HomeMy WebLinkAboutpitkin.eh.246734308002 (1977)Document Layout
(From Most Recent to Oldest Permit)
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.
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PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER 7M&I n p RECEIPT NUMBER -2/ D70
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Owner STS (� S, / T U l\ D Phone No. �,;7 S �O�
Owner's Mailing Address JAJ• -",q
Contractor 9,,4,n5, Phone No
Address
System's Contractor's Namey e o
Address
G
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,4ri H
X1 -1/y Ai
Legal Description L K �• O T // r y,- :- SiLnul p�i95S
Lot Size dcR;, Type of Building by Use /?s S i o i V CF
Number of Bedroomsw
Type of Water Supply S (y f
Owner's Signature Z6L Date S1�y a
PLOT PLAN: ATTACHED AS REQUIRED
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Type of Individual Sewage Disposal System - XI,I f0ii- I i
Sy
Type of Soil or Soil Classification l -LAY —/0 SAN0 A
Proximal Location of Bedrock
Proximal Location of Ground Water Table
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Percolation Test Date — / �7/ Minutes Per Inch 6 -7
Minimum Recommended Absorption System Size I i• /X /a/ ORMU IJ'rLC7
Minimum Recommended Tank Size &00 CAI LO/v/-S'
Special Conditions of Issue: NOTICE
When properly signed for Issuance, this application
dot If your p ideal App a disposal
valitl one year from
tlets. I} en individual sewage tlispoaal permit Is issued
for property on which no building permit has boon
issued, the individual sewage disposal permit shell
expire 120 days after Its issuance If construction has
not been commenced. Any change in plans or aped.
fications after the permit has been issued invalidates
the permit, unless approynI 's secured from the Health
/ Officer for fuck ogee.
Aet
Approved for Issuance By I'11/CDate 72
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Date
FINAL INSPECTION APPROVAL
i
(Drawing of System on Back)
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FA
Date
Bill
7
Inspection Requested By
Original Report To Be Sent
Copy Of Report To Be Sent
Property
E
0 4 o- 1 a ':•
it • o- . �.
Check/Receipt Nmber
Parcel ID Number1 }6 7 1 U`6 - rlC'�
Legal 1/4, 1/4, Sec. , T S, R W;
Loth_, BlockFiling_, Subdivision
Address ti
Building Occupied Vaca r Age Of
Date Septic Tank La Rmtped ( a,, - # Bedr
DEPAR 74ENT MOMS -
Permit Number Year Issued No Records and
Septic Tank Capacit //i77 �) ((cellons) Septic Tank Matfrial
Leach Field Size Lon (Sq. Ft.) Leach Field Type
INSPDate OfIIn x /n//_J-
Date Of Inspection Inspector �/ YY((���(
Soil Conditions: Dry Saturated Snow Covered Other
Septic System: Functions Satisfactorily Not Functioning
Comments:
Water Supply: Public: Namez'-
Private: Well , ring , Cistern ,
Other
Well Construction And Location: Approved
Unapproved ause
Bacteriological Water Test: Lab Number Date
Acceptable
A.P.E.H.D.:4/87
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0 0
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY L
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
TEST HOLE No.1
TEST HOLE No. 2 TEST HOLE No. 3
17
Drop
Time
2
Dro Time Drop Time
—72
%
c
S
Percolation Rate Each Hole
Average Rate
Comments on soil or site:
Cly 4e qm ?b G'kAVRL FIND d0469GE5; 14�+✓l1--/
11ir/C,e4uz�L.
Signature
Date 6 S
0 0
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
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
i
9 rl �
-2�r
If X
1-%
I3r� -lam
TEST HOLE No.1 TEST HOLE No. 2
TEST HOLE No. 3
3L Z3 L
Drop Time Drop Time
X32
Drop Time
57 d 3 a
'v S
15l�k
13 3
� �7
i
9 rl �
-2�r
If X
1-%
I3r� -lam
TEST HOLE No.1 TEST HOLE No. 2
TEST HOLE No. 3
3L Z3 L
Drop Time Drop Time
X32
Drop Time
57 d 3 a
'v S
13 3
� �7
Percolation Rate Each Hole
Average Rate JAIA C'rA8t6-
Comments soil or . e•
Signature
- Date