HomeMy WebLinkAboutpitkin.eh.246734303001 (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.
•
;y67-3y3_o3-ova
PITKIN COUNTY HEALTH DEPARTMENT ¢
PERMIT NUMBER 76009 RECEIPT NUMBER 02O�U Z
` V Soc RflczAk
Owner Phone No. q 7f _ <is (C. -Al Z.i
Owner's Mailing Address
Contractor 56 %,Ae � Phone No. -C
Address
System's Contractor's Name Ll VAC
C
.o
Address
Legal Description
Lot Size t*O I ,G'r4tS Type of Building by Use
Number of Bedrooms Type of Water Supply
Owner's SignatureDate
PLOTPLAN: ATTACHED ilEQUIRED
lS
*****************r*****w******************************************************t***********
Type of Individual Sewage Disposal System ��OrIC "'NC
Type of Soil or Soil Classification
Proximal Location of Bedrock NOT f JL�I �K/r'l INE I C�/CC./Tf < �C f fTf I ry
Proximal Location of Ground Water Table / � Ml Gef?F-T,e 7-HAAJ /,D' FT
***********r*****w**r*****w#r*****#w***#*4*#*****M**#****r**f*#********* Ywrrr*#w#wt****ww
Percolation Test Date Minutes Per Inch
Minimum Recommended Absorption System Size A1110 �X F77
Minimum Recommended Tank Size _1000 G,4ZZl 'NS — V 1_0
Special Conditions of Issue: 'DEA %' }r' NOTICE
p - SFr, When properly signed for issuance, this application
/� /� ' I G—�t C becomes your permit Application valid one year from
eJ�7.C'J LIAJEAC F_r Or Z;0C- /ey date. If an Individual sewage disposal permit Is Issued
3 r17 IVI DE «1T� 3FT 0,r—for property on which no building permit hes been
issued. the individual wwega disposal permit shall
��� ���/�
expire b n c days atter Its y than If n plans tionor
hes
not been commenced. Any change in plans or id aci-
� fi<etions attar the permit has been issued invalidates
the permit, unless approval is secured from the Health
Officer for such changes.
Approved for Issuance By /— Date "
rrr*#www#rrr*wrrw*r++###wwrw*4*r�t #+wirrr+tib�+ +#wit#cirri+wr+#r+ti#+4
FINAL INSPECTION APPROVAL r� 7sJlSj�i Date �D
(Drawing of System on Back)
y
L
It
_-MAIIC�
SUBDI0
WD
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNERPHONE
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
1/ Z—
Drop Time Drop Time Drop Time
341,10 7a
I
1114
7
/ s
Percolation Rate Each Hole b u
Average Rate (,:�o—
Comments on soil or site:
Signature
3
Date
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER ) RIL 4CIVIIC Y PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
GATF/,rl/i Y Sn/ou MASS /1lESA .2t/!iD/ ✓ /S/onI
LOCATION OF TEST HOLES
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes y I l q , /
Water remaining after 24 hour soak O O
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
Drop Time
Drop Time
Drop Time
`2 1'
471 �O
f
3g l6 1
s
?O
zS
Percolation Rate Each Hole
Average Rate
Comments on soil or site:
U
Signature
L'
/6o 8o 12P
Date1�6