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HomeMy WebLinkAboutpitkin.eh.264321202002 (1972)C4LORA DO 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) : & p F Mai l Address: Jboz 35'/ Cn City: C— Al 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. Location of Facility: County f /i'U City or Town Legal Description k_�, ��� Glf�/G'r+5/G� Lot Size: 3 Ce,,P5 2. Type of area and facility - Number of persons served: Subdivision `-.- Motel Restaurant Trailer 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: Vic) If so name: 5. Distance to nearest sewer system:v' Have negotiations been attempted with owner to connect: Ivf� 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: g. Est. bid opening date: Est. Completion Date: Est. Pro�ect Cost: Date: 94- ignature of Owner c B. SIGNATURESFORLOCAL 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 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: WP -10 (Rev. 5-70-100) Section j N COLORADO DEPARTMENT OF HEALTH DIVISION OF ENGINEERING AND SANITATION A C T I V I T Y R E P O R T FILE REFERENCE: 4,- , INDIVIDUAL OR ESTABLISHMENT: ADDRESS: NARRATIVE: r Code �p County' LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS: DATE: F fc;2? / , 19--Z�z ES: 7 (Rev. 6-70-100) REPRESENTATIVE: „ t`, -1 Section j N COLORADO DEPARTMENT OF HEALTH DIVISION OF ENGINEERING AND SANITATION A C T I V I T Y R E P O R T FILE REFERENCE: 4,- , INDIVIDUAL OR ESTABLISHMENT: ADDRESS: NARRATIVE: r Code �p County' LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS: DATE: F fc;2? / , 19--Z�z ES: 7 (Rev. 6-70-100) REPRESENTATIVE: „ t`, DEPARTMENT OF ENVIRONMENTAL HEALTH AND POLLUTION �CONTROL COU��TYePITKIN P. O. BoxAspen, Colorado 81611 Bear OFFICIAL NOTICE T TO 4 1 ! ' ADDRESS LOCATION YOUR ATTENTION IS CALLED TO THE EXISTING VIOLA RESPONSIBLE V(S) OF WHICH YOU ARE i 1 1f YOU ARE HEREBY NOTIFIED TO ABATE THE SAME BY 1iC--'� 19 (Legal service shall include posting of this notice in a conspicuous place). This office must be notified by letter or phone, as soon as compliance has been effected. If at the expiration of this time the same remains unabated, such action will be taken as the Law requires. `z // 7,4 tf DAT ) DATE r S4flITARIAhl OWNER &OCCUPANT POSTED AT T ,. DATE 7 A/ rT �ed a,ae� I j f IMPARTMENT OF ENVIRONMENTAL HEALTH� COUNTY OF PITKIN P.O. Box 1025, Aspen, Colorado 81611 Pitkin County Courthouse 925-4366 OFFICIAL D TE .7 A/0 ADDRESS LOCATION LTJ 1 lrL' YOUR ATTENTION IS ,CALLED TO THE EXISTING VIOL XIO (JO FOR I YOU E RESPONSIBLE _. �^�` ' e -01� L- YOE Fi'EREBY j W'2;4 MMUNI ATE WITH THIS OFFICE WITH REGARD TO THE VIOLATIONS BY9 Failure to so communicate will result in the matter being referred to the appropriate authorities for enforcement. Failure to correct the violations may subject you to a civil suit for an injunction, or a fine, or both; or to misdemeanor criminal prosecution, which uporyconviction may result in a fine. 2 - DA DATE IAN _b 1 - t - OWNER & OCCUPANT 'ENDER: Comp ete items i rnd 2. Add YoLf alldress in the "RETURN TO" spa • reverse. 1. The following service is requested (check one) . KjShow to whom and date delivered ------------ 15¢ F1 Show to whom, date, & address of delivery.. 35¢ DELIVER ONLY TO ADDRESSEE and show to whom and date delivered------------ 65Q DELIVER ONLY TO ADDRESSEE and show to whom, date, and addreks of deliver --- ------------------••----------•- 2. ARTICLE ADDRESSED TO: Stephen A. 'Rate Box 1170 Aspen, Co. 81611 3. ARTICLE DESCRIPTION: REGISTERED NO. CERTIFIED NO. I INSURED NO. 733025 (Always obtain signature of addressee or agent) I have received the article described above. SIGNATURE N >4. / DATE OF DELIVERY POSTMARK � r 5. ADDRESS (Complete only if requeste 6. UNABLE TO DELIVER BECAUSE: CLERK'S INITIALS it GPO : 1974 0 - 527- 803 � 3 m n ===888 • o w J F¢ - O 0- w H N W H Z I. LL O " „m W E -« p O I CO W rd CH cd O O 4-3 •ri r -I cd U � W � cd N Q o PA Ul Z O w W. Nb. 5d 3 8 $ aS. © - County Treasurer's Office, Pitkin County, Colo. Aspen, Colo., ,� 19-�M, '1,R�rPtUP� Af. 00 :DOLLARS Account o Credit to 0- 00-11R-22 - / I?, Fund. 6..� o/- 00 -3Q --2-2-/;2,o I THE C. F. HOECKEL CO., DENVER ' Treasurer BY Deputy