HomeMy WebLinkAboutpitkin.eh.264306202005 (1997)Document Layout
(From Most Recent to Oldest Permit)
Permit
Application
Log Sheet/Notes & Photos
Communications.
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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.
' ASPWITKIN ENVIRONMENTAL HEALTH DEPP ENT
APPL N FOR INDIVIDUAL SEWAGE DISPOEWSTEM
130 S. Galena St.. Aspen Colorado 81611
Phone 970-920-5070/Fax 970-920-5039
Permit# `70/2— Parcel ID# 3 —Atk —402—t
Permit For. New Installation (k) Repan( ) Remodel( ) Emergency use( )
Name of OWNER TAOL AAA GINA SAnaetsort
Street Address OO�AQ Ale Ai Ey LAPiE SAllamASs� CO /r�q��.54
Owner's Mailing Address 0040 AREIA4 1 WE JNc I.(NMASSr
Business Phone 917' 03_1 Home Phone 92 3 - Y539
Legal Description: Lot b ,Block C1RC1E.Subdivision
Size of lot: 1_ acres Type of propo's'ed structure: DdFLE)C Size of bldg. envelope: e1 A em
Total areafting space (sq. ft): 13-14 # of Bedrooms. offices and similar size rooms. 3
yt )
Caretaker Unit Attached ( )Detached (1.60) Total area living space of caretaker und(sq ft.) ( 2 ) If of Bedrooms, offices and similar size rooms
Primary Contact Person SP -FF (;,FeFJA7- JTOTS,NAN 6eC6IAZ, WC_
Contact Mailing Address 3m.4e�WAY 82- Sy V)mos G0 glb.��]
Business Phone: 9.23-2%3 4 Cell Phone. .379-7301 Fax q;Z3-0647
Water(X1Pnvate well ( )Spring ( )Stream ( ) Community/Pubic (Name of System)
Is Proof of Adequate Water Attached (Required) ? (yJ Yes ( ) No (A water quality test and well pump test of approval letter from community system)
Has this project been approved by Pilkin County ? (XI Yes ( ) No
Is a copy of the floor plan attached ( Require ) ? (A)Yes( ) No
Is a copy of the site plan attached
Application for an individual sewage disposal system is hereby submitted. I hereby certify that the above information is true and accurate and that I have provided we and
accurate infonnalion on locations of all existing and proposed walls, contour intervals. buildings, property Ines, ditches, slopes, waferfines, springs, suction or irrigation lines.
drinking water ciders. drain tiles, irrigation ditches. lakes, water counties. steamei floodplans, dry gulches, and existing septic systems. I acknowledge that any false or
incomplete information will invalidate the application and any subsequent perml Issuance of the pertno does not imply the approval of any other permit required for construction
pursuant to Pitkin County codes. No construction, may be undertaken until all approvals and Permits have been obtaineo. The owner assumes all respons billies in case of failure
or inadequacy of this system.
J
Signature of applicant ;l�Aj %/1G�67iGi.✓//�//y/yGrG.fs�.t� Date
----------------------- __------______---_______ _____ ______-_
For department use below
wesign untieria Qu 5v5kej m ii i /01,
Perc Rate /& min per inch Profile Hole Depth $ / feet
Septic tank capacity: ZfOCJD gallons Absorption area. PfffoQ sq. ft.
)�r)Ds� 3T a6soi�oNaracr re$��iirdGd/gip No 78i%G/�<+io
µH:Ts )f Gr5 ®o/ o4 91:0e � , y'gvoG, &/, 349/-S d144771) cc S /yy S`/
I/V�iG%Aiar c#.✓/T , /rrry/irrm -�.o/d s;7� /w� :// 60 98og$ � Tf 7trayr--c / s c-
cL,c,/vice %%ice w.// 6e 4 GT�'6�di-oo�, /ti %ho74l�jLi/L�� nfirvillsHih i 4Mr4 SiZ-B SG�AP//
6e 25_oo9gG.d,Sch�ii�ja%✓jTo czn/absey®Tio�4.eaof/6$O51-P?&3u,
o r 3 0 % ;,+;///!e,�Sf 47- G i /µSi17i,
/...:TS _ 5&—e Gwa'lTasr iY vs, -r —7, ff cnimo,,..;/ d ar♦�vt y/2/
An Inspection is required prior to backfill of any component of the distribution system. `&q4-4;rB/o4
Design by Engineer Required ? ( ) Yes 91No All plans and spedfications of the engineer must be followed. Any changes must be approved by the
Aspen/Pitkin Envirommntal HealtInDepartmenlfin waling and,0e engineer must certify the final installation to the Environmental Health Department in
writing. / / �/
Permit approval by: X/Lf//ZS���,i�z�fs C Date %f�
Duins and spermscations of the proposed individual sewage disposal system have been reviewed and are considered satisfactory. Permission is hereby granted to the owner or
the agent to perform the work indicated in accordance with the Pitkin County ISDS Regulation n effect at the time of issue. This permit becomes invalid 6 months from the date
Tat the permit was issued unless system construction has commenced or an extension has been approved in writing by the Department,
As -Built drawings must be included with this permit before the final approval will be issued.
Installer.
�a-4-2-Q-1 Receipt e Site Plan
-Q Date received j�� Floor Plan
1--YYI w Received by ✓ Comm Dev Approval
t� Well Permit and ✓ Soils Test
Z Water Quality Test or z f Date Info Complete �r�Pv✓7
✓ Water System Letter Final Insp Requested
1 J 9 Final Inspection Approval:
Date: APeeo tans
ASP§MTKIN ENVIRONMENTAL HEALTH DEPA ENT
} APPL N FOR INDIVIDUAL SEWAGE DISPOSWSTEM
13U S. Galena St., Aspen Colorado 81611
/�
Phone xx
e 970-920-5Oi0/Fa970-920-5039
Permit # / 7,012 Parcel ID # 2&11+3 - 2i -*Z- 605-
Permit For: New Installation (k Repair( ) Remodel ( ) Emergency Use( )
Nameof OWNER Ago GINA &A'Jusm�r
Street Address 00 NEY N SabtU SS CO T1
Owaee's Mailing Atldress R SIVO 6.Y
Business Phone: �7- 0331 Home Phone: .2 J
Legal Description. Lot 5_ .Block . 00111&k/N.YIY1[Ttie eiRaa6,Subdivision
Size of lot 3 acres Type of proposed structure: DOFLEX Size of bldg. envelope: .91 Aso
Total arealliving space (sq. ft): 13-1 8 of Bedrooms, offices and similar size rooms: 3
Caretaker Unit: MAttached Detached 460 Total ama/iivim space of caretaker units ft.) I K of Bedrooms offices and similar size rooms
Primary Contact Person .14a Q05BIl Z STtrSMAN49C1Ce 7- Wc._
Contact Mailing Address 3,I,?7& "OV g2 Stile s"014 i r %o 9/esy
Busness Phone -4.23-2%.34 Cell Phone 3%9'71 Fax: 72,3'0497
Water(Xprivstewell ( )Spring ( )Stream ( ) Community/Public (Nam of System)
Is Proof of Adequate Water Attached (g@g tr ) ? (y4Yes ( )NO (A water quality test and well pump test or approval letter from community system)
Has this project been approved by Pitkin County? W Yes ( ) No
Is a copy of the Boor plan attached (Reuulred) 7 (A) Yes ( ) No
? QQ Yes ( ) No
Application for an individual sewage disposal system is hereby submitted. I hereby certify that the above information is true and accurate and that I have provided We and
acwrale information an locations of all existing and proposed wells, contour intervals. buildings, property lines, ditches, slopes, waterlines. springs, suction or irrigation Imes,
drinking water cisterns, drain tiles, irrigation ditches, lakes, water courses, streams, noodplains, dry gulches, and existing septic systems. I acknowledge that any false or
incomplete information will invalidate the application and any subsequent patina. Issuance of the permit does not imply the approval of any other permit required for construction
pursuant to Pakln County codes. No construction may be undertaken until all approvals and permits have been obtained The owner assumes all respons'to If as In case of failure
or inadequacy of this system.
