HomeMy WebLinkAboutpitkin.eh.264308100007 (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
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.CTY,IV COUNITY llr,i nL<<.,ir. OF ItIll R 7.-,'j: YiBAL.I'd
Boy V AsPcI-f City Ha
�_
rspan, Colorado
925•-2020
System Lo
Contract•a
SI -1
PrRs,IT '` 7200 j�
1. Construction apJroval:
Plans and location are hereby approved.____ _._•__
Perc. rate inches in minutes= sq. feet of
absorption -area ,oar bcdroo:l.
&-.J. feet ^minium reauire-
2. Finc_l. approval of system:
No system stall be 3ea.;,ad to be in comaliance r:ith the
Sewage Disposal La::s until the asst Ibled system is ap?roved
Prior to co•ve.,ing any Fe"'t•_—.--•-------R_.—_
se,
':ic tarsi cle2nov=,ci�h has scL'
F_i
Proper materials and .^ssemo ;r
j Adeouatc absor .on area.
j�+
Aneoua..e ccn.,rate cover (d: s..
Date
or*'keta:tn ::it'r. per:eit rcccrdr a cun:.tru r
,y
�COL'ORADO DEPARTMENT OF HEALTH
Water Pollution Control Division
4210 East llth Avenue
Denver, Colorado 80220
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
Applicant (Owner): n�� ( �) VLC tk)(' cc)(
Mail Address:City: ,aEi[/ Phone 1.2 IA4-2 s
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, soilprofilesin test holes.
1. Location of Facility: County )VI rt City or Town Gc�o-mol (/SGP
Legal Description /d1GL �pQ /%S itSSrJ �nfJ1_ Lot Size: L
2. Type of area and facility - Number of persons served: d1'co6u-- L. --E._ -
Subdivision /% Motel p/4 Restaurant railer Court
Other:
3. Source of domestic water: Public (name):
Private: Well Depth /Other Depth to first ground water table
4. Is facility within boundaries of City or Sanitation District:
If so name: /1/�1
5. Distance to nearest sewer system: 47
Have negotiations been attempted with owner to connect:
If rejected, give reason: 42
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
sand telephone Af person who made soil absorption tests:
Z- ,tiPGST - 915- YsG 6
8. Name, address and telephone of person responsible for design of the system:
.)
9. Est. bid opening date: Est. Completion Date
r7's�/'
t. Project Cost:
Date: i/ �.% ',LQ , •- 11?,
A � , V,
Signature of Owne
LN 1
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
Signature for Local Health Department
Comments:
Signature for Mayor or City Manager
Signature for County Commissioners
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:
WP -10 (Rev. 5-70-100)
APPRATE SYSTEM LOCATION- Give distfes in feet
Type of system applied for dimensions to be
filled in upon permit issuance.
❑ Septic & Bed
Septic
I
gal. --P.-
1"
1" Top Soil
1 4" Straw
To Septic 6"1" Gravel
4" Gravel
❑ Septic & Nordak
Septic
depth�[—
❑ Septic & Dry Well(s)
1" Gravel
Cender Block
Septic==W
2" Gravel
8" clean out hole
_ Concrete cover
13 Mechanical +
Bed
Dimensions
Dry Well
� Nordac
Holding pond
Chlorinated dis.
Septic Tank
---
- See Page 16 ofSewage Disposal Systems
o as vo e eo�r
❑ Sealed Holding e ❑ Pit Privy
K • •
_ COLORADO DEPARTMENT OF HEALTH
COUNTY s 7 REQUEST FOR SERVICE
PROGRAM /___R —RECEIVED BY
LOCATION /E /;?-C v P_I
O'N 1 .'✓r r
REPORTED BY a �ADDI
TE �? /
TELEPHONE %,73 -
m
ACTION REPORT
ACTION BY - DISPOSIT10
DA TE
SH -M-71 (4-71-5C)
NO