HomeMy WebLinkAboutpitkin.eh.264929102112 (1973)Owner
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PITKIN
COUNTY HEALTH
DEPARTMENT
Lot size 60 1 Y2.Qcics
PERMIT NUMBER
`� 40
RECEIPT
NUMBER
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Phone # 2`l�.-I82c)
Address Locm-C - 835 `�"e�cas ,L(I COM AA 1unri-.'.*� , 0,-, . 57 I so I
Contractor 0u),(,C-,c- Phone #
Address
Location of system
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Lot size 60 1 Y2.Qcics
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Legal description
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Number of bedrooms Date 7!1017 3
Signature of owner
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Percolation test data "r_ 4 o *� minutes per inch
Minimum recommended absorption system size
Minimum recommended tank size
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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. a ?6u&A
DRAWINGIOF SYSTEM
Date �l 10M 1
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PERCOLATION TEST FIELD SHEET
COMPLETE IN DUPLICATE
(Check person responsible for or performing tests)
✓ OF OWNER
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( ) NAME
ADDRESS LOCUL Ctd&ess -
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( ) NAME OF CONTRACTOR OR
EXCAVATOR dun
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LEGAL DESCRIPTION OF-PROPERTYtan
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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. A
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Soak ir4� is to be performed 4n the 2 -hour period between
v M. and 100 _ - . M. on the z30A and 31 st days of
—'� 1 h9 3 The actual percolation bests are to be
perf sec at k;3M. and M. on IV-14_31aF ,
19-7-3
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.
TEST HOLE I ��11�:.,.�Gi� TEST HOLE II
Reading Drop Time
Reading Drop Time
(, 1:35
3�� :v5
+ 2-3s
1W it 3109
�`i:05
3/4 it 4i3S
31i� 5;35
PERCOLATION TEST RESULTS:
HOLE I Minutes per inch (HOLE II Minutes per inch
Average percolation rate: Minutes per inch
Comments on soil and/or site:
Address: I �r,o t It q71K la
Signature:
TEST FEE $25.00, payable in Advance
AFFIDAVIT
(Percolation Test)
/(% 1)tt,Z�-- , 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: zi6 u % / , 19 73.
ignature of Person Running Test
STATE OF )
COUNTY OF )
SUBSCRIBED AND SWORN
197.
SS:
to before me this 1'�-4 day of
My Commission Expires:
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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).