A 2 /7
Signature of applicant A+/} dk 1i'2 SEA/1/A(G 4, 0, YiU"4"J <//y^Y//cG.se.� Date
------------------------- ------- -
-------------------------------------------
For department use below
PERMIT FOR INDMDUAL SEWAGE DISPOSAL SYSTEM
U631 n - r System 1 rs'
Perc Rate ` min per inch Profile Hole Depth S feet
Septic tank capacity: 20 DO gallons Absorption area: III[Alli sq. ft.
1,�//Ds� absor�on�area re$�,iirdw�73,.vo si/tidvo]:o�v, 78i%GTir
/y+'i'Ts i dvseB i ✓Placa e f ai��G, L✓,7� aD /'s discTaxJ tc -W Sy
/�v¢i l Tr.��r u.✓iT , in:.vlms�m ���/d S�ZG wi/! 6G 980A$:6�7-7 r£ 7A•r+-- / s el-
GlyyyycE %%ice w.//,6� 4 G'A'6o�ioonr 7A� 7Jt o-fi+�lAar� piNYimNir, TOiYy, 5/71B
6e 25-P R 9gG.41, s 51-F`7 6-73
or 3,09, re�sa ons �orva�i G7i^rs �dr� /../ I e�ui /IG+Ssgi�i G k.�iG77 y
An inspection is required prior to backfill of any component of the distribution system. -S-r'o ' Z&- d -J;7;l
Design by Engineer Required ? ( ) Yes 9PNo All plans and specifications of the engineer must be followed. Any changes must be approved by the
AspenlPitkin Envirommntal Health partment in writing and a engineer must certify the final installation to the Environmental Health Department in Date �1�
writing. `7� /� -7
Permit approval by: i'
m
-'arts and specifications of the proposed Individual sewage disposal system have been reviewed and are considered satisfactory. Permission is hereby granted to the owner or
rte agent to perform me work indicated in accordance with the Pitkin County ISDS Regulation in effect at the time of issue. This permit becomes invalid 6 months from the date
Tat the permit was issued unless system construction has commenced or an extension has been approved in writing by the Department.
As -Built drawings must be included with this permit before the final approval will be issued.
Installer:
Receipt#
Date received
Received by
0 Final Inspection Approval:
Site Plan ✓ Wel( Permit and ✓ Soils Test
k,� Floor Plan Water Quality Test or 9 Date Info Complete 1 r'4DPH1
✓ Comm Dev Approval ✓ Water System Letter Final Insp Requested
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Contact Log Sheet
Name: EO/J t-
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Address:
;t S' -&,53Y f 13 - 074
Date Person SpokervTo
Comments / Action to be Taken Initials
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446611 09/01/2000 11:20A MEMO DAVIS SILVI
1 of 1 R 5.00 D 0.00 N 0.00 PITKIN COUNTY CO
To: Paul & Gina Samuelson
0040 Arbaney Lane
Snowmass. CO 81654
February 22, 2000
Re: Lot 5, Double X Quarter Circle Subdivision; permit #97012
Dear Mr. & Mrs. Samuelson:
4? 3Vi3-00a -0,aCb5
6
ASPEN • PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
A permit for an individual sewage disposal system (ISDS) was issued for the above noted property on 4/4/97.
Without an I51)5 permit being issued, we would not have been able to sign off on your building permit to build
your home. Your home has been completed and your Certificate of Occupancy (CO) is waiting to be signed.
Pitkin County Environmental Health cannot sign your CO without first finaling your I5D5 permit.
You must have your ISD5 permit finaled by June 15, 2000. The requirements that must be met prior to your
I5DS being finaled are that your driveway be moved from over the I5D5 field and that Pitkin County
Environmental Health receive an as -built drawing of your system installation by your installer, 5tutsman-
Gerbaz. You should contact your installer and have them complete your as -built drawing.
You have been previously notified that the driveway must be moved so that it is not over your I5D5 field. As
is noted in the Pitkin County Individual Sewage Disposal System Regulation, for the type of system that you
have, no driveway may be on top of a leaching area. There are good reasons for this. Driving on top of soils
compacts them, making them less effective in absorption. Driving on system components can damage them.
Either one or both of these factors can cause a system to fail. Our main concern is the protection of
groundwater quality, but also the expense to the homeowner should a repair or replacement be necessary.
Our efforts to work with you to see this I5DS permit to completion have failed. As was previously stated,
we must be able to final your ISDS permit by June 15, 2000. If the permit is not finaled by this
date, we will record a copy of this letter against your property as public notice of non-compliance.
In addition, because there are public health concerns due to your lack of compliance, we, may also seek
injunctive relief through the courts.
Should you have questions regarding this issue, please don't hesitate to contact this department.
Since
Th/ 5 DunloG^
Director, Pitkin County Environmental Health Department
CC: Pitkin County Attorney
Printed on Recycl Par
130 Som GALENA STREET ASPEN, CoLoRAoo 81611-197 . PHONE 970.920.5070 FAx 970.920.5197
L_—
To: Paul & Gina Samuelson
0040 Arbaney Lane
5nowmass. CO 81654
February 22, 2000
Re: Lot 5, Double X Quarter Circle Subdivision; permit #97012
Dear Mr. & Mrs. Samuelson:
77
ASPEN • PnxN
ENVIRONMENTAL HEALTH DEPARmw
A permit for an individual sewage disposal system (ISDS) was issued for the above noted property on 4/4/97.
