HomeMy WebLinkAboutpitkin.eh.264328201006 (1973)Q ,U43- a -U- (it -C30(P
PITKIN COUNTY HEALTH DEPARTMENT /
PERMIT NUMBER 2
/�f% RECEIPT NUMBER
Owner/.? �' l - t Phone
Address /�%� G vAZ1J
Contractor S ti—F Phone y Z Z-1-2 6,
Address OK 14S A&vc-
Location of system
I- Lot Size 1, Ai r t f
Legal descri tion ? &_ ,- ,',/ i a
Date 1Vq 7 /� IqT� Si a
/ g nture of owner
Percolation test data (0 0. --
Minimum recommended absorption system size
Minimum recommended'tank size
minutes per inch
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 construction site.
DRAWING OF SYSTEM
NoUsE
Colq pResS
a -LCT NCAcrE P �T
e 1000 GA LL 014
PRFA GLAss AERA-W U e t�r1E�T' PLA �T
g Upl
MPUNG PART
25 /
Date (� Sanitarian /.
COLORADO DEPARTMENT OF I LTH
Water Pollution Control Division
4210 East 11th Avenue
Denver, Colorado 80220
v'� J
F ^
ti
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
Applicant (Owner) : 'Ai► / G �' I
Mail Address: 6'JC-- cg ` City: Q
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Phone: 2 S - ic/ 4/ 5
732
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 �r-G� City or Town
Legal Description Z, 7`�Lot Size:
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 ./.i Depth Other
Depth to first ground water table r z Z-
4. Is facility within boundaries of City or Sanitation District: xt-'d
If so name:
5. Distance to nearest sewer system:
Have negotiations been attempted with owner to connect:
If rejected, give reason:
/v v
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:
Date:
Est. Completion Date: Est. Project Cost:
711�
Signature o 0 ner
r ♦♦ C
PERCOLATION TEST FIELD SHEET
t
COMPLETE IN DUPLICATE
(Check person responsible for or performing tests)
(
/)NAME OF OWNER [ \ �--�- � ►J'�-� �
ADDRESS
2
( ) NAME OF CONTRACTOR OR EXCAVATOR
ADDRESS
LEGAL DESCRIPTION OF PROPERTY
General Information & Instructions
PHONE
PHONE
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.
oaking is to be performed in th 24-hour period between
�U C�
�.M. and 0;0 '.M. on the 11 and 'M days of
The actual percolationT_estys are to Peper�tormed at �c�:(y(� .. M. and M. on ,U NC 2"i�
19
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 dept o- he 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.
TEST HOLE I
TEST HOLE II
R ading
Drop
Time
Reading Drop Time
0
M(N
PERCOLATION TEST RESULTS:
HOLE I Minutes
Average percolation rate:
r inch
:::;)-1
Comments on soil and/or site;
Address:
�(J�
HOLE II Minutes per inch
Minutes per inch
N�V)�w
k - ILW. U �\
Signature:
TEST FEE $25.00, payable in Advance
AFFIDAVIT
(Percolation -Test)
being first duly sworn upon
his oath un er penalty of perjury, states,avers and certifies as
follows:
1. That he is the person who performed the percolation
tests as required on the reverse hereof.
2. That the tests were performed in accordance with the
time schedules and specifications as set forth on the reverse hereof.
3. That the test results of the said percolation tests
were as set forth on the reverse hereof.
4. (In paragraph 4, affiant shall insert additional
statement(s) which may be properly and reasonably required by
the Pitkin County Control Officer or the affiant may wish to
insert.)
DATED: I I
STATE OF C1�3w )
COUNTY OF \A
SS:
1973
ignature of Person unni est
SUBSCRIBED AND SWORN to before me this c;�ff i-1day of
19 7�
My Commission Expires:
otary is
NOTE: This affidavit must be returned to the Pitkin County
Pollution Control Department within 24 hours of the time
the percolation tests are completed (Saturdays and
Sundays excepted).
COLORADO DEPARTMENT OF HEALTH
COUNTY �� REQUEST FOR SERVICE
PROGRAM_ /RECEIVED BY O JJ�� DATE
LOCATION ,ci �it���/ _NAME
REPORTED BY /L/yrh/� ADDRESS �O lYi f7�t�/ TELEPHONE
SERVICE REQUESTED -I!- �4,e4
U 902.E -ate
I
• ••• , IA $"-- , i
SH -M-71 (4-71-50)
.rrrr...�
V /
• COLORADO DEPART NT OF HEALTH
DIVISION OF ENGINEERING AND SANITATION
A C T I V I T Y R E P O R T
Section
FILE REFERENCE: Private Sewage Disposla
INDIVIDU4L OR
ESTABLISHMENT: Sandy Munro
ADDRESS: Lot 9 Blick 2, lst filing, BnUhh Creek Village
NARRATIVE:
Code 12
County 57
They have a fiberglass aerated treatment plant, Colorado West,
and a leach field 12/x 85.` Prior approval on the leach field was
given in July. They used a 55 gallon drum to house their compressor
unit. The timer was set 3 hours on and 1 hour off. I suggested they
bolt the compressor down because of possible vibrations. I suggested
t14 they contact us if there were any problems.
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE: 4:4:/- , 19 -74_ . RE PRESENTATIVE :
ES: 7 (Rev. 6-70-100)