HomeMy WebLinkAboutpitkin.eh.246313301002 (1977)Document Layout
(From Most Recent to Oldest Permit)
Permit
Application
Log Sheet/Notes & Photos
Communications
As -built Design
Engineer Design
Soil Information
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Water Permit & Information
Land Use Approvals
Second System on property
Third System etc
(All relevant older documents in the same order as above)
(A red sticker will be placed on both sides of the file tab when doc. is scanned)
C.
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER
770// RECEIPT NUMBER
Phone No.
Owner
Owner's Mailing Address
Phone No.
Contractor
Address
System's Contractor's Name
Address
Legal Description
Type of Building by Use
Lot Size
Number of Bedrooms Type of Water Supply
Owner's SignatureDate
PLOT PLAN: ATTACHED AS REQUIRED
12
Type of Individual Sewage Disposal System, LANK.
Type of Soil or Soil Classification
Proximal Location of Bedrock
Proximal Location of Ground Water Table
Percolation Test Date
Minutes Per Inch
Minimum
Recommended Absorption System Size`
Minimum Recommended Tank Size
NOTICE
Special Conditions of Issue: when properly signed for issuance, this application
becomes your permit. Application valid one year from
i date. If an individual sewage disposal permit is issued
for property on which no building permit has been
issued, the individual sewage disposal permit shall
expire 120 days after its issuance if construction has
not been commenced. Any change in plans or speci-
fications after the permit has been issued invalidates
r 1 ^ O (� the permit, unless approval is secured from the Health
tvl : �J Officer for su cha ges.
Approved for Issuance By
Date
FINAL INSPECTION APPROVAL
4 LDate
(Drawing of System on Back)
6IM4
tOOJI2
"',PEL.ANO"eD "
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PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY Z07-
LOCATION
OF TEST HOLES PCOT �LA�
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 24 hour soak
3-5
711
d �
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
Drop I
Time
I V 0 i1 L -
Drop Time Drop
Time
3
5 �g
7
535-
,2 3
8
3 Ss
��
I�
J410
O
7
lob
t t
l
Percolation Rate Each Hole
Average Rate 57
Comments on soil or site
000003
Signature
3z V-0 -/®
Date
000004
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