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Second System on property
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Please See Building and Land Use Approvals Files for additional information.
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PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMB ``R 76010 RECEIPT NUMBER
Owner /1V �`�cK Phone No.
Owner's Mail
Contractor
Address I>20�o//-4"f-'
System's Contractor's Name
Address
Legal Description
Phone No.
Lot Size / AF�e _;X — Type of Building by U
Number of Bedrooms Type of Water Supply
Owner's Signature Date —
PLOT PLAN: ATTACHED AS REQUIRED
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Type of Individual Sewage Disposal System WrIO. TANK - SEEPAGE 1!fc`D
Type of Soil or Soil Classification, RED CLAY LOAM To R FEET
Proximal Location of Bedrock l^/oT- /D�E)eM�NED - C464 7M TH/�N 9 FEET
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Proximal Location of Ground Water Table / YerF rx7�5cMI t4ED-6P,E/4-'e 71-10 D pF6,61--
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Percolation Test Date /�� �� GMinuttes Per Inch L419/76
Minimum Recommended Absorption System Size _6-X Sd,• �",0X5-7XA9C,.R,yD��Ax�Z�O�M/H F
Minimum Recommended Tank Size,/" CJ&ZZ�S T�n ������i�/i7Ul/TS7
Special Conditions of Issue: � / NOTICE
p Q/Y� When properly signed for issuance, this application
becomes your permit. Application valid one Yeararfrom
data. If an intlivldual 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
the permit, unless approval Is secured from the Health
Officer for suc changes
Approved for Issuance By � � —Date ��// ,
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FINAL INSPECTION APPROVAL ate
11jl( Drawing of System on Back)
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PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test ^7
PROPERTY OWNER C LLi LYo/�) PHONE 92/ — 359Z
MAILING ADDRESS
LEGAL DESCRIPTIOI
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LOCATION OF TEST HOLES
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
`12 JZ 12,/
Water remaining after 24 hour soak 0 O 0
TEST HOLE Ne.1
TEST LE No. 2
TEST HOLE No. 3
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Drop Time
a
Drop Time Drop
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Time
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4:253
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Percolation Rate Each Hole ! (Z
Average Rate _1_
Comments on soil or site: SA. IDY AQ)
T CLAY
Signature
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