HomeMy WebLinkAboutpitkin.eh.264515400010 (1973)otc)
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER
RECEIPT NUMBER
Owner 3 f
J* C.
D gs,o N
Phone
Address <I os %
Contractor CO
(., k
Phone
Address
Location of systemCL
" 6
Lot Size ��3 5 CQ`k¢O
Legal description
Date 6 ( ((
Siganture of
owner
Percolation test data
�'G„� "'-
minutes per inch
Minimum recommended absorption
system size
�%
)
Minimum recommended tank size
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
IO N /
Date V l a� ! Sanitarian .
i
rw 4
PERCOLATION TEST FIELD SHEET
t.
COMPLETE IN DUPLICATE
(Check person responsible fjor or performing tests)
( ) NAME OF OWNER
ADDRESS 'UYZ eZ - Ol PHONE
( ) NAME OF CONTRACTOR OR EXCAVATOR
ADDRESS / ��� PHONE3,5'�
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 beerformed in the 24-hour period between
JP.M. and �.M. on the W"/ wand ��-/� days of
1T� The actual percolation Te - are to be
Performed at
19 ' �.M. and M. on �yii/� & ,
�' .
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 bf 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.
AFFIDAVIT
(Percolation ion 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: 19 'S
L�
('4i4g.af�u—red PerEToif Runn g Test
STATE OF 0,941 Dl'j )
COUNTY OF ) SS:
SUBSCRIBED AND SWORN to before me this ,,& L2L day of
192
My Commission Expires: MY Commission Expires November 9, 1974
of ry PrX uc
1
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).
TEST HOLE I TEST HOLE TT
Re ng
Drop Time
Reja4ing
Drop Time
f�
11
' of
j,
0a
ZMic
PERCOLATION TEST RESULTS:
HOLE IQ Minutes per inch I HOLE II Minutes per inch
Average percolation rate: G �y Minutes per inch `
Comments on soil �and/or site:
Address : 25, F le -0
Signaturj6:
TEST FEE $25.00, payable in Advance
r
Lel-le . ?ice z
19
DEPARTMENT OF ENVIRONMENTAL HEALTH
AND POLLUTION CONTROL
COUNTY OF PITKIN
P. O. BOX I
ASPEN, COLORADO 81611
" opt . ,' ► , j.9-(2
UUm Utler and Than" Patterson
4038
Asvft,q
ftw Biro;
After insertion of the proposed site locations and reriev. ,.
of your phots for using aeration systernfa, this Department feels
that viitb the size of the lots being approximately 3.33 acres*
that y*w systems will be adequate and comply with all mini
state and oounty regulations at %hi.s point in time.
If this office asst be of wW turth" aesi ststsee • pl osse
*all M4366.
Sincerely,
D.L." Kirkland
Assistaaae Sanitarian
w1t
MVtb
Section
FILE REFERENCE:
INDIVIDUAL OR
ESTABLISHMENT:
COLORADO DEPARTMENT OF HEALTH
DIVISION OF ENGINEERING AND SANITATION
A C T I V I T Y R E P O R T
V
ADDRESS: , 1r'l..l� v -AA
Code / #'
rl
County /
NARRATIVE:
� ' � 00LL
,a
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE:
ES: 7 (Rev. 6-70-100)
REPRESENTATIVE:
COLORADO DEPARTMENT OF HEALTH
DIVISION OF ENGINEERING AND SANITATION
ACT I V I T Y RE PORT Code 12
Section County 57
FILE REFERENCE: Private Sewage
INDIVIDUAL OR
ESTABLISHMENT: Jacobson
ADDRESS: Snowmass Creek, Colorado
NARRATIVE:
On June 15, 1973, I made a field inspection of the
Jacobson property on the Snowmass Creek. The leaching field
turns out to be 3 ten foot lengths of pipe, with the perforations
turned up. There is very little rock.
No one was at the house at the time of my visit,
so I left an activity report at the door.
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE: June 19 , 19 73. RE PRESENTATIVE :
ES: 7 (Rev. 6-70-100)
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