Without an I5D5 permit being issued, we would not have been able to sign off on your building permit to build
your home. Your home has been completed and your Certificate of Occupancy (CO) is waiting to be signed.
Pitkin County Environmental Health cannot sign your CO without first finaling your ISD5 permit.
You must have your I5D5 permit finaled by June 15, 2000. The requirements that must be met prior to your
I505 being finaled are that your driveway be moved from over the I5D5 field and that Pitkin County
Environmental Health receive an as -built drawing of your system installation by your installer, Stutsman-
Gerbaz. You should contact your installer and have them complete your as -built drawing.
You have been previously notified that the driveway must be moved so that it is not over your I5D5 field. As
is noted in the Pitkin County Individual Sewage Disposal System Regulation, for the type of system that you
have, no driveway may be on top of a leaching area. There are good reasons for this. Driving on top of soils
compacts them, making them less effective in absorption. Driving on system components can damage them.
Either one or both of these factors can cause a system to fail. Our main concern is the protection of
groundwater quality, but also the expense to the homeowner should a repair or replacement be necessary.
Our efforts to work with you to see this I5D5 permit to completion have failed. As was previously stated,
we must be able to final your ISDS permit by June 15, 2000. If the permit is not finaled by this
date, we will record a copy of this letter against your property as public notice of non-compliance.
In addition, because there are public health concerns due to your lack of compliance, we. may also seek
ajunctive relief through the courts.
%iould you have questions regarding this issue, please don't hesitate to contact this department.
Sincerely,
Thomas S. Dunlop
Director, Pitkin County Environmental Health Department
CC: Pitkin County Attorney
Printed on Rec cled PaQ[r
L 130 Soum GALENA STREET - ASPEN, COLORADO 81611-1975 PHONE 970.920.5070 FAx 970.920.5197
PMW on Rm,W Paper
C,
■ C, are items 1, 2, and 3. Also complete
itt if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Arrvle Addressed to:
A.
B.
C. Signal
X ❑ Agent
❑ Accra
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3 1 3. Service Type
�S ✓ ��I-�s' ck Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
Q O l a > -14 $b-1 01 nsured Mail ❑ C.O.D.
4. Restricted D Ivairyt Xxba Fee) ❑ Yes
2. Article Number (Copy from service label)
7— t. -IE> —113 lto-a
PS Form 3811, July lggg Dom,
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US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not ese Inr u.a rcee .e..,,...,,�
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street d tiartber
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Post Office, Sine, 8 ZIP Cade
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X -Sender: rickm@comdev.aspen.co.us
Date: Thu, 03 Apr 1997 14:43:05 -0700
To: Tom Dunlop <tomd@comdev.aspen.co.us>
From: Rick Magill <rickm@comdev.aspen.co.us>
Subject: Re: Paul Samuelson Building Envelope
Tom,
Based on your representations regarding the Samuelson ISDS application and
my understanding of the property, I feel that additional Planning Office
review is not necessary for the installation of the septic system in the
area indicated by you. The area proposed for the septic system is
relatively
flat (slopes of less than 15%) and is free of any other 1041 Environmental
Hazards.
Rick Magill
Senior Planner
Aspen Pitkin Community Development Department
At 02:33 PM 4/3/97 -0700, you wrote:
>Rick,
>As per our discussion on 4/3/97 concerning the Paul Samuelson ISDS
>application and proposed Building permit, the following was agreed to by
you
>as presented by this office.
>The Aspen/Pitkin Community Development Department is requested to approve
>the installation of an individual sewage disposal system outside the
>building envelope on Lot 5, Double X Quarter Circle Subdivision, commonly
>know as 0040 Arbany Lane, Snowmass, Colorado. This request for
>consideration is made by the Aspen/Pitkin Environmental Health Department.
>Further, this request for approval can be made administratively without
>formal action of the BOCC as per your comment to me.
>The property in question was approved as a subdivision by the BOCC in
>Resolution No. 80-98.
>The reason for this approval is based on required setbacks defined in the
>Pitkin County Individual Sewage Disposal System Regulation, and the fact
>that Mr. Samuelson cannot physically fit his water well, septic system and
>house within the defined envelope. Also, the requirement that all
utilities
>be located within a defined building envelope was implemented
approximately
>15 years after this subdivision was approved.
>>From the public health perspective it will be more protective of ground
>water and drinking water if the ISDS is installed at the location shown on
>the map reviewed with you on this date.
>If this representation of our conversation is accurate, please acknowledge
�i
,Printed or Tom Duniop <tomd@comdev.aspen.co.us>
3
>by return e-mail. This communication will become a permanent part of the
>ISDS record for this specific property.
>Tom dunlop
>Tom Dunlop
>Environmental Health
>920-5073
lFrInted for TOM DIMIOP <tomd@comxIev.aspen.co.u9>
ASPEN/PITIRN ENVIRONMENTAL HEALTH DEPARTMOV
ISDS DESIGN REQUIREMENTS
DEPARTMENT USE ONLY
Name Paul Samuelson
Permit#y7d/Z
Parcel ID #
House Siz 6 (75 gpd, 100 gpd, or 130 gpd) 100
Number of Bedrooms, Lofts, Offices, Similar Rooms, Main House 4
Number of Bedrooms, Lofts, Offices, Similar Rooms, Caretaker unit 2
Average Daily Waste Flow 1 200 900 # bedrooms X 2 people/br X 75
State Review Required? no
Perc Rate 16 (T)
Design Flo w (Q) = # bedrooms X 2 people/bedroom X gpd X 1.75
Q= 2100
Absorption Area (A= Q/5 X SART)
A = 1680 sq. ft. of absorption area required
93 infiltrator units without reduction
A maximum 30% reduction is allowed for use of deep gravel or gravelless chambered system.
1176 sq.ft. with reduction
65 infiltrator units with reduction
Type of system: DAbsorption trenches DAbsorption bed D Gravelless chambers
DDry well DSeepage Pit DPumping Chamber
Is an Engineer -Designed System required? no XX
yes reason:
Minimum tank capacity —al]Wgallons
Coll z 55)ep
SETBACK FROM WELL
# of feet = 188
Remember: 8 feet of additional distance for each 100 gallons/day of design flow over 1,000 gallons/day
should be added unless an RPE can verify that it is not necessary to prevent contamination.
