIC LOCATIONa
COLORADO STATE DEPARTMENT OF PUBLIC HEALTH
Water Pollution Control Commission
4210 East 11th Avenue
Denver, Colorado 80220
.p43 -351-057-011
LAMONT KIS KJ
ENVIRONMENTAL H&L a
BOX V
Aspen, Colorado 81611
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
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Applicant (Owner):
Mail Address: --
Ci ty
Phone:
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, soil profiles in test holes.)
1. Location of Facility: County�'-��LF--� _City or Town
Legal Description / r o& _L.J�- Irl], _Lot size:
2. Type of area and facility - Number of persons to be served:
Subdivision Motel Restaurant Trailer Court
Other:C,d— Jaa"'___---
3. Source of domestic water: Public(name):��I,- /,o 0,9
Private: Well Depth Other Depth to First Ground Water Table
4. Is facility within boundaries of City or Sanitation District:_ " 0
If so, name:_
5. Distance to nearest sewer system:
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 & telephone of person who made soil absorption tests:
8. Name, address & telephone of person responsible for design of the system:
9. Est. bid opening date: Est. Completion date: Est. Project Cost:
Date:
Signature orWh6r