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HomeMy WebLinkAboutpitkin.eh.264504303001 (1971)COLORADO DEPARTMENT OF - ,HEALTH Water Pollution Control Division 4210 East 11th Avenue Denver, Colorado 80220 &�5-083-03 -6aI /0'5/ 6ff/e- UA APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS Applicant (Owner): Mail Address: City. A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW: ,qAfC Phone: 5Z 3 - 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, soll profiles in test holes. 1. Location of Facility: County rr K / C i ty or Town N ©� �u� /� 5 S Legal Description L7' 24. 4,rt4,-j7t ', d Lot Size: /u/ 2. Type of area and facility - Number of persons served: Subdivision Motel Restaurant Trailer Court Other: 3. Source of domestic water: Public (name)�nrt l(%irMgic/ Private: Well Depth Other iiiDepth to first ground water table 4. Is facility within boundaries of City or Sanitation District: A)o If so name: 5. Distance to nearest sewer system: (� "t L —'ee:"S, 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: '// 7-Z 9. Est. bid opening date: Est. Completion Date: ZSl Est. Project Cost: 2 y -U Date: Sig ure of Owner Type of system applied for dimensions to be filled in upon permit issuance. Septic & Bed 111 -7 ' Septic _ �. gal. �.,•, ... --� -t 1" Top Soil _ _...-.._�_ 4" Straw To Septic _ t--� - - 6"1" Gravel 4" Gravel `= Septic_ & Norda'L Septic depth t�= Septic & Dry T,•Tell (s ) --= -� ~-- 1" Gravel r,.- - ---- Cender Bloc': Septic ' " ..� t'._- .�� 2 Gravel . 8" clean out Concrete co -:e lig ;b6 �c r ,i. .... EJMechanical + Dimensions Bed Dry Well Nordac �. ra r --.a Holding pond ti� r Chlorinated dis. Septic Tank See Page 16 ofSe-wac-e Dls 0s2_l Syste--r.s J_ ,._ ..i Sealed Holding =._� Pit Privy n LJ COLORADO DEPARTMENT Of HEALTH Water Pollution Control Commission 4210 East 11th Avenue Denver, Colorado 80220 DECLARATION OF COVENANTS KNOW ALL MEN BY THESE PRESENTS, THAT: WHEREAS, the COLORADO WATER POLLUTION CONTROL COMMIS HAS approved f p the llowing described land, situate in the , f l ocv S of 7,TK iand State of Colorado, to -wit: (describe a tire parcel to be served by septic tank) S a.cJ as a location for a septic tank, as defined by the Colorado Water Pollution Control Act of 1966, as amended, for the treatment of domestic sewage on a temporary basis. NOW, THEREFORE, in consideration of the approval of the above described land as a location for a septic tank, the undersigned, as the owner(s) of said land does/do hereby declare that the following covenants shall be and constitute cove- nants running with said land: 1. When the Colorado Water Pollution Control Commission determines that a community or municipal disposal system is available and can provide service to the above described land, the septic tank located upon said land will be abandoned and wastes from the described lands will be carried to the available community or municipal disposal system and the owner of the above described land shall bear the entire cost of constructing and installing any sewerage system necessary to carry such wastes to the available community or municipal disposal system. 2. If at any time hereafter, the septic tank shall adversely affect the quality of the waters of this State, the owner of the above described land shall use such other sewage disposal system as will maintain the quality of the waters of this State within the limits set by the applicable water quality standards adopted, from time to time, by the Colorado Water Pollution Control Commission. 3. This Declaration of Covenants shall be binding upon the undersigned - and the heirs, personal representatives, successors and assigns of the undersigned. (Continued on reverse side) DECLARATION OF COVENANTS Page 2 IN WITNESS WHEREOF, the undersigned owner(s) has/have executed this Declaration of Covenants as of the l7 day of /�-1`y 19 Z• --OWNERS)-- STATE OF COLORADO ) ss. AND COUNTY OF PITKIN ) The foregoing Declaration of Covenants was executed before me this 17th day of MAY , 19 71, by Douglas K. Severance as ownerls Witness my hand and official seal. My commission expires: Feb. 23. 1972 Notary,Public Approved this day of 19 This approval subject to withdrawal if the foregoing Declaration oT7ovenants is not recorded within sixty (60) days of this Approval. COLORADO WATER POLLUTION CONTROL COMMISSION By Technical Secretary WP -30(1-71-40)