HomeMy WebLinkAboutpitkin.eh.264335402001 (1973)ap43 64 -aoi
PITKIN COUNTY HEALTH DEPARTMENT (�� �anir- ISS
PERMIT NUMBER `'s RECEIPT NUMBER
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Owner j () V � N4 Phone # �= -Z %7Z
Address 51S C Q0AA-Al
Contractor _EA1( on1 � 41 IL tlA -.7W(L Phone #
Address 1-;6)( 1100 (000 /e
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Location of system n ,Lot size 2�vUC�
Legal description 57XIZ 41"Q �� LOT 70
Number of bedrooms
Signature of -owner
Date
Percolation test data �r, minutes per inch
Minimum recommended absorption system size ! v x 1 O 0 d
Minimum recommended tank size 10 b
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,
p/ DRAWING OF SYSTEM
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Date 111 V\ q, � ) 3 Sanitarian
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AFFIDAVIT
(Percolation est)
/ 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.)
(Signature of Person n
Runnig Test
STATE OF 1 4".jeAq o )
SS:
COUNTY OF )
1rK� 1v
SUBSCRIBED AND SWORN to before me this 3t) day of
e. ) 19-B
My Commission Expires: My COWISSion ex ' Matcl1 30,E 1977
X
�Vubl c
OTE: 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
' DIVISION OF ENGINEERING AND SANITATION
ACT I V I T Y RE PORT Code
Section County 57
FILE REFERENCE:
INDIVIDUAL OR
ESTABLISHMENT
ADDRESS:
NARRATIVE:
Private Sewage Disposal
On September 7, 1973, I made a field visit at the Erikson & Wilber
construction site in Starwood. There was a problem in the location of the
septic tank above the irrigation ditch. I told them they could place the
septic tank above the irrigation ditch,if they made sure that it was grouted
and sealed with a mastic so there would be no leaks.
Stutsman-Gerbaz dug the leaching field and put the rock in. It
appears, to me, that in bottom of the bed on the down hill side, may
well be in fill dirt r t r that in vir in soil.
54�
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE:, 19 REPRESENTATIVE:
r 73
ES: 7 (Rev. 6-70-100)
"►. r"
V
PERCOLATION TEST FIELD SHEET
COMPLETE IN DUPLICATE
(Check person responsible for or performing tests)
( ) NAME OF OWNER
ADDRESS �� ����� �HONE
NAME OF CONTRACTOR OR EXCAVATOR
/ \ ADDRESS �j p �(�(i d" PHONE
LEGAL DESCRIPTION OF PROPERTY
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 performed in the 24-hour period between
VV Q .M. and o:eo M. on the _/ and days of
f�— 1`9 The actual percolation are to be
per or at ��-.M. and _.M. on ,
191% .
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 depth of the 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.