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PITKIN COUNTY HEALTH DEPARTMENT
7201 f,ti
PERMIT NUMBER
RECEIPT NUMBER 1G—
b) Ct hn .e G. � 6 D 54/e�O
Location of system , 514 P f -s' 0 i'. -?-f ZC 80, ro,-t
Legal description
Number of bedrooms
Signature of owner
Percolation test data
Minimum recommended absorption
Minimum recommended tank size
. L� 7 -& yic
.9-020"-2'1 1
minutes per inch
Permit application valid one year from date 'Application to become permit and final
only after lower portion is completed and signed. Retain this form at the construction
site.
�D�RAWING�M
I 1"�
Joao
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Date '3/,-,0 / 0/ / q ( Sanitarian
/C+ 1 s� 1.0 L&a
(S�e, g��.74
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PITKIN COUNTY HEALTH DEPARTMENT
PERMI NUMBER 720165 RECEIPT NUMBER
Phone N i
Address
{ ki
Contractor
�C7 .A phone N
Address
Location of system ) ' %) 1 Lot size
Legal description
Number of bedrooms Date
Signature of owner
(p �— minutes per inch
Percolation test data
Minimum recommended absorption system size 7r) C U'
!
Minimum recommended tank size
Permit application valid one year from date. Application to become permit and final
only after lower portion is completed and signed. Retain this form at the construction
site.
DRAWING OF SYSTEM
N
Fj
,
Date Sanitarian _
3
9
OOLORADO DEPARTMENT OF HEALTH 0
DIVISION OF ENGINEERING AND SANITATION
A C T I V I T Y R E P O R T
Section
Private Sewage Disposal/Violation
FILE REFERENCE:
INDIVIDUAL OR Jack Mason
ESTABLISHMENT:
ADDRESS: W. Sopric Creek
NARRATIVE:
Code I
County ;
Jack Mason called for a final inspection of his septic
system on October 19, 1973 at approximately 2:30 pm. I was
on sick leave at that time, and was unable to make the inspec-
tion that day.
Monday, October 22, 1973 was a legal holiday and the
office was closed.
Tuesday, T had a full schedule which took me from Ashcroft
to Thomasville to make inspections and perc. tests.
%vA 4
At the request of the County Commissioners, I attended
An Air Pollution meeting in Denver on Wednesday, October 24, 1973
That meeting took the entire day. That moring Mr. Mason,
called my office to check on when the final would be done.
At that time, he was informed that it would be the next day,
as I was out of the office. He stated that he had scheduled
a back -hoe to come in that afternoon. He was going to cover
the system with or without an inspection. The secretary
informed him that if he did so, he would be in violation of
the regulation concerning sewage disposal. He said that he
wouldn't wait, he was going to cover the system before bad
weather set in.
On Thursday, October 2b, 1973 when I arrived at the
septic site for the final inspection, I found that he was
true to his word, the system had been covered.
T RS
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE: October 26
pES: 7 (Rev. 6-70-100)
19 73 REPRESENTATIVE:
COLORADO DEPARTMENT OF HEALTH
DIVISION OF ENGINEERING AND SANITATION
A C T I V I T Y R E P O R T
Section
FILE REFERENCE: Private Sewage Disposal/Violation
INDIVIDUAL OR Jack Mason
ESTABLISHMENT:
ADDRESS: W. Sopric Creek
NARRATIVE:
Code 12
County
Jack Mason called for a final inspection of his septic
system on October 19, 1973 at approximately 2:3C pm. I was
on sick leave at that time, and was unable to make the inspec-
tion that day.
Monday, October 22, 1973 was a legal holiday and the
office was closed.
Tuesday, I had a full schedule which took me from Ashcroft
to Thomasville to make inspections and perc. tests.
At the request of the County Commissioners, I attended
An Air Pollution meeting in Denver on Wednesday, October 24, 1973
That meeting took the entire day. That moring Mr. Mason,
called my office to check on when the final would be done.
At that time, he was informed that it would be the next day,
as I was out of the office. He stated that he had scheduled
a back -hoe to come in that afternoon. He was going to cover
the system with or without an inspection. The secretary
informed him that if he did so, he would be in violation of
the regulation concerning sewage disposal. He said that he
wouldn't wait, he was going to cover the system before bad
weather set in.
