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Please See Building and Land Use Approvals Files for additional information.
E
02683-08J -0'0-010
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER 72018 4; RECEIPT NUMBER /& y�e
Owner
Address h L a"'i"
Phone N X2 > -` , ,.Zs
22
Contractor ��^ P(.Z � ate) - Q /-1 Phone #
Address
-7, ��
Location of system/� 0 Lot size 2 %9 0 �Al2ChPC
Legal description AZ42,,7Z /SLC h/p
feC, T 95 /� 2TV -PH
Number of bedrooms
Signature of owner
Percolation test data — )/ -
---
Date
minutes per inch
Minimum recommended absorption system size (d x5(' L-A;L� D-,Pj,
Minimum recommended tank size
Permit application valid one yearrory eJfte .4pplicaticn to become permit and final
only after lower portion is compl ted a d signed. Retain this form at the construction
site. 100� "
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DRAWING
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SYSTEM
Date Sanitarian
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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): 13 k 4 d zJ L Lk L! J
Mail Address: zl7oX 3?,?S City: Phone: 92.L-2q?l —
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 /prrofil/e's in test holes.
1. Location of Facility: County r j �/c / �% City or Town
Legal Description LOY 1,-c, f 7—f3 /2B P t Size: . eVf czGhe-J
2. Type of area and facility - Number of persons served:
Subdivision Motel Restaurant Trailer Court
Other:
3. Source of domestic water
Private: Well _1,//Uepth
Public (name):
Other Depth to first ground water table
4. Is facility within boundaries of City or Sanitation District: .012 4)
If so name:
5. Distance to nearest sewer system:
Have negotiations been attempted with owner to connect: [/J C9
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 and telephone of person who made soil absorption tests:
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: -fe—1
Signature f Owner
I
0 0
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 DISAPPROVAL in the space provided below:
DATE APPROVAL DISAPPROVAL
/__7 /__7
Signature for Local Health Department
/—
Signature for Mayor or City Manager
/—T /-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:
3 WP -10 (Rev. 5-70-100)
9
• i
PERCOLATION TEST FIELD SHEET
a
COMPLETE IN DUPLICATE
(Check person responsible for or performing tests)
( ) NAME OF OWNER 1-1 L f r ed t [5 eZ 1,( K
ADDRESS BOX 37 3.r /_JsPHONE _L2
( ) NAME OF CONTRACTOR OR EXCAVATOR
ADDRESS Q k PHONE 92p3-3207
LEGAL DESCRIPTIO OF PROPERTY LOT h ,fe,
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 erformed in the 24-hour period between
A.M.and _�� M. on the _2 0 and %_ days of
e,„/, 19 ;Ma
percolation tests ry to be
peer rm— ed at _lam A_,M. and M. on q1Z
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 oche 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.