HomeMy WebLinkAboutpitkin.eh.264921301004 (1970)AfRON ENTAL HEALTH KINKAQE
COLORADO STATE DEPARTMENT OF Pl;�3LIC HEALTH 6Cx V
Water Pollution Control Commission
4210 East 11th Avenue Aspen, Colorado 81611
Denver, Colorado 80220
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
Applicant (Owner):
Mail
Address: ��_—_
City ���/Lwc�
Phone : j.� �•�/L�
A.
INFORMATION REGARDING PROJECT SUBMITTED
FOR REVIEW:
1.
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 of Owner
t
(Attach separate sheets or report showing entire area with respect to surrnding
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—
C i ty or Town 4iA"
6O, 31)3-y� �—
Legal Description ` Al _9-gf f,
_Lot size: CUJu�
2.
Type of area and facility - Number of persons to be
served:
Subdivision Motel Restaurant
Trailer Court
-'
Other:
3.
Source of domestic water: Public(name):
Well Depth Depth
First Water
Private: V
_10Other
to Ground Table
4.
Is facility within boundaries of City or Sanitation
District:_ ".7t,Z)
If so, name: _
;5.
Distance to nearest sewer system:_--/,)-- At
Have negotiations been attempted with owner to connect: �cl
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 of Owner
t
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