On Thursday, October 26, 1973 when I arrived at the
septic site for the final inspection, I found that he was
true to his word, the system had been covered.
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE: October 26
ES: 7 (Rev. 6-70-100)
19 73. REPRESENTATIVE:
rI
COLORADO DEPARTMENT OF HEALTH
COUNTY REQUESTZ0,R SERVICE
PROGRAM Imo- RECEIVED BY
LOCATION It _ 1.tria.M� G NAME
TE D p.3
REPORTED BY ADDRESS �./ TE LE PHO NE
ACTION
ACTION BY
SH -M -7i (4-71-50
ISPOSI TI
DATE /O
COLORADO DEPARTMENT OF HEALTH
COUNTY S7 REQUEST FOR SERVICE
PROGRAM /.%- RECEIVED
TE
SS TELEPHONE
SERVICE REQUESTE
ACTION
ACTION BY
SH -M-71 (4-71-50
DI SPOSI TI
COLORADO DEPARTMENT OF HEALTH
COUNTY
PROGRAM RECEIVED B1
LOCATI
REQUEST
SERVICE
REPORTED BY
TELEPHONE
ACTION REPORT
ACTION BY
SH -M -7t (4-71
DI SPOS I TI
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER
MAILING ADDRESS
PHONE _" ' i A
LEGAL DESCRIPTION OF PROPERTY 2 i zyiL.S /' p - `S i oTA ,Vq r
'C �i Q-!' �� f � -Y/` � ✓�K i i/ter � � Y s'/ // Q �c.
LOCATION OF TEST HOLES Q % Zr, p �r
Three (3) test holes required per system
Test Hole Depths (24" minimum) I D /0 9
Diameter of Test Holes /,Z / a "
Water Remaining after 24 hour soak NZI Ile 11 &Z Atd
1
TEST HOLE Nl 1 TEST HOLE N2 1. TEST HOLE H� k1
Drop Time Drop Time Drop Time
71
Percolation Rate Each Hole �Lq
Average Rate yh vw / V•�
wH,
NAME OF RESPONSIBLE PARTY RUNNING TEST _\ ,u (? ('jy, y �1 PHONE
SIGNAL'URP PHONE
COLORADO DEPARTMENT OF HEALTH
Water Pollution Control Division
4210 East 11th Avenue
Denver, Colorado 80220
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
Applicant (Owner):
Mail Address: City: 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 -j
Legal Description
City or Town
Lot Size:
2. Type of area and facility - Number of persons served:
Subdivision Motel
Other:
Restaurant Trailer Court
3. Source of domestic water: Public (name):
Private: Well / Depth _ Other Depth to first ground water table S
4. Is facility within boundaries of City or Sanitation District:
If so name:
5• Distance to nearest sewer system:
3
I.1
L''
Have negotiations been attempted with owner to connect:
If rejected, give reason:
Rate of absorption in test holes in minutes per inch of drop in water level after
holes have been soaked for 24 hours: i
Name, address and telephone of person who made soil absorption tests:
1. 4 ✓�i_,._ 01% /T zip i /%,�— 9:37_ 74 ui/_
, address and telephone of person responsible for design of the system:
9. Est. bid opening date: Est. Completion Date: Est. Project Cost:
Date: 1 i 6r 4
Sigr(�2ure of wnerof wner
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 D[SAPPROVAL in the space provided below:
DATE APPROVAL DISAPPROVAL
F-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:
lU WP -10 (Rev. 5-70-100)
PERCOLATION TEST FIELD SHEET
a
COMPLETE IN DUPLICATE
(Check person responsible for or performing tests)
( ) NAME OF
ADDRESS
( ) NAME OF CONTRACTOR OR EXCAVATOR
ADDRESS PHONE
LEGAL DESCRIPTION OF PROPERTY
General Information & Instructions
In addition to compliance with all other rules and regula-
tions for sewage systems as promulgated by the County of Pitkin
and State of Colorado, it shall be the responsibility of every
property owner/installer/contractor/excavator (the person running
the tests) installing a sewage system to conduct percolation tests
in accordance with the specifications hereinafter set forth.