APPROVED FOR ISSUE DATE:/'�"/� %
SYSTEM INSTALLED BY:
DATE OF FINAL INSPECTION REQUEST:
FINAL INSPECTION BY:
10 Printed on Recycled Paper
DATE:
X -Sender: rickm@comdev.aspen.co.us
Date: Thu, 03 Apr 1997 14:43:05 -0700
To: Tom Dunlop <tomd@comdev.aspen.co.us>
From: Rick Magill <rickm@comdev.aspen.co.us>
Subject: Re: Paul Samuelson Building Envelope
Tom,
Based on your representations regarding the Samuelson ISDS application and
my understanding of the property, I feel that additional Planning Office
review is not necessary for the installation of the septic system in the
area indicated by you. The area proposed for the septic system is
relatively
flat (slopes of less than 15%) and is free of any other 1041 Environmental
Hazards.
Rick Magill
Senior Planner
Aspen Pitkin Community
Development Department
At 02:33 PM 4/3/97 -0700, you wrote:
>Rick,
>As per our discussion on 4/3/97 concerning the Paul Samuelson ISDS
>application and proposed Building permit, the following was agreed to by
you
>as presented by this office.
>The Aspen/Pitkin Community Development Department is requested to approve
>the installation of an individual sewage disposal system outside the
>building envelope on Lot 5, Double X Quarter Circle Subdivision, commonly
>know as 0040 Arbany Lane, Snowmass, Colorado. This request for
>consideration is made by the Aspen/Pitkin Environmental Health Department.
>Further, this request for approval can be made administratively without
>formal action of the BOCC as per your comment to me.
>The property in question was approved as a subdivision by the BOCC in
>Resolution No. 80-98.
>The reason for this approval is based on required setbacks defined in the
>Pitkin County Individual Sewage Disposal System Regulation, and the fact
>that Mr. Samuelson cannot physically fit his water well, septic system and
>house within the defined envelope. Also, the requirement that all
utilities
>be located within a defined building envelope was implemented
approximately
>15 years after this subdivision was approved.
>>From the public health perspective it will be more protective of ground
>water and drinking water if the ISDS is installed at the location shown on
>the map reviewed with you on this date.
>If this representation of our conversation is accurate, please acknowledge
lPrinted for TOM DUnIOP < o co ev.aspen.co.us>
r,
►a
>by return e-mail. This communication will become a permanent part of the
>ISDS record for this specific property.
>Tom dunlop
>Tom Dunlop
>Environmental Health
>920-5073
Printed-forTom—Dunlop <tomd@c6xde_v.aspen.co.us>
I"
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ENGINEERS
' • SURVEYORS 40
(970) 925-6727 SC'1�i
SE
FAX (970) 925-4157 CORDONRDON MEYERM
3/
April 2, 1997
Mr. and Mrs. Paul Samuelson
0040 Arbaney Lane
Snowmass, CO 81654
RE: 0040 Arbaney Lane, On -Site Wastewater System Location
Dear Gina and Paul:
P.O. Box 2155
Aspen, CO 81612
I am writing in follow-up to my discussions with Bob Nelson of NEWS, Ltd, regarding the location
of an on-site wastewater disposal system (ISDS) for your proposed residence on Lot 5 of the
Double X Quarter Circle Subdivision, addressed as 0040 Arbaney Lane. As Gina knows, I also
attended a site visit on Tuesday, March 25th at the site with Gina, Bob, Jerry Gerbaz and Tom
Dunlop of the Aspen/Pitkin Environmental Health Department.
Based on Bob Nelson's Soils Evaluation and Percolation Test report for the site dated March 31,
1997, it appears that a conventional (non -engineered) ISDS will be feasible for the proposed
residence. Based on Bob's initial percolation results and our observation of the profile pit during
the site visit on March 25th, test holes were prepared somewhat deeper and re -tested, resulting
in more consistent rates well within the non -engineered criteria of the Pitkin County regulations.
Based on the site plan included as Figure 1 in Bob's report, two things are apparent with regard
to the system layout;
The system should not be located within the defined building envelope. Several
constraints cause us to recommend that the system not be placed within the building
envelope;
a. The setback from the existing well within the property to the ISDS under County
criteria could be up to 160 feet (our recommended system location will still
encroach on this setback distance, more on this under item 2, below). The 160
foot setback effectively encompasses the entire building envelope.
b. The logical location for an ISDS within the defined building envelope would
probably be within the lower (northeasterly) corner of the envelope. From our site
visit, it is apparent that the northeast corner of the envelope is within the irrigated
meadow area fed by an irrigation ditch below the embankment to the east of the
homesite. Locating an ISDS in an irrigated meadow area is problematic from an
operational standpoint due to possibly fluctuating surface saturation or
groundwater conditions and would require, at least, that a substantial area around
and over the system be removed from irrigated use. I think you, as the property
owners, and Pitkin County are probably in agreement that it would be undesirable
to remove a portion of the meadow from irrigated use for ISDS purposes. This
location, as noted above would still encroach on the well setback.
118 West 6th, Suite 200 • Glenwood Springs, Colorado • (970) 945-1004
April 2, 1997
Gina and Paul Samuelson
Page 3
less than 160 feet from the well head as proposed. I should also note that care should be taken
to route any substantive surface drainage around the final bed area. I hope these comments will
be sufficient for issuance of your building permit. Feel free to contact me if I may provide
additional comment or detail.
Very Truly Yours,
SCHMUESER GORDON MEYER INC.
UlI
lammond, P.E.
, Aspen Office
JHAh SISDS
GORDON MEYER,
April 2, 1997
Gina and Paul Samuelson
Page 2
For perhaps the last 1 1/z years Pitkin County has been requiring that building envelopes
be defined to include most disturbance areas including ISDS systems. Created in 1980,
this lot clearly pre -dates the recent application of this policy and we would anticipate that
placement of the ISDS outside the building envelope will not be an issue for the County
in approving a building permit for the property. It is anticipated that the ISDS sytem will
be located entirely below grade and revegetated upon completion.
2. The ISDS will need to encroach somewhat on the setback defined under the Pitkin
County ISDS Regulations from the existing well. From Bob's report, the proposed
residence comprises two units including a three bedroom main residence and a two
bedroom attached caretaker unit. As attached units, it is my understanding that the
Environmental Health Department views them in the aggregate as a five bedroom
residence totalling 2,984 square feet. Due to the flow assigned to residences over 2,000
square feet under4he Pitkin County Individual Sewage Disposal System Regulation, at 100
gallons per capita per day, the combined structure would generate a theoretical design
flow of 1,750 gallons per day (gpd). This design flow requires a setback from the
wellhead of 160 feet under the requirements of Table II on page 24 of the County
regulation "... unless it can be demonstrated by an RPE (Registered Professional
Engineer) that this is not necessary to prevent contamination."
Recommendation
From my review of the design requirements for an ISDS for the 0040 Arbaney Lane property, we
would recommend a generally conventional seepage type disposal system located in the area
of the percolation and profile test holes north-northwest of the proposed home and building
envelope. It is anticipated that sewage flow would be collected in the area of the northeast
corner of the building footprint and routed to a septic tank downslope of the house. Treated
effluent would then be lifted from the septic tank to the bed area by an effluent pump located in
the second chamber of the septic tank (or in a separate vault).
