HomeMy WebLinkAboutpitkin.eh.264504303032 (1973)v
! PITKIN COUNTY HEALTH DEPARTMENT
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PERMIT NU14BER 720150 RECEIPT NUMBER
Owner
Address
Contractor
Address
Location of systen
Legal description
Number of bedrooms
Signature of owner
C
0,
Phone #
Phone #
40 Lot size lao��
In
Percolation test data Aminutes per inch
Minimum recommended absorption system size
l' % A''�`
Minimum recommended tank size" 41
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
J
Date ,� Sanitarian ,
COLORADO DEPARTMENT 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 Disposal
INDIVIDUAL OR
ESTABLISHMENT: Schlumberger
ADDRESS:
Code 12
County 57 -
NARRATIVE:
On August 13, 1973, I made a field visit to the Schlumberger
property at Little Elk Creek Village. Schlumberger told me that I
all. ready had run the perc. test, sized the system for an aerated
unit, and 18' X 56" leaching field. I asked him where he got the
information. He replied from Jim Ruggles Royalty Water Service.
I said that I DID NOT run a perc. test, I DID NOT size a leaching
field, and I DID NOT specify an aeration unit.
I DID MAKE a field visit to the site to check on the test
hole for the ground water and that was all.
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE: Allg s,t 1-3? 19_x. REPRESENTATIVE:
ES: 7 (Rev. 6-70-100)
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER M 14127 V --cc/M001 ,E �t G'` �r� PHONE a 317
MAILING ADDRESS z b5-7 ! . A-Cil'op-e4
LEGAL DESCRIPTION OF PROPERTY 1,07'
LOCATION OF TEST HOLES 1�
'lThba, RULE ffi� 'i'hb'i' VLE ff j
Drop Time
Dr o Time DropTime
Three (3) test holes required
per system
s
� t
1/1
Test Hole Depths (24" minimum)
r
Diameter Test
of Holes
Water Remaining after 24 hour
soak f�
%C -J
i'EbT RULE ffl
'lThba, RULE ffi� 'i'hb'i' VLE ff j
Drop Time
Dr o Time DropTime
it _.rte 47 a
s
� t
1/1
f vv
s,. c
L
i 512 ;4
Percolation Rate Each Hole
Average Rate % _ Air—
NAME OF RESPONSIBLE $ARTY
SIGNATURE
I
TEST PHONE 12,3
�n,•k. PHONE 1
4
AFFIDAVIT
(Percolation Test)
, being first duly sworn upon
his oath under 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: 02 , 197.E
Signature of/Pe-"r-son Running Tes
STATE OF )
COUNTY OF ) SS:
SUBSCRIBED AND SWORN to before me thiV"��day of 197-1
My Commission Expires: YG %rT 7c/,
- ZZ,
Notar lic
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).
F
r
PERCOLATION TEST FIELD SHEET
a
COMPLETE IN DUPLICATE
(Check person responsible for or performing tests)
( ) NAME OF OWNER Alt ,
ADDRESS HONE n3'3�7
( ) NAME OF CONTRACTOR OR EXCAVATOR
ADDRESS �"� I PHONE
LEGAL DESCRIPTION OF PROPER4RY � O/
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 beerformed in the 24-hour period between
�i,M. and M. on the �� 4nd days of
1 e actual p4co7ation restare to be
per-lorVU at .M. and _-�d f,M. on
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 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.