Subsequent to the performance of the required test, it ,
will be necessary for the person responsible for/or person perform-
ing the tests to file, complete and under oath and penalty of
perjury, the affidavit form contained on the reverse hereof.
Warning is hereby given that spot checks and inspections will be
performed by the Pitkin County Pollution Control Officer and his
authorized agents with or without the knowledge of person perform-
ing or responsible for the tests to insure compliance with the
requiements hereof.
Soaking is to be performed in the 24-hour period between
O M. and 6.,TO �} M. on the «�Snd days of
19'7,3. `I' actual percolation e s are to be
performed at a A_.M, and Q:,3a A M. on
At least two (2) test holes per system must be run. They
should be in the area (within feet) of the proposed leach-
ing system and dug to the deptE—o—f—The proposed system, generally
2.5 to 3 feet deep and 12 to 16 inches in diameter.
The holes are to be soaked for a 24-hour period prior to
running the test.
0
AFFIDAVIT
(Percolation Test)
, being first duly sworn upon
his oath under penalty of perjury, states, avers and certifies as
follows:
1. That he is the person who performed the percolation
tests as required on the reverse hereof.
2. That the tests were performed in accordance with the
time schedules and specifications as set forth on the reverse hereof.
3• That the test results of the said percolation tests
were as set forth on the reverse hereof.
4. (In paragraph 4, affiant shall insert additional
statement(s) which may be properly and reasonably required by
the Pitkin County Control Officer or the affiant may wish to insert.)
DATED: , 19
Signature of Person Running Test
STATE OF )
COUNTY OF ) SS:
SUBSCRIBED AND SWORN to before me this _ day of , 19_
My Commission Expires:
Notary Public
NOTE: This affidavit must be returned to the Pitkin County Pollution
Control Department within 24 hours of the time the percolation
tests are completed (Saturdays and Sundays excepted).
v. 4.70 CRIMINAMPLAINT, SUMMONS AND W� 4NT-c .. ro--_,r. co.. ocrvice. c=.c
CRUMAL CASE NO..�_-_—! ! ._..._ ..._.......
:,LORADO IN TEZ COUNTY COURT.
2i tk i n........ ... ._..........
.._..�sa.
OB SHE STATE OF COLORADO
vs.
son.__,
_ I
Time of Filing..—._..._.._.....__ O'clock_._. .
The ..o:.alaint and Information of_.........._..James_... 07,Sk__...._._........... ......
_._`...—.-'..-.-.._...'.-..__�...
made before._...FXAX1G.CS..... Ka..ulllRP........ ._... .............. Ck;k, of the County Court in and for the said County, .
41.f1._ ............... _...._.daY of ..... D,gCP.2RbeY:...--_„........ A. D. 19_11.. being duly sworn on oath says th..,
Jack Mason
..on, to-wit:rne_..___. on. or about October 24th___.__.__._._._....._,�.A
to -wit: the said County of....__.._.Ql)i'.11l._.—._.... in the State aforesaid unlawfully
Pitkin county, Colorado, sewage disposal regulations,
VI, in that he, failed to obtain a final inspection of
..waca disposal system installed on his property locates: on
SLEis Creek, Pitkin County, Colorado, in violation of
Coiorado Revised Statutes 66-3-14(7)(d).
A14 hj�
,
1
_ � .ry to the form of the statute in such case made and provided, and against the peace and dignity of the People of the State
C. :,iorado. He therefore prays that the said ...... ...._..._.___JA.fek_..a ..xi._..........._._........._..._—..�.__._..._.__......... ...
. . be arrested and dealt with according to law.
_. .. •--i__•_ - ems♦ I 1 , j 1
'.scribed and sworn
tocbefore me 1 . _.......
- .r9f �' _.�.,./....1� .•
day of_
(SEAL OF C .:URT)
l r{ '"WCLERK
EPZITY
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130 S. (;alma 1LDING PERMIT APPLICATION UU I Z>General
Aspen, CO 81611 ASPEN&PIT�1COMMUNITY DEVELOPMEN PARTMENT Construction
920-5090 Permit
920-5448 Inspection Line PITKIN COUNTY K CITY OF ASPEN - L�
Apchcant w complete numbered spaces only. No.
