HomeMy WebLinkAboutpitkin.eh.246717401009 (1977)Document Layout
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Permit
Application
Log Sheet/Notes & Photos
Communications
As -built Design
Engineer Design
Soil Information
Water Permit & Information
Second System on property
Third System etc.
Floor Plans
Please See Building and Land Use Approvals Files for additional information.
-009
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER}!! �7��1/ RECEIPT NUMBER "095
Owner `r 1 /'/ ILL Phone No.
Owner's Mailing Address
Contractor F11 /'' a �,K O d h 5f— Phone No. 9,;? i ` 3 2IS-
Address
System's Contractor's Name
Address fJ ����� ✓eP{ lis 1.
Legal Description T IN U % �/ a C I r
Lot Size - i (, U d C r - Type of Building by Use /1 ad U S
Number of Bedrooms I Type of Water Supply
Owner's Signature c rur-uo Date - Z l 2- 7
PLOT PLAN: ATTACHED AS REQUIRED
***ii!*****a**a*#*#!*f*******%*i*****i**f*****!*************i#*********i**i*********N***if
Type of Individual Sewage Disposal System /,�� TA��-� �EEP/9ce nf--0
Type of Soil or Soil Classification 6-41 LOAM TO
Proximal Location of Bedrock / r07- nETEW�D — ;e><ATF,e -77414/
Proximal Location of Ground Water Table /rc'� //C7 Fig/"///VCU -
##4444#*a%4a#aa#a###*#%4#*{%#**%4%#f%%#%%%YY%4%a*aY#4%a*###%**%f%%%%%Y%*%%f %f a%*!a*a*aa a as
Percolation Test Date ,� Minutes PerIn�hh / X4
Minimum Recommended Absorption System Size/ZX S-4�T i o /2 / RED
Minimum Recommended Tank Size /4"� U l
Special Conditions of Issue: NOTICE
When properly signed for Issuance, this application
�/ 6-29 A/1/
r/1 /� 667 �/1A1 TIr. if your permit swageApplicdisposal
salltl ons, Year from
�-G/7 ��(�(/� /J (j.�/j ICJJ'/ta l} an Individual sewage Olsposel permit U Issued
for property on which no building permit hes been
� / auatl, Me individual sewage disposal permit hall
/ % 'I/ ,•' L L� 7�:./ , 4i /I Ci expire 120 days after Its inuance If construction has
1 I4T�� [-/lVeS not been commenced. per Any thenen In plena I or pecl-
r.. fieatlom after the permit hes been Issued Invalidates
the permit, unless approval Is secured from the Has"
Officer for suchthan as.
Approved for Issuance ByI zg&A Date a
ii#i!i###fYYYMYa!!!#YYi#iiNIYY## #iiYN!%Y##N Y{iii N##Yi#**%*####i!Y##YYYYN#YiNY##YYYYYYYl4
FINAL INSPECTION APPROVAL � L Date /z/y1�77
(Drawing of System on Back)
1� y
• • .f 0..1
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER A/A/� PHONE
MAILING ADDRESS i _ 456
LEGAL DESCRIPTION OF PROPERTYL_
LOCATION OF TEST HOLES
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 24 hour soak
32', ,3.:2
D
0
O
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
e13 L-
Dro
Time
v3 z--
Drop Time
S(3 e—
Drop Time
3D(o
2 1q, 307I
S
70
3
3
/,77
Percolation Rate Each Hole
Average Rate _31�—
Comments on soil or site:
G/
Signature �/. Date
z
Li