HomeMy WebLinkAboutpitkin.eh.246734303013 (1973)Document Layout
(From Most Recent to Oldest Permit)
Permit
Application
Log Sheet/Notes & Photos
Communications
As -built Design
Engineer Design
Soil Information
Water Permit & Information
Second System on property
Third System .etc.
Floor Plans
Please See Building and Land Use Approvals Files for additional information.
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER 7201 v RECEIPT NUMBER
Owner —4 ^ S J -?t-1 S % S'if.H j A.s Phone #
Address COm �i n�7or a
Contractor r Phone #
Address dec�� 7/ A -
Location of system Lot size Aferc S
Legal description ��} �q74 SidOal�NilSS
Number of bedrooms Date
Signature of owner �,
Percolation test data ""� ' minutes per inch
Minimum recommended absorption system size
} 0
Yry`, (J �C�(7
Minimum recommended tank size / �+ ktA
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 ?a�04
ON
`Date .i ) Sanitarian
I o -P S . Z
ff
*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
INDIVIDUAL OR Kelly Lyons
ESTABLISHMENT:
ADDRESS:
NARRATIVE:
Code 12
County 57
On August 7, 1973, I made a field visit with Kelly Lyons at
the Gateway Subdivision. He had 3 perc. test holes dug in the blue
shale, one dug in a lighter brownish shale, and one dug in soil mixed
with small stones. All these holes had been dug with a back -hoe.
In my conversation with him, I found they only had a total of 15
to 20 gals, of water put in them. I indicated to him that it was
not the proper way to run a perc. test.
I recommended that new perc. holes be dug with a post hole
digger. One test hole dug shallow, to accommodate a shallow leaching
field in the area of soil and stone. And one in the bottom of the
blue shale hole. Running these two tests, we could get a comparision
of the perc. rate.
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE:s , 193 REPRESENTATIVE:
PaguES: 7 (Rev. 6-70-100)
PERCOLATION TEST FIELD SHEET
COMPLETE IN DUPLICATE
(Check person responsible for or performing tests)
( ) NAME OF
ADDRESS
( ) NAME OF CONTRACTOR OR EXCAVATOR �4ya/f �Q�-7�
FS
ADDRESS ,r,2,( /5 n.sa/� (► ,/ PHONE 9,q i-S.Sr 7
LEGAL DESCRIPTION OF PROPERTY
(TA'�t waV .4 / sc✓avV .�tA sc l" ,7/0 - 1-41, K
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.
Sgaking is to be pirformed in the 24-hour period between
/100 0 M. and U a y M. on the __ and S� days of
d ✓or Zr 1LT — THe actual perc lation �p- are to be
perf rm�c ed at /.'000 M. and ; oo P.M. on 7 ,
19f.
At least two (2) test holes per system must be run. They
should be in the area (within O feet) of the proposed leach-
ing system and dug to the deptI of the proposed system, generally
2.5 to J 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.
3
AFFIDAVIT
(Percolation Test)
A"O a) 41 being first duly sworn upon
his oath under jefialty of Kerjury, 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:
Sign re of Per y6RG1nrA4WTest
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).
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):
eA/ R -f- d ' ,
//�J �J
C° rE ('O i€ v t
Mai 1 Address: /amp A—r' v, Z" • City: n . 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.
I. Location of Facility: County/r7 ,c City or Town
Legal Description ��� #� /� s� T�w" L49'tSIze:
2. Type of area and facility - Number of persons served:
Subdivision Motel Restaurant Trailer Court
Other:
3. Source of domestic water: Public (name): (7 �✓% s��vf
Private: Well Depth Other Depth to first ground water table
4. Is facility within boundaries of City or Sanitation District: /j/D
If so name:
5. Distance to nearest sewer system: 4X==w1js& M«t j
Have negotiations been attempted with owner to connect: /y A
If rejected, give reason: IVA
6. Rate of absorption in test holes in minutes per inch of drop in water level after
holes have been soaked for 24 hours: 4 ro C o7 .2,1� -� r 1� N
7. Name, address and telephone of person who made soil absorption tests:
9� 7-
8. Name, address and telephone of person responsible for design of the system:
9. Est. bid opening date: Est. Completion Date: Est. Project Cost:
Date:
Signature of Owner