HomeMy WebLinkAboutpitkin.eh.264321203001 (1977)y to --3-2 � (
' PITKIN COUNTY HEALTH DEPARTMENT L�"�7 J .— 0-Il01 -a 3
PERMIT NUMBER 720 0 It RECEIPT NUMBER
Owners �� `. �. S e u rcl ,� L'hr, S7nn�ie �/tPe�r Phone
Address bd y 22-01 1425 p,pA-,
�Contractor �_ J Ae e � w Phone qZS- 444
Address' -- }- ��7 (//1// /L L, A9ie/
Location of system ��rJsk �ree k �� � .u� Lot Size 2.1 c
11 n
Legal description L.d G l AA& 3 dSH (WeZ74j/luAGC
Date Siganture of owner
Percolation test data 40minutes per inch A191 -7,7
+Minimum recommended absorption system sizeZ,0 2 � 1/5/
Minimum recommended tank size /Qf7 G L"AIS,— 7W(O EVE:
-nw —rmE�5 $ FT A84oe'r- LVA/ Cert/' U,4, 4AJO 71 X 6 2
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�®or}7 ruction site. ;5)
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DRAWING OF 'YSTEM
LL -
70 ' STo�Y
®os PAXKItJC
Uo GAu04 'TRi - Coffin Gess
R 8WCL4sS SEPTA c.TA#*—
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y
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Date N Sanitarian
�CUL65',ADO DEPARTMENT OF HEALTH :.
f WAer Pol l uti rm Control Divi s i--
4210 East 11th Avenue
-Denver, Colorado 80220
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
A
Applicant (Owner):
Mail Address: ox Z2 8i C i ty 4,2e'0 Phone: qZ-q-'g97
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 Lt k„') City or Town
Legal Description I-oi 6 /ask 2 �.�.N9 Z Lot Size: -2-. 1 aoYet
2. Type of area and facility - Number of persons served:
Subdivision J Motel Restaurant Trailer Court 'J
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: ,)CI
If so name:
5: Distance to nearest sewer system: lfA,/��
Have negotiations been attempted with owner to connect:
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.:
)ate:
Signature of Owner
rr..
6."SiG,,,'ATURES FOR LOCAL GOVERNIMf cNT O'rFICIALS: The undersigned r -e reviewed the
proposal for -the location o, he ;above-described septic tank /stem and
RECOMMEND APPROVAL or DISAPPROVAL in the space provided below:
DATE APPROVAL DISAPPROVAL'
Signature or'Local Health Department
Signature for Mayor or City Manager
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:
1.0-10 (Rev. 5-70-100)
I'1 I KIN UUUN I Y tNV1KUNMtN I HL Ht:AL 111
Field Test Data Sheet on Percolation Test
PROPERTY OWNER _ - PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 24 hour soak
-3 y �r
16: .r
i�
TEST HOLE No.1
TEST HOLE No. 2 TEST HOLE No. 3
%
Drop Time
3_� 1
Drop Time Drop Time
c
Percolation Rate Each Hole
Average Rate }
Comments on soil or site:
Signature
yo
X0
Date
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER
PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 8 hour soak
26
16
D D
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
D— Time
Drop Time
Drop Time
20
3�Z
�s"� 32
6 35/0
70
71&
2-
.4 7 d
1 i
Percolation Rate Each Hole SZ_
Average Rate 151
Comments on soil or site:
Signature
Date