From our discussion of the bed area and configuration requirements, the required disposal area
could encroach on the 160 foot distance by up to 35 feet leaving a minimum 125 foot setback
from the wellhead. (It is worth noting that, while this reduced setback encroaches on the
requirements under the Pitkin County Code, it would exceed the 110 foot setback defined under
the recommended standard for well setbacks under the State ISDS guidelines.) Noting the
relative location of the ISDS to the wellhead, which is hydraulically downstream relative to the
river aquifer, and plotting a section through the proposed well and closest likely ISDS discharge,
effluent projected at 450 will not intercept the projected water level (at T7 feet) upstream of the
well. It is then anticipated that effluent would flow downstream, away from the well location. The
distances from the ISDS bed area to the depth of the aquifer from which the water supply is to
be drawn also render it unlikely that any pathogenic organisms or other pollutants would make
it to the aquifer in any direction from the bed.
In short, we feel that the site characteristics provide adequate demonstration that contamination
of the on-site well will not be a concern due to the placement of a properly installed ISDS system
GORDON MEYER,
ASPEN/PlAENVIRONMENTAL HEALTH DEPARTMO
ISDS DESIGN REQUIREMENTS
DEPARTMENT USE ONLY
�Z3-67�`f Permit#
Name Lisa & Mark samuelson
Parcel ID #
House Size 2-6,000 (75 gpd, 100 gpd, or 130 gpd)
Number of Bedrooms, Lofts, Offices, Similar Rooms, Main House 4
Number of Bedrooms, Lofts, Offices, Similar Rooms, Caretaker unit 1
Average Daily Waste Flow 750 # bedrooms X 2 people/br X 75
State Review Required? no
Perc Rate 25 (T)
Design Flow (Q) = # bedrooms X 2 people/bedroom X gpd X 1.75
Q= 1750
Absorption Area (A= Q/5 X SQRT)
A = 1750 sq. ft. of absorption area required
97 infiltrator units without reduction
or 583.3333 lineal feet of 3' wide trenches
A maximum 30% reduction is allowed for use of deep gravel or gravelless chambered system.
1225 sq.ft. with reduction
68 infiltrator units with reduction
408.333333 LINEAL FEET of 3' wide trenches
Type of system: OAbsorption trenches []Absorption bed O Gravelless chambers
[]Dry well OSeepage Pit OPumping Chamber
Is an Engineer -Designed System required? no
Minimum tank capacity
SETBACK FROM WELL
# of feet = 160
yes reason:
2187.5 gallons
i1§111
Remember: 8 feet of additional distance for each 100 gallons/day of design flow over 1,000 gallons/day
should be added unless an RPE can verify that it is not necessary to prevent contamination.
APPROVED FOR ISSUE BY:
SYSTEM INSTALLED BY:
DATE OF FINAL INSPECTION REQUEST:
FINAL INSPECTION BY:
3 Il
Printed on Recycled Paper
DATE:
DATE:
ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT
ISOS DESIGN REQUIREMENTS
DEPARTMENT USE ONLY
Name Paul Samuelson
House Siz 5 (75 gpd, 100 gpd, or 130 gpd)
Number of Bedrooms, Lofts, Offices, Similar Rooms, Main House 3
Number of Bedrooms, Lofts, Offices, Similar Rooms, Caretaker unit 2
Average Daily Waste FlowyO # bedrooms X 2 people/br X 75
State Review Required? !l no
Perc Rate 16 (T)
Design Flo w (Q) = # bedrooms X 2 people/bedroom X gpd X 1.75
Q= 1750
Absorption Area (A= Q/5 X SART)
A = 1400 sq. ft. of absorption area required
78 infiltrator units without reduction
A maximum 30% reduction is allowed for use of deep gravel or gravelless chambered system.
980 sq.ft. with reduction
54 infiltrator units with reduction
Type of system: OAbsorption trenches OAbsorption bed 0 Gravelless chambers
ODry well OSeepage Pit OPumping Chamber
Is an Engineer -Designed System required? no XX
yes reason:
Minimum tank capacity 2,000 gallons
SETBACK FROM WELL
# of feet = 160
Sr/` Cit!
Permit # Z
Parcel ID# Z.4!jf3-4$62- dt oos
Will
Remember: 8 feet of additional distance for each 100 gallons/day of design flow over 1,000 gallons/day
should be added unless an RPE can verify that it is not necessary to prevent contamination.
APPROVED FOR ISSUE BNDATE:�
SYSTEM INSTALLED BY:
DATE OF FINAL INSPECTION REQUEST:
FINAL INSPECTION BY: DATE:
Printed on Recycled Paper
3S-
ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMO
ISDS DESIGN REQUIREMENTS
DEPARTMENT USE ONLY
Name Paul Samuelson
�
Permit# '97,')12-
Parcel
7D/ZParcel ID #Z -
House Siz 6 (75 gpd, 100 gpd, or 130 gpd) 100
Number of Bedrooms, Lofts, Offices, Similar Rooms, Main House 4
Number of Bedrooms, Lofts, Offices, Similar Rooms, Caretaker unit 2
Average Daily Waste Flow 1 200 900 # bedrooms X 2 people/br X 75
State Review Required? no
Perc Rate 16 (T)
Design Flo w (Q) = # bedrooms X 2 people/bedroom X gpd X 1.75
Q= 2100
Absorption Area (A= Q/5 X SART)
A = 1680 sq. ft. of absorption area required
93 infiltrator units without reduction
A maximum 30% reduction is allowed for use of deep gravel or gravelless chambered system.
1176 sq.ft. with reduction
65 infiltrator units with reduction
Type of system: OAbsorption trenches OAbsorption bed O Gravelless chambers
ODry well OSeepage Pit OPumping Chamber
Is an Engineer -Designed System required? no XX
Minimum tank capacity
SETBACK FROM WELL
# of feet = 188
yes reason:
-3111 gallons
comw L5D:�p
Remember: 8 feet of additional distance for each 100 gallons/day of design flow over 1,000 gallons/day
should be added unless an RPE can verify that it is not necessary to prevent contamination.