.x1B ADDRESS
/ J
Zoning Validation
_
2'
LEGAL
2- DESC.
LOT NO.
BLOCK
TRACT OR SUBDIVISION� (C SEE ATTACHED SHEET)
s'`
co
DE
OWNER MAILADD SS ZIP PHONE
MILAD
CONTRACTORIDRESS PHONE LICENSE NO
FN
4.
ARCHITECTORDESIGNER MAILADDRE33 - PHONE LICE ENO
— C
MS
ENGINEER MAILADDRESS PHONE LICENSE NO
O.
RF
CLASS OF WOR
❑ NEW ❑ 7�DITION ❑ ALTERATION ❑ REPAIR ❑
VVV"`
SQUARE FOOTAGE
E
ZONING FEE
L "
CENSUS CODE
USE OF BUILDINGPLAN
a. C NZ—r r4 k; T
CHECK FEEPERMIT
/
��/ �'�
FEE 3. 6% USE TAX DEP.
VALUATION
10. $
Typo d ColrcVucoon
-
0=0anc, lid
R3 -I
Araa
11. Is there food service in this building ❑ ves ❑ No
sue dl BwMi
halal s,w,a"kI,I �
No W S
`
Occ, Load
�
`^—S
12. Is LPG used? ❑ YES NO
NO.OFSEDROOM5
I Uoa Zane /1
P13.
F 2 - l o
�� r
RNSPdIMen Reauued? ❑
Abm S".a�weeai Dyes
Remarks
EXISTING
A p
c Qq -13
No. of O b, Unas
OFFSTREET PARKING SPACES
Caverel
llI)ooveled
^� C
I
t
SPECIAL APPROVALS REQUIRED I AUIflORQED Y DATE
2DNING
PARK DEDICATION
IO E}.
DNI%Lt"V f
PR AL
C f
TED
By
PLANS CHECKED
APPROVED FOR I$SUANLE
ENGINEERING
PARKS
HOUSING
DOTE
DATE
DATE
DA
PLANNING
OTI
FIRE MARSHAL
A' FFJ_B-]_TE P_ EBJ�ITS ARE R ELECTRICAL. PLUMBING,
HEAD- ILATING OR AIR CONDITI'aaaaaONING. �- �"
WATER TAP
OTHER
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 120/180 DAYS, OR IF CON-
STRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD
PAYMENT OF PITKIN COUNTY USE TAX
OF 120/180 DAYS AT ANY TIME AFTER WORK IS COMMENCED,
MONTHLY OR QUARTERLY RETURNS WILL BE SUBMITTED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
❑ DEPOSIT METHOD 3.5 % 25% OF THE PERMIT VALUATION PAID
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF
AT ISSUANCE. A FINAL REPORT ON TOTALACTUAL COST MUST
LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COM-
PLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA
PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CAN-
BE FILED WITH IN 90 DAYS OF SUBSTANTIAL COMPLETION OF
WORK AND /OR ISSUANCE OF THE CERTIFICATE OF OCCUPANCY.
CEL TH a111(((ISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING
CTIOV OR THE PERFORMANCE OF CONSTRUCTION.
O EXEMPT. EXEMPT ORGANIZATION
C RESALE. STATE a PITKIN COUNTRY RESALE NO.
ANYONE WHO USES AND / OR CONSUMES BUILDING MATERIALS AND FIXTURES IN
PITKIN COUNTY IS SUBJECT TO THE 3.5% USE TAX.
PROPERTY LIENS MAY BE PLACED ON THE OWNER'S AND /OR THE CON-
TRACTOR'S PROPERTY WHEN USE TAX IS NOT PAID
SI ATUREOF A o PF7R CAG NT tppr I
• L.' (, " �t I _
SIGNATURE OF O ER RF OWNER aULLO A) (DATE)
HIS FORM IS A PERMIT ONLY WHEN VALIDATED
Plan Check Validation
Zoning Validation
—I•aT—WHITE-FILE COPY CANARY-APPLIC
IS
WORK STARTED WITH OUT PERMIT WILL BE DOUBLE FEE
Pennit Validation 3.5 %Use Tax Deposit Validation