HomeMy WebLinkAboutpitkin.eh.264929402040 (1973)i'
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PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER 2 1 RECEIPT NUMBERS
Owner G )L � HA
Address 5T6 rl ,a'5 ci c4a a cwt AL -e
Phone # 0/6 3 - PO
Contractor S C.L �- Phone #
Address /.r, �3 Ll--EZQA.zL-
Location of system S VJiss UtILACC t�- �2— Lot size RE
Legal description
Number of bedrooms
Signature of owner
Date ./D
Percolation test data minutes per inch
Minimum recommended absorption system size 0 x U D
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
ME
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PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
MOM
PROPERTY OWNER t Z &_,y,,/
MAILING ADDRESS 1 aj/, Lc
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES
Three 4r test holes required pens stem
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Test Hole Depths (24" minimum) oSCo ~
Diameter of Test Holes
Water Remaining after 24 hour soak
TEST HOLE #1 TEST HOLE #2 TEST HOLE #3
Drop Time —Drop Time Drop Time
1 ,
"
7 t
Percolation Rate Each Hole �0
!� N
Average Rate L o
NAME OF RESPONSIBLE PARTY RUNNING TEST �' f,Lv�-'�""' PHONE 494S -o[ -C/ X
PHONE
SIGNATURE
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AFFIDAVIT
(Percolation Test)
being first duly sworn upon
his oath and 99
lty 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
(Si natur rso Running Test)
STATE OF _ )
COUNTY OF ' ) SS:
SUBSCR ED AND SWORN to before me this�day of 1gz—.
My Commission Expires: my ['otmen ines August 2,
z7l
Notary Public
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).
COLORADO DEPARTMENT OF HEALTH
DIVISION OF ENGINEERING AND SANITATION
A C T I V I T Y R E P O R T
Section
Private Sewage Disposal
FILE REFERENCE:
INDIVIDUAL OR Mr, and Mrs. Hawks
ESTABLISHMENT:
Redstone, Colorado
ADDRESS
NARRATIVE:
12
Code
County q7
Mrs. Hawks asked me to make a field visit at her
home in reference to a malfunctioning septic system. The
sewage was backing into the house, and they would like to
know what could be done about it.
I made two recommendations for the septic system.
One, was to determine the size and condition of the present
septic tank. This might tell them something about the size
and condition of the exsisting dry well. The other recommendation
was to install a new leaching area. The only area they have
left for that is in the NE corner of their property.
I informed them they would have to apply for a permit,
pay the fee, and run the perc. test.
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE:
June 2� 19 73 . REPRESENTATIVE:
ES: 7 (Rev. 6-70-100)
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