APPROVED FOR ISSUE DATE: e/4//� %
SYSTEM INSTALLED BY:
DATE OF FINAL INSPECTION REQUEST:
FINAL INSPECTION BY:
2 Printed on Recycled Paper
J�
DATE:
ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT
ISDS DESIGN REQUIREMENTS
DEPARTMENT USE ONLY
Name Paul Samuelson
Permit # 4Wl 2i
Parcel I D # 21df3-t62-
dt �vs
House Siz 5 (75 gpd, 100 gpd, or 130 gpd) 100
Number of Bedrooms, Lofts, Offices, Similar Rooms, Main House 3
Number of Bedrooms, Lofts, Offices, Similar Rooms, Caretaker unit 2
Average Daily Waste Flovy0 # bedrooms X 2 people/br X 75
State Review Required? [[ no
Perc Rate 16 (T)
Design Flo w (Q) = # bedrooms X 2 people/bedroom X gpd X 1.75
Q= 1750
Absorption Area (A= Q/5 X SORT)
A = 1400 sq. ft. of absorption area required
78 infiltrator units without reduction
A maximum 30% reduction is allowed for use of deep gravel or gravelless chambered system.
980 sq.ft. with reduction
54 infiltrator units with reduction
Type of system: DAbsorption trenches DAbsorption bed 0 Gravelless chambers
ODry well OSeepage Pit OPumping Chamber
Is an Engineer -Designed System required? no XX
yes reason:
Minimum tank capacity 2,000 gallons
SETBACK FROM WELL
# of feet = 160
Remember: 8 feet of additional distance for each 100 gallons/day of design flow over 1,000 gallons/day
should be added unless an RPE can verify that it is not necessary to prevent contamination.
APPROVED FOR ISSUE B DATE:
SYSTEM INSTALLED BY:
DATE OF FINAL INSPECTION REQUEST:
FINAL INSPECTION BY: DATE:
Printed on Recycled Paper
3�
•
l
Nelson Environmental l; Wastewater Solutions Ltd
W March 31, 1997 Gj/1 Gj 2-
Mr. and Mrs. Paul Samuelson
S 0040 Arbaney Lane
Snowmass, Colorado 81654
Subject: Soils Evaluation and Percolation Test for Individual Sewage System Design for the
Residence on Lot 5, Double X Quarter Circle Ranch Subdivision, numbered as 0040 Arbaney
Lane
Dear Gina and Paul,
As requested, Nelson Environmental and Wastewater Solutions, Ltd., has performed a soils study
and percolation testing to design a septic system for the residence at the subject site. We
conducted this study according to Article 5 of the Pitkin Counter Readations on Individual
Sewage Disposal Systems on Thursday, March 27, 1997. In addition we have attempted to
conform to the Individual Sewage System Winter Soil Testing Policy (Policy 96-1) of the
Aspen/Pitkin Environmental Health Department. We have based our recommendations on the
subsurface conditions encountered at that time. We will furnish this letter and a copy of the
enclosed data sheet to the Aspen/Pitkin Environmental Health Department to obtain a permit to
construct this individual sewage system.
Proposed Construction:
The proposed two-story residence is to consist of two separate units. The main residence has .
2324 square feet of living area with three bedrooms and two and one-half bathrooms proposed.
A 660 square foot caretaker apartment with two bedrooms and one bathroom is planned over the
garage.
Site Conditions:
This site is in the Double X Quarter Circle Subdivision, overlooking the common pasture land
fronting State Highway 82. Most of the lot is now pasture. The lot consists of a flat potion at the
westerly property line, a relatively steep hillside sloping toward the meadow area, and a portion to
the East of the power line that slopes at less than 5% toward the bottom of the lot. The ground
surface, which appears natural in the proposed area of the absorption field, slopes to the
Northeast at about a 10% grade. There is a small irrigation ditch overflow and culvert coming
from the other common area pasture across the road to the West, about 25 feet from the closest
percolation test hole locations. There is also a small stream along Watson Divide Road South of
the southern property line.
There is an existing drilled well recently completed on the property, reportedly 161 feet in depth.
The lot is approximately 2.7 acres in size.
�� P.O. Box 6961 Snowmass Village, CO 81615 Office (970) 923.3289 Home & Fax (970) 923.2766
0 0
Samuelson Duplex Residence Percolation Tests
Lot 5, Double X Quarter Circle Subdivision
March 31, 1997
Page 2
Subsurface Conditions: _
A soil profile pit to a depth of eight and three-fourths feet was excavated within 10 feet of the
proposed absorption area. This excavation revealed that no groundwater or bedrock was
observed to the depth of the profile pit. The soil consisted of a dark gray silty clay loam with
small cobbles and rock fragments, two to eight inches in diameter, to the depth of profile
excavation. The soil exhibited little tendency to swell when wetted or compacted under the
pressure of the excavating equipment.
The subsurface soil conditions were evaluated with the standard percolation test procedures at the
approximate locations shown on Figure 1. The test holes were excavated by hand by the owner.
Percolation Testing:
Percolation testing was performed in the proposed absorption area North and Northeast of the
residence. Normal winter procedures were used in preparing and presoaking the percolation test
holes to determine the percolation rate for this area of the referenced property.
The test holes were excavated by hand to a depth of 4 to 5 feet. At this depth, there was no
evidence of frost, and the soil was relatively warm from the recent mild temperatures. The soil
temperatures within the percolation test holes varied from 35° to 38° F. with the topsoil in the
area of test hole #6 reaching 50° F. in the sunshine on the day of the percolation test
measurements. Before and during the initial presoaking period the holes were covered with
burlap sacks, a plastic tarp and a layer of 3/4" plywood. There was no snow cover on the
proposed absorption area having melted in the two weeks prior to the percolation testing.
We waited for weather conditions that were predicted to be above freezing during the day, before
setting up the percolation test procedure. The weather on March 26 and 27 was clear and the
afternoon temperatures were 50° F. The low was only about 20° F on March 26. Before the
presoak was begun, the sidewalls were scrapped, all loose soil material removed, and gravel
placed in the test hole to prevent scouring when water was added. There was no evidence of
freezing or frost at the bottom of the test holes during these final preparation procedures.
An initial filling of the percolation test holes was done by adding approximately 6 gallons of water
to each of the holes the evening of the day before the percolation test was conducted. As soon as
the water was added, the holes were again covered with insulation and plywood. As a check,
water was left in plastic jugs overnight to check for freezing. None occurred. The percolation
holes were then further pre-soaked by adding water to refill the test holes to a depth of fourteen
inches several times for the nine hour period before beginning the percolation test. The ambient
139
0 0
Samuelson Duplex Residence Percolation Tests
Lot 5, Double X Quarter Circle Subdivision
March 31, 1997
Page 3
air temperature during the presoaking on March 27, 1997 was above freezing for most of the day,
and no ice formed on the water in the test holes at any time during the presoaking period. The
temperature at 5:00 p.m. was still 47° F.
The test results obtained appear to be consistent with the soil type on the property and not
significantly different from those rates obtained in earlier percolation tests or on adjacent lots. It
is our opinion that if the test holes had frozen, the measured rates would have been much slower.
This testing was performed in three shallow holes excavated with hand tools to a depth of
c approximately inches.
