HomeMy WebLinkAboutpitkin.eh.246727200008 (1976)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 26211 RECEIPT NUMBER
Owner ,2�c' /\/ L z-5 MOS //, C Phone No. `� Z T- y % IQ -
Owner's Mailing Address 0 3 z1 ,<,L��Ze-2y,
Contractor
Address l
System's Contractor's Name
Phone No.
Address
Siff C 2 7 7'L�SN i S �r �, e6 `v
Legal Description �
Lot Size )L� -- —�} C Type of Building by Use S
Number of Bedrooms 2. Type of Water Supply LU e .e -
Owner's Signature ��i �'^t°�� Dated
PLOT PLAN: ATTACHED AS REQUIRED
*****************N*****#************#****#*********************a**a****************N*#****
Type of Individual Sewage Disposal System ��Z /C:. //iA1K
Type of Soil or Soil Classification /S AAD AAin 2AVEL X-17-9 (t)RALL'S ( 1;"TO III"WP(AMI
Proximal Location of Bedrock % Y�/Q—j f)E(TM/A!EI)— �A7'
ETT6K � 1z F
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Proximal Location of Ground Water Table / y f DETMMIAIED — G M7EK TNAt J 12 Fr
**#a*a**#****#**N##*****NaN#NN#N#N######NN#N##Y#N#N#******************##**/#***a#NN N##aa##*#
Percolation Test Date Minutes Per Inch�
Minimum Recommended Absorption SystemSize� FT l I ,
s'x 15/x /o'/i�EPSEAC16,PrF)
Minimum Recommended Tank Size A061'ALL&JS--rboy e2 MAA" -640
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Special Conditions of Issue: Nwje
p
When properly signed issuance, this application
becomes your permit. Application valid one year from
date. If an individual sewage disposal permit is issued
for property on which no building permit hes 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 attar the permit has been issued Invalidates
the permit, unless approval Is secured from the Health
Officer for such c angel.
/
/D S
Approved for Issuance By
Date
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143
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FINAL INSPECTION APPROVAL
ate
(Drawing of System on Back)
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Appermhoose
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PITKIN COUNTY ENVIRONMENTAL HEALTH
%%%% l/ Field Test Data Sheet on Percolation Test
PROPERTY OWNER l/ AZCVZJ 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
TEST HOLE No.1 TEST HOLE No. 2
TEST HOLE No. 3
Drop Time Drop Time
Drop Time
3 Y �?-
2
1410 s - 7 3a
3
Percolation Rate Each Hole S
Average Rate
Comments on soil or site:
Signature
13
Date / v J
11