The results of the percolation testing are presented in Table I. These results indicate the silty clay
loam soils have an average percolation rate of 16 minutes per inch, a satisfactory percolation rate
under Pitkin County criteria.
Limitations: This report has been prepared according to generally accepted practices in this area
for use for sewage disposal design purposes. The conclusions and recommendations submitted in
this report are based upon data obtained from our site visits at the location indicated. There is
some possibility that the nature and extent of variations in the subsurface soil across the site may
not have been evident at the time of this investigation, and may require additional evaluation if
further excavation reveals conditions different from those described. This office should be
advised of these situations as soon as possible so we may reevaluate our recommendations.
If you have questions or if we may be of further assistance, please call the office.
Sincerely, f ��
Robert F. Nelson
President
Lam
Reviewed By:
'V.
tSchmeusei,
ond, P.E.
Gordon, Meyer Engineering
i6
Nelson Environmental & Wastewater Solutions, Ltd
E
W TABLE I
S PERCOLATION TEST RESULT FORM
Hole
Length
Depth at
Depth at
Drop in
Average
Hole Depth
of Interval
Start of Interval
End of Interval
Water Level
Percolation
No. (in.)
(Minutes)
(Inches)
(Inches)
(Inches)
Rate(Min./Inch)
4 50
12
59/16
43/4
13/16
10
43/4
41/4
1/2
(refill)
10
61/2
57/8
5/8
10
57/8
5 1/4
5/8
10
5 1/4
45/8
5/8 16
6 60
10
4
3 5/8
3/8
10
3 5/8
3 1/4
3/8
(refill)
10
8
75/8
3/8
10
75/8
7 1/8
1/2
10
71/8
65/8
1/2 20
7 48 1/2
10
43/4
4
3/4
10
4
33/8
5/8
(refill)
10
57/8
5
7/8
10
5
43/8
5/8
10
43/8
3 5/8
3/4 11
Gina and Paul Samuelson Property
0040 Arbany Lane
Lot 5, Double X Quarter Circle Ranch
Date of Percolation Test: 03/27/97
Iq / P.O. Boz 6961 Snowmass Village, CO 81615 Office (970) 923.3289 Home & Fax (970) 923.2766
0
Nelson Environmental & Wastewater Solutions, Ltd
0
E Property Address: 0020 Arbanev Lane
W
S Legal Description: Lot 5, Double X Quarter Circle Subdivision
Property Owner
Name
Paul and Gina Samuelson
Address
0040 Arbanev Lane
Snowmass, CO 81654
Phone:
923-4538
Contractor:
Name:
Dan Gruenefeldt
Address:
P. O. Box 1910
Basalt, CO 81621
Phone: 963-4979
Saturation and Swelling
o Smeared surfaces removed X Yes
o Gravel Added X Yes To a 4" Depth
o Date and Time presoak water added
03/26/97 (d), 4:05 am.
o Amount of presoak water added
6 gallons/test hole on 3/26/97
24 gallons/test hole on 3/27/97
o Water remaining in holes after overnight presoak?
Hole 4: _Yes X No
Hole 6: Yes X No
Hole 7: Yes X No
Percolation Rate Measurement
Hole 4: 16 minutes/inch
Hole 6: 20 minutes/inch
Hole 7: 11 minutes/inch
AVERAGE 16 minutes/inch
Excavating Contractor:
Name: Stutsman-Gerbaz.lnc.
Address: 0755 Gerbazedale Dr.
Snowmass, CO 81654
Phone: 923-2734
Groundwater:
o Not Encountered to 8 3/4 ft.
o Estimated depth to high seasonal
water if not encountered- 100 feet
o Is area believed to be subject to
seasonal fluctuations which could
result in a seasonal water table?
_ Yes X No
Slope in absorption area
10% to the Northeast
Bedrock
o Not Encountered
o Estimated depth if not encountered -180 feet
o Type of bedrock:
Sandstone X Claystone or Shale
Siltstone Other:
o Is bedrock believed to be permeable?
Yes X No
I certify that the above information is correct and complete to the best of my knowledge
and that all tests were performed in accordance with the provisions of Pitkin County
Individual Sewage Disposal System Regulation, Articles 5.1 through 5.8 and under the
supervision of a Registered Professional Engineer.
Robert F. Nelson
President
Reviewed by:
ASGMammond,P.E.
nc., Engineers
P.O. Box 6961 Snowmass Village, CO 81615 Office (970) 923.3289 Home & Fax (970) 923.2766
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Samuelson Property
Lot 5, Double X Quarter Circle Subdivision
FROM
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STUTSMRN GERBRZ r FAX NO. : 970 923 0647
1-
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AMay. 09 2000 07:41AM P1
J & M PUMP COMPANY
0241 COUNTY ROAD 167
GL NWOOD SPRINGS, CO 61601
(303) 9456159
March 13,1997
Paul & Gina Samuelson
0040 Arbaney Lane
Snowmass Co. 81654
RE: Well Test
Attn: Paul,
A two hour well test was performed by J & M Pump Co. on property
located at 0040 Arbaney Lane. The following results were obtained:
Well: 161'
Water Level: 77'
Drawdown: 2'
Sustained Yeild: 15 GPM
Water Clarity: Cloudy
A bacteria sample was drawn at the end
Snowmass Water for analysis. Results will be
have any questions, please feel free to call
J & M Pump Co.
Aa
Richard A Holub
Lic. No. 1196
LIS
of the test and taken up to
sent to my office. If you
945-6159. Thank You.
Form No.' OFFICE OF THE STA ENGINEER
GWS -25• COLORADO DMSIOIWF WATER RESOURCES 46
618 Centennial Bldg., 1313 Sherman St, Denver, Colorado 80203
_ L303� 866-3581
APPLICANT
GINA & PAUL SAMUELSON
0040 ARBANEY LN
SNOWMASS CO 81654-
(970)923-8911
PERMIT TO CONSTRUCT A WELL
WELL PERMIT NUMBER 047946 -
DIV. 5 CNTY. 49 WD 38 DES. BASIN MD
Lot: 5 Block: Filing: Subdiv: DOUBLE X QUARTER CIH(:LE
1095
APPROVED WELL LOCATION
PITKIN COUNTY
SW 1/4 NW 1/4 Section 6
Twp 9 S RANGE 85 W 6th P.M.
DISTANCES FROM SECTION LINES
2280 Ft. from North Section Line
1170 Ft. from West Section Line
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF APPROVAL
1) This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of the
permit does not assure the applicant that no injury will occur to another vested water right or preclude another
owner of a vested water right from seeking relief in a civil court action.
2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless
approval of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump
Installation Contractors in accordance with Rule 18.
3) Approved pursuant to CRS 37-90-137(2) on the condition that the well be operated in accordance with the Aspen
Village Inc. Augmentation Plan approved by the Division 5 Water Court in case no. 81CW432 for CXQC Well #5.
If the well is not operated in accordance with the terms of said decree, it will be subject to administration including
orders to cease diverting water.
4) Approved as the only well on a residential site of 3 acres described as lot 5, Double X Quarter Circle Subdivision,
Pitkin County.
5) The use of ground water from this well is limited to domestic purposes on one residential lot and the irrigation of
not more than i acre of lawns and gardens as decreed in case no. 81CW432.
6) The maximum pumping rate shall not exceed 15 GPM.
7) The annual amount of ground water to be withdrawn shall not exceed 3.0 acre-feet.
8) The return flow from the use of the well must be through an individual waste water disposal system of the non-
evaporative type where the water is returned to the same stream system in which the well is located.
9) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records
of all diversions must be maintained by the well owner (recorded at least annually) and submitted to the Division
Engineer upon request.
10) This well shall be constructed not more than 200 feet from the location specified on this permit.
11) The owner shall mark the well in a conspicuous place with well permit number(s), name of the aquifer, and court
case number(s) as appropriate. The owner shall take necessary means and precautions to preserve these
markings. r, y. i
APPROVED44.1
Z ,State !�
Receipt No. 0410519 EngineerDATEISSUED MAR 0 1997 EXPIRATION DATE MAR 0 6 1998
IWill
0 0
Shelton Drilling Corp.
P.O. Box 1059
Basalt, Colo. 81621
(970) 927-4182
Lic. # 1095 Invoice # C-1032
Name
Gina & Paul Samuelson Date 03/13/97
Go :
Casing ID
Address
Permit # : 047946-F
0040 Arbanev Lane
City, St, Zip
Location Watson Divide
Snowmass, Co. 81654
Phone # :
(970) 923-8911
Hole Size
Depth
Type
Casing ID
Casing OD
From -To
9.0
85
Steel
6.5
7.0
0-85
6.5
160
Steel
5.0
5.0
73-160
Perforated Ft
40
ft
Estimated
15
gprn
Static Level
75
ft
Total Drilled
160
ft
Recommended Pump Set Depth 155 Ft. Pumping 15 GPM.
For Pump Installation We Recommend : Aqua Tec Pump 984-0311 (Tom Platzer)
Samuelson Pump 945-6309 (Raun Samuelson)
J & M Pump Cc 945-6159 (Rick Holub)
Special Instructions :
Price Per Foot 5 Feet @ $ 30.00 Per Foot = $ 1,950.00
Feet @ $ � Per Foot = $ 2,125.00
Total Invoice. . . . . . . . $ 4.075.00
Conditions Of Payment : pay $ 4.075.00
PLEASE READ THE FOLLOWING RECOMMENDATIONS
1.. WE STRONGLY RECOMMEND A VALID PUMP TEST BE CONDUCTED BY A LICENSED PUMP
INSTALLER TO DETERMINE THE ACTUAL WELL PRODUCTION AND WATER QUALITY. THIS SHOULD
ESTABLISH THE ACTUAL WELL PRODUCTION PARAMETERS WHICH WE CANNOT DETERMINE WHILE
DRILLING.
2. On Monitoring/Observation Holes (test holes) it is the customer's responsibility to obtain the proper
permit before the well is put to beneficial use (within one year) or the State may require the hole be plugged
and abandoned. We will be happy to assist you whenever possible in filling out the appropriate well
application.
3. The landowner is ultimately responsible for the plugging and abandoning of dry holes or replaced wells,
according to State Rules and Regulations. Please contact us for details and/or prices.
BILLING.
Please call us if you have any questions .
9�
THANK YOU
161
FORM N0.
GWS -32
10164
PUMP INSTAlifigN AND TEST REPORT
STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
For Office Use only
1.
WELL PERMIT NUMBER 047946 F
2.
OWNER NAME(S) Gina & Paul Samuel on
Mailing Address 0040 Arhanay Tana
City, St. Zip Rnnwmacc rn 81 654
Phone ( 970) 923-8911
3
WELL LOCATION AS DRILLED: SW 1/4 NW 1/4, Sec. 6 Twp. 9 S Range 85 W 6th
DISTANCES FROM SEC. LINES:
2280 ft. fromNo�Sec. line. and 1170 ft. from Ws Sec. line.
SUBDIVISION: LOT_ BLOCK FILING(UNIT)
STREET ADDRESS AT WELL LOCATION:
PUMP DATA: Type Submersible Installation Completed 3/13/97
Pump Manufacturer rnu1 d -g Pump Model No. 1 or-gl nd, 2T
4.
Design GPM 1 0 at RPM -j4Sn __ HP 1 , Volts 2 -in Full Load Amps 8 6
Pump Intake Depth 1 55 , Feet, Drop/Cure:,., ripe Size 1 i ll Inches, Kind Sch 80 PVC
ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM:
TURBINE DRIVER TYPE: ❑ Electric ❑ Engine ❑ Other
Design Head feet, Number of Stages Shaft size inches.
5.
OTHER EQUIPMENT:
Airline Installed ❑ Yes ❑ No, Orifice Depth ft. Monitor Tube Installed ❑ Yes ❑ No, Depth ft.
Flow Meter Mfg. Schlumberger Meter Serial No. 39301 976
Meter Readout ® Gallons, ❑ Thousand Gallons, ❑ Acre feet, ❑ Beginning Reading 0
6.
TEST DATA: ❑ Check box if Test data is submitted on Supplemental Form.
Date 3/13/97
Total Well Depth 161' Time 2 14R
Static Level 77, Rate (GPM) is
Date Measured Pumping Lvl. _____2_9_r
7.
DISINFECTION: Type Chlorox Amt. Used 1 cup Liquid
8
Water Quality analysis available. ❑ Yes ❑ No
9.
Remarks
0. 1 have read the statements made herein and know the contents thereof, and that they are true to my knowledge.
[Pursuant to Section 24-4-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury in the secon
degree and is punishable as a class 1 misdemeanor.]
CONTRACTOR J & M Pump Cn Phone (970) 945-6159 Lic. No. 11 96 .
Mailing Address 0241 Co Rd 167 Glen SPgs CQ. 81 601
Nama/ a/(Please type or print)Signat
// -
Date
L/31
STANDARD BACTERIOLOGICAL WATER TEST
Colorado Department of Public Health and Environment AFFIX FEE
x270 East t ith Avenue • Denver. Colorado 80220 PREPAID L.AB SEE BACK OF THIS COPY
�!��� T�� �� �J'• / C STAMP HERE FOR
EXPLANATION
OF
(II Applicable) TESTS
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t SAMPLE NAME Of RAW o �.����•�
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/ COUNT O COLIf0E1M/10a MI U
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